Prevalence and determinants of underweight among children under five years in Southern African countries: A comparative study

Shirley ML. Mathabatha

Abstract

Underweight is a public health issue that affects children in low-middle income countries. It is defined as low weight for age. The study aimed to examine factors associated with underweight among children under five years in SADC.  The study used Demographic and Health Surveys conducted in Lesotho (2014), Malawi (2015-16), South Africa (2016) and Zambia (2018). The study population consisted of children under the age of five years: 1869 in Lesotho, 5786 in Malawi, 1416 in South Africa and 9689 in Zambia. Chi-square test and logistic regression were used to establish social and demographic factors associated with underweight. The study results show that Malawi and Zambia had high prevalence (11.7% and 11.8%) of underweight as compared to Lesotho and South Africa (10.3% and 5.9%) respectively. It is therefore suggested by this study that the predominant factors such as child’s age, child’s sex, birth weight, mother’s education, and household income to be considered by policymakers and stakeholders when implementing programmes and policies to reduce underweight. Furthermore, the study emphasizes the importance of multisectoral interventions that address the basic, underlying, and immediate causes of malnutrition to reduce the prevalence of underweight among children under five years.

Full Text:

PDF

References

World Health Organization. The double burden of malnutrition: policy brief: World Health Organization, 2016.

Prasad JB, Pezhhan A, Patil SH. Effect of wealth, social inequality, Mother's BMI, and education level on child malnutrition in India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2021;15(6):102304.

Manoochehri S, Faradmal J, Poorolajal J, Asadi FT, Soltanian AR. Risk factors associated with underweight in children aged one to two years: a longitudinal study. BMC Public Health 2024;24(1):1875. doi: 10.1186/s12889-024-19147-9

National Department of Health, and ICF. South Africa Demographic and Health Survey 2016. Pretoria: National Department of Health - NDoH - ICF, 2019.

National Statistical Office/Malawi, and ICF. Malawi Demographic and Health Survey 2015-16. Zomba, Malawi: National Statistical Office and ICF, 2017.

Zambia Statistics Agency - ZSA, Ministry of Health - MOH, University Teaching Hospital Virology Laboratory - UTH-VL, and ICF. Zambia Demographic and Health Survey 2018. Lusaka, Zambia: ZSA, MOH, UTH-VL and ICF, 2020.

Ministry of Health/Lesotho, and ICF International. Lesotho Demographic and Health Survey 2014. Maseru, Lesotho: Ministry of Health/Lesotho and ICF International, 2016.

Hossain S, Shuvo TA, Mia N. Factors associated with underweight and overweight prevalence among children in Bangladesh. Journal of Medicine, Surgery, and Public Health 2024;3:100110. doi: https://doi.org/10.1016/j.glmedi.2024.100110

Kumar R, Abbas F, Mahmood T, Somrongthong R. Prevalence and factors associated with underweight children: a population-based subnational analysis from Pakistan. BMJ open 2019;9(7):e028972.

Moshi CC, Sebastian PJ, Mushumbusi DG, Azizi KA, Meghji WP, Kitunda ME, Kasankala LM. Determinants of underweight among children aged 0–23 months in Tanzania. Food Science & Nutrition 2022;10(4):1167–74.

Luzingu JK, Stroupe N, Alaofe H, Jacobs E, Ernst K. Risk factors associated with under-five stunting, wasting, and underweight in four provinces of the Democratic Republic of Congo: analysis of the ASSP project baseline data. BMC Public Health 2022;22(1):2422. doi: 10.1186/s12889-022-14842-x

Boah M, Azupogo F, Amporfro DA, Abada LA. The epidemiology of undernutrition and its determinants in children under five years in Ghana. PLOS ONE 2019;14(7):e0219665. doi: 10.1371/journal.pone.0219665

Adhikari D, Khatri RB, Paudel YR, Poudyal AK. Factors Associated with Underweight among Under-Five Children in Eastern Nepal: Community-Based Cross-sectional Study. Front Public Health 2017;5:350. doi: 10.3389/fpubh.2017.00350 [published Online First: 20171222]

Addo IY, Boadu EF, Osei Bonsu E, Boadi C, Dadzie FA. Prevalence and factors associated with undernutrition among children under the age of five years in Benin. PLOS ONE 2023;18(8):e0289933. doi: 10.1371/journal.pone.0289933

UNICEF. Strategy for improved nutrition of children and women in developing countries. 1990,

Tranmer M, Elliot M. Binary logistic regression. Cathie Marsh for census and survey research, paper 2008;20:90033–9.

