Maternal profiles and social determinants of malnutrition and the MDGs: What have we learnt?
Tóm tắt
Maternal socio-demographic and health profiles are important determinants of malnutrition in children. In the 1990s, malnutrition was associated with low-birth-weight, young mothers and low maternal socio-economic status at Princess Marie Louise Children’s Hospital (PML). It is not known how this has changed by efforts to achieve the Millennium Development Goals. We examined socio-demographic and health profiles of mothers of children with acute malnutrition and those without the condition to identify risk factors for malnutrition and focus on preventive efforts. An unmatched case–control study was conducted in 2013 at PML, the largest facility for treating malnourished children in Ghana in 2013. Mothers of children with moderate and severe acute malnutrition were compared with mothers of well-nourished children. Weight-for-height was used to classify malnutrition. Record forms and a semi-structured questionnaire were used for data collection. An analysis was done with Stata 11.0 software. Altogether, 371 mothers were studied consisting of 182 mothers of malnourished children and 189 mothers of well-nourished children. Mothers of malnourished children were more likely to be unmarried or cohabiting, have lower family incomes, HIV infection and chronic disease. They were less likely to stay with or provide alternative care for their child. Awareness and use of social services, health insurance and a cash transfer programme were low. A remarkable reduction in the number of malnourished children occurred when families earned more than $250 USD a month. Over-nutrition was present in both groups of mothers. Low family income, unmarried status and type of child care were the main social determinants of malnutrition. There appears to be a reduction in the number of other poor socio-demographic characteristics in both the study and control groups compared to results from a previous study at the same centre, probably because of efforts toward attaining the MDGs. These findings suggest that prevention and optimum management need to involve multidisciplinary teams consisting of health professionals, social workers and/or key workers to enable families at risk to access social care and social protection interventions (MDG 1). This will make the management of malnutrition more effective, prevent relapse, protect the next child and address maternal over-nutrition.
Tài liệu tham khảo
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.
Child Malnutrition [http://www.unicef.org/specialsession/about/sgreport-pdf/02_ChildMalnutrition_D7341Insert_English.pdf].
UNICEF, WHO, The World Bank: Levels and Trends in Child Malnutrition. UNICEF 2014, UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates for 2013.
Rikimaru T, Yartey JE, Taniguchi K, Kennedy DO, Nkrumah FK. Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutr Sci Vitaminol (Tokyo). 1998;44(3):391–407.
Ighogboja SI. Some factors contributing to protein-energy malnutrition in the middle belt of Nigeria. East Afr Med J. 1992;69(10):566–71.
Maleta K, Virtanen SM, Espo M, Kulmala T, Ashorn P. Childhood malnutrition and its predictors in rural Malawi. Paediatr Perinat Epidemiol. 2003;17(4):384–90.
Adekunle L. The effect of family structure on a sample of malnourished urban Nigerian children. Food Nutr Bull. 2005;26(2):230–3.
Van de Poel E, Hosseinpoor AR, Jehu-Appiah C, Vega J, Speybroeck N. Malnutrition and the disproportional burden on the poor: the case of Ghana. Int J Equity Health. 2007;6:21.
Ruel MT, Levin CE, Armah-Klemesu M, Maxwell D, Morris SS. Good care practices can mitigate the negative effects of poverty and low maternal schooling on children’s nutritional status: evidence from Accra. In: FCND Discussion Paper No 62, Food Consumption & Nutrition Division. Washington D.C.USA: International Food Policy Research Institute; 1999.
GHS. Annual report of the reproductive and child health and family health division. Accra: Ghana Health Service; 2007.
Ghana Statistical Service, Ghana Health Service. Ghana demographic and health survey 2008. Calverton: IFC Macro; 2009.
National Social Protection Strategy (NSPS). Investing in People. Government of Ghana, Ministry of Manpower, Youth and Employment .2008.
UNDG. Indicators for Monitoring the Millennium Development Goals. In. New York: United Nations; 2003.
Ghana Health Service. Interim National Guidelines for Community-Based Management Of Severe Acute Malnutrition in Accra.
WHO. Management of the child with a serious infection or severe malnutrition. Guidelines for care at the first-referral level in developing countries. Geneva: World Health Organization; 2000.
Body mass index - BMI [http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi]
Amsalu S, Zemene T. Risk factors for severe acute malnutrition in children under the age of five: A case–control study. Ethiop J Health Dev. 2008;22(1):21–5.
Egata G, Berhane Y, Worku A. Predictors of acute undernutrition among children aged 6 to 36 months in east rural Ethiopia: a community based nested case - control study. BMC Pediatr. 2014;14:91.
Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226–34.
Nti CA, Lartey A. Influence of care practices on nutritional status of Ghanaian children. Nutr Res Pract. 2008;2(2):93–9.
Tette EMA, Sifah EK, Nartey ET. Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. In: BMC Paediatrics.
Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536–51.
Deleuze Ntandou Bouzitou G, Fayomi B, Delisle H. Child malnutrition and maternal overweight in same households in poor urban areas of Benin. Sante. 2005;15(4):263–70.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.
Jehn M, Brewis A. Paradoxical malnutrition in mother-child pairs: untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Econ Hum Biol. 2009;7(1):28–35.
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.
Welfare-UNICEF MoEaS. National plan of action for orphans and vulnerable children. Accra: Ministry of Employment and Social Welfare-UNICEF; 2010.
Addae-Korankye A. Challenges of financing health care in Ghasna: The case of National Health Insurance Scheme (NHIS). International Journal of Asian Social Science. 2013;3(2):511-522.
Binka FN, Maude GH, Gyapong M, Ross DA, Smith PG. Risk factors for child mortality in northern Ghana: A case–control study. Int J Epidemiol. 1995;24:127–35.
Hall DMB, Elliman D (eds.). Health for All Children, 4th edn. Oxford: Oxford Medical Publications. 2003.
Government HM. Working together to safeguard children, 2 edn. London: London TSO. 2009.
Saloojee H, De Maayer T, Garenne ML, Kahn K. What’s new? Investing risk factors for severe childhood malnutrition in a high HIV prevalence South African setting. Scan J Public Health. 2007;69:96–106.
Heikens GT, Manary M. 75 years of Kwashiorkor in Africa. Malawi Med J. 2009;21(3):96–8.