Risk Factors and Predictors of Severe Acute Malnutrition Among 6-59 Months Children in Lumbini Province, Nepal: A Facility-Based Cross-Sectional Study

Abstract

BACKGROUND Adversity over malnutrition results in the most extreme and visible form of undernutrition, ultimately leading to Severe Acute Malnutrition (SAM). Globally, undernutrition among children is observed as a significant contributor to the global burden of disease and a leading cause of child mortality. AIM Owing to the limitation of evidence on SAM, this study aimed to bridge the existing knowledge gap by investigating the predictors of severe acute malnutrition among children visiting Out-Patient Therapeutic Centers (OTCs) and Nutrition Rehabilitation Home (NRH) in Lumbini Province. METHODS A facility-based descriptive cross-sectional study design was adopted in OTCs and NRHs of Lumbini Province, Nepal, among 278 children aged 6-59 months and their mothers. Face-to-face interviews were conducted among mothers of eligible children by trained enumerators using a paper-based structured questionnaire, and the Shakir tape was used to measure Mid-Upper Arm Circumference (MUAC). Written consent from the participants was sought prior to the survey. Ethical approval was obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC). Data obtained were systematically coded and entered into Epi Data 3.1 and subsequently exported to Statistical Package for Social Sciences (SPSS) Version 20 for analysis. Descriptive statistics (frequency, mean, and standard deviation) were presented in a frequency table, whereas inferential statistics such as the chi-square test were applied to test the significance of the association between independent and dependent variables. RESULTS Socio-demographic characteristics of the participants showed that slightly more than fifty percent (55.8%) resided in rural municipalities, and less than fifty percent (44.2%) resided in urban municipalities. Approximately three-fifths had a household income of less than NRs. 30,000. More than four-fifths had a toilet facility, whereas two-thirds had their own kitchen garden. Agriculture was found to be the major source of income for the population interviewed. Nearly two-thirds of the participants were Madhesi/terai, with more than half (53.2%) of the children involved in this study being male, while 46.8% were female. Risk factors of SAM identified during cORs include place of residence, household income, toilet facility, land ownership, household having service/business as an occupation, households of relatively advantaged ethnic group, household having kitchen garden, food secure household, wealth index of the age of the child, mother’s age at childbirth, mother’s education, early initiation of breastfeeding, and exclusive breastfeeding. Analysis of aORs highlighted age of the child with aORs [6-11 months; 0.21(0.09-0.52), 12-23 months; 0.20(0.10-0.45)], and mother’s age at childbirth with aOR 2.77(1.33-5.77) as significant predictors of SAM. CONCLUSION This study concluded that the prevalence of SAM in Lumbini Province was found to be 34.9%. As observed from our study, household income, toilet facility, occupation, ethnicity, kitchen garden, sex of the child, mother’s age at childbirth, food security access, and wealth index of the family were significant determining factors of severe acute malnutrition, whereas only the child’s age and mother’s age at childbirth were observed as significant predictors of SAM.