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NEWPORT INTERNATIONAL JOURNAL OF

RESEARCH IN MEDICAL SCIENCES (NIJRMS)
Volume 3 Issue 3 2023 Page | 123

Prevalence of Malnutrition and Associated Risk

Factors among Children Aged 6-59 Months in
Mubende Regional Referral Hospital
Emmanuel Kasaine Muteleu

Department of Medicine and Surgery, Kampala International University,

Uganda.
ABSTRACT
Globally, approximately 151 million children under 5 suffer from stunting and in 2017, nearly 51 million children
under 5 were wasted. In Uganda, child malnutrition is one of themost serious public health problems and among the
highest in the world with about 28.9% stuntedand 3.6 % wasted in 2015. Therefore, the purpose of this study was to
identify prevalence of malnutrition and associated factors among children aged 6-59 months in Mubende Regional
Referral Hospital. A facility based cross-sectional descriptive study was conducted. Data collection was done using
a pretested questionnaire and the Emergency Nutrition Assessment software version 2015 was used to generate z-
scores and the Weight for Height Z-scores (WHZ) were generated using WHO 2005 Growth Standards. The data
was then exported to IBM SPSS version 25 for analysis. Malnutrition was found to be at 31.9% (n=135) and factors
associated with malnutritionwere, sex of the child where, female children were more likely to be malnourished than
boys (X2=9.56; P=0.002). Low birth weight was statistically associated with malnutrition (P=<0.001; X2=18.19).
Results further showed that children who had no history of illness had reduced risk of being malnourished have
(OR=0.276; 95%CI=0.119-0.641). Lack of formal education by the caretaker and being a peasant were statistically
significant at (P=<0.001, X2 =20.09) and (P=<0.001, X2=17.94) respectively. This study found out that prevalence
of malnutrition was high (31.9%). This was associated with female sex, low birth weight, history of infectious disease,
caretakers with no formal education and being a peasant were all significantly associated with malnutrition. It is
recommended that a strong nutrition specific and sensitive intervention should be implemented in the study area
with a special focus on supporting housewives, promoting education on child feeding and nutrition.
Keywords: malnutrition, risk factors, children, 6-59 months

INTRODUCTION
Child malnutrition remains a major public health problem in developing countries and major contributor to global
disease burden [1]. Malnutrition’s impact on child survival and future national economic productivity cannot be
over-emphasized [2]. Although estimates suggested a declining trend in the global prevalence of stunting and
wasting among children less than five years, Africa among other United Nation regions registered the lowest
percentage decrease in prevalence of stunting (12.2%) from 1990 (42.5%) to 2017 (30.3%)[3]. In most sub-Saharan
African countries, the level of wasting among children under-five years of age remained below emergency threshold
level but at poor nutritional thresholdlevels (6.4%) for East Africa [4]. Subramanianand colleagues showed that
approximately 45% of all deaths in children under five years were associated with malnutrition [5]. This further
underpins the impact of malnutrition on child survival [6-10]. The 2016 Uganda Demographic and health survey
(UDHS) showed a wasting and stunting prevalence of 3.6% and 28.9% respectively among children under five years
of age [11].Rural children were more disproportionately affected than their urban counterparts. In addition, the
Muteleu, 2023
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economic costs associated with childhood malnutrition in Uganda are of serious concern to policy makers, public
health professionals and public health researchers. To reduce the burden of wasting and stunting among children
under five years, globally applicable evidence-based nutrition specific and sensitive interventions were recommended
[12], however the success of these interventionsdepends on several factors among which include identification
of local and country specific malnutrition risk factors, the benchmark for nutrition policy and interventions
development, advocacy for resource envelop and political commitment [13-21]. Risk factors for wasting and
stunting are overt across the globe. In the Lancet series of maternal and child nutrition, two systematic reviews by Page | 124
Black et al delineated the potential risk factors for wasting and stunting among children under five years of age at
both global and regional level [22], in middle and low-income countries [23], let alone the comprehensive UNICEF
framework of determinants of malnutrition [24]. Risk factors for stunting range from socio-economic to individual
level factors such as inadequate dietary intake and infections. Low socio-economic status is an important distal risk
factor for stunting. In particular limited maternal opportunity to earn and limited health knowledge resultingfrom
lack of or limited formal education as opposed to paternal education, aggravates other correlates of stunting such as
poor child-care practices related to nutrition, health and access to existing nutrition and health interventions [25].

