Background
Methods
Study setting
Study design and sampling
Study population
Definitions for malnutrition
-
Children with an admission weight for height <70 % of the National Centre for Health Statistics (NCHS) median value or below −3 z score with or without bilateral pitting oedema have Severe Acute Malnutrition (SAM).
-
Children with a weight for height <80 % but ≥70 % of the National Health Statistics (NCHS) median value or between −2 and −3 z score have Moderate Acute Malnutrition(MAM).
Measurements
Data collection
Statistical methods
Ethics
Results
Socioeconomic and demographic characteristics
Characteristic | Nutritional status of child | |||||
---|---|---|---|---|---|---|
Malnourished n, % | Well-nourished n, % | Crude OR [95 % CI] | p-value | Adjusted OR [95 % CI]*
| p-value | |
Mother’s current age (N = 357) | ||||||
≤19 years | 8 (4.7) | 2 (1.1) | 4.39 [0.85–42.97] | 0.045 | 1.00 [0.14–7.22] | 0.999 |
≥35 years | 30 (17.5) | 38 (20.4) | 0.87 [0.49–1.53] | 0.599 | 1.07 [0.57–1.98] | 0.841 |
20–34 years | 133 (77.8) | 146 (78.5) | 1.00 | 1.00 | ||
Mother's age during pregnancy (N = 357) | ||||||
≤19 years | 19 (11.1) | 8 (4.3) | 2.78 [1.12–7.54] | 0.015 | 1.50 [0.47–4.73] | 0.492 |
≥20 years | 152(88.9) | 178 (95.7) | 1.00 | 1.00 | ||
Mother’s marital status (N = 346) | ||||||
Single | 29 (17.6) | 11 (6.1) | 4.21 [1.91–9.79] | <0.001 | 2.43 [1.05–5.61] |
0.038
|
Separated/Divorced/widowed | 9 (5.5) | 9 (5.0) | 1.60 [0.61–4.18] | 0.340 | 0.54 [0.16–1.82] | 0.324 |
Co-habiting | 40 (24.2) | 22 (12.2) | 2.90 [1.56–5.48] | <0.001 | 2.24 [1.16–4.34] |
0.016
|
Married | 87(52.7) | 139 (76.8) | 1.00 | 1.00 | ||
Mother's educational status (N = 365) | ||||||
None | 25 (14.0) | 12 (6.5) | 7.18 [2.35–22.50] | <0.001 | 2.73 [0.75–9.96] | 0.128 |
Basic | 112 (62.6) | 93 (50.0) | 4.19 [1.80–10.37] | <0.001 | 2.10 [0.81–5.45] | 0.126 |
Secondary/Vocational | 33 (18.4) | 50 (26.9) | 2.27 [0.90–6.11] | 0.059 | 1.35 [0.50–3.62] | 0.549 |
Tertiary | 9 (5.0) | 31 (16.7) | 1.00 | 1.00 | ||
Mother can read and write (N = 368) | ||||||
No | 81 (44.8) | 49 (26.2) | 2.28 [1.44–3.63] | <0.001 | 1.09 [0.58–2.03] | 0.794 |
Yes | 100 (55.2) | 138 (73.8) | 1.00 | 1.00 | ||
Monthly family income (N = 371) | ||||||
≤ 500 Gh Cedisa
| 140 (76.9) | 85 (45.0) | 4.08 [2.55–6.56] | <0.001 | 2.73 [1.61–4.65] |
<0.001
|
> 500 Gh Cedisa
| 42 (23.1) | 104 (55.0) | 1.00 | 1.00 | ||
Receives extra financial support due to inadequate family income (N = 371) | ||||||
Yes | 44 (24.2) | 24 (12.7) | 2.19 [1.23–3.96] | 0.004 | 1.47 [0.77–2.82] | 0.241 |
