Inappropriate feeding practices as a risk factor for severe acute malnutrition in children aged between one month to five years: a case control study

Deepak D. H.


Background: In developing country like India, inappropriate feeding practices like lack of exclusive breastfeeding, early or late introduction of complimentary diet, lack of direct breastfeeding, prelacteal feed, bottle feeding are the major risk factors for development of severe acute malnutrition in children aged between one month to five years.

Methods: It was a case control study, 109 children aged between one month to five years with severe acute malnutrition (SAM) who fulfilled the WHO criteria for SAM admitted to KIMS Hubli were taken as cases and 109 children aged between one month to five years without SAM admitted to KIMS Hubli were taken as control, the data gathering tool was questionnaire of children and mother. Data were entered and analysed using SPSS software version 11. Proportions were compared using Chi square (χ2) test of significance, categorical variables were assessed using χ2. Odds ratio (OR) and 95% confidence interval (CI) were calculated. To estimate the independent effect of the factors that were significantly associated with SAM and to control the confounding effect they may have on each other, logistic regression analysis was done. In all the above test the p value of less than 0.05 was accepted as indicating statistical significance.

Results: In the study lack of EBF (exclusive breastfeeding), DBF (direct breastfeeding), h/o prelacteal feeds, h/o bottle feed and late initiation of complimentary diet >6 months were significantly associated with SAM (p value less than 0.05).

Conclusions: The findings of this study clearly establishes the association of SAM with inappropriate infant feeding practices prevailing in our country.


SAM, EBF, DBF, Complementary diet, Prelacteal feed

Full Text:



IntechOpen. Fact sheet: Childhood malnutrition in India, perspective of recent advances in acute diarrhea. Available at: Accessed on 13 November 2021.

Grebmer KV, Bernstein J, Mukerji R, Patterson F, Wiemers M, NíChéilleachair R, et al. 2019 Global hunger index: the challenge of hunger and climate change. Dublin: Concern Worldwide; 2019.

Ministry of Health and Family Welfare. Factsheet: National Family Health Survey IV. 2015-2016. Available at: Accessed on 13 November 2021.

Jamro B, Junejo AA, Lal S, Bouk GR, Jamro S. Risk factors for severe acute malnutrition in children under the age of five year in Sukkur. Pak J Med Res. 2012;51(4):111-3.

Haidar J, Abate G, Kogi-Makau W, Sorensen P. Risk factors for child under-nutrition with a human rights edge in rural villages of North Wollo, Ethiopia. East Afr Med J. 2005;82(12):625-30.

Rikimaru T, Yartey JE, Taniguchi K, Kennedy DO, Nkrumah FK. Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutri Sci Vitaminol (Tokyo). 1998;44(3):391-407.

Jeyaseelan L, Lakshman M. Risk factors for malnutrition in south Indian children. J Biosoc Sci. 1997;29(1):93-100.

Islam MA, Rahman MM, Mahalanabis D. Maternal and socioeconomic factors and risk of severe malnutrition in a child: a case-control study. Eur J Clin Nutr. 1994;48(6):416-24.

Gragnolati M, Shekar M, Gupta MD, Bredenkamp C, Lee YK. India’s undernourished children: a call for reform and action. Washington DC: The International Bank for Reconstruction and Development/The World Bank; 2005.

WHO. Factsheet: Guideline: Updates on the management of severe acute malnutrition in infants and children, 2013. Available at: Accessed on 13 November 2021.

WHO. Community-based management of severe acute malnutrition: a joint statement. Geneva : World Health Organization, World Food Programme, United Nations System Standing Committee on Nutrition and The United Nations Children’s Fund, 2007.

Ramachandran P, Gopalan HS. Assessment of nutritional status in Indian preschool children using WHO 2006 Growth Standards. Indian J Med Res. 2011;134(10:47-53.

Sahu SK, Kumar SG, Bhat BV, Premarajan KC, Sarkar S, Roy G, et al. Malnutrition among under-five children in India and strategies for control. J Nat Sci Biol Med. 2015;6(1):18-23.

Scherbaum V, Srour ML. The role of breastfeeding in the prevention of childhood malnutrition. World Rev Nutr Diet. 2016;115:82-97.

Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiopian J Health Develop. 2008;2(2).

Inayati DA, Scherbaum V, Purwestri RC, Hormann E, Wirawan NN, Suryantan J, et al. Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia. Int Breastfeed J. 2012;7(1):3.

Wang X, Wang Y, Kang C. Feeding practices in 105 counties of rural China. Child Care Health Dev. 2005;31(4):417-23.

Kumar D, Goel NK, Mittal PC, Misra P. Influence of infant-feeding practices on nutritional status of under-five children. Indian J Pediatr. 2006;73(5):417-21.

MEASURE DHS. Haiti. DHS 2012. 2012 mortality, morbidity, and service utilization survey. IHE-Haitian Childhood Institute; 2013.

Lamberti LM, Zakarija-Grkovic I, Walker CL, Theodoratou E, Nair H, Campbell H, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health. 2013;13(3):18.

Field CJ. The immunological components of human milk and their effect on immune development in infants. J Nutr. 2005;135(1):1-4.

Oddy W, McHugh MF. The impact of infant feeding on later metabolic health. In: Watson RR, Grimble G, Preedy VR, Zibadii S, eds. Nutrition in Infancy Nutrition and Health. New York: Springer Science Business Media; 2013: 221-37.

Li R, Fein SB, Grummer-Strawn LM. Do infants fed from bottles lack selfregulation of milk intake compared with directly breastfed infants? Pediatrics. 2010;125(6):1386-93.

Bloss E, Wainaina F, Bailey RC. Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya. J Trop Pediatr. 2004;50(50):260-70.

World Health Assembly Resolution. Infant and young child nutrition. WHA. 2001.Available at: Accessed on 3 August 2021