Risk factors for undernutrition of young children in a rural area of South Africa

Objective: To identify the factors associated with childhood undernutrition. Design: Cross-sectional survey. Setting: Hlabisa health district in KwaZulu/Natal, South Africa. Subjects: Eight hundred and sixty-eight children aged 3-59 months. Methods: Questionnaire survey and anthropometric survey of 516 random households with children in the health district. Multivariate analysis took into account the hierarchical relationships between the proposed risk factors. This conceptual model was built up during qualitative studies and with reference to international research in this area. Results: The mean Z-scores for weight-for-age and height-for-age were -0.52 (95% confidence interval (CI) -0.44 to -0.60) and -1.25 (95% CI -1.15 to -1.35), respectively. Of the children, 26.3% (95% CI 23.3-29.3%) were stunted, 12.0% (95% CI 9.8-4.2%) were underweight-for-age (UWFA) and only 1.3% were wasted. Migrant father, mother's education, literate mother, whether the house was made of traditional materials, the presence of a toilet, whether the last child was breast-fed, duration of breast-feeding and birth weight were found to be significantly related to UWFA, the latter with an odds ratio of more than eight. Conclusion: While there are individual health and feeding behaviours that need to be addressed, this study has also uncovered the maternal and socio-economic factors which present an array of constraints in the social environment shaping the infant feeding and caring practices employed by women. For the full potential of nutrition promotion activities to be realised, there is a need to address some of these 'deeper' constraints.