Risk Factors for Undernutrition among Children in South Central Somalia
DOI:
https://doi.org/10.6000/1929-4247.2022.11.01.2Keywords:
Risk factors, Underweight, Stunting, Wasting, SomaliaAbstract
Objectives: Undernutrition is a global public health challenge, especially in countries that experience extreme climate conditions and armed conflict. In Somalia, undernutrition is chronic, often graded for emergency response. The purpose of this study was to provide evidence on immediate, proximate, and distal risk factors for undernutrition in the most affected region of Somalia.
Setting: Data for the study was from cross-sectional nutritional surveys implemented by the Somalia Food Security and Nutrition Analysis Unit. Sampling for the surveys followed a multistage cluster sampling methodology where in the first stage, 30 clusters were randomly assigned to villages, and then 30 households were randomly selected from each cluster. Generalized Estimation Equations were used to determine risk factors for undernutrition. Data analysis followed survey analysis procedures.
Participants: 60,856 children aged 6-59 months from cross-sectional nutritional surveys implemented in South-Central Somalia from 2007 to 2012.
Results: When factors at the individual, household, and society level were considered simultaneously, diarrhea diseases and geographical region were the main risk factors for underweight, child gender, meal frequency, and livelihood zone were risk factors for stunting, while diarrhea and livelihood zone were the risk factors for wasting. Geographical region and livelihood system were significant factors for undernutrition.
Conclusions: Interventions to address undernutrition in Somalia should be tailored to the region and livelihood zone while prioritizing innovative climate-smart food production and addressing childhood illnesses. The study findings provide evidence to inform nutrition policy and programs that could eliminate nutrition disparities and the burden of childhood undernutrition in Somalia and other countries with similar contexts.
References
UNICEF. Situation Analysis of Children in Somalia 2016 [Internet] 2016 [cited 2022 Jan 29]. Available from: https://www.unicef.org/ somalia/reports/situation-analysis-children-somalia-2016-0
Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi WW, et al. Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies. PLoS One [Internet] 2013; 8(5). https://doi.org/10.1371/journal.pone.0064636
Tette EMA, Nyarko MY, Nartey ET, Neizer ML, Egbefome A, Akosa F, et al. Under-five mortality pattern and associated risk factors: A case-control study at the Princess Marie Louise Children’s Hospital in Accra, Ghana. BMC Pediatr [Internet] 2016; 16(1): 1-11. https://doi.org/10.1186/s12887-016-0682-y
Mcdonald CM, Olofin I, Flaxman S, Fawzi WW, Spiegelman D, Caulfield LE. The effect of multiple anthropometric deficits on child mortality : meta-analysis of individual data in 10 prospective studies from. Am J Clin Nutr [Internet] 2013; 97(4): 896-901. https://doi.org/10.3945/ajcn.112.047639
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 [Internet] 2013; 382: 427-51. https://doi.org/10.1016/S0140-6736(13)60937-X
Crookston BT, Schott W, Cueto S, Dearden KA, Engle P, Georgiadis A, et al. Postinfancy growth, schooling, and cognitive achievement: Young lives 1-4. Am J Clin Nutr [Internet] 2013; 98(6): 1555-63. https://doi.org/10.3945/ajcn.113.067561
Waber DP, Bryce CP, Girard JM, Zichlin M, Fitzmaurice GM, Galler JR. Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a 40-year study. Nutr Neurosci [Internet] 2014; 17(2): 58-64. https://doi.org/10.1179/1476830513Y.0000000061
