Quantitative and qualitative assessments of malnutrition in children under 5 and barriers to effective nutrition from mother's perspectives in Madagascar

Background: Little data is available on malnutrition and its risk factors in remote Northern Madagascar. Methods Height and weight of 313 randomly selected children, aged 6 months to 5 years were measured using a recumbent measuring board and calibrated scale during summer 2011. Demographic and risk factor data were collected through vaccination cards and semi-structured interviews with 61 mothers of children. Supplemental food was provided. Results Mean age was 26 months (+- 15.37). Mean height-for-age Z score was -1.50 (+- 1.71). Mean weight-for-age Z score was -0.82 (+- 1.22). Prevalence of global acute malnutrition and low weight-for-height by WHO criteria was 10.5%. Low weight-for-age was 14.4%. Children living in villages closer to center township had higher weight (p<0.05). Regression analysis revealed no significant association with relevant predictors in the model. Mothers' mean age was 26.6 years with average of 3 children. Only 53.3% had completed primary school. Mothers worked 16.2 hours per week obtaining and preparing food. 30% did not have enough food during the past year. 52% skipped meals to give the food to children in past month. 48% preserved food improperly. Common cultivated food were rice, peanuts and legumes. Discussion Limited access to high-energy and high-protein food and lack of diverse crops and knowledge regarding nutrition and proper food practices may play roles in malnutrition in this region. Improving social services and health and nutritional education for families at community level is warranted and necessitate a collaborative work of health and social service agencies coupled with transnational strategies.