Academic journal article Journal of Health Population and Nutrition

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

Academic journal article Journal of Health Population and Nutrition

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

Article excerpt

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 deve-lopment 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.

MATERIALS AND METHODS

Study design

A 1:1 case-control study with individual matching was deemed to be the most efficient for the study (13,14). Cases were defined as underweight children aged 6-35 months. Controls were non-underweight children matched by village of residence, sex, and age (within one month).

Study sample

For a 0.05 first-type error risk and a power of 0.80, assuming a 20% prevalence of exposure among controls, the sample size to detect an odds ratio of 2.0 was computed as 187 case-control pairs (n=374) (calculation performed with the Epitable module in the Epi Info software, version 6.04 (15)).

Cases were selected from four (Muscat, Dhakhilia, North and South Sharqia) of the 10 health regions in Oman which represent different situations and prevalences of underweight among children aged 0-59 month(s) (respectively 12.8%, 22.7%, 26.8%, and 19.7% in 1998) (6).

Inclusion of case-control pairs

In each commune, the Community Support Group members screened all children aged less than three years for cases and suitable controls using the reference growth charts and individual screening forms, including relevant inclusion/exclusion information. After verification at the Department of Nutrition of the Ministry of Health in Muscat, the case-control pairs were included based on age, validation of weight-for-age status (by calculation by computer), absence of any visible congenital diseases that might affect growth, and accuracy of the matching criteria, as reported by the field teams. …

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