Determinants of Severe Acute Malnutrition in under-five children in Dibrugarh District, Assam

Background: Malnutrition is a major public health problem and leading determinant of morbidity and mortality in under-five children in India. Aim & Objective: To assess determinants of Severe Acute Malnutrition (SAM) in under-five children of Dibrugarh district, to assess knowledge and practice of Infant, Young Child Feeding Practices (IYCF) and to assess the knowledge and practice of identification of SAM of Anganwadi workers. Settings and Design: Dibrugarh district, Assam. Mixed method study. Methods and Material: It was a case-control study that interviewed mothers of children between 6-59 months between June 2021 to May 2022. Using a pre-tested semi-structured questionnaire Interviews of a total of 164 under-five children’s mothers (82 cases and 82 controls)] were done. Qualitative data was also collected by in-depth interviews of Anganwadi workers (AWWs). Statistical analysis used: SPSS version 25.0. Chi-Square test, unadjusted OR for Bivariate analysis and adjusted odds ratio using Multiple logistic regression was calculated. Results: Determinants of severe acute malnutrition were joint family (AOR 3.08, 95% CI 1.02-9.31, p= 0.046); birth weight less than 2.5 kg (AOR 20.6, 95% CI 4.50-94.03, p=<0.0001); mothers with less than 4 antenatal check-ups (AOR 5.13, 95% CI 1.28-29.47, p=0.021); partial immunization (AOR 9.2, 95%CI 1.83-46.59, p=0.007); and irregular utilization of ICDS services (AOR 27.36, 95%CI 5.73-130.66, p=<0.0001). Problems faced by AWWs during service delivery were communication barriers, community resistance during home visits, and increased workload during COVID-19. Conclusions: IYCF practices need to be promoted with screening and growth monitoring for early detection and timely referral of malnutrition along referred back and linkages of services so that home-based and community-based management can be done to prevent severe acute malnutrition