Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-14T15:19:46.122Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of poor anthropometric status among children under 2 years of age in rural Uganda

Published online by Cambridge University Press:  02 January 2007

Henry Wamani ,
Anne Nordrehaug Åstrøm ,
Stefan Peterson ,
James K Tumwine  and
Thorkild Tylleskär
Henry Wamani*
Affiliation:
Centre for International Health, University of Bergen, Norway Ministry of Health, PO Box 16705, Kampala, Uganda
Anne Nordrehaug Åstrøm
Affiliation:
Centre for International Health, University of Bergen, Norway
Stefan Peterson
Affiliation:
Division of International Health (IHCAR), Karolinska Institute, Stockholm, Sweden
James K Tumwine
Affiliation:
Department of Paediatrics and Child Health, Makerere University Medical School, Kampala, Uganda
Thorkild Tylleskär
Affiliation:
Centre for International Health, University of Bergen, Norway
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To assess predictors of poor anthropometric status among infants and young children.

Design

Cross-sectional survey.

Setting

The rural subsistence agricultural district of Hoima, western Uganda.

Subjects

Seven hundred and twenty children aged 0–23 months with their mothers/carers.

Methods

Participants were recruited in September 2002, using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health, household socio-economic status, child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status.

Results

The mean Z-score for weight-for-height was −0.2 (95% confidence interval (CI) −0.1, −0.7), for height-for-age was −1.1 (95% CI −1.2, −0.9) and for weight-for-age was −0.7 (95% CI −0.8, −0.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR) = 4.4, 95% CI 1.5, 13), while underweight was associated with a history of fever (OR = 2.4, 95% CI 1.3, 4.4) and cough (OR = 3.0, 95% CI 1.3, 6.8). Stunting was positively associated with a wider range of factors, including: history of a fever episode (OR = 1.7, 95% CI 1.0, 2.9), lack of a latrine in the household (OR = 2.7, 95% CI 1.5, 4.9), failure to de-worm children 12 months or older (OR = 1.7, 95% CI 1.1, 2.8), and being born to a non-formally educated mother compared with mothers educated above primary school (OR = 2.1, 95% CI 1.1, 4.0).

Conclusions

In analyses guided by the hierarchical interrelationships of potential determinants of malnutrition, wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting, however, was predicted by socio-economic (distal), environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures.

Keywords

WastingStuntingUnderweightInfantsHierarchical conceptual analysis
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 3 , May 2006 , pp. 320 - 326
Copyright
Copyright © The Authors 2006

