Determinants of Severe Acute Malnutrition in Children Aged 0-59 Months

Abstract

Introduction: Infant malnutrition is endemic in Chad. In 2018 in N’Djamena, the prevalence was 13.5%. This study aimed to identify factors influencing Severe Acute Malnutrition (SAM) in children under 59 months admitted to two Medical Feeding Centre in N’Djamena. Patients and method: We conducted a cross-sectional, descriptive and analytical study of the files of children aged 6 to 59 months admitted for severe acute malnutrition in two feeding centre in N’Djamena, from September 2019 to February 2020. The files were selected randomly, and the study sample size was calculated using the Schwarz formula. Descriptive and analytical analysis was done using Chi-2 and binary logistic regression; a P value < 0.05 is considered statistically significant. Results: Age 0-24 months (p = 0.001), breastfeeding mode (p = 0.027), early diarrhoea (p = 0.040), age of weaning (p = 0.013) and diversification (p = 0.034), self-medication (p = 0.047), and use of traditional care (p = 0.020) were significantly associated with SAM. The mother’s age and education level (p = 0.029) are also factors in the occurrence of SAM. Environmental hygiene and especially hand washing before feeding the child (p = 0.007) were significant for the occurrence of SAM. Conclusion: Factors related to the mother, the child and the environment interact closely to lead to SAM in the child. Only con crete and multidisciplinary actions can overcome this problem. served as the study framework. The study was a descriptive and analytical cross-sectional study conducted over six months which involved all children under 59 months admitted for severe acute malnutrition, with consenting mothers or caregivers. Children under 59 months admitted for Failure to Thrive associated with a chronic cardiovascular or cerebral pathology (cerebral palsy) and any malformation that could hinder their growth regardless of their diet were not included in the study. Sampling was random and concerned any case of severe acute malnutrition corresponding to the study population and the inclusion criteria. The sample size was 287 children. Variables studied: The dependent variable was the occurrence of severe acute malnutrition in children under 59 months-Independent variables: Socio-demographic characteristics of the child and the mother, socio-cultural characteristics, and environmental factors. Severe acute malnutrition is classified according to WHO 2006 standards [4]: Children aged 6 to 59 months whose W/H weight-height index is <-3 z-score and/or MUAC <115 mm and/or having nutritional oedemas. Pre-established questionnaires were sent to mothers and caregivers who consented. The available child follow-up notebooks were also consulted. We used the baby scale or SECA weight scale with 10 g precision; the Salter scale allows weighing up to 25kg with an accuracy of 0.100 kg. The electronic personal scale with an accuracy of 0.100 kg. The height was measured with the Shorr height chart for children; the Mid Upper Arm Cir-cumference (MUAC) was measured with Shakir’s bandages. We used the unisex tables of the WHO 2006 classification to determine the Weight-Height, Height-Age and Weight-Age ratios. Data entry and analysis were done using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel software. The results are refined and