Risk factors for severe acute malnutrition in under-five children attending nutritional rehabilitation centre of tertiary teaching hospital in Karnataka: a case control study

M. R. Prashanth, Savitha M. R., Prashantha B.


Background: To determine and analyse the risk factors leading to severe acute malnutrition (SAM) in children under 5 years of age attending nutritional rehabilitation centre of our hospital.

Methods: This questionnaire based case control study was conducted from January 2016 to December 2016 on SAM children. For comparison children attending outpatient department without any evidence of malnutrition were included. These SAM children were admitted to the nutritional rehabilitation centre of Cheluvamba Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka.

Results: A total of 103 SAM cases were compared with 100 controls. The sociodemographic risk factors were age less than 2 yrs, more family members (55.3% had 5 to 8 members), Birth spacing less than 2 years (39.8%), open air defecation (37.9%) and living in kucha house (32%). The dietary risk factors which were statistically significant were poor appetite (33%), prelacteal feed (19.4%), lack of exclusive breast feeding (42.7%), discontinuing breast feed before 2 years (74.8%), receiving complementary feed before 6 months (67%), bottle feeding (32%), calorie deficit (79.6%), protein deficit (66%) and feeding difficulty (17.5%).

Conclusions: The social risk factors identified in this study were large family size, low income, more number of siblings and living standards like type of house, open air defecation. The nutritional risk factors were giving prelacteal feed, not giving exclusive breast feeding until 6 months, starting complementary feed before 6 months and giving food low in calories and protein.


Risk factors, Severe acute malnutrition

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WHO, WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight for-height and body mass index-for-age: Methods and development; 2006. Available from;

National Family Health Survey NFHS-4 India 2015-16, International Institute for Population Sciences (IIPS) Mumbai: India. Available from;

Mishra K, Kumar P, Basu S, Rai K, Aneja S. Risk Factors for severe acute malnutrition in children below 5 y of age in India: a case control study. Indian J Pediatr. 2014;81(8):762-5.

Joyce K. Kikafunda, Ann F. Walker, David Collett, Tumwine JK. Risk factors for early childhood malnutrition in Uganda. Pediatrics. 1998;102;e45.

Shamsir AAM, Ahmed T, Roy SK, Alam N, Hossain I. Determinants of undernutrition in children under 2 years of age from rural Bangladesh. Indian Pediatr. 2012;49:821-4.

Basit A, Nair S, Chakraborthy KB, Darshan BB, A Kamath Kasturba Medical College-Manipal, Manipal University. Risk factors for under-nutrition among children aged one to five years in Udupi taluk of Karnataka. Ind Austral Medic J. 2012;5(3):163-7.

Sakisaka K, Wakai S, Kuroiwa C. Nutritional status and associated factors in children aged 0-23 months in Granada, Nicaragua. Public Health. 2006;120(5):400-11.

State of world’s children; 2009. Available form;

Henry FJ, Briend A, Fauveau V, Huttly SR, Yunus M, Chakraborty J. Risk factors for clinical marasmus: a case-control study of Bangladesh children. Int J Epidemiol. 1993;22(2):278-83.

Odunayo SI, Oyewole AO. Risk factors for malnutrition among rural Nigerian children. Asia Pac J. 2006;15(4):491-5.

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

Savage King. Helping Mothers to Breastfeed. Revised Edition. Nairobi AMREF; 1992. Available from; Accessed April 20, 2017.

Wang X, Wang Y, Kang C. Feeding practices in105 counties of rural China. Child Care Health Dev. 2005;31(4):417-23.

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 54.2, 2001. Available from;

Ethiopia Demographic and health Survey 2005, 2006. Central Statistical Agency Addis Ababa, Ethiopia, ORC Macro Calverton, Maryland, USA. Available at