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Determinants of impaired growth among hospitalized children: a case-control study
Marilia de Carvalho Lima1, Maria Eugênia Farias Almeida Motta, Eliane Cavalcanti Santos
1Department of Pediatrics, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. mlima@truenet.com.br
Insights
Low birth weight and poor sanitation significantly increase infant malnutrition risk in Brazil. Interventions should address these factors for effective prevention strategies.
Area of Science:
- Public Health
- Pediatrics
- Nutritional Epidemiology
Background:
- Protein energy malnutrition is a critical public health issue, particularly in developing nations.
- Identifying predictive risk factors is crucial for effective intervention planning to combat infant malnutrition.
Purpose of the Study:
- To determine the risk factors associated with protein energy malnutrition in hospitalized low-income children aged 6 to 24 months.
- To analyze sociodemographic, environmental, reproductive, healthcare, feeding, and morbidity factors influencing malnutrition.
Main Methods:
- A case-control study was conducted in two public hospitals in Recife, Brazil.
- 124 infants with length-for-age below the 10th percentile (cases) and 241 infants at or above the 10th percentile (controls) were analyzed.
- Hierarchical logistic regression was employed to identify independent risk factors for infant malnutrition.
Main Results:
- Low birth weight was identified as the most significant risk factor for impaired growth.
- Factors such as lack of toilet facilities or refrigerator, high maternal parity, absence of breastfeeding, inadequate vaccination, and prior hospitalization for diarrhea/pneumonia were associated with increased malnutrition risk.
- Initial associations with maternal age, TV ownership, water supply, family size, and home location were not significant after adjustment.
Conclusions:
- Chronic malnutrition, indicated by low length-for-age, is influenced by factors beyond low income, as observed in this study.
- Comprehensive strategies for malnutrition reduction must consider the complex interplay of multiple determinants.
Context:
Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition.
Objective:
To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months.
Type Of Study:
Case-control study.
Setting:
Two public hospitals in Recife, Brazil.
Participants:
The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary.
Methods:
Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables.
Results:
The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia.
Discussion:
The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth.
Conclusions:
In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.
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