A case-control study of risk factors of clinical marasmus was undertaken to determine which factors differed according to gender and age groups. Case patients were children whose mid-upper arm circumference measured less than 110 mm and control subjects were children matched for age and sex with an arm circumference more than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1 to 4 years were studied. The effect of various demographic, socioeconomic, environmental, and health factors was investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children with siblings under 5 years old. This increased risk was observed irrespective of gender or age. Children who consumed formula foods also had an increased risk of marasmus. Again, this elevated risk was maintained for boys and girls. Overall, higher maternal education was associated with a reduced risk of marasmus; however, this was only statistically significant for boys and for children 18 months or older. Religion was also associated with marasmus but only in older children (> or = 18 months). These results indicate that better strategic planning is necessary to formulate effective interventions to reduce severe malnutrition, particularly in societies where strong age- and sex-preferential behavior exists.
PIP: Between June 1988 and June 1989, a study of 164 case-control pairs, 1-4 years mold, in the Maternal and Child Health-Family (MCH-FP) area in the Matlab of Bangladesh was conducted to examine risk factors of clinical marasmus within gender and age groups. 73% of marasmus cases were females 12-23 months old. For all the children, presence of siblings younger than 5 years old (odds ratio [OR] = 2.84; p .001), maternal education (OR = 0.29 for = or 5 years; p .001 for the trend), and ingestion of formula food (OR = 18.4; p .001) were significant risk factors for marasmus. Religion bordered on significance (OR = 0.49 for Hindu; p = .06). Both boys and girls faced an increased risk of marasmus if they had a sibling younger than 5 years old living in the same household (OR = 2.85; p = .05 and OR = 3.07; p .001, respectively). They both were also at increased risk of marasmus if they consumed formula (OR = 12.4; p = .01 and OR = 25.7; p .001). Boys were significantly less likely to develop marasmus if their mothers had any education (OR = 0.51 for 5 years and 0.12 for = 5 years; p .001). Yet, maternal education had only a weak effect on reducing the risk of developing marasmus in girls. Younger (18 months) and older children were both likely to develop marasmus if they had a sibling younger than 5 years old at home (OR = 2.37 and 3.27; p = .01 and .005, respectively). The risk of marasmus was much lower in older children if they had educated mothers and if they lived in Hindu families (OR = 0.2 for = or 5 years education and 1.19; p = .007 and .01, respectively). These findings suggest that the free services of the MCH program may not reach the disadvantaged due to age and sex biases and that maternal education does not benefit the nutritional status of the most vulnerable age group to marasmus, the very young.