Galler JR, Bryce CP, Waber DP, Hock RS, Harrison R, Eaglesfield GD, et al. Infant malnutrition predicts conduct problems in adolescents. Nutr Neurosci [Internet] 2012; 15(4): 186-92. https://doi.org/10.1179/1476830512Y.0000000012
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 (London, England) [Internet] 2008 Jan 26 [cited 2016 Dec 12]; 371(9609): 340-57. https://doi.org/10.1016/S0140-6736(07)61692-4
Lee SK, Nam SY, Hoffman DJ. Growth retardation at early life and metabolic adaptation among North Korean children. J Dev Orig Health Dis [Internet] 2015; 6(4): 291-8. https://doi.org/10.1017/S204017441500118X
Grillo LP, Gigante DP, Horta BL, de Barros FCF. Childhood stunting and the metabolic syndrome components in young adults from a Brazilian birth cohort study. Eur J Clin Nutr [Internet] 2016; 70(5): 548-53. https://doi.org/10.1038/ejcn.2015.220
World Health Organization. Malnutrition [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition
UNICEF/WHO/World Bank Group. Levels and trends in child malnutrition: key findings of the 2021 edition of the joint child malnutrition estimates. [Internet]. Geneva; 2021. Available from: https://www.who.int/publications/i/item/9789240025257
World Bank. GDP per capita (current US$) - Somalia [Internet] 2022. Available from: https://data.worldbank.org/indicator/ NY.GDP.PCAP.CD?locations=SO
United Nations Development Program. Somalia Drought Impact & Needs Assessment [Internet]. Vol. I 2018. Available from: https://www.undp.org/publications/somalia-drought-impact-and-needs-assessment
Moore PS, Marfin AA, Quenemoen LE, Gessner BD, Miller DS, Toole MJ, et al. Mortality rates in displaced and resident populations of central Somalia during 1992 famine. Lancet [Internet] 1993; 341(8850): 935-8. https://doi.org/10.1016/0140-6736(93)91223-9
Checchi F, Robinson WC. Mortality among populations of southern and central Somalia affected by severe food insecurity and famine during 2010-2012 [Internet] 2013. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Somalia_Mortality_Estimates_Final_Report_1May2013.pdf
FSNAU and FEWS NET. FSNAU-FEWS NET 2021 Post Gu Technical Release [Internet]. September 9, 2021. 2021 [cited 2021 Nov 1]. Available from: https://www.fsnau.org/node/1891
Kinyoki DK, Berkley JA, Moloney GM, Kandala N-B, Noor AM. Predictors of the risk of malnutrition among children under the age of 5 years in Somalia. Public Health Nutr [Internet] 2015; 18(17): 1-9. https://doi.org/10.1017/S1368980015001913
UNICEF. Strategy for improved nutrition of children and women in developing countries [Internet] 1990. Available from: https://digitallibrary.un.org/record/227230?ln=en
Ferdous F, Das SK, Ahmed S, Farzana FD, Latham JR, Chisti MJ, et al. Severity of diarrhea and malnutrition among under five-year-old children in rural Bangladesh. Am J Trop Med Hyg [Internet] 2013; 89(2): 223-8. https://doi.org/10.4269/ajtmh.12-0743
Tette EMA, Sifah EK, Nartey ET. Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. BMC Pediatr [Internet] 2015; 15(1): 189. https://doi.org/10.1186/s12887-015-0496-3
Fekadu Y, Mesfin A, Haile D, Stoecker BJ. Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross-sectional study. BMC Public Health [Internet] 2015; 15: 2-9. https://doi.org/10.1186/s12889-015-2190-7
Mbuya MNN, Humphrey JH. Preventing environmental enteric dysfunction through improved water, sanitation, and hygiene : an opportunity for stunting reduction in developing countries 2016; 12: 106-20. https://doi.org/10.1111/mcn.12220
Keusch GT, Rosenberg IH, Denno DM, Duggan C, Guerrant RL, Lavery JV, et al. Implications of acquired environmental enteric dysfunction for growth. Food Nutr Bull 2013; 34(3): 357-64. https://doi.org/10.1177/156482651303400308
