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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 102-109

Nutritional status of children under five years of age and factors associated in rural areas of Sana'a Governorate, Yemen


1 Department of Biomedical Engineering, Sana'a Community College, Sana'a, Yemen
2 Beit Annam Health Center, Ministry of Public Health, Sana'a Governorate, Sana'a, Yemen

Date of Submission01-Sep-2019
Date of Decision18-Oct-2019
Date of Acceptance23-Jun-2021
Date of Web Publication27-Oct-2021

Correspondence Address:
Gawad M A. Alwabr
Department of Biomedical Engineering, Sana'a Community College, Sana'a
Yemen
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_95_19

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  Abstract 


Background: The nutritional status of children determines their health, physical development, educational performance, and progress in life. This study aimed to assess the nutritional status and associated factors of children under 5 years of age in rural areas in Sana'a Governorate, Yemen. Materials and Methods: A descriptive cross-sectional study was conducted at five rural health centers of Sana'a Governorate, from March to May 2018. A convenience sampling method was used in the selection of 150 mothers and their children under five. A semi-structured questionnaire was used in data collection. According to WHO standards, the middle-upper arm circumference tool was used to measure the circumference of the upper part of the arm of the study children. Results: This study results showed that of all the children, 38.7% had Mild Malnutrition, 34% had Moderate Malnutrition, 6.7% had Severe Malnutrition, and 20.7% were normal. Majority of the participants' mothers (81.3%) were not knowledgeable about malnutrition causes. Place of delivery, mothers' education, fathers' education, age of mothers in the first pregnancy, numbers of all children per household, a child's weight at birth, and age of the child at weaning, were associated with the nutritional status of children under 5 years of age (P < 0.05). Conclusions: Despite the efforts of redressing child malnutrition issues in Yemen, the proportion of malnutrition among children under the age of five still high. Multiple intervention strategies based on risk factors can reduce early malnutrition of the children under the age of five.

Keywords: Malnutrition, nutritional status, rural areas, Sana'a governorate, under-five children, Yemen


How to cite this article:
A. Alwabr GM, A. Alwabr NM. Nutritional status of children under five years of age and factors associated in rural areas of Sana'a Governorate, Yemen. CHRISMED J Health Res 2021;8:102-9

How to cite this URL:
A. Alwabr GM, A. Alwabr NM. Nutritional status of children under five years of age and factors associated in rural areas of Sana'a Governorate, Yemen. CHRISMED J Health Res [serial online] 2021 [cited 2021 Dec 2];8:102-9. Available from: https://www.cjhr.org/text.asp?2021/8/2/102/329453




  Introduction Top


The nutritional status of children determines their health, physical development, educational performance, and progress in life.[1],[2],[3],[4] Malnutrition plays a crucial role in increased morbidity and mortality, weakening cognitive development in children, and increasing common childhood infections.[5] Annually there are over 10 million deaths of children under five, over 33% of them because of malnutrition associated with inadequate nutrition.[6],[7],[8],[9]

Children's malnutrition is affected by multidimensional factors such as biological, behavioral, social, demographical, economic, and environmental factors.[10],[11] The socioeconomic situation plays a major role in nutrition type, also the quality, and quantity of food.[12],[13] In some rural areas, there are persistent problems with poverty, the environment, and other major problems that had negative effects on household food security leading to undernourishment.[14],[15] The prevalence of infectious diseases and total micronutrient deficiencies is widespread mainly because of social, economic, and geographic factors.[10]

Adequate nutrition during childhood is essential to ensure children's development and health.[1],[16] Several efforts have been made to reduce the burden of malnutrition, especially in developing countries.[7],[8] However, malnutrition is still a major health problem in most developing countries.[1],[9] In South Asia, half of the childhood deaths are associated with malnutrition.[3] In Yemen, childhood malnutrition has continued as a severe health problem for decades, with 42.5% of children under the age of five stunted, 12.6% severely stunted, and 9.7% had wasted.[13] This study was conducted to assess the nutritional status and its associated factors of children under 5 years of age in rural areas of Sana'a Governorate, Yemen.


  Materials and Methods Top


A descriptive cross-sectional study was conducted at five rural health centers of Sana'a Governorate, from March to May 2018. Sana'a Governorate is a mountainous region with a semi-arid climate, and it is located in the middle of the western part of Yemen. It surrounds the capital, Sana'a, and is divided into 16 administrative regions. The population of Sana'a Governorate is 1.4 million, according to the latest official estimates, and the population density is approximately 96/km2. Agriculture is the main economic activity in Sana'a Governorate. There are 12 government hospitals and a number of health centers in the governorate.[17]

Using a convenience sample technique (non-random opportunistic sample), 150 mothers and their children under 5 years of the age that had attended one of the five selected medical centers of the study time, were selected.