No | 138 (75.8) | 165 (87.3) | 1.00 | 1.00 |
Maternal health and malnutrition
Characteristic | Nutritional status of child | |||||
---|---|---|---|---|---|---|
Malnourished n, % | Well-nourished n, % | Crude OR [95 % CI] | p-value | Adjusted OR [95 % CI]*
| p-value | |
Mother’s marital status (N = 346) | ||||||
Single | 29 (17.6) | 11 (6.1) | 4.21 [1.91–9.79] | <0.001 | 2.70 [1.12–6.51] | 0.027 |
Separated/Divorced/widowed | 9 (5.5 | 9 (5.0) | 1.60 [0.61–4.18] | 0.340 | 0.14 [0.02–0.99] | 0.048 |
Co-habiting | 40 (24.2) | 22 (12.2) | 2.90 [1.56–5.48] | <0.001 | 2.23 [1.13–4.40] | 0.021 |
Married | 87(52.7) | 139 (76.8) | 1.00 | 1.00 | ||
Monthly family income (N = 371) | ||||||
≤500 Gh Cedisa
| 140 (76.9) | 85 (45.0) | 4.08 [2.55–6.56] | <0.001 | 3.05 [1.75–5.31] | <0.001 |
>500 Gh Cedisa
| 42 (23.1) | 104 (55.0) | 1.00 | 1.00 | ||
Mother's BMI category (N = 336) | ||||||
Normal Weight | 89 (55.3) | 66 (37.9) | 1.01 [0.14–6.20] | 0.989 | - | - |
Over-weight/Obese | 68 (42.2) | 105 (60.3) | 0.49 [0.07–2.98] | 0.345 | - | - |
Under-weight | 4 (2.5) | 3 (1.7) | 1.00 | |||
Mother’s BMI category (N = 347) | ||||||
Yes | 22 (13.5) | 24 (13.0) | 1.04 [0.53–2.03] | 0.901 | - | - |
No | 141 (86.5) | 160 (87.0) | 1.00 | |||
Maternal HIV status (N = 288) | ||||||
Positive | 13 (7.1) | 3 (1.6) | 5.92 [1.57–32.91] | 0.002 | 5.41 [1.29–22.77] | 0.021 |
Negative | 115 (63.2) | 157 (83.1) | 1.00 | 1.00 | ||
Presence of chronic illness in mother (N = 371) | ||||||
Yes | 10 (5.5) | 3 (1.6) | 3.60 [0.91–20.65] | 0.041 | 6.51 [1.27–33.47] | 0.025 |
No | 172 (94.5) | 186 (98.4) | 1.00 | 1.00 |
Child care and malnutrition
Characteristic | Nutritional status of child | |||||
---|---|---|---|---|---|---|
Malnourished n, % | Well-nourished n, % | Crude OR [95 % CI] | p-value | Adjusted OR [95 % CI]*
| p-value | |
Mother’s marital status (N = 346) | ||||||
Single | 29 (17.6) | 11 (6.1) | 4.21 [1.91–9.79] | <0.001 | 2.45 [1.09–5.53] | 0.031 |
Separated/Divorced/widowed | 9 (5.5 | 9 (5.0) | 1.60 [0.61–4.18] | 0.340 | 0.99 [0.31–3.18] | 0.987 |
Co-habiting | 40 (24.2) | 22 (12.2) | 2.90 [1.56–5.48] | <0.001 | 2.24 [1.18–4.26] | 0.014 |
Married | 87(52.7) | 139 (76.8) | 1.00 | 1.00 | ||
Monthly family income (N = 371) | ||||||
≤500 Gh Cedisa
| 140 (76.9) | 85 (45.0) | 4.08 [2.55–6.56] | <0.001 | 2.81 [1.65–4.78] | <0.001 |
>500 Gh Cedisa
| 42 (23.1) | 104 (55.0) | 1.00 | 1.00 | ||
Mother directly cares for/stay with child (N = 371) | ||||||
No | 16 (8.8) | 5 (2.6) | 3.55 [1.20–12.62] | 0.010 | 2.08 [0.60–7.18] | 0.245 |