Wong HJ, Moy FM, Nair S. Risk factors of malnutrition among preschool children in Terengganu, Malaysia: a case-control study. BMC Public Health [Internet] 2014; 14(1): 785. https://doi.org/10.1186/1471-2458-14-785
Chege PM, Ndungu ZW, Gitonga BM. Food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County, Kenya. J Health Popul Nutr [Internet] 2016; 35(1): 21. https://doi.org/10.1186/s41043-016-0058-9
Mutisya M, Kandala N-B, Ngware MW, Kabiru CW. Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya. BMC Public Health [Internet] 2015; 15(1): 1052. https://doi.org/10.1186/s12889-015-2403-0
Singh Abhishek, Singh Ashish RF. Household food insecurity and nutritional status of children and women in Nepal. Food Nutr Bull [Internet] 2014; 35(1): 3-12. https://doi.org/10.1177/156482651403500101
Ali D, Saha KK, Nguyen PH, Diressie MT, Ruel MT, Menon P, et al. Household food insecurity is associated with higher child undernutrition in Bangladesh, Ethiopia, and Vietnam, but the effect is not mediated by child dietary diversity. J Nutr [Internet] 2013; 143(12): 2015-21. https://doi.org/10.3945/jn.113.175182
Hanieh S, Ha TT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, et al. Exclusive breastfeeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: A prospective cohort study Global health. BMC Public Health [Internet] 2015; 15(1): 1-11. https://doi.org/10.1186/s12889-015-2431-9
Smith LC, Haddad L. Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era. World Dev [Internet] 2015 [cited 2017 Apr 8]; 68: 180-204. https://doi.org/10.1016/j.worlddev.2014.11.014
Minoiu C, Shemyakina ON. Armed conflict, household victimization, and child health in Côte d'Ivoire. Dev Econ [Internet] 2014; 108(237-255). https://doi.org/10.1016/j.jdeveco.2014.03.003
Kinyoki DK, Moloney GM, Uthman OA, Kandala N, Odundo EO, Noor AM, et al. Conflict in Somalia : impact on child undernutrition. BMJ Glob Heal [Internet] 2017. https://doi.org/10.1136/bmjgh-2016-000262
Brcanski J, Jović-Vraneš A, Marinković J, Favre D. Social determinants of malnutrition among Serbian children aged <5 years: ethnic and regional disparities. Int J Public Health [Internet] 2014; 59(5): 697-706. https://doi.org/10.1007/s00038-014-0591-5
Imai K., Annim SK, Kulkarni V, Gaiha R. Women’s empowerment and Prevalence of Stunted and underweight children in rural India. World Dev [Internet] 2014; 62: 88-105. https://doi.org/10.1016/j.worlddev.2014.05.001
Rachmi CN, Agho KE, Li M, Baur LA. Stunting, underweight and overweight in children aged 2.0-4.9 years in Indonesia: Prevalence trends and associated risk factors. PLoS One [Internet] 2016; 11(5): 1-18. https://doi.org/10.1371/journal.pone.0154756
Loret De Mola C, Quispe R, Valle GA, Poterico JA. Nutritional transition in children under five years and women of reproductive age: A 15-years trend analysis in Peru. PLoS One [Internet] 2014; 9(3). https://doi.org/10.1371/journal.pone.0092550
Kumar A, Kumari D, Singh A. Increasing socioeconomic inequality in childhood undernutrition in urban India: Trends between 1992-93, 1998-99 and 2005-06. Health Policy Plan [Internet] 2015; 30(8): 1003-16. https://doi.org/10.1093/heapol/czu104
Headey D, Ali D, Tesfaye R, Dereje M, Hoddinott J. The Other Asian Enigma : Explaining the Rapid Reduction of Undernutrition in Bangladesh. WORLD Dev [Internet] 2015; 66: 749-61. https://doi.org/10.1016/j.worlddev.2014.09.022
SMART. Standardized Monitoring and Assessment of Relief and Transitions [Internet] 2017. Available from: https://smartmethodology.org/survey-planning-tools/smart-methodology/smart-methodology-manual/
