Factors associated with malnutrition among under 5-year old children hospitalised in Sedibeng district, Gauteng province

Abstract

Background Globally, malnutrition accounts for about 60% of all deaths among children younger than five years with socio-economic deprivation underlying most cases. Although Sedibeng district is more socio-economically challenged than other districts in Gauteng Province, no local study has explored the factors that influence malnutrition among children admitted in hospitals in this district. Aim To explore the factors associated with malnutrition among hospitalised children aged less than five years in hospitals in the Sedibeng District. Objectives 1) To determine the proportion of children admitted with malnutrition to hospitals in the Sedibeng District. 2) To describe participants’ characteristics (any of socio-demographic, clinical, dietary and anthropometric). 3) To compare children admitted with and without malnutrition in terms of socio-economic, dietary and clinical characteristics. Method A cross-sectional study was done that involved 306 consecutively sampled under-five-year-old children and their carers during admission to the children’s wards of the three hospitals in the Sedibeng district. A researcher-administered questionnaire was used to collect information from the carers on socio-demography and the child’s diet. Information on anthropometry, immunisation and other clinical measures were extracted from the medical records. Analysis included descriptive statistics, chi square tests and logistic regression. Main outcome measures were factors significantly associated with admission for malnutrition. Results Of 306 children admitted to hospital, 59.8% (183) were male and 9.47% (29) had acute malnutrition associated with other illnesses. Of those with acute malnutrition, moderate acute malnutrition accounted for 17.2% (5) while severe acute malnutrition accounted for 82.8% (24). The majority of children (43.14%, n=132) had a maximum of three meals per day at home and 194 (63.4%) had at least one additional snack per day. On tests of association, a family income of more than R 2,000.00 per month, fathers’ and mothers’ employment status, lack of breast feeding, and concurrent diarrheal diseases were all significantly associated with admission for malnutrition. In the adjusted logistic regression, only a history of never having being breast fed and admission for diarrhoeal diseases predicted admission for malnutrition: Compared to children who were breastfed, those never breastfed were significantly more likely to be admitted for malnutrition (OR=3.9; 95% CI: 1.23 – 12.29; p =0.021). Compared to those with pneumonia or any other concurrent illnesses, children who had diarrhoea were significantly more likely to have malnutrition (OR=23.3; 95% CI: 6.85 – 79.43; p=<0.000). Conclusion This study found a high prevalence of acute malnutrition in under-fives admitted to hospitals in Sedibeng district. This finding highlights huge missed opportunities for regular anthropometric screening in this district. While the protective effects of breast feeding in early childhood was reiterated by this study, the strong association of diarrhoea with admission for malnutrition signify the importance of screening any child who presents with diarrhoea for malnutrition.