Determinants of Persistent Underweight among Children, Aged 6-35 Months, after Huge Economic Development and Improvements in Health Services in Oman

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ABSTRACT

Over the last decades, health indicators have witnessed major improvements in the Sultanate of Oman. This study was aimed at factors associated with underweight among children in four regions of Oman, as, in 1998, underweight was prevalent among 17.9% of children aged less than five years. A case-control study was conducted in 2002: 190 cases were 6-35-month old children with weight-for-age <-2 z-scores. Controls were individually matched by village of residence, sex, and age. The questionnaire included anthropometry of children, child-feeding practices, morbidity, anthropometry of mothers, parity, birth-spacing, and socioeconomic characteristics. Conditional logistic regression was used for analyses. Birth-weight of <2,500 g was strongly associated with underweight and also were height of mother, low level of education of mother, bad quality of water in households, diarrhoea of children in the last two weeks, and regular use of infant formula. Factors, such as birth-weight, height of mother, supply of safe water in household, and care for mothers and children were the determinants of persistent underweight after huge economic development and improvements in health services. Further research is also needed to investigate further specific determinants of low birth-weight in the Omani context and try to disentangle emaciation and determinants of linear growth retardation.

Key words: Birth-weight; Case-control studies; Childcare; Child nutrition disorders; Underweight; Oman

INTRODUCTION

In the last three decades, due to oil revenues and policy choices, the Sultanate of Oman has undergone drastic economic and sociodemographic changes. Between 1975 and 2003, its human development status, as assessed by the human development index (HDI), experienced the world's largest observed increase for this period, from 0.493 to 0.780 (1). Oman now ranks 71 among 177 nations in the first quarter of the medium human development countries. In the same period, most health indicators witnessed major improvements (2). Between 1960 and 2002, the rate of infant mortality dropped from 164% to 11%, and the rate of mortality of children aged less than five years (under-five mortality) went down from 280% to 13% (3). Rate of infant immunization rose from 10% in 1980 to 99% in 2001 (4). Also, during the same period, the prevalence of different forms of undernutrition decreased markedly. Between 1980 and 1998, underweight among Omani children aged less than five years decreased from 62.9% to 17.9% and stunting from 20.3% to 10.4% (5,6). Wasting decreased from 12.8% in 1995 to 7.2% in 1998 (6). By the international standards of the World Health Organization (WHO) for prevalence of child malnutrition (7), level of underweight in Oman is still in the 'medium' range, even if the health of all Omani children can be monitored due to sufficient resources and adequate heath services.

The conceptual framework of our analysis is that of the international conceptual framework of the causes of malnutrition (8). Due to the specific Omani context, our hypotheses were that (a) the factors from the 'health environment and services' (with the exception of water supply which is historically important in Oman) and 'household food security categories of the underlying causes of malnutrition (8) could be considered at a sufficient level (9) and (b) that risk factors of underweight could, thus, be more likely found in the child and maternal care categories (also without excluding the legacy of the predevelopment years via prenatal factors). Despite a few descriptive studies (10,11) or aimed at specific risk factors (10,12), no data were available to assess the relationships between a sufficiently large number of factors and the anthropometric status of children. Therefore, this study was aimed at assessing the risk factors of underweight among young Omani children. For that purpose, a matched case-control study was conducted among 6-35-month old children residing in four regions of Oman. …