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Introduction: Child undernutrition is a major public health problem in Nigeria and other Sub-Saharan African countries. However, few analytical studies have quantified the role of risk factors. This study was conducted to determine the socio-economic and family related risk factors for undernutrition among children in Ibadan, Nigeria. Methods: A case-control study was conducted among children100 cases and 200 controls aged 6-23 months. A semi-structured interviewer- administered questionnaire was used to obtain information on socio-economic status, infant feeding practices of the mothers, children’s immunization status and recent episodes of common childhood illnesses. Bivariate and multivariate analyses were conducted to identify the risk factors. Results: On bivariate analysis, the maternal factors associated with undernutrition were maternal level of education below secondary level, monthly income below $20 and polygamous marriage. Socio-economic factors significantly associated with malnutrition were residence in a high density area, family accommodation in a single room apartment and family weekly expenditure on food below $55. Children’s characteristics associated with child malnutrition included incomplete immunization for age, recent episodes of diarrhoea and acute respiratory infection. The significant risk factors on multivariate analysis were maternal monthly income <$20, monthly household food expenditure <$55, residence in a one room apartment, higher birth order and incomplete immunization of the child. Conclusion: The multiplicity of risk factors identified is indicative of the need for a multidisciplinary approach in developing preventive strategies child undernutrition. © Eme Owoaje et al.
Oni Memorial Children's Hospital is a 60-bed paediatric specialist facility in Ibadan, southwest Nigeria. The hospital provides preventive and curative health services for children from varying socio-economic classes. It also serves as a referral hospital for primary health care centres and other secondary health centres in the state. On average, about 2,000 children are seen in the hospital out-patient clinic severy month. This was a case control study among children 6 to 23 months of age. Nutritional status was defined based on the American National Center for Health Statistics (NCHS) standards.[12] All the new cases of underweight children i.e. with weight-for-age<2 standard deviations from the median weight-for-age of the reference population the eligible age group who presented at the Nutrition Clinic within the period of data collection (6 weeks) were recruited as cases until the desired number was attained. Controls were children in the target age group who were not underweight i.e. weight-for-age values equal or above 2 standard deviations from the median weight-for-age of the reference population, who presented at the Immunization clinic and the Infant welfare clinic. Children who had underlying conditions which could lead to the faltering of growth, such as chronic diseases, congenital malformations and chromosomal abnormalities were excluded from the study. Using the formula for case control studies, [13] The sample size was calculated based on the proportion of Nigerian mothers with no formal education(50% based on findings of the 2003 NDHS), a ratio of one case to two controls, power of 80%,significance level of 5% (95% confidence interval) and an odds ratio of two. A minimum sample size of 99 and 198 for cases and controls respectively was obtained, hence 100 cases: 200 controls. Each case was matched by age and sex with two controls. An interviewer administered semi-structured questionnaire was used to interview the mothers of the children who were selected to participate in the study. Data was collected on the family social and demographic characteristics, household characteristics, infant feeding practices, immunization history and recent episodes of acute illnesses in the children. The questionnaire was administered in English or Yoruba depending on the respondents’ preference. Weight: weight measurements were taken to the nearest 0.1kg using Salter 914WHLKR baby scale. The scale was checked before each weighing to ensure that the mark returned to zero. The children were weighted without clothes on and weights were taken in kilograms. Each child was weighed twice. Length: measurement of supine or recumbent length was taken to the nearest 0.1cm using a portable calibrated board, the child's growth chart. The sole of the baby's feet were held firmly against the wall at the zero point while the length was marked off on the chart at the crown of the head. Data was entered and analyzed using SPSS version 15. The Nutritional module of CDC/WHO Epi-Info 6.0 software was used to convert the anthropometrical indices weight for age, height for age and weight for height Z- scores based using the WHO/CDC 2000 reference standards. The wealth index developed was on the principle components analysis of household assets. The questions used to establish the wealth index included household access to electricity, radio or television; household ownership of bicycle, motorcycle or car; type of material of used for flooring the house; number of rooms in the house; main source of drinking water; type of toilet facility. Principle components analysis was used to derive wealth index quintiles and the ranking of these quintiles were used to represent household wealth. Pearson's Chi square test was conducted to determine associations between categorical variables. Bivariate analysis was conducted; odds ratios with95% confidence intervals were calculated to determine the risk factors for childhood undernutrition. Multivariate analysis was conducted to assess the contribution of each risk factor.
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