Rihab Dahab1, Laia Bécares2, Mark Brown3. 1. School of Social Sciences, Department of Social Statistics, University of Manchester, Humanities Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK. rihab.dahab@manchester.ac.uk. 2. University of Sussex, Brighton, UK. 3. School of Social Sciences, Department of Social Statistics, University of Manchester, Humanities Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK.
Abstract
BACKGROUND: Children's nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health. METHODS: We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors. RESULTS: Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03-2.49 for the low intensity group). CONCLUSION: Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.
BACKGROUND:Children's nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health. METHODS: We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors. RESULTS: Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03-2.49 for the low intensity group). CONCLUSION: Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.
Entities:
Keywords:
Armed conflict; Children under-5; Malnutrition; The Sudan
Authors: Sheikh Shoib; Osman Kamal Osman Elmahi; Mohd Faizan Siddiqui; Randa Ahmed Abdalrheem Altamih; Sarya Swed; Eman Mohammed Sharif Ahmed Journal: Ann Med Surg (Lond) Date: 2022-05-11