DETERMINANTS OF MATERNAL AND UNDER-FIVE CHILD MALNUTRITION IN AGUATA LOCAL GOVERNMENT AREA OF ANAMBRA STATE, NIGERIA

Abstract

High maternal and under-five child malnutrition still persists in Nigeria, despite interventions such as development of relevant policies to combat them by government and other agencies. Though risk factors of malnutrition have been documented, few studies exist on priority-action factors that should be integrated. This study was carried out to determine the prevalence and identify priority-action determinants of malnutrition among mother-child pairs in Aguata Local Government Area, Nigeria. This was a cross-sectional study involving 455 mothers and their 6 to 59 month old children selected through a four-stage sampling technique. Five measurement instruments used in the study were a 29-item structured anthropometric and socio-demographic questionnaire for mother-child pairs, 14-item FAO individual dietary diversity questionnaire for mothers and children above 36 months, 22-item Demographic Health Survey dietary diversity questionnaire for children aged 6 – 36 months. Other instruments include 3-item Household Hunger Scale (0-1 as little/no household hunger, 2-3 as moderate household hunger and 4-6 as severe household hunger) and 24-hour activity time allocation for mothers. WHO Anthro 3.2.2 was used to analyse the anthropometry of children and categorised them as stunting (height-for-age z-score <-2SD), wasting (weight-for-height z-score <-2SD) and underweight (weight-for-age z-score <-2SD). Mothers‘ Body Mass Index (BMI) was estimated and classified as overweight/obese (>25.00 kg/m2), normal (18.50 – 24.99 kg/m2) and underweight (<18.50 kg/m2). Data were analysed using descriptive statistics and multiple logistic regression at p< 0.05. Mean age of the mothers and their children were 30.5±6.3 years and 26.6±16.4 months respectively. Mean BMI of mothers was 27.4±5.9. Sixty-four percent of the mothers were overweight/obese. The proportion of children stunted, wasted and underweight was 27.3%, 14.8% and 14.5% respectively. Mean number of food groups consumed was 5.5±1.3 and 5.2±1.1 by mothers and children older than 36 months respectively. Children 6 – 36 months old consumed 4.8±2.0 food groups. A few (2.2%) of the mother-child pairs were from households with severe household hunger. Mean number of hours spent by the mothers cooking the previous day was 2.5±1.1. Factors associated with maternal overweight/obesity included having post-primary education (OR=2.5; 95% CI: 1.4-4.3) and mother‘s monthly income above N5000 (OR=1.9; 95% CI: 1.2-3.0). Irrespective of child‘s age and gender, risk factors for stunting included father‘s income below N9000 (OR=4.4; 95% CI: 2.3-8.2), maternal time for cooking less than 2 hours (OR=7.7; 95% CI: 2.2-26.8), fathers with primary education/none (OR=11.9; 95% CI: 5.4-24.1) and severe household hunger (OR=30.3; 95% CI: 13.1-70.3). Factors associated with child underweight included nuclear family (OR=5.9; 95% CI: 2.4-14.4) and father‘s monthly income below N9000 (OR=3.4; 95% CI: 1.5-7.6). Child wasting was associated with mother‘s income below N5000 (OR=5.6; 95% CI: 2.8-11.4) and father‘s monthly income below N9000 (OR=2.4; 95% CI: 1.2-4.5). Father‘s income was the most consistent factor associated with all indices of child malnutrition while the strongest risk factor for child malnutrition (stunting) was household hunger. Mother‘s education above primary school was the strongest risk factor for maternal overweight/obesity. Thus, to combat malnutrition in this Local Government, an integrated approach should be employed, targeting these priority factors.