Abstract
BackgroundSevere wasting affects 16 million under 5’s and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants.MethodsWe undertook a case-control study from November 2014 to June 2015, in rural Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < −3 on at least 1 occasion in infancy. Controls with a WLZ > −3 in the same interval, matched on age, gender, village size and distance from the clinic were selected. Standard questionnaires were used to assess maternal socioeconomic status, water sanitation and hygiene and maternal mental health. Conditional logistic regression using a multivariable model was used to determine the risk factors for severe wasting. Qualitative in depth interviews were conducted with mothers and fathers who were purposively sampled. A thematic framework was used to analyse the in-depth interviews.ResultsTwo hundred and eighty (77 cases and 203 controls) children were recruited. In-depth interviews were conducted with 16 mothers, 3 fathers and 4 research staff members. The mean age of introduction of complementary feeds was similar between cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe wasting were associated with increased frequency of complementary feeds (range 1–8) [adjusted OR 2.06 (95%: 1.17–3.62), p = 0.01]. Maternal adherence to the recommended infant care practices was influenced by her social support networks, most importantly her husband, by infant feeding difficulties and maternal psychosocial stressors that include death of a child or spouse, recurrent ill health of child and lack of autonomy in child spacing.ConclusionIn rural Gambia, inappropriate infant feeding practices were associated with severe wasting in infants. Additionally, adverse psychosocial circumstances and infant feeding difficulties constrain mothers from practising the recommended child care practices. Interventions that promote maternal resilience through gender empowerment, prioritising maternal psychosocial support and encouraging the involvement of fathers in infant and child care promotion strategies, would help prevent severe wasting in these infants.
Highlights
Severe wasting affects 16 million under 5’s and carries an immediate risk of death
We found that the infant feeding and rearing capacity of mothers was heavily influenced by 3 key factors: i) her social support network, most importantly her husband; ii) infant feeding difficulties; and iii) maternal psychosocial stressors
In rural Gambia, mothers were the primary caregivers of infants and were often the recipients of infant feeding advice from health care providers
Summary
Severe wasting affects 16 million under 5’s and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. Severe wasting affects 16 million under 5’s worldwide and carries an immediate risk of death [1, 2]. Attributable factors include poor maternal health, nutrition and socio-economic status, and infant factors including inadequate dietary intake and recurrent infections that could indicate sub-optimal child care practices [1, 11,12,13]. It has been estimated that, with optimal coverage, a combination of nutrition specific and nutrition sensitive interventions could reduce under 5 deaths by 15% in low income settings [14,15,16]. Scaling up of nutrition sensitive interventions has the potential to enhance progress in childhood undernutrition [17]
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