Yes | 166 (91.2) | 184 (97.4) | 1.00 | 1.00 | ||
Having problems with child care (N = 371) | ||||||
Yes | 94 (51.6)) | 52 (27.5) | 2.81 [1.79–4.44] | <0.001 | 1.57 [0.92–2.67] | 0.100 |
No | 88 (48.4) | 137 (72.5) | 1.00 | 1.00 | ||
How mother cares for child during the day (N = 368) | ||||||
Takes child to work | 61 (33.7) | 63 (33.7) | 3.05 [1.42–6.80] | 0.002 | 2.90 [1.27–6.62] | 0.012 |
Leaves child with care giver | 39 (21.6) | 50 (26.7) | 2.46 [1.10–5.69] | 0.017 | 2.03 [0.86–4.79] | 0.106 |
Mother is with child at home | 68 (37.6) | 33 (17.7) | 6.50 [2.91–14.93] | <0.001 | 4.46 [1.90–10.48] | 0.001 |
Leaves child at crèche/nursery | 13 (7.2) | 41 (21.9) | 1.00 | 1.00 |
Social support systems
Characteristic | Nutritional status of child | |||
---|---|---|---|---|
Malnourished n, % | Well-nourished n, % | OR [95 % CI] | p-value | |
Ever heard of social services (N = 371) | ||||
No | 118 (64.8) | 101 (53.4) | 1.61 [1.04–2.49] | 0.026 |
Yes | 64 (35.2) | 88 (46.6) | Ref | |
Seen Social service for help (N = 371) | ||||
No | 178 (97.8) | 187 (98.9) | 0.48 [0.43–3.37] | 0.384 |
Yes | 4 (2.2) | 2 (1.1) | Ref | |
Ever heard of LEAP programme (N = 371) | ||||
No | 176 (96.7) | 187 (98.9) | 0.31 [0.03–1.79] | 0.138 |
Yes | 6 (3.3) | 2 (1.1) | Ref | |
Ever benefited from hospital needy fund (N = 371) | ||||
Yes | 5 (2.7) | - | Not estimable | <0.001 |
No | 177 (97.3) | 189 (100) | Ref | |
Child had registered with NHIS before hospital visit (N = 371) | ||||
No | 79 (43.4) | 87 (46.0) | 0.90 [0.58–1.38] | 0.611 |
Yes | 103 (56.6) | 102 (54.0) | Ref |
NHIS enrolment
Characteristic | Nutritional status of child | |
---|---|---|
Malnourished n, %a
| Well-nourished n, %a
| |
Reason for non-enrolment in NHIS | ||
About to register | - | 4 (4.6) |
Forgetfulness | 7 (8.9) | 1 (1.1) |
It doesn’t work | 39 (49.4) | 3 (3.4) |
It is expensive | 14 (17.7) | 7 (8.0) |
It is not necessary | 2 (2.5) | 3 (3.4) |
It takes too long to be attended to | 1 (1.3) | 2 (2.3) |
It takes too long to get registered | 6 (7.6) | 1 (1.1) |
No satisfactory reason | 28 (35.4) | 59 (67.8) |
Registered but card not ready | 13 (16.5) | 5 (5.7) |
Wanted to do it but not yet | 5 (6.3) | 2 (2.3) |
Type of problem with child care | ||
Disability | 2 (2.1) | 2 (3.8) |
Financial | 86 (91.5) | 34 (65.4) |
Housing | 6 (6.4) | 5 (9.6) |
Marital | 23 (24.5) | 14 (26.9) |
Paying hospital bills | 17 (18.1) | 9 (17.3) |
Retrieving child support from partner | 31 (33.0) | 6 (11.5) |
Unemployment | 45 (47.9) | 20 (38.5) |