Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

Sarah McCuskee; Andres Garchitorena; Ann C Miller; Lara Hall; Mohammed Ali Ouenzar; Victor R Rabeza; Ranto H Ramananjato; Hery-Tiana Rahaniraka Razanadrakato; Marius Randriamanambintsoa; Michele Barry; Matthew H Bonds

doi:10.1080/16549716.2018.1452357

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

Glob Health Action. 2018;11(1):1452357. doi: 10.1080/16549716.2018.1452357.

Authors

Sarah McCuskee¹, Andres Garchitorena^{2

3}, Ann C Miller^{2

3}, Lara Hall⁴, Mohammed Ali Ouenzar³, Victor R Rabeza⁵, Ranto H Ramananjato^{5

6}, Hery-Tiana Rahaniraka Razanadrakato⁵, Marius Randriamanambintsoa⁵, Michele Barry^{7

8}, Matthew H Bonds^{2

3}

Affiliations

¹ a Stanford University School of Medicine , Stanford , CA , USA.
² b Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA.
³ c PIVOT , Ranomafana , Madagascar.
⁴ d Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.
⁵ e Institut National de la Statistique , Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar.
⁶ f UNICEF , Madagascar Country Office , Antananarivo , Madagascar.
⁷ g Center for Innovation in Global Health , Stanford University , Stanford , CA , USA.
⁸ h Office of the Dean , Stanford University School of Medicine , Stanford , CA , USA.

Abstract

Background: Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering.

Objective: This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar.

Methods: We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted.

Results: Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02-1.04) for each additional month), very small birth size (OR = 2.32 (1.24-4.32)), low maternal weight (OR = 0.94 (0.91-0.97) for each kilogram, kg) and height (OR = 0.95 (0.92-0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92-0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97-0.99)), very small birth size (OR = 2.48 (1.23-4.99)), and low maternal BMI (OR = 0.84 (0.75-0.94) for each kg/m²). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median.

Conclusion: Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

Keywords: Child undernutrition; acute malnutrition; chronic malnutrition; household survey; stunting; wasting.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Height*
Body Weight
Child Health*
Child Nutrition Disorders / epidemiology*
Child, Preschool
Female
Growth
Humans
Infant
Logistic Models
Madagascar
Male
Nutritional Status
Poverty
Rural Population
Sanitation
Socioeconomic Factors

Grants and funding

SM was supported by the Stanford University School of Medicine Medical Scholars program. MHB and AG were funded by the James S. McDonnell Foundation [#220020322]. ACM was supported by a grant from the Herrnstein Family Foundation.