Park H-A. An introduction to logistic regression: from basic concepts to interpretation with particular attention to nursing domain. Journal of Korean academy of nursing 2013;43(2):154–64.

Fenta HM, Tesfaw LM, Derebe MA. Trends and Determinants of Underweight among Under-Five Children in Ethiopia: Data from EDHS. Int J Pediatr 2020;2020:3291654. doi: 10.1155/2020/3291654 [published Online First: 20200613]

Chowdhury TR, Chakrabarty S, Rakib M, Saltmarsh S, Davis KA. Socio-economic risk factors for early childhood underweight in Bangladesh. Globalization and Health 2018;14(1):54. doi: 10.1186/s12992-018-0372-7

Tamir TT, Zegeye AF, Workneh BS, Mekonen EG. Underweight and associated factors among children under age of five in low and lower-middle income African countries: hierarchical analysis of demographic and health survey data. Front Public Health 2024;12:1423603. doi: 10.3389/fpubh.2024.1423603 [published Online First: 20240909]

Rahman M. Association between order of birth and chronic malnutrition of children: a study of nationally representative Bangladeshi sample. Cadernos de saude publica 2016;32:e00011215.

Tosheno D, Mehretie Adinew Y, Thangavel T, Bitew Workie S. Risk factors of underweight in children aged 6–59 months in Ethiopia. Journal of nutrition and metabolism 2017;2017(1):6368746.

Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia. BMC Public Health 2015;15(1):41. doi: 10.1186/s12889-015-1370-9

Susan T, Charles O, Andrew S, Jonathan W, Tanya K, Carmel D, André B, Mark M, Michel G, Rebecca S,

Marko K. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Global Health 2020;5(12):e004030. doi: 10.1136/bmjgh-2020-004030

Aboagye RG, Ahinkorah BO, Seidu A-A, Frimpong JB, Archer AG, Adu C, Hagan JE, Jr., Amu H, and Yaya S. Birth weight and nutritional status of children under five in sub-Saharan Africa. PLOS ONE 2022;17(6):e0269279. doi: 10.1371/journal.pone.0269279

Rahman MS, Howlader T, Masud MS, Rahman ML. Association of Low-Birth Weight with Malnutrition in Children under Five Years in Bangladesh: Do Mother’s Education, Socio-Economic Status, and Birth Interval Matter? PLOS ONE 2016;11(6):e0157814. doi: 10.1371/journal.pone.0157814

Ntenda PAM. Association of low birth weight with undernutrition in preschool-aged children in Malawi. Nutrition Journal 2019;18(1):51. doi: 10.1186/s12937-019-0477-8

Welch C, Wong CK, Lelijveld N, Kerac M, Wrottesley SV. Adolescent pregnancy is associated with child undernutrition: Systematic review and meta-analysis. Matern Child Nutr 2024;20(1):e13569. doi: 10.1111/mcn.13569 [published Online First: 20231002]

Chileshe V, Kamiya Y. The association between single motherhood and child undernutrition in Zambia: analysis of the 2007, 2013-14 and 2018 Demographic and Health Surveys. BMC Public Health 2025;25(1):1439. doi: 10.1186/s12889-025-22651-1

Wemakor A, Garti H, Azongo T, Garti H, and Atosona A. Young maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana. BMC Research Notes 2018;11(1):877. doi: 10.1186/s13104-018-3980-7

Gbratto-Dobe SAW, Segnon HB. Is mother's education essential to improving the nutritional status of children under five in Côte d′Ivoire? SSM - Health Systems 2025;4:100056. doi: https://doi.org/10.1016/j.ssmhs.2025.100056

Yorke FR, Wahab S, Turkson D. Maternal education and child malnutrition: evidence from selected West African countries. SN Social Sciences 2023;3(12):200. doi: 10.1007/s43545-023-00792-7

Poda GG, Hsu C-Y, Chao JC-J. Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010. International Journal for Quality in Health Care 2017;29(7):901–08. doi: 10.1093/intqhc/mzx129

Hossain MB, Khan MHR. Role of parental education in reduction of prevalence of childhood undernutrition in Bangladesh. Public Health Nutr 2018;21(10):1845–54. doi: 10.1017/s1368980018000162 [published Online First: 20180219]

Gebregergis CM. Socioeconomic determinants of child malnutrition: Evidence from Ethiopia. Discover Global Society 2024;2(1):47. doi: 10.1007/s44282-024-00062-8

Adamou H, Naba G, Koné H. Socioeconomic inequalities in underweight children: a cross-sectional analysis of trends in West Africa over two decades. BMJ Open 2024;14(2):e074522. doi: 10.1136/bmjopen-2023-074522.

Refbacks

  • There are currently no refbacks.