Food insecurity, feeding practices and associated factors of acute malnutrition among children under 5 years of age in a post-conflict context in the Kasai region, Democratic Republic of Congo: a community-based case-control study.

Background: The Kasai region in the Democratic Republic of Congo suffered a violent conflict in 2016-17 and has been facing high household food insecurity and acute malnutrition (AM) in under 5 children ever since. This study aims to describe food security and feeding practices in a rural health district of this region in which the clinical randomised control trial OptiMA was implemented, and to assess the associated factors of AM among children aged 6 to 59 months in the aftermath of the conflict.

Methods: A community-based matched case-control study was nested in the OptiMA trial. Cases (n = 91) were children aged 6 to 59 months suffering from AM enrolled in the trial. Two neighbourhood controls (n = 181) were randomly selected per case, matched on age. The required sample size, based on the Household Hunger Score (HHS) in the area, was 81 pairs of cases and controls. Of the 282 heads of households interviewed, 272 were included in the analyses. The heads of household and the children's caregivers were interviewed on household, caregiver, and child acute malnutrition risk factors. A conditional logistic regression was used to fit a model of wasting risk factors.

Results: A total of 91% of households faced severe food insecurity and 33% severe hunger. Dietary diversity of both children and mothers was low with no mothers and only 5 children in the controls group reaching minimum dietary diversity. The mean diet diversity of mothers and children in both groups was only comprised between 2 and 2.5 out of 10 and 8 food groups, respectively in the classification. The HHS (AOR 2.9, 95% CI 1.6 to 5.6) and both moderate and severe stunting (AOR 10.2, 95% CI 3.2 to 32.2 and AOR 11.0, 95% CI 3.5 to 34.9, respectively) were strongly associated with acute malnutrition in the adjusted model.

Conclusions: The dire food security and hunger described in this study calls for multi-sectoral actions to improve food access and evidence-based preventive actions for all types of undernutrition in the area.

Trial registration: The trial in which this ancillary study is embedded was registered on clinicaltrials.gov under the number NCT03751475 on November, 23rd 2018.