Introduction
Malnutrition is the immediate result of inadequate dietary intake, the presence of disease or the
interaction between these two factors. It is a complicated problem, an outcome of several
etiologies. SAM is one of the leading causes of morbidity and mortality among children under
the age of five in developing countries. Although studies in Botswana show some improvement
in child malnutrition since the 1980s, severe acute malnutrition still remains a cause for concern
in many parts of the country. There is little information on undernourishment situation of
children under the age of five years in the urban areas of the country.
Aim
The purpose of this study was to determine the risk factors to severe acute malnutrition among
children under the age of five years in Francistown, Botswana. The UNICEF conceptual
framework was used as a guide in assessing and analysing the causes of the nutrition problem
in children and assisted in the identification of appropriate solutions.
Methods
The study was conducted on cases who had been admitted and referred at any time between
March and July 2015. A quantitative research methodology was used to conduct the study. A
case-control study design was utilised. Random selection of cases and controls was done on a
ratio of 1:2 case per control. Cases included children under the age of five years admitted to
Nyangabgwe Referral Hospital and those referred to the Nutritional Rehabilitation Centre
within the hospital in Francistown-Botswana with a diagnosis of severe acute malnutrition.
Controls were children of the same age, gender and attending the same Child welfare clinic as
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the case and with good nutritional status. Data was collected through face-to-face standardised
interviews with care-givers.
Results
Data collection was done using a combination of a review of records (child welfare clinic
registers, and child welfare clinic cards) and structured questionnaires. 52 cases and 104
controls were selected with the primary or secondary care-giver as the respondent. (N=156).
Data was collected using a self-developed structured questionnaire and the review of
documents. Of all the cases 36.5% (n=19) were diagnosed with MAM, 46.2% (n=24) with
SAM, 1.9% (n=1) with moderate PEM and 7.7% (n=4) each for PEM and Severe PEM. All the
cases had presented with clinical signs and symptoms of severe acute malnutrition and/or the
weight-for-height Z-score of ≤ -3 SD.
Following placement of the data in regression models, the factors that were found to be
significantly associated with child malnutrition were low birth weight (AOR = 0.437; 95% CI
= 0.155-1.231) , exclusive breastfeeding (AOR = 2.741; 95% CI = 0.955-7.866), child illness
(AOR = 0.383; 95% CI = 0.137-1.075), growth chart status (AOR =7.680; 95% CI = 1.631-
36.157), level of care-giver’s education (AOR = 0.953; 95% CI = 0.277-3.280), breadwinner’s
work status (AOR = 1.579; 95% CI = 0.293-8.511), mother’s HIV status (AOR = 0.777; 95%
CI = 0.279-2.165), alcohol consumption (AOR = 0.127; 95% CI = 0.044-0.369), household
having more than one child under the age of five (AOR = 0.244; 95% CI = 0.087-0.682),
household food availability (AOR = 0.823; 95% CI = 0.058-11.712), living in a brick type of
house (AOR = 13.649; 95% CI = 3.736-49.858), owning a tap (AOR = 1.269; 95% CI = 0.277-
5.809) and refuse removed by the relevant authority (AOR= 2.095; 95% CI = 0.353-12.445)
were all statistically significantly associated with severe acute malnutrition (p < 0.05).
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Therefore, all these variables were included in the binary stepwise regression where living in a
mud house type was the most significant factor and not being breastfed for at least three months
was the least significant.
Conclusion
The findings of this study suggested that immediate determinants to SAM were; child born
with a low birth weight, appetite and child illness. Underlying contributing factors were; the
child not exclusively breastfed for at least three months, growth chart not up to date, care-givers
education level, employment status, alcohol consumption, household food availability, type of
housing, owning a tap and number of children under the age of five year. Therefore, increasing
household food security and strengthening educational interventions for women could
contribute to a reduction in the prevalence of SAM in Francistown, Botswana.