TY - JOUR
T1 - Risk factors associated with under-five stunting, wasting, and underweight in four provinces of the Democratic Republic of Congo
T2 - analysis of the ASSP project baseline data
AU - Luzingu, Joy Kinko
AU - Stroupe, Nancy
AU - Alaofe, Halimatou
AU - Jacobs, Elizabeth
AU - Ernst, Kacey
N1 - Funding Information:
We thank Kacey Ernst, Halimatou Alaofe, and Elizabeth Jacobs for serving as members of the thesis committee and for reviewing this manuscript. Joy Luzingu would like to thank Nancy Stroupe for having facilitated the acquisition of the ASSP dataset from IMA World Health/DRC. We also thank IMA World Health/DRC for accepting to provide the ASSP dataset on which research for this manuscript has been conducted. Also, thank you to the Zuckerman College of Public Health, University of Arizona.
Funding Information:
This study uses data from the baseline evaluation survey a project funded by the United Kingdom (UK) Department for International Development (DFID) and implemented by IMA World Health in 52 HZs of 5 provinces of the DRC, namely North Ubangi (formally Equateur), Tshopo (formally Oriental province), Kasai and Kasai central (formally Kasai occidental) and Maniema. The project was titled “Accès aux soins de santé primaire (ASSP)” and aimed at reducing morbidity and mortality in women and children under five while strengthening the country’s health system. In March of 2015, a presidential ordinance was issued calling for a new administrative configuration of DRC’s provinces, such that the existing 11 provinces were split into 26. The former Kasai Occidental was split into 2 provinces, Kasai and Kasai Central, both of which contained ASSP health zones; Equateur was divided into 5 provinces, with ASSP health zones located in North Ubangi; Province Orientale was split into 4 provinces with ASSP health zones located in Tshopo; Maniema remained one province. The number of HZs per province supported by the ASSP project differed greatly (17 in Kasai, 11 in Kasai Central, 10 in Maniema, 4 in Tshopo and 11 in North Ubangi) (Fig. ). Those targeted health zones were chosen for two reasons: 1) they were considered to have weak health systems, and/ or 2) DFID had started to provide support to the health zones under a preceding project and wanted to continue that assistance. For consistency with the way data were collected in 2014 in the four former provinces, before the presidential ordinance, we considered those four provinces and named them accordingly in this study: Equateur, Kasai occidental, Maniema and Orientale.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Determining the magnitude and risk factors of undernutrition in a country that has one of the highest prevalence of undernutrition in the world is paramount for developing contextual interventions. Methods: This study used baseline data from the ASSP project to estimate prevalence of stunting, wasting, and underweight in four provinces of DRC. It involved 3911 children aged 0–59 months old and mother pairs. Height-for-age Z scores, Weight-for-height Z scores, and Weight-for-age Z scores were calculated and used to classify child stunting, wasting and underweight respectively, based on the 2006 World Health Organization (WHO) growth reference. Hierarchical logistic regressions were used to identify risk factors associated with stunting, wasting and underweight. All analyses were conducted using STATA 15.1, and statistical significance was set at p < 0.05. Results: The prevalence of stunting, underweight and wasting was 42.7%, 21.9% and 8.2% respectively. Increasing child’s age was a risk factor associated with stunting and underweight, while sex was not associated with the 3 indicators of undernutrition. Low levels of mother’s education, mothers working in the last 12 months prior to the survey, children living in the province of Kasai occidental, children born at a health facility, children perceived by their mothers to be born very small were associated with higher risks of stunting. Factors associated with underweight were children from the province of Kasai occidental, mothers who worked in the last 12 months prior to the survey, and children perceived to be born very small or small by their mothers. Children born to mothers aged 35–49 years and children breastfed in combination with drinking water were at higher risk of wasting. Conclusion: Prevalence of undernutrition in DRC is high. This study has identified certain modifiable risk factors associated with stunting, wasting and underweight. To reduce the burden of undernutrition in DRC, authorities should target factors at individual and community levels by improving women’s education, child feeding practices and promoting agriculture.
AB - Background: Determining the magnitude and risk factors of undernutrition in a country that has one of the highest prevalence of undernutrition in the world is paramount for developing contextual interventions. Methods: This study used baseline data from the ASSP project to estimate prevalence of stunting, wasting, and underweight in four provinces of DRC. It involved 3911 children aged 0–59 months old and mother pairs. Height-for-age Z scores, Weight-for-height Z scores, and Weight-for-age Z scores were calculated and used to classify child stunting, wasting and underweight respectively, based on the 2006 World Health Organization (WHO) growth reference. Hierarchical logistic regressions were used to identify risk factors associated with stunting, wasting and underweight. All analyses were conducted using STATA 15.1, and statistical significance was set at p < 0.05. Results: The prevalence of stunting, underweight and wasting was 42.7%, 21.9% and 8.2% respectively. Increasing child’s age was a risk factor associated with stunting and underweight, while sex was not associated with the 3 indicators of undernutrition. Low levels of mother’s education, mothers working in the last 12 months prior to the survey, children living in the province of Kasai occidental, children born at a health facility, children perceived by their mothers to be born very small were associated with higher risks of stunting. Factors associated with underweight were children from the province of Kasai occidental, mothers who worked in the last 12 months prior to the survey, and children perceived to be born very small or small by their mothers. Children born to mothers aged 35–49 years and children breastfed in combination with drinking water were at higher risk of wasting. Conclusion: Prevalence of undernutrition in DRC is high. This study has identified certain modifiable risk factors associated with stunting, wasting and underweight. To reduce the burden of undernutrition in DRC, authorities should target factors at individual and community levels by improving women’s education, child feeding practices and promoting agriculture.
KW - Children
KW - Democratic Republic of Congo
KW - Prevalence
KW - Socio-economic
KW - Undernutrition
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U2 - 10.1186/s12889-022-14842-x
DO - 10.1186/s12889-022-14842-x
M3 - Article
C2 - 36564730
AN - SCOPUS:85144637951
SN - 1471-2458
VL - 22
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 2422
ER -