Food Security Nutrition Analysis Unit. Guidelines for Somalia [Internet]. Vol 1997 2006. Available from: http://www.fsnau.org/ products/manuals-guides
FSNAU. Guidelines for Emergency Nutrition & Mortality Surveys in Somalia [Internet]. Fsnau 2011. Available from: http://www.fsnau.org/products/manuals-guides
WHO Child Growth Standards Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age Methods and development. [cited 2017 Sep 14]; Available from: http://www.who.int/childgrowth/standards/ Technical_report.pdf
ACLED. ACLED [Internet]. Available from: https://www.acleddata. com/
Hubbard AE, Ahern J, Fleischer NL, Laan M Van Der, Satariano A, Jewell N, et al. To GEE or Not to GEE. Source Epidemiol [Internet] 2016; 21(4): 467-74. https://doi.org/10.1097/EDE.0b013e3181caeb90
Hanley JA, Negassa A, Edwardes MD d. B, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: An orientation. Am J Epidemiol [Internet] 2003; 157(4): 364-75. https://doi.org/10.1093/aje/kwf215
Jones K, Thitiri J, Ngari M, Berkley JA. Childhood malnutrition: Toward an understanding of infection, inflammation, and antimicrobials. Food Nutr Bull [Internet] 2014; 35(2): S64. https://doi.org/10.1177/15648265140352S110
Aheto JMK, Keegan TJ, Taylor BM, Diggle PJ. Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana. Paediatr Perinat Epidemiol [Internet] 2015; 29(6): 552-61. https://doi.org/10.1111/ppe.12222
Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty-nine months in Bule Hora district, South Ethiopia. BMC Public Health [Internet] 2015; 15(14): 1-9. https://doi.org/10.1186/s12889-015-1370-9
Fink G, Günther I, Hill K. The effect of water and sanitation on child health: Evidence from the demographic and health surveys 1986-2007. Int J Epidemiol [Internet] 2011; 40(5): 1196-204. https://doi.org/10.1093/ije/dyr102
Tufa EG, Tekle HA, Solomon FB, Angore BN, Bekru ET, Dake SK, et al. Magnitude of wasting and underweight among children 6-59 months of age in Sodo Zuria District, South Ethiopia: a community based cross-sectional study. BMC Res Notes 2018; 11(1): 1-7. https://doi.org/10.1186/s13104-018-3880-x
Kinyoki DK, Kandala N-B, Manda SO, Krainski ET, Fuglstad G-A, Moloney GM, et al. Assessing comorbidity and correlates of wasting and stunting among children in Somalia using cross-sectional household surveys: 2007 to 2010. BMJ Open [Internet] 2016 Mar 9 [cited 2017 May 4]; 6(3): e009854. https://doi.org/10.1136/bmjopen-2015-009854
Debashish D, Philippe G, Kasia S, Rashid M, Grais R, Emelda O. Complex and vicious interactions between malaria and malnutrition: a systematic review. BMC Med [Internet] 2018; 16(186): 1-14. https://doi.org/10.1186/s12916-018-1177-5
Ning TR, Kimbi HK, Nkuo-Akenji T, Sumbele IUN, Bopda OSM. Nutritional status of children in a malaria meso endemic area: cross-sectional study on prevalence, intensity, predictors, influence on malaria parasitaemia and anaemia severity. BMC Public Health [Internet] 2015; 15(1): 1-10. https://doi.org/10.1186/s12889-015-2462-2
Checkley W, Buckley G, Gilman RH, Assis AMO, Guerrant RL, Valentiner-branth P, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol [Internet] 2008; 30(4): 816-30. https://doi.org/10.1093/ije/dyn099
Choudhury N, Raihan MJ, Sultana S, Mahmud Z, Farzana FD, Haque MA, et al. Determinants of age-specific undernutrition in children aged less than 2 years—the Bangladesh context. Matern Child Nutr [Internet] 2017; 13(3): 1-16. https://doi.org/10.1111/mcn.12362
Chandrasekhar S, Aguayo VM, Krishna V, Nair R. Household food insecurity and children’s dietary diversity and nutrition in India. Evidence from the comprehensive nutrition survey in Maharashtra. Matern Child Nutr [Internet] 2017; 13(October 2016): 1-8. https://doi.org/10.1111/mcn.12447
