RISK-FACTORS FOR CLINICAL MARASMUS - A CASE-CONTROL STUDY OF BANGLADESHI CHILDREN

A case-control study of risk factors of clinical marasmus was undertaken to guide intervention efforts in rural Bangladesh. Cases were children whose mid-upper arm circumference measured <1 10 mm and controls were children matched for age and sex with arm circumference >120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied. The effects of various demographic, socioeconomic, environmental, and health factors, reported by mothers, were investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio [OR] = 2.51; 95% confidence interval [CI]: 1.33-4.74), and children who consumed formula foods (OR = 16.41, 95% CI : 3.39-79.36). Higher maternal education was associated with reduced risk of marasmus, compared with no education, the OR for <5 years of schooling = 0.57, 95% CI : 0.23-1.41; OR for greater-than-or-equal-to 5 years of schooling = 0.34, 95% CI : 0. 15-0.76. The strong association of child hood marasmus with mother's education and child spacing supports the notion that non-nutritional factors should be essential components of efforts to reduce severe malnutrition in Bangladesh.