Academic journal article Journal of Health Population and Nutrition

Risk Factors Associated with Severe Underweight among Young Children Reporting to a Diarrhoea Treatment Facility in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Risk Factors Associated with Severe Underweight among Young Children Reporting to a Diarrhoea Treatment Facility in Bangladesh

Article excerpt


Protein-energy malnutrition (PEM) is one of the most serious health problems in Bangladesh and other resource-poor countries where PEM accounts for more than 35% of deaths of children aged less than five years (under-five mortality) and 11% of the total burden of disease (1). Earlier reviews reported that severely-underweight children [weightfor- age z-score (WAZ) <-3], aged 6-59 months, had more than eight-fold increased mortality (2), and stunting, severe wasting, and intrauterine growth restriction together are responsible for 2*2 million deaths and 21% of disability-adjusted life-years (DALYs) for children aged less than five years (under- five children) (1). The latest national nutrition survey found that 29% of under-five children were moderately underweight (WAZ <-2 to -3), and 12% were severely underweight (WAZ <-3) (3).

The aetiology of childhood malnutrition is complex, involving interactions of the biological, cultural and socioeconomic factors. In most South Asian countries, poverty, high population density, low status of women, poor antenatal care, high rates of low birth weight, unfavourable child caring practices, and poor access to child healthcare are the underlying contributors to the development of PEM (4), although specific risk factors that can be used for targeting nutrition-intervention programmes have not been well-defined. Therefore, the objective of this study was to compare the characteristics of young children with or without severe underweight reporting to a diarrhoea treatment hospital in Bangladesh.


The study of young children, aged 6-24 months, who reported to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) during September 2005-June 2007, with or without severe underweight, used a case-control design. Cases with severe underweight were defined as children of either sex whose WAZ were <-3.0 with respect to the new growth standards of the World Health Organization (5) and who did not have any congenital anomalies that might have been responsible for their underweight. The controls were children from the same communities who reported to the hospital during the same period and whose WAZ were >-2.5 and length-for-age z-scores (LAZ) were >-3.0.

The Dhaka metropolitan area (1,500 sq km) has a total population of ~11 million. Each year, the Dhaka Hospital of ICDDR,B provides care and treatment to over 100,000 patients with diarrhoea, with or without other associated health problems. The hospital also conducts research on enteric and other common infectious diseases and malnutrition and provides training on case management of diarrhoeal diseases and malnutrition and research methodology. Under-five children constitute about 60% of the total number of patients, and the majority (57%) of the patients come from poor socioeconomic communities in urban and peri-urban areas of Dhaka.

Selection of cases and controls

Children enrolled in the study were recruited at the time of their discharge from inpatient treatment for diarrhoea and other acute illnesses. Cases were recruited from children who participated in a study of outpatient treatment of severely-underweight children (6). Children were selected as controls only if they resided in the same neighbourhoods as the cases. Each week/working day, potentially-eligible children who were ready for discharge from the hospital were weighed and measured, and the children who satisfied the entry criteria for cases and controls were invited to participate in the study. Verbal consent was obtained from a parent, usually the mother of the child.

Collection of data

A research assistant interviewed the mothers using a pretested, structured questionnaire, and a medical doctor examined the children for signs of illness. Information recorded from the interviews included: age and sex of child, birth-order, number of total and under-five siblings, feeding and immunization history, type of residence and latrine, marital status of mother, monthly family income, and parental age, education, and occupation. …

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