Application of ordinal logistic regression analysis in determining risk factors of child malnutrition in Bangladesh

Abstract

BackgroundThe study attempts to develop an ordinal logistic regression (OLR) model to identify the determinants of child malnutrition instead of developing traditional binary logistic regression (BLR) model using the data of Bangladesh Demographic and Health Survey 2004.MethodsBased on weight-for-age anthropometric index (Z-score) child nutrition status is categorized into three groups-severely undernourished (< -3.0), moderately undernourished (-3.0 to -2.01) and nourished (≥-2.0). Since nutrition status is ordinal, an OLR model-proportional odds model (POM) can be developed instead of two separate BLR models to find predictors of both malnutrition and severe malnutrition if the proportional odds assumption satisfies. The assumption is satisfied with low p-value (0.144) due to violation of the assumption for one co-variate. So partial proportional odds model (PPOM) and two BLR models have also been developed to check the applicability of the OLR model. Graphical test has also been adopted for checking the proportional odds assumption.ResultsAll the models determine that age of child, birth interval, mothers' education, maternal nutrition, household wealth status, child feeding index, and incidence of fever, ARI & diarrhoea were the significant predictors of child malnutrition; however, results of PPOM were more precise than those of other models.ConclusionThese findings clearly justify that OLR models (POM and PPOM) are appropriate to find predictors of malnutrition instead of BLR models.

Magnitude and factors associated with malnutrition in children 6–59 months of age in Shinille Woreda, Ethiopian Somali regional state: a cross-sectional study

“…The risk of having poor nutrition condition was found significantly higher for the children with poor feeding practices compared to those having better feeding practices [50]. For instance, in agreement with our study, breastfeeding was found to reduce the occurrence of underweight among children [4].…”

“…Mother's education has been identified in other populations as a predictor of childhood malnutrition [19,20,25,31,44,48,50]. We also found mother's education to be a predictor of stunting.…”

Estimated prevalence and predictors of undernutrition among children aged 5–17 months in Yerevan, Armenia

“…Undernutrition and intra-uterine growth restriction cause 2?2 million deaths annually among children under 5 years of age -a substantial proportion of all deaths occurring in infancy and childhood (10,11) . Many studies suggest that poor socio-economic status (SES), low level of mother's education, larger family size with many siblings under 5 years of age and shorter inter-birth intervals are risk factors for child undernutrition (12)(13)(14)(15)(16)(17)(18)(19)(20) , while higher levels of per capita public spending on health care are proved to contribute to better health outcomes among the poor and dramatically reduce mortality and undernutrition of children from poor families (21) . Health-related risk factors for child undernutrition include maternal common mental disorders, poor nutritional status of mothers, child's small size at birth and recurrent infections (12)(13)(14)16,18,22,23) .…”

Pengaruh Home Visit Terhadap Penurunan Episode Penyakit Infeksi dan Peningkatan Angka Kecukupan Gizi pada Balita Malnutrisi Akut Berat

“…Hal ini sesuai dengan pernyataan penelitian sebelumnya bahwa kejadian infeksi yang sering terjadi pada balita malnutrisi adalah infeksi saluran pernafasan dan penyakit infeksi sistem gastrointestinal (22,23). Penyakit infeksi saluran pernafasan dan diare merupakan dua penyebab utama kesakitan dan kematian pada balita malnutrisi di negara berkembang.…”