Risk factors in the development of severe acute malnutrition in vulnerable children under five years of age living in Region B and surrounding referral areas of the City of Johannesburg, South Africa

Ferguson, Jessica Kate (2016-12)

Thesis (MNutr)--Stellenbosch University, 2016.

Thesis

ENGLISH SUMMARY : Background: Malnutrition is still a serious problem, both globally and in South Africa, and has significant consequences for survival, disease prevalence, healthy development, and economic productivity.1 It is important to have an understanding of the risks, causes, extent and distribution of diseases in order to work on strategies for improving a population’s health.2 There have been several studies investigating the risk factors for malnutrition in young children. However, few looked specifically at risk factors associated with SAM3,4,5 and few were conducted in South Africa. Risk factors for malnutrition vary in different settings and few epidemiological patterns are consistent globally.6 Therefore, specific populations need to be identified that need context-specific approaches.7 Objective: To determine which risk factors are associated with the development of SAM in vulnerable children under five years of age who reside in region B and surrounding referral areas of the City of Johannesburg. Methods: A descriptive, cross-sectional study with an analytical component and a quantitative approach was undertaken. Children under the age of five years who were admitted to Rahima Moosa Mother and Child Hospital were eligible for inclusion. Data was collected by performing anthropometrical measurements and collating data from a series of questionnaires that the participant’s mother or caregiver answered. These questionnaires had sections pertaining to socioeconomic and demographic factors, family health and dynamics, nutritional history, food security, feeding habits, medical history and birth history. Results: The study population consisted of 159 participants, comprising 53 children in each of the following groups: diagnosis of SAM, moderate malnutrition and a well-nourished control group. The disease-related factors associated with SAM Human were: Immunodeficiency Virus (HIV) infection [𝑛=14, 13.2% (𝑝<0.01)]; acute gastroenteritis [𝑛=32, 60.38%(𝑝<0.05)]; diarrhoea in the past year [77.36%; 𝑛=41 (𝑝<0.05)]; dehydration on admission [𝑛=31, 58.49% (𝑝<0.01)]; and previous malnutrition diagnosis [𝑛=7, 13.21% (𝑝<0.05)]. Dietary-related risk factors associated with SAM included the inappropriate choice of replacement feeds after early cessation of breastfeeding [𝑛=6, 20% (𝑝<0.05)]; and early and late introduction of complementary foods [𝑛=15, 31.25% (𝑝<0.01) and 𝑛=8, 16.67% (𝑝<0.01)]. Exclusive breastfeeding between four and six months was protective against SAM [𝑛=14, 30.43% (𝑝<0.05)]. Underlying causes of malnutrition that were associated with SAM were immunisations not being up-to-date [n=14, 26.42% (𝑝<0.05)]; Vitamin A doses missed [𝑛=26, 49.06%(𝑝<0.01)]; no deworming in the past year [𝑛=28, 93.33% (𝑝<0.05)]; having more than three children in the house [𝑛=10; 18.87% (𝑝<0.05)]; and an age of 12–24 months [𝑛=26, 49.06% (𝑝<0.01)]. All these factors were associated with moderate malnutrition (but had a lower prevalence compared to the SAM group), except for: exclusive breastfeeding for less than four months or more than six months; inappropriate replacement feeds after early breastfeeding cessation; and immunisations, Vitamin A, and deworming schedules that were not up-to-date. Recommendations: In order to be most effective, interventions need to occur in the first 1 000 days of life. These interventions include aspects relating to: 1) infant and young child feeding (including breastfeeding and complementary feeding guidelines); 2) promotion of healthy practices and the use of health services; 3) prevention and treatment of micronutrient deficiencies; 4) prevention and treatment of SAM; 5) promotion of good sanitation; and 6) maternal nutrition.

