Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad

A matched case-control study

Jovana Dodos, Chiara Altare, Mahamat Bechir, Mark Myatt, Brigitte Pedro, Francois Bellet, Jean Lapegue, Joachim Peeters, Mathias Altmann

Research output: Contribution to journalArticle

Abstract

Background: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. Methods: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. Results: At the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2-27.3)], fever [AOR (95% CI) = 8.4 (3.1-22.8)], vomiting [AOR (95% CI) = 7.6 (3.0-19.7)], being stunted [AOR (95% CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95% CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95% CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0-3.1)]. Conclusion: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.

Original languageEnglish (US)
Article number35
JournalArchives of Public Health
Volume76
Issue number1
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

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Chad
Case-Control Studies
Nutritional Status
Food
Hand Disinfection
Women's Rights
Sanitation
Severe Acute Malnutrition
Marriage
Hygiene
Habits
Vomiting
Meals
Diarrhea
Fever
Logistic Models
Interviews
Morbidity

Keywords

  • Childhood illnesses
  • Household determinants
  • Risk factors
  • Severe acute malnutrition

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad : A matched case-control study. / Dodos, Jovana; Altare, Chiara; Bechir, Mahamat; Myatt, Mark; Pedro, Brigitte; Bellet, Francois; Lapegue, Jean; Peeters, Joachim; Altmann, Mathias.

In: Archives of Public Health, Vol. 76, No. 1, 35, 01.08.2018.

Research output: Contribution to journalArticle

Dodos, Jovana ; Altare, Chiara ; Bechir, Mahamat ; Myatt, Mark ; Pedro, Brigitte ; Bellet, Francois ; Lapegue, Jean ; Peeters, Joachim ; Altmann, Mathias. / Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad : A matched case-control study. In: Archives of Public Health. 2018 ; Vol. 76, No. 1.
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title = "Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: A matched case-control study",
abstract = "Background: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. Methods: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. Results: At the individual level, SAM was significantly associated with diarrhoea [AOR (95{\%} CI) = 10.7 (4.2-27.3)], fever [AOR (95{\%} CI) = 8.4 (3.1-22.8)], vomiting [AOR (95{\%} CI) = 7.6 (3.0-19.7)], being stunted [AOR (95{\%} CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95{\%} CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95{\%} CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95{\%} CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95{\%} CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95{\%} CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95{\%} CI) = 1.8 (1.0-3.1)]. Conclusion: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.",
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T1 - Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad

T2 - A matched case-control study

AU - Dodos, Jovana

AU - Altare, Chiara

AU - Bechir, Mahamat

AU - Myatt, Mark

AU - Pedro, Brigitte

AU - Bellet, Francois

AU - Lapegue, Jean

AU - Peeters, Joachim

AU - Altmann, Mathias

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. Methods: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. Results: At the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2-27.3)], fever [AOR (95% CI) = 8.4 (3.1-22.8)], vomiting [AOR (95% CI) = 7.6 (3.0-19.7)], being stunted [AOR (95% CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95% CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95% CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0-3.1)]. Conclusion: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.

AB - Background: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. Methods: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. Results: At the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2-27.3)], fever [AOR (95% CI) = 8.4 (3.1-22.8)], vomiting [AOR (95% CI) = 7.6 (3.0-19.7)], being stunted [AOR (95% CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95% CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95% CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0-3.1)]. Conclusion: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.

KW - Childhood illnesses

KW - Household determinants

KW - Risk factors

KW - Severe acute malnutrition

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