Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case-control study.

OBJECTIVE: To examine the relation of maternal and socioeconomic factors with the development of severe malnutrition in young children.
DESIGN: A case-control study.
SETTING: A large diarrhoea treatment centre in a metropolitan city.
SUBJECTS: Cases were 125 severely malnourished children, aged < 36 months, having weight-for-age < 55% of the United States National Center for Health Statistics (NCHS) median values. Controls (n = 125) were recruited concurrently matching for gender, disease type (i.e. diarrhoea or dysentery) and age stratum, having weight-for-age > 60% of NCHS median values. INTERVENTION: Mothers of the children were interviewed to record personal history and various socioeconomic variables and examined for height and weight.
RESULTS: Maternal factors such as illiteracy, mothers' employment outside, lack of breastfeeding and maternal malnutrition (as indicated by low body mass index, weight or height); and selected socioeconomic indicators such as poor family income, use of unprotected surface water or unhygienic latrine were found to be significantly associated with severe malnutrition in their children. In multivariate analysis, maternal illiteracy and lack of breastfeeding were associated with approximately fourfold increased risk of severe malnutrition in their children. A strong positive association of employment of mothers outside homes with fivefold increased risk was surprising and may reflect a complex social problem of poor urban mothers; malnourished mothers were 2.5 times more likely to have severely malnourished children.
CONCLUSION: The findings confirm the well-known association of lack of maternal education and breastfeeding with severe malnutrition of their children. Maternal malnutrition may be a useful indicator to identify at-risk families with severely malnourished children. However, its causal association, though plausible, cannot be inferred from the study.