Severe Acute Malnutrition Among Under-Five Children in Low- and Middle-Income Countries: A Hierarchical Analysis of Associated Risk Factors

Abstract

Introduction: Malnutrition is one of the top killer diseases among under-five children in Low- and Middle-Income Countries (LMIC). It accounts for about a third of preventable deaths among children. Reduction of malnutrition, especially severe acute malnutrition (SAM) is very crucial, directly, or indirectly, to a targeted decrease in child mortality and improvement in maternal health and would help achieve the sustainable development goal (SDG) 2 on the improvement of nutrition across board and SDG 3 on ensuring healthy lives and well-being promotion for all at all ages. We aim to develop and test a model of risk factors associated with SAM among under-five children in LMIC. Methods: We used 51 recent Demographic and Health Survey (DHS) cross-sectional nationally representative data collected between 2010 and 2018 in LMIC. We used multivariable Bayesian logistic multilevel regression models to analyse the association between individual compositional and contextual risk factors associated with SAM. Results: We analysed information on 532,680 under-five children (Level 1) nested within 55,823 communities (Level 2) from 51 LMIC (Level 3). The prevalence of SAM ranged from 0·1% in Guatemala to 9·9% in Timor-Leste. Children who are males, infants, low birth weight, whose mothers had no formal education, from the poorer household, who has no access to any media were more likely to have SAM. In addition, children from rural areas, neighbourhoods with high illiteracy and high unemployment rates and those from countries with high intensity of deprivation and high rural population percentage were more likely to have SAM. Conclusion: Individual compositional and contextual factors were significantly associated with SAM. Attainment of SDG 1, 4, and 10 will automatically aid eradication SAM which in turn leads to the attainment of SDG 2 and 3. These findings underscore the need to revitalize existing policies and implement interventions to rescue and prevent children from having SAM at the individual-, community- and societal-levels. Funding: The authors receive no funding for this study. However, the consortium for advanced research and training in Africa (CARTA) provided logistic supports to AFF in the course of writing this paper. Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: This study was based on an analysis of existing survey data with all identifier information removed. The survey was approved by the Ethics Committee of the ICF Macro at Fairfax, Virginia in the USA and by the National Ethics Committees in their respective countries. All study participants gave informed consent before participation and all information was collected confidentially.