Determinants of growth failure in 12-24-month-old children in a high-density urban slum community in East London, South Africa.

OBJECTIVE: The study's main objectives were the identification of determinants of growth failure in 12-24-month-old children from an urban slum community attending a day hospital as well as the identification of focus areas for intervention.
DESIGN: The research was executed as a case-control study with a one-to-two design. A hypothetical causal model was developed for the undernutrition situation in Duncan Village. A questionnaire to assess the direct and underlying causes of growth failure in the study population was developed from this model.
SUBJECTS: One-hundred and fifty children were selected for the study, with 100 children in the control group and 50 children in the growth-failure group. Each child in the growth-failure group was matched with two children in the control group based on age and sex. The children were chosen according to anthropometric indices and p-albumin levels.
SETTING: The research was conducted at a primary health care centre in Duncan Village, an overpopulated urban slum area in East London, a small city on the east coast of South Africa.
RESULTS: No significant differences were found between the two groups for the occurrence of disease and infection. Dietary intake seemed to be generally poor in all the children. No significant differences were found between the two groups for the indicators of household food security, health service utilization and environmental conditions. The most important underlying determinants of growth failure that were identified in the study population seem to be related to the caring capacity, and the resultant caring behaviours of mothers. The risk for growth failure is increased when a child has a mother who is not the head of the household (relative risk) (RR=4.3), who is not involved with the discipline of her children (RR=2.2), who is not the guardian of the child (RR=8), who was not born in Duncan Village or in a city (RR=2.16), who is not able to write (RR=2.7) or read Xhosa (RR=2.53), who has a school education of <or=grade 9 (RR=2.9), who did not receive nutrition education (RR=2.2), who smokes (RR=10) and drinks beer regularly (RR=10), who has a BMI <25 (RR=2.7), who was subjectively judged to show little interest in her child (RR=4) as well as an inadequate caring attitude towards her child (RR=3.61), and whose clothing was dirty (RR=2.7) and not tidy (RR=2.9). Further determinants included the following: a child who weighed <2500 g at birth (RR=4.96), who had not received supplemental milk while still breast-fed (RR=2.00), who did not receive baby cereal as first food (RR=2.6), whose clothes (RR=2.7) were dirty and whose hands were infrequently washed (RR=10).
CONCLUSIONS: The results of this research suggest that initiatives to address the problem of growth failure in 12-24-month-old children attending the Duncan Village Day Hospital should focus mainly on improving the caring capacity of mothers in the study area.