Malnutrition remains a major cause of morbidity and mortality among children under five years especially in developing countries. The high burden of wasting and stunting among children under five years of age is of great concern to policy makers and public health practitioners in Uganda. Prevention and treatment of malnutrition is a priority in the United Nations 2030 development agenda. This study investigated the risk factors for wasting and stunting among children aged 6-59 months in the general population in Uganda. Secondary data from the 2011 Uganda Demographic and Health Survey was utilised. A sample of 2214 children was studied. Bivariate analysis and multivariate conditional logistic regression was used to determine the association between risk factors and childhood wasting and stunting. 5% and 33.5% of the children were wasted and stunted respectively. Risk factors associated with wasting were lack of maternal education; OR (3.66; 1.22-11.01), maternal underweight -BMI < 18.5 kg/m2; OR (3.39; 1.72 -6.70) and children aged 6-11 months OR (2.20; 1.09 – 4.42). On the other hand, those risk factors associated with stunting included: child`s very small size at birth; OR (2.59; 1.58-4.27), male children; OR (1.5; 1.12 -2.18), children aged 24-35 months (1.17-3.23), maternal height <150cm; OR (7.53; 4.07-13.94) and lack of maternal education; OR (2.47; 1.37-4.44). In conclusion, children’s age and low maternal formal education level predicts wasting. Likewise, children`s male gender, age, size at birth, maternal height and low maternal formal education level also predicts stunting among children under five years of age. This finding suggests that interventions to reduce under-five stunting and wasting in Uganda may benefit from focusing on improvement of maternal nutritional status and formal education.
Malnutrition Among Children Under Five Years in Uganda, American Journal of Health Research.
Vol. 6, No. 2,
2018, pp. 56-66.
Haddad, L. J., et al., Global Nutrition Report 2015: Actions and accountability to advance nutrition and sustainable development. 2015: Intl Food Policy Res Inst.
Black, R. E., et al., Maternal and child undernutrition: global and regional exposures and health consequences. The lancet, 2008. 371(9608): p. 243-260.
Ruia, A., R. K. Gupta, and G. Bandyopadhyay, Implication of Malnutrition on Human Capital: Bridging the Inequality through Robust economic Policies. Indian Journal of Public Health Research & Development, 2018. 9(1): p. 75-79.
Group, U. W. W. B., Joint child malnutrition estimates: key findings of the 2017 edition. U. 2017.
Group, U. W. W. B., Joint Child Malnutrition Estimates 2016 edition. 2016.
Black, R. E., et al., Maternal and child undernutrition and overweight in low-income and middle-income countries. The lancet, 2013. 382(9890): p. 427-451.
UBOS, I., Uganda demographic and health survey 2011. Kampala and Claverton: Uganda Bureau of Statistics and ICF International Inc, 2012.
Africa, U. N. E. C. f., The cost of hunger in Uganda: implications on national development and prosperity. 2014.
Bourke, C. D., J. A. Berkley, and A. J. Prendergast, Immune Dysfunction as a Cause and Consequence of Malnutrition. Trends in immunology, 2016. 37(6): p. 386-398.
Victora, C. G., et al., Maternal and child undernutrition: consequences for adult health and human capital. The lancet, 2008. 371(9609): p. 340-357.
Hallal, P., et al., Maternal and child undernutrition: consequences for adult health and human capital. 2015.
Dewey, K. G. and K. Begum, Long‐term consequences of stunting in early life. Maternal & child nutrition, 2011. 7(s3): p. 5-18.
Bhutta, Z. A., et al., Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet, 2013. 382(9890): p. 452-477.
Pelletier, D. L., et al., The nutrition policy process: the role of strategic capacity in advancing national nutrition agendas. Food and Nutrition Bulletin, 2011. 32(2 suppl2): p. S59-S69.
Halleröd, B., et al., Bad governance and poor children: a comparative analysis of government efficiency and severe child deprivation in 68 low-and middle-income countries. World Development, 2013. 48: p. 19-31.
Group, W. W., Use and interpretation of anthropometric indicators of nutritional status. Bulletin of the World Health Organization, 1986. 64(6): p. 929.
De Onis, M. and M. Blössner, The World Health Organization global database on child growth and malnutrition: methodology and applications. International journal of epidemiology, 2003. 32(4): p. 518-526.
Onis, M., WHO Child Growth Standards based on length/height, weight and age. Acta paediatrica, 2006. 95(S450): p. 76-85.
Keller, W. and C. Fillmore, [Prevalence of protein-energy malnutrition]. World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales, 1983. 36(2): p. 129-67.
Allen, L., Maternal micronutrient malnutrition: effects on breast milk and infant nutrition, and priorities for intervention. SCN news, 1994. 11: p. 21-24.
Unicef, The state of the world's children. 1998. 1994: Unicef.
WHO, Stunted Growth and Development. 2016.
Wamani, H., et al., Predictors of poor anthropometric status among children under 2 years of age in rural Uganda. Public Health Nutrition, 2006. 9(03): p. 320-326.
Kikafunda, J. and J. Tumwine, Diet and socio-economic factors and their association with the nutritional status of pre-school children in a low income suburb of Kampala City, Uganda. East African medical journal, 2006. 83(10): p. 565-574.
