International Journal of Health Policy and Management

International Journal of Health Policy and Management

Prevalence and Determinants of Under-Nutrition Among Children Under Six: A Cross-Sectional Survey in Fars Province, Iran

Document Type : Original Article

Authors
Elham Kavosi 1
Zahra Hassanzadeh Rostami 1
Zahra Kavosi 1
Aliasghar Nasihatkon 2
Mohsen Moghadami 3
Mohammadreza Heidari 1
1 Social Determinants of Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Fars Petroleum Industry Health Organization, Fars, Iran
3 Department of Internal Medicine, Social Determinants of Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
10.15171/ijhpm.2014.63
Abstract
Background
Childhood malnutrition as a major public health problem among children in developing countries can affect physical and intellectual growth and is also considered as a main cause of child morbidity and mortality. The objective of this study was to estimate the prevalence of under-nutrition and identify determinants of malnutrition among children under 6 years of age in Fars province, Iran.
 
Methods
This survey was conducted by house to house visit through multi-stage sampling in 30 cities of Fars province, during December 2012 to January 2013. A total of 15408 children, aged 0–6 years old, were studied for nutritional assessment in terms of underweight, stunting, and wasting. Also, socio-demographic measures were obtained from structured questionnaire. Backward stepwise logistic regression was used to relate underlying factors to the odds of under-nutrition indices.
 
Results
The rates of stunting, underweight, and wasting were 9.53, 9.66, and 8.19%, respectively. Male children were more stunted compared to females (OR= 1.41, CI: 1.26–1.58). Also, stunting was significantly associated with lower family income (OR= 3.21, CI: 1.17–8.85) and lower maternal education (OR= 0.80, CI: 0.64–0.98). Living in urban areas, and poor water supply were identified as significant risk factors of all three types of childhood under-nutrition. Moreover, Khamse and Arab ethnic groups were more vulnerable to under-nutrition. There was a suggestion that non-access to health services were associated with wasting (OR= 1.87, CI: 1.39–2.52) and also large family size was related to underweight (OR= 1.35, CI: 1.10–1.65).
 