METHODOLOGY
Study design
This was a facility-based study which used a descriptive cross sectional study design.
Study setting
The study was conducted in Mubende Regional Referral Hospital, commonly known as MubendeHospital and is located
in the town of Mubende, in the Central Region of Uganda about 150 kilometres (93 mi) west of Kampala, the Ugandan
capital city. It is the referral hospital for the districts of Mubende, Mityana, Kiboga, and Kyankwanzi. The hospital
serves a catchmentpopulation estimated at about 610,600 people, as of July 2020 with the coordinates of 0°34'03.0"N,
31°23'35.0"E (Latitude:0.567496; Longitude:31.393041).
Study population
The study population included children aged 6-59 months attending Mubende Regional Referral Hospital during the
time of the data collection.
Inclusion criteria
Only children aged 6 – 59 months whose caretakers gave informed consent recruited in the study.
Exclusion criteria
Children who were seriously sick, Care takers
who refused to consent, Children with
deformity like kyphosis
Sample size determination
The sample size was calculated using Kish and Leslie formula (Rutterford, Copas, & Eldridge,2015) which states
that.
𝑧2(1−𝑝)
𝑛 = for a population ≥10,000
𝑑2
Where:
n = the desired sample size
P = 9.7% estimated number of children with malnutrition in Central region [11].
Z2 = (1.96) Standard normal value at 95% confidence level
d = Margin of error between the sample and the population = 5%
1.962𝑥 0.097 (1−0.097)
Therefore 𝑛 = =135. Therefore, the required sample was 135.
0.05 2
Sampling procedure
Using the average number of children admitted on the ward and the total sample required, the sampling interval was
determined, and the first sample was randomly selected from the admissionregister. The sampling interval was then
added to enroll the remaining sample. Any eligible participant whose parent/caretaker did not consent for the study
was replaced by the next availableparticipant till the whole sample was achieved.
Data collection methods and management
The weight was measured using electronic digital weighing scale (Seca®). For height/length, children <2 years were
measured lying down (recumbent length) while those >2years were measured standing up. For MUAC and head
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circumference, a non-stretch tape was used. An interviewer administered questionnaire was used for each participant
to obtain demographic, clinical, nutritional and economic information. Data entry, cleaning and validation was done
using Microsoft excel version 2019. Anthropometric data was analyzed using the Emergency Nutrition Assessment
(ENA) software version 2015 to get the z-scores. Z-scores obtained from ENA will then be incorporated into the
Microsoft excel data.The data will then be exported to IBM SPSS version 25 for analysis.

Data analysis Page | 125

Central tendency and dispersion for continuous and proportions of categorical variables were measured. Chi-square
statistics at 95% confidence interval were calculated and variables with p- value ≤0.5 were considered to be statistically
significant.
Ethical consideration
Ethical approval was sought from Kampala international university western campus Faculty of clinical medicine and
an introduction letter was issued after approval of the proposal. A written consent was sought from the
mothers/caretakers before participating in the study. Permission to collect data was sought from Mubende hospital
administration.
RESULTS

Results from the study show that majority 81 (60%) of children were females, 96 (71.1%) had an uptodate Vit A
supplement, 93 (68.9%) were feeding adequately and 80 (59.3%) of the care takerswere peasants. Table 1.
Table 1: Characteristics of study participants (N=135)

Characteristics of study participants Frequency Percent

Sex of child Female 81 60.0
Male 54 40.0
Age of the child 6-11 46 34.1
12-23 30 22.2
24-35 12 8.9
36-47 34 25.2
48-59 13 9.6
Birth weight Low 26 19.3
Normal 66 48.9
Large 43 31.9
Vitamin A supplement Not up to date 39 28.9
Up to date 96 71.1
Infectious disease No 54 40.0
Yes 81 60.0
Adequacy of feeding Adequate 93 68.9
inadequate 42 31.1
Care taker Not the mother 14 10.4
Mother 121 89.6
Care taker's education level No formal education 81 60.0
Primary 38 28.1
Secondary 12 8.9
Tertiary 4 3.0
Employment level Peasant 80 59.3
Employed 14 10.4
Self employed 41 30.4