Menon P, Bamezai A, Subandoro A, Ayoya MA, Aguayo V. Age-appropriate infant and young child feeding practices are associated with child nutrition in India: Insights from nationally representative data. Matern Child Nutr [Internet] 2015; 11(1): 73-87. https://doi.org/10.1111/mcn.12036
Motbainor A, Worku A, Kumie A. Stunting is associated with food diversity while wasting with food insecurity among under-five children in East and West Gojjam Zones of Amhara Region, Ethiopia. PLoS One [Internet] 2015; 10(8). https://doi.org/10.1371/journal.pone.0133542
McDonald CM, McLean J, Kroeun H, Talukder A, Lynd LD, Green TJ. Household food insecurity and dietary diversity as correlates of maternal and child undernutrition in rural Cambodia. Eur J Clin Nutr [Internet] 2015; 69(2): 242-6. https://doi.org/10.1038/ejcn.2014.161
Hillbruner C, Moloney G. When early warning is not enough—Lessons learned from the 2011 Somalia Famine. Glob Food Sec [Internet] 2012 [cited 2017 Jan 17]; 1(1): 20-8. https://doi.org/10.1016/j.gfs.2012.08.001
Egata G, Berhane Y, Worku A, Collins S, Dent N, Binns P, et al. Predictors of acute undernutrition among children aged 6 to 36 months in east rural Ethiopia: a community based nested case-control study. BMC Pediatr [Internet] 2014 Dec 4 [cited 2016 Dec 5]; 14(1): 91. https://doi.org/10.1186/1471-2431-14-91
Kuchenbecker J, Jordan I, Reinbott A, Herrmann J, Jeremias T, Kennedy G, et al. Exclusive breastfeeding and its effect on growth of Malawian infants : results from a cross-sectional study. Paediatr Int Child Health [Internet] 2015; 35(1): 14-23. https://doi.org/10.1179/2046905514Y.0000000134
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young child feeding indicators: Associations with growth measures in 14 low-income countries. Matern Child Nutr [Internet] 2012; 8(3): 354-70. https://doi.org/10.1111/j.1740-8709.2011.00380.x
WHO. Improving nutrition outcomes with better water, sanitation and hygiene : practical solutions for policies and programmes. [Internet]. Switzerland; 2015. 76 p. Available from: https://apps.who.int/iris/handle/10665/193991
Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India : a cross-sectional analysis of surveys. BMJ Open [Internet] 2015; 5(2). https://doi.org/10.1136/bmjopen-2014-005180
Spears D, Ghosh A, Cumming O. Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts. PLoS One [Internet] 2013; 8(9): 1-9. https://doi.org/10.1371/annotation/9ffcb740-f394-41af-bbbc-800c7cc25ea8
Majid N, McDowell S. Hidden dimensions of the Somalia famine. Glob Food Sec [Internet] 2012; 1: 36-42. https://doi.org/10.1016/j.gfs.2012.07.003
Kismul H, Acharya P, Mapatano MA, Hatløy A. Determinants of childhood stunting in the Democratic Republic of Congo : further analysis of Demographic and Health Survey 2013 - 14. BMC Public Health [Internet] 2017; 18(74): 1-14. https://doi.org/10.1186/s12889-017-4621-0
Tranchant JP, Justino P, Müller C. Political violence, adverse shocks, and child malnutrition: Empirical evidence from Andhra Pradesh, India. Econ Hum Biol 2020; 39: 100900. https://doi.org/10.1016/j.ehb.2020.100900
Summers A, Bilukha OO. Suboptimal infant and young child feeding practices among internally displaced persons during conflict in eastern Ukraine. Public Health Nutr [Internet] 2018; 21(5): 917-26. https://doi.org/10.1017/S1368980017003421
UNICEF. Improving child nutrition. The achievable imperative for global progress [Internet]. 2013. 132 p. Available from: https://data.unicef.org/resources/improving-child-nutrition-the-achievable-imperative-for-global-progress/
Downloads
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
