Factors associated with under-nutrition among children under five at French Medical Institute for Mother and Children Kabul, Afghanistan: a case control study

Introduction: Under nutrition is a major health and nutritional problem in all over the world especially in third world countries. More than 90% of the global burden of under nutrition is attributable to 36 countries of the world, and Afghanistan is one of them. In 2013, about 50% of all stunted children lived in Asia and over one third in Africa. Nutritional problems affect the lowest socioeconomic layer with negative consequences manifested in school-age, learning problem, high level of school dropout, and a low percentage of students enrolling into higher education. This limits development of economic benefits and adult productivity. Determinants of under nutrition may differ based on region, culture, communities and over time. Knowing underlying causes of under nutrition in particular locality is important to take steps for solving these problems. Therefore, this study was conducted to find out the associations between child under nutrition and its different demographic determinants and nutritional practices. Methods and material: To achieve the objective of the study, a case-control study design was applied. The cases were 134 under-nourished (who were according to WHO screening tool, underweight, wasted or stunted) children under the age of 5 years and the controls (n=134) were recruited concurrently from children under 5years (who were not, according to WHO screening tool, underweight, wasted or stunted) coming to FMIC hospital for medical treatment. The study was conducted from July 2016 to September 2016 at FMIC (French Medical Institute for Mother and Children). The statistical analysis was done using SPSS Version 22; Logistic regression was used to identify the association among independent variables and dependent variables. Results: The mean age of the participants were 23.62+12.84 & 19.40+12.3 months for cases and controls respectively. The majority of participants [95(70.9%) cases & 98(73.1%) controls] were from urban area. 88% of cases & 93% of controls participants were born at Hospital. 96(71.6%) & 93(69.4%) of the cases and controls received vaccine according to their age, 36(26%) from cases and 40(29.9%) from controls were partially vaccinated. Children whom EBF to 6 months of life 36(26.9%) were from cases and 86(64%) from controls. CF started before 6month of life 21(15.7%), 9(6.7%) at 6 months 64(47.8%), 101(75.4%) after 6 months 49(36.6%) of cases & controls respectively. Mothers having one child under the age of 5years were 50(37.3%) and 76(56.7%) for cases and controls and the number of mothers having more than one child were 84(62.3%), 58(43.3) for cases and controls respectively. Maternal education among cases was as following, illiterate 43(32.1%), Primary 27(20.1%), Secondary 37(27.6%) & Higher education 27(20.1%) and among controls was as such, illiterate 33(24.6%), Primary 39(29.1%), Secondary 42(31.3%) and High education 20(14.9%). Further analysis with logistic regression revealed that age periods from 6 to 12months and from 13 months to 24 months were statistically significant with undernutrition (OR=2.01; CI 1.11-3.67, P-value=0.021), (OR=2.51; CI 1.36-4.64, P-value=0.003) respectively while age period of 25-59 months had protective effect compared to other two groups. Children for whom CF started before and after 6 months of age were supposed to be 3.68 & 3.22 time more susceptible to undernutrition as compared to those received CF in appropriate age (at 6 months of age). Children who didn’t receive EBF for the first 6 months of life are 4.8 times more prone to undernutrition in comparison to children who received only EBF for the first 6 months of their lives (OR=4.87; CI 2.90-8.20, P-value=0.001). Children living in crowded family (6-8 member or more) were 1.07 times more undernourished compared to children living in small family (3-5 members). Conclusion and recommendations: This study identified specific age period of childhood, Exclusive breastfeeding, starting age of complementary feeding, household size, number of children under five years, and relatively gender as determinants of mal nutrition in this study. These results indicate that Age group (6-24 months) is critical and children in this age are vulnerable to be undernourished. Therefore, to reduce the burden of under-nutrition, early intervention should be taken. The EBF for first 6 months of life and appropriate time for initiating the complementary feeding (at 6 months of age) will protect the child from under-nutrition.We also found factors such as large household size and mothers having more than 2 children under five years were significantly associated with mal nutrition. Male gender was found to be relatively more malnourished in comparison to female gender