A semi-structured interview questionnaire was developed for data collection of the participants' mothers and their children under the age of five. Five nurses from the same selected health center were selected as data collectors and were trained for the administration of the interview questionnaire and procedure of application of the middle-upper arm circumference (MUAC) tool. The MUAC is a useful tool for rapid assessment of nutritional status, using in developing countries for rapid surveillance and screening programs.[18],[19]

Ethical approval for the study was got from the Ministry of Public Health and population. The participant's mothers were asked to assess their eligibility and readiness to take part in the study. The participants' mothers were informed of the study aim, and verbal consent was got before data collection. A pilot study of 10 mothers was conducted to test the validity and reliability of the interview questionnaire. Feedback got from the pilot study was considered and the participants in the pilot study were excluded.

Two types of tools were used to data collection: An interview questionnaire and anthropometric measurements. The interview questionnaire consisted of three sections: The first section contains the respondents' socioeconomic status (age of the mothers, the person cared for the child, mother's marital status, place of delivery, mother's education, father's education, mother's occupation, family size, family income per month, child gender, the previous child age, age of mothers in the first pregnancy, a series of the child, numbers of fewer than 5 years children per household, and numbers of children per household). The second section contains information about the factors contributing to malnutrition (knowledge of the mothers about malnutrition causes, the weight of the child at birth, child age, practice exclusive breastfeeding for the first 6 months, weaning age of the child, weaning diet, child feeding frequency per day). The third section was about the nutritional status of the children under 5 years of age based on MUAC (Mild Malnutrition [12.5–13-5 cm], Moderate Malnutrition [11.5–12.5 cm] [MAM], Severe Malnutrition [<11.4 cm] [SAM], and normal [>13.5 cm]). The nutritional status of the participated children under 5 years of age was assessed through a conducting of anthropometric measurements using the MUAC tape to measure the circumference of the upper part of the arm of the study children according to the WHO standards.

The statistical package SPSS version 21 (IBM Statistics, Chicago, IL, USA) was used for data analysis. Frequencies, percentages, and cross-tabulations for descriptive analysis were used. Pearson Chi-square was performed to evaluate the association for the nutritional status of the children toward demographic characteristics and the factors contributing to the nutritional status of the children. The statistical significance level of the results was determined at P < 0.05.


  Results Top


A total of 150 children under 5 years of age and their mothers have taken part in this study. Among the total children included in the study, 98 (65.3%) were female and 52 (34.7%) were male. Majority of the children 89 (59.3%) living in a family having up to two children, while only 61 (40.7%) were living in a family having three or more children, and 79 (52.7%), of the children living with at least two under-five children. Only 42 (28%) children were of first birth order, 57 (38%) were of second birth order, 28 (18.7%) were of third birth order, and 23 (15.3%) children of birth order more than a third [Table 1].
Table 1: Sociodemographic characteristics of the participants' mothers and their children under 5 years of age (n=150)

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Of the total mothers included in the study, 96 (64%) were in the age group 21–40 years, 149 (99.3%) were care for their children by themselves, 138 (92%) were married, 78 (52%) of them delivered was at a hospital, 84 (56%) were literate, while 38 (25.3%) had a secondary education and 23 (15.3%) were illiterate. Furthermore, 147 (98%) of the children's mothers were housewives by occupation, 135 (90%) had less than 6 family size, 128 (85.3%) earned <300$ as monthly income. Whereas, 107 (71.3%) of the children's mothers were in an age <20 years in their first pregnancy [Table 1].

Based on the classification of nutritional status of children under 5 years of age by using of MUAC tool, 58 (38.7%) of the children had Mild Malnutrition (12.5–13.5 cm), 51 (34%) had MAM (11.5–12.5 cm), and 10 (6.7%) had SAM (<11.4 cm), while 31 (20.7%) were normal [Figure 1].
Figure 1: Distribution of nutritional status among the participants' children under 5 years of age (n = 150)

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Out of 150 children, 60 (40%) were low birth weight babies (<2.5 kg) while 90 (60%) children had a normal birth weight (>2.5 kg), and 55 (36.7%) of the children's age was between 13 and 24 months. More than a third of the children 53 (35.3%) had started their weaning at <6 months age and 86 (57.3%) were using industrial milk as a weaning diet. More than half of the children 85 (56.7%) had three times fed per day while only 33 (22%) had more than thrice. Majority of the participants' mothers 122 (81.3) did not know the causes of malnutrition, and 73 (48.7%) of them had practiced exclusive breastfeeding for the first 6 months [Table 2].
Table 2: Factors contributing to the nutritional status of children under 5 years of age (n=150)

