Academic journal article Journal of Health Population and Nutrition

Malnutrition among Pre-School Children in Alexandria, Egypt

Academic journal article Journal of Health Population and Nutrition

Malnutrition among Pre-School Children in Alexandria, Egypt

Article excerpt


Information on child growth is helpful in monitoring trends, determining priorities, and evaluating the effectiveness of nutritional intervention programmes. Malnutrition, one of the most important global health problems, affects large numbers of children in developing countries (1). It is synonymous with protein energy malnutrition (PEM) and signifies an imbalance between the supply of protein and energy and the body's demand for these to ensure optimal growth and function. PEM, a consequence of various factors, is often related to poor quality of food, insufficient food intake, and severe and repeated infectious diseases, or, frequently, combinations of the three (2). The major outcomes of PEM during childhood may be classified in terms of morbidity (3), mortality (4), and psychological and intellectual development (5) with important consequences in adult life (6).

A recent WHO report states, "the stagnation of nutritional improvement combined with a rapid rise in population has resulted in an increase in the total number of malnourished children in all subregions of Africa" (2). Consistently with this, the findings of the Egypt's Multiple Indicators Cluster Survey reveal that malnutrition is still a serious problem (7).

Urbanization and inflow of migrants from rural to urban Alexandria lead to overcrowding and development of squatter areas in the city (8), resulting in a heavy pressure on food, environment, and health services as indicated in the community-based studies on the prevalence of malnutrition. The present study was carried out to assess the current status of malnutrition among pre-school children in Alexandria and to define its correlates.


This cross-sectional study was conducted in Alexandria, Egypt during February-June 1998. A two-stage clustersampling technique, with probability proportionate to the size of population and a constant number of children per cluster at the second stage, was used. In the first stage, 30 clusters were selected based on probability proportionate to the size of population in different communities of seven districts of Alexandria. The 30 clusters were selected to assume a valid estimate of the prevalence of the problem. The study covered both urban and rural areas. In the second stage, 30 children, aged 6-71 months, from each cluster were selected to form the target population of the study. From a random starting point in each cluster, selection of households was started, and then search was made from door to door until 30 children (one per family) were selected. This sample size ensures, with probability of 95%, that the estimated prevalence is within [+ or -] 5% of the true prevalence, irrespective of the prevalence and assumption of a design effect of 2. To represent the population of squatter areas, 10 clusters from 64 squatter areas were chosen. The total 'required' sample size stood at 1,200 children, whereas the actual number of pre-school children study was 1,217.

A pre-structured questionnaire was used for collecting data during the early months of 1998. Two teams--each comprising a nutritionist, an epidemiologist, a biochemist, and a local field facilitator--interviewed the mothers to collect information on the characteristics of children, such as age, sex, birth order, breast-feeding and morbidity patterns in the last two weeks, and family and environment characteristics, e.g. crowding index, source of water, sanitation facility, and refuse disposal. Anthropometric measurements (length, height, and weight) for each child were recorded following the method of Jelliffe et al. (9).

Double data entry was performed and checked for completeness and consistency. Statistical analysis was done by the SPSS package. The prevalence of PEM was assessed by the following indicators:

Stunting prevalence: proportion of pre-school children below -2 standard deviations from the median height/ length-for-age of the World Health Organization/National Center for Health Statistics (WHO/NCHS) reference population. …

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