Abstract
BackgroundChild undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.MethodsA population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).ResultsThe prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.ConclusionThere was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.
Highlights
Child undernutrition is a major public health problem in low income countries
Feeding practices individually adjusted for full model Non-exclusive breast-feeding at 2 months No pre-lacteal food Colostrums not given Breast feeding delayed for 1 hour Fully adjusted model Characteristics of mother Age Height Mid upper arm circumference Being in polygamous marriage Autonomy scale (0-5) Use khat and/or alcohol Had at least one obstetric complication Household characteristics Urban residence Number of under 5 children: 0 1 ≥2 Age of father in years Poverty index (0 - 11) Poor sanitary condition (0 -3) Level of social support (0 - 4) Characteristics of index child Female gender Not immunised at two months Severe illness in the first 2 months Birth weight: Normal (> = 2500 g) Low (
After adjusting for other risk factors, none of the measured early infant feeding practices were associated with undernutrition, suggesting that interventions directed only at these maternal behaviours may have a limited impact in this setting
Summary
Child undernutrition is a major public health problem in low income countries. The burden of undernutrition is still a major public health problem especially in resource poor countries [2,3]. Undernutrition remains a major cause of disability and mortality [5], ranked as the top cause of global burden of disease [6] and underlying 53% of deaths in children. Despite an encouraging global downward trend in the prevalence of stunting, the progress is not uniform across countries [2,11] According to global estimates taking the most recent available data for the years 20002006, the prevalence of underweight and stunting among under five children in sub-Saharan Africa were 28% and 38% respectively, while among least developed countries in general it was 35% and 42% respectively [12]. Maternal age Age of father Maternal MUAC Poverty index Sanitary index Maternal support Maternal autonomy
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