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[Table 3] shows that mothers delivery's place (P = 0.010), education of the mothers (P = 0.001), education of the fathers (P = 0.018), and age of mothers in the first pregnancy (P = 0.010) were significantly associated with nutritional status of the children under 5 years of age.
Table 3: Association of sociodemographic variables toward the nutritional status of children under 5 years of age (n=150)

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[Table 4] shows that the child weights at birth (P = 0.001) and the age of the child at weaning (P = 0.010), were significantly associated with the nutritional status of children under 5 years of age.
Table 4: Association between common risk factors towards the nutritional status of children under 5 years of age (n=150)

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  Discussion Top


In Yemen, malnutrition has become a major problem of children, especially children under 5 years of age, which is in continuous increasing because of the current conflicts that have led to several economic factors affecting the living standards of families.

In the present study, 64% of the participants' mothers were in the age group (21–40 years), 92% were married, 52% of them delivered was at a hospital, 56% were literate, 15.3% were illiterate, 98% were housewives, and 71.3% of the mothers' first pregnancy was in an age <20 years. This might be because of the Yemeni community culture that gives less attention to women, also, to unequal to women and men. This result was in contrast with previous studies. A study conducted in Southern Sierra Leon reported that more than half of the mothers reported that they live alone and 49% of the parents had little or no education.[20] A study conducted in Afghanistan reported that 83.1% of mothers were illiterate and 13.6% primarily education, 60.1% were reported that their delivered was at home and only 38.6% of their delivered was at health facilities.[10]

In the current study, 99.3% of the participants' children were cared for by their mothers and only 0.7% by their grandmothers. This might be attributed that grandmothers had other activities such as agriculture activities. This result was agreed with a previous study conducted in Afghanistan reported that 95% of children were cared for by their mothers and only 5% by caretakers mostly grandmothers.[10]

In the present study, 90% of the children were living in households with <6 members while only 10% were living in households with 6–10 members. This result was in contrast with previous studies. A study conducted in Afghanistan reported that 44.2% of women reported that their children were living with 7–9 family members, while 37.5% were living with 4–6 members and only 14% were living with 10-12 family members.[10] A study conducted in Ghana reported that 35% of the children were from households with 5–8 members while 35% were from households with 1–4 members.[8]

In the present study, 85.3% of the participants' mothers reported that their households monthly income was less than 300$. This might be attributed to the economic situation resulting from the current conflict in Yemen. This result was in contrast with a study conducted in Afghanistan reported that 49.2% of their household monthly income was less than 150$, and only 2.3% over 300$ per month.[10]

In the present study, 38.7% of the participants' children had mild malnutrition, 34% had MAM and 6.7% had SAM, while 20.7% were normal. This might be attributed to many factors, such as an economic situation, a lack of mothers to enough knowledge about adequate feeding to children, and malnutrition causes. This result was agreed with a previous study conducted in rural Nepal reported that moderate acute malnutrition was a higher prevalence than severe acute malnutrition.[21] However, was in contrast with other studies. A study conducted in Southern Ethiopia reported that 7.8% were found to be malnutrition.[22] A study conducted in Southern Sierra Leon reported that 52% were normal, 31% moderate and 17% were SAM.[20] A study conducted in Bangladesh reported that 43% of children were borderline and 16% were malnourished.[23] A study conducted in Pakistan reported that 33.8% were normal, 43.3% mild, 12.8% moderate, and 10% were SAM.[19] A study conducted in Nepal reported that 60% had a normal nutritional status and 32% had a mild malnutrition status, and 4% had moderate and SAM.[24]

In the present study, 81.3% of the participants' mothers were not knowledgeable about the causes of malnutrition. This might be attributed to the lack of maternal awareness programs about nutrition and health. This result was in contrast with previous studies. A study conducted in Southern Sierra Leon reported that 33% of the parents of the under-five children have lacked the knowledge of the malnutrition causes.[20] A study conducted in Afghanistan reported that about 3% to 4% of mother does not have any knowledge/information about key health and nutrition issues.[10]

In this study, 40% of the participants' children had low weight at birth (less than 2.5 kg), while 60% had a normal birth weight (>2.5 kg). This might be because of the health and nutritional status of their mothers during the pregnancy. This result was agreed with a previous study conducted in Afghanistan reported that 46.2% of children had a birth weight <2.5 kg, while 53.8% with normal birth weight (>2.5 kg).[10]

In the current study, 48.7% of the participants' mothers had practiced exclusive breastfeeding for the first six months. This might be attributed to a lack the mothers to adequate knowledge about significant of breastfeeding to the health of children and mothers. This result was agreed with a previous study conducted in Southern Sierra Leon reported that 43% of the mothers never gave adequate exclusive breastfeeding to their children.[20] However, was in contrast with a study conducted in Afghanistan reported that 88.4% were breastfed during the first 6 months of age while 11.6% never breastfed.[10]