AFRIKAANSE OPSOMMING : Agtergrond: Wanvoeding is nog steeds 'n ernstige probleem, beide Internasionaal en in Suid-Afrika en het beduidende gevolge vir oorlewing, die voorkoms van siektetoestande, gesonde ontwikkeling en ekonomiese produktiwiteit.1 Dit is belangrik om die risiko's, oorsake, omvang en verspreiding van siektes te verstaan om sodoende aan strategieë te kan werk vir die verbetering van ‘n bevolking se gesondheid.2 Daar is verskeie studies wat die risikofaktore vir wanvoeding by jong kinders ondergesoek het en slegs ‘n paar van die studies het die risikofaktore wat verband hou met Ernstige Akute Wanvoeding (EAW) ondersoek3,4,5 Weinige navorsing is in Suid-Afrika uitgevoer. Risikofaktore vir wanvoeding verskil in verskillende omgewings en daar is min epidemiologiese patrone wat wêreldwyd konstant is.6 Vir die rede moet spesifieke bevolkings wat konteks-spesifieke benaderings benodig, geidentifiseer word.7 Doel: Om te bepaal watter risikofaktore verband hou met die ontwikkeling van EAW in kwesbare kinders jonger as vyf jaar oud wat in die stad Johannesburg woon. Metodes: 'n Beskrywende, deursnit studie met ‘n analitiese komponent an kwantitatiewe benadering is onderneem. Kinders onder die ouderdom van vyf jaar wat in Rahima Moosa Mother and Child Hospital opgeneem is, is in aanmerking geneem vir insluiting. Data is ingesamel deur die uitvoering van antropometriese metings en deur die samevatting van 'n reeks vraelyste wat die deelnemer se moeder/versorger beantwoord het. Hierdie vraelyste het afdelings met betrekking tot sosio-ekonomiese en demografiese faktore, die familie se gesondheid en dinamika, voedings geskiedenis, voedselsekuriteit, eetgewoontes, mediese geskiedenis en geboorte geskiedenis. Resultate: Die studie populasie het bestaan uit 159 deelnemers met 53 kinders in elk van die volgende groepe: 'n diagnose van EAW, matige wanvoeding en 'n goed gevoede kontrolegroep. Menslike Immuniteitsgebrekvirus (MIV) infeksie (𝑛= 14, 13.2%, 𝑝 <0.01); akute gastro-enteritis [𝑛= 32, 60.38% (𝑝<0.05)]; diarree in die afgelope jaar [𝑛 = 41, 77.36% (𝑝 <0.05)]; dehidrasie met opname [𝑛= 31, 58.49% (𝑝 <0,01)]; en 'n vorige wanvoeding diagnose [𝑛= 7, 13.21% (𝑝 <0.05)] was die siekte-verwante faktore wat verband hou met EAW. Dieet-verwante risikofaktore wat verband hou met EAW het ingesluit: ʼn onvanpaste keuse van 'n voeding ná vroeë beëindiging van borsvoeding [𝑛 = 6, 20% (𝑝<0.05)] asook vroeë en laat bekendstelling aanvullende voedsels [𝑛 = 15, 31.25% (𝑝 <0,01), en 𝑛 = 8, 16.67% (𝑝<0.01)] Eksklusiewe borsvoeding tussen vier en ses maande was beskermend teen EAW [𝑛 = 14, 30.43% (𝑝 <0.05)]. Onderliggende oorsake van wanvoeding wat verband hou met SAM is immunisering wat nie op datum is nie [𝑛 = 14, 26.42% (p <0.05)]; onvoldoende Vitamien A dosisse [𝑛 = 26, 49.06% (𝑝<0.01)]; geen ontwurming in die laaste jaar [𝑛 = 28, 93.33% (𝑝 <0.05)]; meer as drie kinders in die huis [𝑛 = 10; 18.87% (𝑝 <0.05)]; en ʼn ouderdom tussen 12 en 24 maande [𝑛 = 26, 49.06% (𝑝<0.01)]. Al hierdie faktore is ook geassosieer met matige wanvoeding (maar kom minder voor in vergelyking met die EAW groep), behalwe vir: eksklusiewe borsvoeding vir minder as vier maande of langer as ses maande; onvanpaste vervangingsvoeding ná vroeë staking van borsvoeding; en immuniserings-, vitamien A-, en ontwurming-skedules wat nie op datum was nie. Aanbevelings: Vir intervensies om effektief te wees moet dit plaasvind in die eerste 1 000 dae van lewe. Hierdie intervensies sluit aspekte in wat verband hou met: 1) voeding van babas en jong kinders (insluitend borsvoeding en riglyne vir aanvullende voeding); 2) die bevordering van gesonde gewoontes en die gebruik van gesondheidsdienste; 3) die voorkoming en behandeling van tekorte aan mikronutriënte; 4) voorkoming en behandeling van EAW; 5) die bevordering van goeie sanitasie; 6) en die voeding van die moeder.

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