Determinants of childhood nutritional status in Al-Dakhliyah region in Sultanate of Oman

Nutrition is one of the major determinants of childhood mortality and morbidity. Poverty and non-availability of quality foods are the main underlying factors of malnutrition among young children. In a country like Oman, where absolute poverty is uncommon, the problem of malnutrition, unfortunately, still exists.

This study is a health facility case-control study with 1:3 case to control ratio. A case was defined as any child 12-47 months of age who was below 2 SD from the median weight for his/her age as plotted on the growth chart used for each child in health institutes in Oman Health facilities were recruited via random selection from the total health facilities in the region. All the children who met the case definition were recruited in the study and controls were matched for gender and age in years. Data was collected by trained nurses by means of questionnaires translated into Arabic. To determine implicating factors, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Multivariate logistic regression was used to eliminate the effect of confounders.

A total of 1000 children (250 cases and 750 controls) were recruited in the study. Overall, 48% were males and 52% were females. In bivariate analysis, sociodemographic factors found to have an association with nutritional status were illiterate mothers (OR 2.03, 95% CI 1.46-2.84); working mothers (OR 2.20 95% CI 1.10-4.51); and large number of people in the household (16-42 per-sons/house) (OR 2.30 95% CI 1.503.53). All nutritional factors were not statistically significant. Significant health status factors included low birth weight < 2.5 kg (OR 4.53, 95% CI 2.89-7.09); sickness in the first year of life (OR 3.81, 95% CI 2.665.45); sickness after the first year of life (OR 3.50, 95% CI 2.25-5.45); occurrence of >6 episodes of diarrhea in the first year of life (3.24, 95% CI 1.49-7.01); occurrence of diarrhea after the first year of life (1.52, 95% CI 1.11-2.09); repeated Acute Respiratory Infections (ARI) in the first year of life (OR 1.50, 95% CI 1.08-2.09); ARI after the first year of life (OR 1.83, 95% CI 1.29-2.60); chronic diseases (OR 2.29, 95% CI 1.194.21); and admission into hospital >3 times (OR 2.28, 95% CI 1.25-4.13).

Adjusting for confounders by Multivariate logistic regression (table 1), the following factors were demonstrated to affect the association: low birth weight (OR 4.88, 95% CI 2.98-8.01); sickness in the first year of life (OR 2.75, 95% CI 1.76-4.28); sickness after the first year (OR 2.29, 95% CI 1.30-4.05); diarrhea after the first year of life (1-6 episodes/year) (OR 1.49, 95% CI 1.05-2.11); ARI after the first year of life (1-6 episodes/year) (OR 1.48, 95% CI 1.012.22); illiterate mother (OR 1.98, 95% CI 1.34-2.92); and number of people in the household (16-45 persons/house) (OR 2.12, 95% CI 1.31-3.44).

There is considerable evidence that childhood malnutrition affects growth, morbidity, mortality, cognitive development, reproduction, physical work capacity and risk for several adulthood chronic diseases. Children who are chronically malnourished exhibit behavioral changes, including irritability, apathy and decreased social responsiveness, anxiety, and attention deficits. Infants and young children with malnutrition frequently demonstrate developmental delay or permanent cognitive deficits. The degree of delay and deficit depends on the severity and duration of nutritional compromise and the age at which malnutrition occurs.[1]

The World Health Organization defines malnutrition as "the cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions".[2] Internationally, the WHO estimated in 1998 that approximately 150 million children (26.7%) younger than 5 years in developing countries are malnourished based on their low weight in relation to their age. An additional 200 million children have stunted height secondary to poor nutrition.[2] Also, there is a strong exponential association between severity of malnutrition and mortality.[3]

In Oman, the percentage of malnutrition in under-fives is 12%.[4] Since the gulf countries share the same cultural and financial characteristics, the rates of malnutrition among children in other Gulf countries are expected to be similar. In Saudi Arabia, according to the Family Health Survey (1997), around 14% of children under 5 years of age were malnourished.[5]

It is important to understand the causes of malnutrition in order to appreciate the depth of the problem, and find adequate solutions. The most common immediate causes of malnutrition are inadequate dietary intake and sickness. However, the determinants of nutritional status of children under five in Al-Dakhliya region of Oman were mostly related to history of illness, illiteracy of mothers and presence of a large number of people in the same household. All these factors are related to the quality of care the child has and health education. It was recommended that a comprehensive health education program be organized by the ministry of health in collaboration with other concerned partners and community support volunteers to provide necessary information and support to families, in particular women of child bearing age.