In the current study, a place of delivery, mothers' education, fathers' education, age of mothers at the first pregnancy, and numbers of all children per household were significantly associated with nutritional status of the children under the age of five (P < 0.05). This result was agreed with previous studies. A study conducted in Yemen showed that mother's education was statistically associated with the nutritional status of the children under the age of five.[13] A study conducted in Southern Ethiopia reported that the place of delivery was significantly associated with nutritional status of the children under the age of five.[25] A study conducted in Southern Ethiopia showed a significant association with fathers' education and prevalence of malnutrition.[22] A study conducted in Ghana reported that the number of children per household was statistically associated with the nutritional status of the children under the age of five.[8] A study conducted in India reported that mother's education was statistically associated with the nutritional status of the children.[26] However, was in contrast to other studies. A study conducted in Iran showed that there was no significant relationship between the nutritional status of children and father education.[27] A study conducted in Karnataka, Belgium, India, showed that there was no significant relationship between the nutritional status of children and mother education.[28] This difference might be attributed to different socioeconomic and cultural factors in these countries' communities.

In the current study, the age of mothers, the person cared for the child, marital status, mothers' work status, family size, family income, a child gender, the previous child age, a series of the child, and numbers of less than 5 years children per household were not associated with the nutritional status of the children under the age of five (P ≥ 0.05). This result was agreed with previous studies. A study conducted in Southern Ethiopia reported that the maternal age group was not associated with the nutritional status of the children under the age of five.[25] A study conducted in Mozambique reported that maternal occupation was not associated with the nutritional status of the children.[29] A study conducted in Abbottabad, Pakistan reported that family income and child gender were not associated with the nutritional status of the children.[30] However, was in contrast with other studies. A study conducted in Mozambique reported that family size was statistically associated with the nutritional status of the children.[29] A study conducted in Southern Ethiopia reported that family size was significantly associated with the nutritional status of the children under the age of five.[25] A study conducted in Iran reported that family size and family income were statistically associated with the nutritional status of the children.[27] A study conducted in Karnataka, Belgium, India, reports that mother's work status was statistically associated with the nutritional status of the children.[28] A study conducted in Ghana reported that family income and mother's age were statistically associated with the nutritional status of the children.[8] A study conducted in India reported that family income was statistically associated with the nutritional status of the children.[26]

In our study, the child's weight at birth and weaning age of the child was significantly associated with the nutritional status of the children under the age of five (P < 0.05). This result was agreed with previous studies. A study conducted in Southern Ethiopia reported that the child's weight at birth was significantly associated with the nutritional status of the children under the age of five.[25] A study conducted in rural Nepal reported the child's weight at birth was statistically associated with the nutritional status of the children.[21] A study conducted in Karnataka, Belgium reported that the child's weight at birth was statistically associated with the nutritional status of the children.[28]

In this study, the knowledge of mothers about malnutrition causes, child age, practice exclusive breastfeeding for the first 6 months, weaning diet and baby feeding frequency per day were not associated with nutritional status of the children under the age of five (P ≥ 0.05). This result was agreed with a previous study conducted in Karnataka, Belgium, India reported that the age of the child was not associated with nutritional status of the children under the age of five.[28] However, was in contrast with other studies. A study conducted in Yemen showed that the child's age was significantly associated with the nutritional status of children under the age of five.[13] A study conducted in Nigeria reported that the child's age and practice exclusive breastfeeding for the first 6 months was associated with the nutritional status of the children under the age of five.[31] A study conducted in Ghana reported that the age of the child was significantly associated with nutritional status of the children under the age of five.[8]


  Conclusions Top


Despite the efforts of redressing child malnutrition issues in Yemen, the proportion of malnutrition among children under the age of five still high. This study especially showed that a place of delivery, parents' education, age of mothers at first pregnancy, numbers of children per household, the child's weight at birth, and weaning age, were as contributing factors to malnutrition of the children under the age of five. Multiple intervention strategies based on these risk factors can reduce early malnutrition of the children under the age of five.

Acknowledgments

We are grateful to the health centers management included in this study for their cooperation. In addition, we would like to thank the Ashraqat Organization for Scientific Research and Sustainable Development for financial support in conducting this study. Many thanks to Mr. Sultan Haza'a Saif Qassim to revise the English language of this manuscript.

Financial support and sponsorship

This work was supported by the Ashraqat Organization for Scientific Research and Sustainable Development.

Conflicts of interest

There are no conflicts of interest.



 
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