Abstract
The Democratic Republic of the Congo (DRC) has one of the highest levels of child undernutrition globally; however, little information exists on the underlying socio-economic inequalities resulting in undernutrition. This study aims to examine the differences in the nutritional statuses of children across different wealth quintiles and explores the association between malnutrition in children and related factors. We utilised the 2018 Multiple Indicator Cluster Survey data. We estimated the prevalence of malnutrition across all twenty-six provinces. The study used the WHO 2006 child growth standards to measure stunting, underweight and wasting. We employed a mixed-effect linear model to analyse the association between nutritional status and healthcare accessibility, domestic sanitation, and socio-demographic factors. Twenty-six provinces in the DRC. 21 477 children under 5 years of age and 21 828 women of childbearing age in the DRC. The national prevalence of underweight, stunting and wasting was found to be 23·33 %, 42·05 % and 5·66 %, respectively. Household wealth and mother's education level were significantly positively associated with the nutritional statuses of children. Among households in the lowest wealth quintile, residence in urban areas was a protective factor against undernutrition. The findings of this study indicate considerable socio-economic inequalities in the nutritional statuses of children under 5 years of age in the DRC, highlighting the need for nutrition promotion as part of maternal and child healthcare. Interventions and policies should include improving nutrition education for less-educated mothers, in particular, in the central provinces of the DRC.
Highlights
A total of 21 456 children under 5 years of age and 21 756 women of childbearing age in the Democratic Republic of the Congo (DRC) were analysed for this study
Among the 21 456 children under 5 years of age, the participants had a mean age of 2·44 years, a mean Height-for-age Z score (HAZ), weight-for-age Z score (WAZ) and weight-for-height Z score (WHZ) of –1·6, –1·05 and – 0·15, respectively
In comparison to the DRC’s MICS survey between 2010 and 2017(34), the prevalence of stunting decreased from 43 % to 42 %, the prevalence of underweight decreased from 29 % to 23 % and the prevalence of wasting decreased from 7 % to 6·5 %, respectively
Summary
Data Data from the 2018 Multiple Indicator Cluster Survey (MICS-Palu) were utilised for this study. Multi-stage stratified cluster sampling was employed for the selection of the survey sample Both urban and rural areas across all twenty-six provinces in the DRC were included. Statistical analysis Univariable and multivariable associations between the nutritional statuses of children and individual determinants such as the child’s age and sex, mother’s education level, maternal healthcare including the use of qualified birthing facilities, antenatal visits of more than four times, skilled attendants at birth, postnatal care checks, and household determinants including household wealth index and place of residence The mixed-effects model with a random intercept specified at the primary sampling unit level was used to adjust for unmeasured factors that might affect the nutritional status of children These features of the regression model account for complex survey design. All the children included in the model were matched to their mother by ‘Cluster number, Household number and Mother’s line number’ provided by the original questionnaires for both adults and children
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