Owor, M., J. Tumwine, and J. Kikafunda, Socio-economic risk factors for severe protein energy malnutrition among children in Mulago Hospital, Kampala. East African medical journal, 2000. 77(9).
Habaasa, G., An investigation on factors associated with malnutrition among underfive children in Nakaseke and Nakasongola districts, Uganda. BMC pediatrics, 2015. 15(1): p. 1.
MeasureDHS. Demographic and Health Surveys 2011 [cited 2016; Available from: http://dhsprogram.com/data/dataset/Uganda_Standard-DHS_2011.cfm.
Statistics, U. B. O., 2002 Uganda population and housing census: main report. 2005: Uganda Bureau of Statistics.
UNICEF. Cuases of malnutrition. 1997; Available from: http://www.unicef.org/sowc98/fig5.htm.
Mei, Z. and L. M. Grummer-Strawn, Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis. Bulletin of the World Health Organization, 2007. 85(6): p. 441-448.
Corsi, D. J., M. A. Subramanyam, and S. Subramanian, Commentary: Measuring nutritional status of children. International journal of epidemiology, 2011. 40(4): p. 1030-1036.
Bhutta, Z. A., et al., What works? Interventions for maternal and child undernutrition and survival. The Lancet, 2008. 371(9610): p. 417-440.
Gove, S., Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bulletin of the World Health Organization, 1997. 75(Suppl 1): p. 7.
Barros, A. J., et al., Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet, 2012. 379(9822): p. 1225-1233.
Romero-Corral, A., et al., Accuracy of body mass index in diagnosing obesity in the adult general population. International journal of obesity, 2008. 32(6): p. 959-966.
WHO/UNICEF. Improved and unimproved water sources and sanitation facilities. 1991 [cited 2016 13/10/2016]; Available from: http://www.wssinfo.org/definitions-methods/watsan-categories/.
Rutstein, S. O., The DHS Wealth Index: Approaches for rural and urban areas. 2008.
MeasureDHS. Demographic and Health Surveys 2013. 2016 [cited 2016 20/11/2016]; Available from: http://www.dhsprogram.com/Data/.
Harding, J. F., Increases in maternal education and low-income children’s cognitive and behavioral outcomes. Developmental psychology, 2015. 51(5): p. 583.
Ickes, S. B., T. E. Hurst, and V. L. Flax, Maternal literacy, facility birth, and education are positively associated with better infant and young child feeding practices and nutritional status among Ugandan children. The Journal of nutrition, 2015. 145(11): p. 2578-2586.
Saleem, A. F., et al., Impact of maternal education about complementary feeding on their infants' nutritional outcomes in low-and middle-income households: a community-based randomized interventional study in Karachi, Pakistan. Journal of health, population, and nutrition, 2014. 32(4): p. 623.
Imdad, A., M. Y. Yakoob, and Z. A. Bhutta, Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. BMC Public Health, 2011. 11(3): p. 1.
Corsi, D. J., I. Mejía-Guevara, and S. Subramanian, Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions. Social Science & Medicine, 2015. 30: p. 1e21.
Belkacemi, L., et al., Maternal undernutrition influences placental-fetal development. Biology of reproduction, 2010. 83(3): p. 325-331.
Brown, K. H., et al., Lactational capacity of marginally nourished mothers: relationships between maternal nutritional status and quantity and proximate composition of milk. Pediatrics, 1986. 78(5): p. 909-919.
Kramer, M. S. and R. Kakuma, SECTION II-SCIENCE AND POLICY: OPTIMAL DURATION OF EXCLUSIVE BREASTFEEDING-The Optimal Duration of Exclusive Breastfeeding: A Systematic Review. Advances in Experimental Medicine and Biology, 2004. 554: p. 63-78.
Keusch, G. T., The history of nutrition: malnutrition, infection and immunity. The Journal of nutrition, 2003. 133(1): p. 336S-340S.
Prendergast, A. J. and J. H. Humphrey, The stunting syndrome in developing countries. Paediatrics and international child health, 2014. 34(4): p. 250-265.
Varela‐Silva, M. I., et al., Influence of maternal stature, pregnancy age, and infant birth weight on growth during childhood in Yucatan, Mexico: a test of the intergenerational effects hypothesis. American Journal of Human Biology, 2009. 21(5): p. 657-663.
Charmarbagwala, R., et al., The determinants of child health and nutrition: a meta-analysis. Washington, DC: World Bank, 2004.
Ahmed, S., et al., Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PloS one, 2010. 5(6): p. e11190.
Özaltin, E., K. Hill, and S. Subramanian, Association of maternal stature with offspring mortality, underweight, and stunting in low-to middle-income countries. Jama, 2010. 303(15): p. 1507-1516.
Martorell, R., Body size, adaptation and function. Human Organization, 1989. 48(1): p. 15-20.
Hasan, M. T., et al., Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996–2011. The American Journal of Clinical Nutrition, 2016. 104(4): p. 1121-1127.
Abu-Saad, K. and D. Fraser, Maternal nutrition and birth outcomes. Epidemiologic reviews, 2010. 32(1): p. 5-25.