Factors associated with malnutrition in children <5 years in western Kenya: A hospital-based unmatched case control study

Abstract

Background Globally, under-nutrition accounts for >3 million deaths annually among children <5 years, with Kenya having ~35,000 deaths. We sought to identify factors associated with malnutrition in children aged <5 years in Western Kenya. Methods We conducted a hospital-based unmatched case-control study carried out between December 2016 and March 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height, ≤-2SD or ≥+2SD; weight-for-age, ≤-2SD or ≥+2SD; or height-for-age of ≤-2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select three controls. Unconditional logistic regression using backward elimination was used to identify independent associative factors using Epi-Info. Results A total 94 cases and 281 controls were recruited. Of the cases, 86% (81/94) were under-nourished. Mother not having attended ante-natal clinic (OR=7.9; 95% CI: 1.5-41.2), deworming (OR=0.8; 95% CI: 0.4-1.2) and pre-lacteal feeding (OR=1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR=13.9; 95% CI: 2.8-68.6); low birth weight (AOR=3.3; 95% CI: 1.4-7.6) and paternal lack of formal education (AOR=4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition. Urban residence (OR=5.4; 95% CI: 0.5-68.8) and male gender (OR=2.7; 95% CI: 0.7-11.8) were associated with over-nutrition with age <12 months (AOR=6.8; 95% CI: 1.6-29.7) and family income >5,000 Kenya shillings (AOR=4.6; 95% CI: 1.2-17.8) being independently associated. Conclusion Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.