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Findings from the present study show that out of the total 135 participants, 43 (31.9%) of thechildren had
malnutrition while their counterparts 92 (68.1%) did not have malnutrition. Figure 2.
Figure 2: Prevalence of malnutrition

Page | 126

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Among the number of factors studied, sex of the child (P=0.002), birth weight (P=<0.001), historyof infectious disease
(P=0.002), care takers’ education level (P=<0.001), and caretakers’ employment status (P=<0.001) were found
statistically significant. Table 2.
Table 2: Association of respondents’ characteristics and malnutrition

Characteristics of Participants Malnutrition Total X2 P value

No Yes Page | 127
Sex of child Female 47 34 81 9.56 0.002*
Male 45 9 54
Age of the child 6-11 30 16 46 0.34 0.987
12-23 21 9 30
24-35 8 4 12
36-47 24 10 34
48-59 9 4 13
Birth weight Small 10 18 26 18.19 <0.001*
Normal 53 13 66
Large 29 12 43
Vit A supplement Not up to date 26 13 39 0.06 0.840
Up to date 66 30 96
Infectious disease No 45 9 54 9.66 0.002*
Yes 47 34 81
Feeding adequacy Adequate 68 25 93 3.41 0.075
inadequate 24 18 42
Care taker Not the mother 10 4 14 0.08 1.000
Mother 82 39 121
Care taker's No formal 50 31 81 20.09 <0.001*
education level education
Primary 35 3 38
Secondary 4 8 12
Tertiary 3 1 4
Employment level peasant 48 32 80 17.94 <0.001*
Employed 6 8 14
Self employed 38 3 41
*Statistical significance

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DISCUSSION

Prevalence of malnutrition among children 6-59 months in this study was 31.9%. This prevalence is higher than the
28.9% that reported by the Uganda demographic and health survey of 2016 [11]. The reasons for this difference
may include study settings and the period in whichthe surveys were conducted. The National Demographic Survey
was conducted over a six-monthperiod from June to December 2016 while this study was done over a period of one
month of September. The prevalence of malnutrition was higher (79%) in the female children than male children. Page | 128
The higher prevalence of malnutrition among girls may be related to the higher growth rate in girls resulting in
greater need for nutrients not supplied by diet. This contradictsthe results of the study by Rahman and colleagues in
Bangladesh who reported that boys were more malnourished than girls. In this study, birth weight was statistically
associated with malnutrition (P=<0.001; X2=18.19). Having a low birth weight had a high risk (41.9%) of being
malnourished. This implies that thereis an early exposure to nutritional stress and therefore the need for nutritional
intervention right from the time of child conception. The observed association between birth weight and malnutrition
in children is consistent with findings of several other studies [26-33]. In this study, more than half of the children
(60%) were reportedly ill in the preceding two-weeksof the study and this was statistically significant (P=0.002).
Children who had no history of illness had a reduced risk (20.9%) of being malnourished. Malnutrition can impair
the immune system hence leading to increased susceptibility to infectious diseases [34-39]. On the other hand,
helminthic infections, malaria and diarrhea have direct impact on malnutrition. For instance, hookworm infections
lead to loss of blood and nutrients as a result of the blood sucking activities of the worms [28-39].
CONCLUSION
This study found out that prevalence of malnutrition was high (31.9%). Among the factors that were investigated,
female sex, low birth weight, history of infectious disease, caretakers with no education and being peasants were all
significantly associated with malnutrition.

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Emmanuel Kasaine (2023). Prevalence of Malnutrition and Associated Risk Factors among Children Aged 6-
59 Months in Mubende Regional Referral Hospital. NEWPORT INTERNATIONAL JOURNAL OF
RESEARCH IN MEDICAL SCIENCES (NIJRMS) 3(3):123-130.

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