Risk factors for severe acute malnutrition in under-five children: a case-control study in a rural part of India

Objectives: The present study was planned to identify some of the risk factors of severe acute malnutrition (SAM) in under-five children in a rural part of India. Study design: Case-control study. Methods: The study was carried out in rural areas of Yavatmal district. A total of 737 cases (under-five SAM children) and an equal number of normal controls were included in the study. Data were collected using a structured questionnaire. Binary logistic regression was used for multivariate analysis using a hierarchical model. Results: The odds of a child being in the SAM category increased significantly if the family: was below the poverty line, have a kuccha house, have more children in the family, have less rooms in the house, have a working mother, has a mother with a lower level of education, have an unemployed father, did not use any water purification measure, did not always ensure parents washed their hands before feeding a child, did not wash hands with soap and water after defecation, have a father with any addictive habit like tobacco or alcohol consumption, have a maternal height < 145 cm, have a maternal weight < 45 kg, have a lower age at marriage for mothers, had an institutional delivery, have the same food utilized more than once in a day, have no age-appropriate vaccination, give prelacteal feeds, have a lower frequency of breast feeding, do not use semisolid food during the weaning period, exclusively breast feed for less than four months or more than six months, had low birth weight, have five or more episodes of illness in the previous year, have < 3 feeds per day apart from breast milk, and not initiation of breast feeding within 30 min of birth. Conclusion: Risk factors identified in the present study can be addressed through health system interventions. The strongest association was observed with child feeding practices; thus, more emphasis is required in nutritional education and counselling in strategies to fight undernutrition. (C) 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.