Primary Health Care providers’ adherence to child growth monitoring protocols and prevalence and predictors of stunting, wasting and underweight among children aged 5-17 months residing in Yerevan

Abstract

Introduction: Malnutrition is defined as deficiency, excess or imbalance in energy, protein or other nutrients which can result from insufficient or poorly balanced food intake, defective digestion or assimilation of food. Both undernutrition and overnutrition are considered as malnutrition leading to numerous health problems: poor cognitive development, restricted growth and even death. The main indicators measuring undernutrition are: stunting, wasting, and underweight. In 2005, stunting, severe wasting, and low birth weight (LBW) were found to be the main reasons of morbidity and mortality among children under five years of age causing 2.1 million deaths and 91.0 million disability-adjusted life years loss (DALYs) worldwide. The prevalence of undernutrition is globally declining; however, it still remains a major public health problem in many low and middle income countries. Objective: The aims of this study were 1) to identify the proportion of properly recorded child growth screenings and to define the prevalence of undernutrition, and 2) to explore the main risk factors of stunting, wasting, and underweight among 5-17 months old children residing in Yerevan, Armenia. Method: The study utilized a cross-sectional study design to identify the proportion of properly recorded child growth screenings and the prevalence of stunting, wasting, and underweight. For that purpose the study reviewed the ambulatory charts of 570 children aged 5-17 months. Then, the study utilized a case-control design for identifying the main risk factors of undernutrition defined as a single presence or any combination of stunting, wasting, and underweight. A total of 107 cases were identified during the record review and 107 controls were matched with the cases by age and gender from the same pool of reviewed records. The study performed binary and multiple conditional logistic regression analyses to test the associations between undernutrition and its possible determinants, while controlling for the potential confounders. Results and discussion: According to the data collected through medical record review, the prevalence of underweight, stunting and wasting in the studied sample were 7.3%, 17.9%, and 3.1%, respectively. These data were comparable with the Armenian Demographic and Health Survey 2010 preliminary findings. The proportion of properly recorded screenings in the age to weight percentiles (to detect underweight) was 60.7%, in the height to age percentiles (to detect stunting) 60% and in the weight to height percentiles (to detect wasting) 26.8%. The study revealed that these percentages could be much higher, because in most cases (91.4%) the screenings were conducted, but the recordings were not done accurately or not done at all. The study team reached mothers of 89 cases and 89 controls and conducted telephone interviews with them. This study discovered that undernutrition status of children aged 5-17 months in Yerevan was associated with low birth height of the child, low SES of the family, not diverse diet of the child, and short duration of predominant breastfeeding. Conclusion and recommendations: The study revealed that the proportion of recordings of child growth data in child growth percentiles was low. The reasons for not compliance to the existing protocols need to be explored and addressed in the future. The study findings suggest that the factors determining the growth patterns of children in Yerevan are mostly environmental. Thus, improvements in social and economic spheres, child nutrition, breastfeeding promotion, and pregnancy management could be power tools improving the health status of children.