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Risk factors for acutely malnourished infants aged under six months

Research snapshot 1

Acute malnutrition (wasting) in infants aged under 6 months (< 6m) is often neglected. Worldwide, some 8.5 million infants < 6m are affected, yet recent World Health Organization (WHO) malnutrition guidelines highlight numerous evidence gaps on how to best manage them. To inform future research, policy and programming this study aimed to identify risk factors associated with infant < 6m wasting through a secondary data analysis of nationally representative, cross-sectional Demographic and Health Surveys (DHS) conducted in the last 10 years. Wasted infants < 6m (weight-for-length z-score (WLZ) <-2) were compared to non-wasted infants (WLZ ≥-2). Simple and adjusted (for infant age, sex, socio-economic status) logistic regression was used to calculate odds of wasting associated with household-related, maternal-related and infant-related risk factors.

A total of 16,123 infants < 6m were analysed from 20 countries. Results showed that multiple risk factors were statistically associated with wasting. These included: poverty (odds ratio (OR) 1.22 (95% CI 1.01-1.48, p=0.04)); low maternal body mass index (BMI) (adjusted OR (aOR) 1.53(1.29-1.80, p<0.001); small infant size at birth (aOR 1.32(1.10-1.58, p<0.01)); delayed start of breastfeeding (aOR 1.31(1.13-1.51, p<0.001)); infant having had a pre-lacteal feed (aOR 1.34(1.18-1.53, p<0.001)); recent history of diarrhoea (aOR 1.37(1.12-1.67,p<0.01)); and disempowered mother (experiences violence, does not make decisions about health issues, does not engage with health services such as antenatal care, does not give birth in a health facility). ‘Protective’ factors associated with significantly decreased odds of infant < 6m wasting included: mother being educated (OR 0.64(0.54-0.76, p<0.001)); mother in work (OR 0.82(0.72-0.94, p<0.01)); infant currently being breastfed (aOR 0.62(0.42-0.91, p=0.02)) and infant having been exclusively breastfed (aOR 0.84(0.73-0.97, p=0.02).

Infant < 6m wasting is a complex, multifactorial problem associated with many risk factors. Many of the risk factors identified in this study are biologically plausible and/or socially important and should therefore be considered when assessing and managing infants < 6m. Although supporting breastfeeding is core to future interventions, this alone is unlikely to be sufficient; strategies should involve multiple sectors beyond just health and nutrition.

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Risk factors for acutely malnourished infants aged under six months. Field Exchange 59, January 2019. p16. www.ennonline.net/fex/59/riskfactorsinfantsu6months

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