Severe acute malnutrition and its associated factors among 6-59 months children in Lumbini province, Nepal: a facility-based cross-sectional study.

Research Report.

SUMMARY:

Nutrition is described as ‘the intake of food, considered in relation to the body’s dietary needs’ by the World Health Organization (WHO) and has always been considered a key determinant of good health. Adversity over this leads to malnutrition resulting in most extreme as well as visible form of under nutrition ultimately leading to SAM. Globally, under nutrition among children is observed as a significant contributor to the global disease burden and a leading cause of child mortality. Despite such adverse intensities, there has been limitation of evidence to generate reliable as well as sufficient evidence and act accordingly to cope up with such adversities. Therefore, this study bridges the existing knowledge gap by investigating the predictors of severe acute malnutrition among children.
A facility based descriptive cross sectional study design was used in Outpatient Therapeutic Care Centers (OTCC) and Nutritional Rehabilitation Home (NRH) of Lumbini province, Nepal. 278 children aged 6-59 months and their mothers who were admitted/visiting in the Outpatient Therapeutic Care Centers (OTCC) and Nutritional Rehabilitation Homes (NRH) were enrolled for the study purpose. Face to face interview was conducted among mothers of eligible children by the trained enumerators using a paper-based structured questionnaire and for anthropometric measurements, height board (Stadiometer) and SECA digital weighing scale was used to measure height and weight respectively. Shakir tape was used to measure MUAC from the child’s arm circumference to the nearest 0.1 cm (1 mm) margin. All the measurements were taken during daytime following the recommendation of WHO growth standards, 2006. Written consent from the participants was taken before conducting the survey. Ethical approval was taken from the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC).

Data compilation, checking, editing and coding was carried out following data collection. Data was systematically coded and entered into Epi Data 3.1. The entered data was exported to Statistical Package for Social Sciences (SPSS) Version 20. All analysis was finally performed using SPSS version 20. Descriptive statistics (frequency, mean and standard deviation) were presented in frequency table. Inferential statistics such as chi square test was applied to test the significance of association between independent and dependent variables.
Socio-demographic characteristics of the participant showed that slightly more than fifty percent (55.8%) were the residence of rural municipality and slightly less than fifty percent (44.2%) were the residence of urban municipality. More than three fifth of family type were joint family (64.7%). Approximately three fifth had less than household income less than Rs. 30,000. More than four fifth had their toilet facility whereas two third had their own kitchen garden. Agriculture was found to be the major source of income for almost four-fifth of the population. More than two third of the respondent mothers were more than 20 years of age with more than fifty percent (58.3%) had more than primary education. Two-fifth of the mothers interviewed were housewives/labor/others, nearly two-fifth of them were involved in business/services, and more than one-fifth were engaged in agricultural activities as their main source of income. Similarly, nearly fifty percent (45.7%) of the participating mothers had the birth interval of more than two years prior to the birth of their second child. Nearly two of the participants were Madhesi/terai, one third of them were advantaged ethnic group and 29.9% were from relatively disadvantaged ethnic group. More than half (53.2%) of the children involved in this study were male while 46.8% were found female.
This study concluded that the severe acute malnutrition in Lumbini Province was found 34.9%. As observed from our study household income, toilet facility, occupation, ethnicity, kitchen garden, sex of the child, mothers age at child birth, food security access and wealth index of the family were significant determining factors of severe acute malnutrition.