Determinants of growth failure in 12–24-month-old children in a high-density urban slum community in East London, South Africa

Abstract

Objective: The study's main objectives were the identification of determinants of growth failure in 12 -24-month-old children from an urban slum community attending a day hospital as well as the identification of focus areas for intervention. Design: The research was executed as a case -control study with a one-to-two design. A hypothetical causal model was developed for the undernutrition situation in Duncan Village. A questionnaire to assess the direct and underlying causes of growth failure in the study population was developed from this model. Subjects: One-hundred and fifty children were selected for the study, with 100 children in the control group and 50 children in the growth-failure group. Each child in the growth-failure group was matched with two children in the control group based on age and sex. The children were chosen according to anthropometric indices and p-albumin levels. Setting: The research was conducted at a primary health care centre in Duncan Village, an overpopulated urban slum area in East London, a small city on the east coast of South Africa. Results: No significant differences were found between the two groups for the occurrence of disease and infection. Dietary intake seemed to be generally poor in all the children. No significant differences were found between the two groups for the indicators of household food security, health service utilization and environmental conditions. The most important underlying determinants of growth failure that were identified in the study population seem to be related to the caring capacity, and the resultant caring behaviours of mothers. The risk for growth failure is increased when a child has a mother who is not the head of the household (relative risk) (RR ¼ 4.3), who is not involved with the discipline of her children (RR ¼ 2.2), who is not the guardian of the child (RR ¼ 8), who was not born in Duncan Village or in a city (RR ¼ 2.16), who is not able to write (RR ¼ 2.7) or read Xhosa (RR ¼ 2.53), who has a school education of grade 9 (RR ¼ 2.9), who did not receive nutrition education (RR ¼ 2.2), who smokes (RR ¼ 10) and drinks beer regularly (RR ¼ 10), who has a BMI < 25 (RR ¼ 2.7), who was subjectively judged to show little interest in her child (RR ¼ 4) as well as an inadequate caring attitude towards her child (RR ¼ 3.61), and whose clothing was dirty (RR ¼ 2.7) and not tidy (RR ¼ 2.9). Further determinants included the following: a child who weighed < 2500 g at birth (RR ¼ 4.96), who had not received supplemental milk while still breast-fed (RR ¼ 2.00), who did not receive baby cereal as first food (RR ¼ 2.6), whose clothes (RR ¼ 2.7) were dirty and whose hands were infrequently washed (RR ¼ 10). Conclusions: The results of this research suggest that initiatives to address the problem of growth failure in 12 -24-month-old children attending the Duncan Village Day Hospital should focus mainly on improving the caring capacity of mothers in the study area.

Maternal Disempowerment and Sever Food Insecurity as Determinants of Undernutrition Among 6-36 Month Old Children in Gurage Zone, Southern Ethiopia: Case-Control Study

“…Additional explanation for rural mother may be if rural women have control over assets, they tend to favor the production of food crops that ensure food security for the family in contrast to Men who more frequently show a preference for cash crops sold on markets [21]. The finding was in line with that of studies done in North West Ethiopia, South Africa, Bangladesh and India [25,[31][32][33]. But, it was inconsistent with studies done in Bangladesh and Tanzania that describes maternal participation in decision making process of household resources allocation /expenditure didn't showed statistical association with undernutrition in that particular set up [29,34].…”

Malaria and Nutritional Status Among Pre-School Children: Results From Cross-Sectional Surveys in Western Kenya

“…Relatively few studies have examined the association of malaria with PEM in areas with intense perennial malaria infection. 28,29 This study was conducted in the context of a large randomized controlled trial of ITNs designed to assess the impact of ITNs on under-5-years morbidity and mortality in an area with a high degree of malaria-attributable morbidity. 30 The focus of two previous analyses was to address the role of ITNs in mediating malaria and nutritional morbidity.…”

Nutritional well-being of young children in Duncan Village, East London, South Africa: accessibility of primary health care clinics

“…The primary researcher worked in the health system in the community for more than 10 years and the current research evolved from the case-control study 10 ; therefore involvement with this research extended over a prolonged period (15 years) Persistent observation: was sufficient time spent on site to get an adequate picture of consistency of behaviour?…”

“…As a first step in the process, a case -control study was undertaken from a health centre in Duncan Village to identify determinants of growth failure in 12-to 24-month-old children attending the centre. Specific priorities for initiatives to address the problem in the area were subsequently identified 10 . These priorities were clearly in line with the priorities of early childhood as set out in the UNICEF medium-term strategic plan for 2002 -2005; i.e.…”