Mathosi Meshack Mzamani, Cele Lindiwe Priscilla, Mathibe Mmampedi, Modjadji Perpetua
Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa.
Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa.
Nutrients. 2025 Jun 18;17(12):2038. doi: 10.3390/nu17122038.
BACKGROUND/OBJECTIVES: Despite ongoing national interventions, pockets of acute malnutrition persist in rural settings of South Africa, contributing to disproportionate rates of child morbidity and mortality. This study aimed to identify risk factors associated with acute malnutrition among under-five children attending primary healthcare facilities in Msinga, KwaZulu-Natal Province, with a specific focus on dietary diversity and selected infant and young child feeding indicators.
A cross-sectional, facility-based study was conducted among 415 mother-child pairs attending five randomly selected PHC facilities in the Msinga sub-district. Participants were selected using a multistage sampling design from a sampling frame of 18,797 under-five children. Of the 551 mother-child pairs approached; the final analytic sample comprised 415 observations. Data were collected through structured interviews, anthropometric assessments, and dietary diversity scores (DDS). Data were analyzed using Stata 18, and Poisson regression was applied to identify risk factors.
The prevalence of acute malnutrition was 29% based on weight-for-height/length z-scores (WHZ/WLZ) and 27% based on mid-upper-arm circumference z-scores (MUACZ). Children aged ≥36 months had significantly higher prevalence of acute malnutrition (aPR = 1.62; 95% CI: 1.15-2.10). Children from households with five or more members had reduced risk (aPR = 0.66; 95% CI: 0.45-0.74), and those born full-term showed a strong protective association (aPR = 0.39; 95% CI: 0.23-0.64). Maternal age was associated with reduced risk, with children of mothers aged 25-34 years (aPR = 0.67; 95% CI: 0.48-0.93) and ≥35 years (aPR = 0.58; 95% CI: 0.35-0.84) experiencing significantly lower prevalence. Mixed feeding was significantly associated with reduced risk (aPR = 0.86; 95% CI: 0.55-1.17), while a DDS ≥4 was protective (aPR = 0.41; 95% CI: 0.04-0.84). Consumption of protein-rich foods was notably low, with only 21% consuming flesh foods and 10% consuming eggs.
Acute malnutrition in under-five children was significantly associated with poor diet quality, older age, low household income, and mixed feeding practices. Protective factors included full-term pregnancy, larger households, older maternal age, and adequate dietary diversity, highlighting the importance of targeted, multisectoral interventions.
背景/目的：尽管南非一直在进行全国性干预，但急性营养不良现象在南非农村地区依然存在，导致儿童发病率和死亡率过高。本研究旨在确定夸祖鲁-纳塔尔省姆辛加地区初级医疗保健机构中五岁以下儿童急性营养不良的相关风险因素，特别关注饮食多样性以及选定的婴幼儿喂养指标。
在姆辛加分区随机选择的五家初级医疗保健机构中，对415对母婴进行了一项基于机构的横断面研究。参与者是从18797名五岁以下儿童的抽样框架中采用多阶段抽样设计选取的。在接触的551对母婴中，最终分析样本包括415份观察数据。通过结构化访谈、人体测量评估和饮食多样性评分（DDS）收集数据。使用Stata 18进行数据分析，并应用泊松回归来确定风险因素。
根据身高/身长体重Z评分（WHZ/WLZ），急性营养不良的患病率为29%；根据上臂中部周长Z评分（MUACZ），患病率为27%。36个月及以上的儿童急性营养不良患病率显著更高（aPR = 1.62；95%CI：1.15 - 2.10）。来自五口及以上家庭的儿童风险降低（aPR = 0.66；95%CI：0.45 - 0.74），足月出生的儿童显示出很强的保护关联（aPR = 0.39；95%CI：0.23 - 0.64）。母亲年龄与风险降低有关，母亲年龄在25 - 34岁的儿童（aPR = 0.67；95%CI：0.48 - 0.93）和35岁及以上的儿童（aPR = 0.58；95%CI：0.35 - 0.84）患病率显著较低。混合喂养与风险降低显著相关（aPR = 0.86；95%CI：0.55 - 1.17），而饮食多样性评分≥4具有保护作用（aPR = 0.41；95%CI：0.04 - 0.84）。富含蛋白质食物的摄入量明显较低，只有21%的儿童食用肉类，10%的儿童食用蛋类。
五岁以下儿童的急性营养不良与饮食质量差、年龄较大、家庭收入低和混合喂养方式显著相关。保护因素包括足月妊娠、家庭规模较大、母亲年龄较大和充足的饮食多样性，突出了有针对性的多部门干预措施的重要性。
