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Risk factors for clinical marasmus: a case-control study of Bangladeshi children
F J Henry1, A Briend, V Fauveau
1Harvard Institute for International Development, Cambridge, MA 02138.
Insights
Clinical marasmus risk in Bangladesh is higher for children in families with multiple young children and those consuming formula foods. Maternal education significantly reduces this risk, highlighting non-nutritional factors for intervention.
Area of Science:
- Public Health
- Pediatrics
- Nutritional Epidemiology
Background:
- Clinical marasmus poses a significant public health challenge in rural Bangladesh.
- Understanding risk factors is crucial for developing effective intervention strategies to combat severe childhood malnutrition.
Purpose of the Study:
- To identify key demographic, socioeconomic, environmental, and health-related risk factors for clinical marasmus in young children in rural Bangladesh.
- To inform targeted interventions aimed at reducing the incidence of severe malnutrition.
Main Methods:
- A case-control study design was employed, comparing children with marasmus (mid-upper arm circumference < 110 mm) to matched controls (arm circumference > 120 mm).
- Data were collected from 164 pairs of children aged 1-4 years between June 1988 and June 1989.
- Multivariate analysis using conditional logistic regression was used to assess the impact of various maternal-reported factors.
Main Results:
- Children in families with other siblings under 5 years of age had a significantly increased risk of marasmus (OR = 2.51).
- Consumption of formula foods was strongly associated with a higher risk of marasmus (OR = 16.41).
- Higher levels of maternal education demonstrated a protective effect, with children of mothers having >= 5 years of schooling showing a reduced risk (OR = 0.34).
Conclusions:
- Maternal education and child spacing are significant non-nutritional factors influencing the risk of childhood marasmus.
- Intervention programs in Bangladesh should incorporate strategies addressing these factors to effectively reduce severe malnutrition.
- The findings underscore the importance of a holistic approach beyond nutritional supplementation for combating childhood marasmus.
Abstract:
A case-control study of risk factors of clinical marasmus was undertaken to guide intervention efforts in rural Bangladesh. Cases were children whose mid-upper arm circumference measured < 110 mm and controls were children matched for age and sex with arm circumference > 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied. The effects of various demographic, socioeconomic, environmental, and health factors, reported by mothers, were investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio [OR] = 2.51; 95% confidence interval [CI]: 1.33-4.74), and children who consumed formula foods (OR = 16.41, 95% CI: 3.39-79.36). Higher maternal education was associated with reduced risk of marasmus, compared with no education, the OR for < 5 years of schooling = 0.57, 95% CI: 0.23-1.41; OR for > or = 5 years of schooling = 0.34, 95% CI: 0.15-0.76. The strong association of childhood marasmus with mother's education and child spacing supports the notion that non-nutritional factors should be essential components of efforts to reduce severe malnutrition in Bangladesh.