Conclusion
The prevalence of under-nutrition in the study population was categorized in low levels. However, planning the public preventive strategies can help to control childhood under-nutrition according to underlying factors of malnutrition in the study population including gender, settlement area, family size, ethnicity, family income, maternal education, health services, and also safe water supply.
Keywords
Children
Prevalence
Malnutrition
Stunting
Underweight
Wasting
Subjects
  1. Demissie S, Worku A. Magnitude and Factors Associated with Malnutrition in Children 6-59 Months of Age in Pastoral Community of Dollo Ado District, Somali Region, Ethiopia. Sci J Public Health 2013; 1: 175-83. doi: 10.11648/j.sjph.20130104.12
  2. Meshram II, Arlappa N, Balakrishna N, Rao KM, Laxmaiah A, Brahmam GNV. Trends in the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among under five year tribal children in India. Asia Pac J Clin Nutr 2012; 21: 568-76.
  3. Masibo PK, Makoka D. Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008-2009. Public Health Nutr  2012; 15: 1715-27. doi: 10.1017/s1368980012002856
  4. Pasricha SR, Biggs BA. Undernutrition among children in South and South-East Asia. J Paediatr Child Health 2010; 46: 497-503. doi: 10.1111/j.1440-1754.2010.01839.x
  5. Jesmin A, Yamamoto SS, Malik AA, Haque A. Prevalence and determinants of chronic malnutrition among preschool children: a cross-sectional study in Dhaka City, Bangladesh. J Health Popul Nutr 2011; 29: 494-9. doi: 10.3329/jhpn.v29i5.8903
  6. Janevic T, Petrovic O, Bjelic I, Kubera A. Risk factors for childhood malnutrition in Roma settlements in Serbia. BMC Public Health 2010; 10: 1-8. doi: 10.1186/1471-2458-10-509
  7. United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF WHO-World Bank Joint Child Malnutrition Estimates. New York, Geneva, Washington DC: UNICEF, WHO, The World Bank; 2012.
  8. Houshyarrad A, Dorosti Motlagh AR, Kalantari N, Abd Elahi M, Abtahi M. Prevalence of stunting, underweight, wasting and overweight among iranian under-five-year-old children (2000-2002). Journal of Nutrition Sciences & Food Technology 2009; 3: 49-56.
  9. Kolahdooz F, Najafi F. Report of a national survey: Food Security Information and Mapping System in Iran. Tehran: Ministry of Health and Medical Education; 2012.
  10. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: Methods and development. Vital Health Stat 11 2002; 246: 1-190.
  11. UN Department of Economic and Social Affairs. The Millennium Development Goals Report 2013 [internet]. Available from: https://www.unfpa.org/public/publications/pid/6090
  12. [No authors listed]. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995; 854: 1-452.
  13. The nutritional status of children, October-November 1998 (ANIS). Teheran: Ministry of Health and Medical Education and UNICEF; 2000.
  14. Sheykhi M, EftekhariNia M, Hadipour M, Esmaillzadeh A. Prevalence of Stunting, Underweight and Wasting According to National Center for Health Statistics Criteria in Rural Children under 6 in Zahedan, Iran, in 2010. J Health Syst Res 2013; 9: 153-8.
  15. Sharifzadeh GR, Mehrjoofard H, Raghebi S. Prevalence of Malnutrition in under 6-year Olds in South Khorasan, Iran. Iran J Pediatr 2010; 20: 435-41.
  16. de Souza OF, Benício MH, de Castro TG, Muniz PT, Cardoso MA. Malnutrition among children under 60 months of age in two cities of the state of Acre, Brazil: prevalence and associated factors. Rev Bras Epidemiol 2012; 15: 211-21.
  17. Zhang J, Shi J, Himes JH, Du Y, Yang S, Shi S, et al. Undernutrition status of children under 5 years in Chinese rural areas - data from the National Rural Children Growth Standard Survey, 2006. Asia Pac J Clin Nutr 2011; 20: 584-92.
  18. Shibulal A. A study on the prevalence of under-nutrition and its determinants in anganwadi children of Malappuram district, Kerala. Trivandrum, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Working Paper no. 10, 2013.
  19. Hien NN, Kam S. Nutritional status and the characteristics related to malnutrition in children under five years of age in Nghean, Vietnam. J Prev Med Public Health 2008; 41: 232-40. doi: 10.3961/jpmph.2008.41.4.232
  20. Ghosh S, Shah D. Nutritional problems in urban slum children. Indian Pediatr 2004; 41: 682-96.
  21. Mahyar A, Ayazi P, Fallahi M, Javadi THS, Farkhondehmehr B, Javadi A, et al. Prevalence of Underweight, Stunting and Wasting Among Children in Qazvin, Iran. Iranian Journal of Pediatric Society 2010; 2: 37-43.
  22. González-de Cossío T, Rivera JA, González-Castell D, Unar-Munguía M, Monterrubio EA. Child malnutrition in Mexico in the last two decades: prevalence using the new WHO 2006 growth standards. Salud Publica Mex 2009; 51: S494-506. doi: 10.1590/s0036-36342009001000004
  23. Sah N. Determinants of Child Malnutrition in Nepal: A Case Analysis from Dhanusha, Central Terai of Nepal. J Nepal Health Res Counc 2004; 2: 1-13.
  24. Phengxay M, Ali M, Yagyu F, Soulivanh P, Kuroiwa C, Ushijima H. Risk factors for protein-energy malnutrition in children under 5 years: study from Luangprabang province, Laos. Pediatr Int  2007; 49: 260-5. doi: 10.1111/j.1442-200x.2007.02354.x
  25. Kabubo-Mariara J, Ndenge GK, Mwabu DK. Determinants of Children’s Nutritional Status in Kenya: Evidence from Demographic and Health Surveys. J Afr Econ 2009; 18: 363–87. doi: 10.1093/jae/ejn024
  26. Oyekale AS. Factors Explaining Acute Malnutrition Among Under-Five Children in Sub-Sahara Africa (SSA). Life Sci J 2012; 9: 2101-7.
  27. Hunter PR, MacDonald AM, Carter RC. Water Supply and Health. PLoS Med 2010; 7: e1000361. doi: 10.1371/journal.pmed.1000361

  • Received Date 15 April 2014
  • Revised Date 10 July 2014
  • Accepted Date 18 July 2014
  • First Published Date 18 July 2014
  • Published Date 01 July 2014