References

1de Onis, M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bulletin of the World Health Organization 2000; 78: 1222–33.Google ScholarPubMed
2Pelletier, DL, Frongillo, EA, Schroeder, DG, Habicht, J-P. The effect of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization 1995; 73: 443–8.Google ScholarPubMed
3Ministry of Finance and Economic Planning Uganda. Demographic and Health Survey. Kampala: Ministry of Finance and Economic Planning, 2000–2001.Google Scholar
4Wagstaff, A, Watanabe, N. Socioeconomic Inequalities in Child Malnutrition in the Developing World. Washington, DC: World Bank, 2000.Google Scholar
5Bernt, LJ, Tadesse, A. Intra-household correlations of nutritional status in rural Ethiopia. International Journal of Epidemiology 1997; 26: 160–5.Google Scholar
6Wollinka, O, Keely, E, Burkhalter, B, Bashir, N. eds. Hearth Nutrition Model: Applications in Haiti, Vietnam, and Bangladesh. Arlington, VA: BASICS, 1997.Google Scholar
7United Nations Children's Fund (UNICEF). The State of the World's Children 1998. New York: UNICEF, 1998.Google Scholar
8Chopra, M. Risk factors for undernutrition of young children in a rural area of South Africa. Public Health Nutrition 2002; 6: 645–52.CrossRefGoogle Scholar
9Victora, CG, Huttly, SR, Fuchs, SC, Olinto, MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology 1997; 26: 224–7.CrossRefGoogle ScholarPubMed
10Cochran, W. Sampling Techniques. New York: John Wiley & Sons, 1977.Google Scholar
11Haraldsdottir, J. Minimizing error in the field: quality control in dietary surveys. European Journal of Clinical Nutrition 1993; 47(Suppl. 2): S19–24.Google ScholarPubMed
12Gibson, R. Principles of Nutrition Assessment. Oxford: Oxford University Press, 1990.Google Scholar
13World Health Organization (WHO). Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series No. 854. Geneva: WHO, 1995.Google Scholar
14Schellenberg, JA, Victora, C, Mushi, A, de Savigny, D, Schellenberg, D, Mshinda, H, et al. Inequities among the very poor: health care for children in rural southern Tanzania. Lancet 2003; 361: 561–6.CrossRefGoogle ScholarPubMed
15The Republic of Uganda. Uganda Participatory Poverty Assessment Report. Kampala: Ministry of Finance, Planning and Economic Development, 2000.Google Scholar
16Martorell, R, Ramakrishnan, U, Schroeder, DG, Melgar, P, Neufeld, L. Intrauterine growth retardation, body size, body composition and physical performance in adolescence. European Journal of Clinical Nutrition 1998; 52(Suppl. 1): S43–53.Google ScholarPubMed
17Adair, LS, Guilkey, DK. Age-specific determinants of stunting in Filipino children. Journal of Nutrition 1997; 127: 314–20.Google ScholarPubMed
18Dewey, K. Cross-cultural patterns of growth and nutritional status of breast-fed infants. American Journal of Clinical Nutrition 1998; 67: 10–7.CrossRefGoogle ScholarPubMed
19Schmidt, MK, Muslimatun, S, West, CE, Schultink, W, Gross, R, Hautvast, JG. Nutritional status and linear growth of Indonesian infants in West Java are determined more by prenatal environment than by postnatal factors. Journal of Nutrition 2002; 132: 2202–7.CrossRefGoogle ScholarPubMed
20Shrimpton, R, Victora, C, de Onis, M, Lima, R, Blossner, M, Clugston, G. Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics 2001; 107: e75.CrossRefGoogle ScholarPubMed
21Vella, V, Tomkins, A, Borghesi, A, Migliori, G, Oryem, V. Determinants of stunting and recovery from stunting in northwestern Uganda. International Journal of Epidemiology 1994; 23: 782–6.CrossRefGoogle Scholar
22Dickson, R, Awasthi, S, Williamson, P, Demellweek, C, Garner, P. Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials. British Medical Journal 2000; 320: 1697–701.CrossRefGoogle ScholarPubMed
23Gupta, M, Arora, KL, Mithal, S, Tandon, BN. Effect of periodic deworming on nutritional status of ascaris-infested preschool children receiving supplementary food. Lancet 1977; 2: 108–10.CrossRefGoogle ScholarPubMed
24Stephenson, LS, Latham, MC, Kurz, KM, Kinoti, SN, Pertet, A. Physical fitness, growth and appetite of Kenyan school boys with hookworm, Trichuris trichiura and Ascaris lumbricoides infections are improved four months after a single dose of albendazole. Journal of Nutrition 1993; 123: 1036–46.Google ScholarPubMed
25Wamani, H, Tylleskär, T, Åstrøm, AN, Tumwine, JK, Peterson, S. Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. International Journal of Equity in Health 2004; 3: 9.CrossRefGoogle ScholarPubMed
26Espo, M, Kulmala, T, Maleta, K, Cullinan, T, Salin, M, Ashorn, P. Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi. Acta Paediatrica 2002; 91: 1364–70.CrossRefGoogle ScholarPubMed
27Ngare, D, Muttunga, J. Prevalence of malnutrition in Kenya. East African Medical Journal 1999; 76: 376–80.Google ScholarPubMed
28Wells, JCK. Natural selection and sex differences in morbidity and mortality in early life. Journal of Theoretical Biology 2000; 202: 65–76.CrossRefGoogle ScholarPubMed
29Caulfield, LE, Bentley, ME, Ahmed, S. Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen demographic and health surveys. International Journal of Epidemiology 1996; 25: 693–703.CrossRefGoogle ScholarPubMed
30Marquis, GS, Habicht, J, Lanata, CF, Black, RE, Rasmussen, KM. Association of breastfeeding and stunting in Peruvian toddlers: an example of reverse causality. International Journal of Epidemiology 1997; 26: 349–56.CrossRefGoogle ScholarPubMed