Ndovie Patrick, Geresomo Numeri, Nkhata Smith G, Pakira Lydia, Chabwera Macdonald, Millongo Faith, Nyau Vincent
Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi; Department of Agriculture and Food Systems, Natural Resources College, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
Nutrition. 2025 Aug 5;141:112922. doi: 10.1016/j.nut.2025.112922.
Undernutrition remains a critical public health issue in Malawi, disproportionately affecting children under the age of 5 years. Factors such as religious affiliation and ethnicity are often overlooked in understanding the drivers of malnutrition. This study aims to explore the association between these sociocultural determinants and the nutritional status of under-five children in Malawi, using data from the 2015-2016 Malawi Demographic and Health Survey (MDHS). It is hypothesised that children from certain religious affiliations and ethnic groups have a higher prevalence of undernutrition due to differences in cultural practices, dietary habits, and access to healthcare.
The study sampled 4742 children aged 6 to 59 months derived from the Children's Record (KR) file in the MDHS document. Nutritional status was assessed using anthropometric indicators, including weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z-scores. Undernutrition outcomes, namely: stunting, wasting, and underweight were classified based on World Health Organization (WHO) standards. Independent variables included religious affiliation, ethnicity, occupation, household size and residency. Data analysis was conducted using Stata version 17, employing descriptive statistics, bivariate analyses, and multivariate regression to determine associations between undernutrition and the selected predictors with a significance level set at P < 0.05.
From the descriptive analysis, the study found that among 4742 Malawian children (mean age 31.8 ± 15.5 months; ∼50% male), 36.0% were stunted, 12.5% underweight, and 3.1% wasted. Multivariate analysis indicated that gender was not a significant factor. Urban residence reduced stunting (AOR = 0.57, P < 0.001, 95% CI: 0.48-0.68) and underweight (AOR = 0.65, P = 0.002, 95% CI: 0.50-0.85). Children from households where the head completed primary (AOR = 0.80, P = 0.014), secondary (AOR = 0.56, P < 0.001), or tertiary education (AOR = 0.20, P < 0.001) had lower malnutrition risk. Secondary (AOR = 0.61, P = 0.001) and tertiary education (AOR = 0.35, P = 0.046) reduced wasting. Stunting was higher among Chewa (AOR = 1.33, P = 0.064), while Tonga had reduced wasting (AOR = 0.38, P = 0.043) and underweight (AOR = 0.15, P = 0.084). Children aged 24 to 47 months showed increased stunting. Birthweight >2.5kg reduced stunting (AOR = 0.57), underweight (AOR = 0.41), and wasting (AOR = 0.48). Larger households (3-5: AOR = 0.31; 6-10: AOR = 0.31; >10: AOR = 0.41) had lower odds of wasting.
Undernutrition, particularly stunting, is prevalent among children. Factors such as being male, urban residency, maternal education, and ethnic background (e.g., Chewa and Yao) influence nutrition. Cultural dietary practices, food taboos, and religious beliefs may also contribute to stunting, notably among Catholic, SDA, and Anglican households.
营养不良仍是马拉维一个关键的公共卫生问题，对5岁以下儿童的影响尤为严重。在理解营养不良的驱动因素时，宗教信仰和种族等因素常常被忽视。本研究旨在利用2015 - 2016年马拉维人口与健康调查（MDHS）的数据，探讨这些社会文化决定因素与马拉维5岁以下儿童营养状况之间的关联。据推测，由于文化习俗、饮食习惯和获得医疗保健的差异，某些宗教信仰和种族群体的儿童营养不良患病率较高。
该研究从MDHS文件中的儿童记录（KR）文件中抽取了4742名年龄在6至59个月的儿童作为样本。使用人体测量指标评估营养状况，包括年龄别体重（WAZ）、年龄别身高（HAZ）和身高别体重（WHZ）z评分。根据世界卫生组织（WHO）标准对营养不良结果，即发育迟缓、消瘦和体重不足进行分类。自变量包括宗教信仰、种族、职业、家庭规模和居住情况。使用Stata 17版进行数据分析，采用描述性统计、双变量分析和多变量回归来确定营养不良与选定预测因素之间的关联，显著性水平设定为P < 0.05。
从描述性分析中，研究发现，在4742名马拉维儿童（平均年龄31.8 ± 15.5个月；约50%为男性）中，36.0%发育迟缓，12.5%体重不足，3.1%消瘦。多变量分析表明，性别不是一个显著因素。城市居住降低了发育迟缓（调整后比值比[AOR] = 0.57，P < 0.001，95%置信区间[CI]：0.48 - 0.68）和体重不足（AOR = 0.65，P = 0.002，95% CI：0.50 - 0.85）的发生率。户主完成小学教育（AOR = 0.80，P = 0.014）、中学教育（AOR = 0.56，P < 0.001）或高等教育（AOR = 0.20，P < 0.001）家庭的儿童营养不良风险较低。中学教育（AOR = 0.61，P = 0.001）和高等教育（AOR = 0.35，P = 0.046）降低了消瘦的发生率。契瓦族儿童发育迟缓发生率较高（AOR = 1.33，P = 0.064），而汤加族儿童消瘦（AOR = 0.38，P = 0.043）和体重不足（AOR = 0.15，P = 0.084）的发生率较低。24至47个月大的儿童发育迟缓发生率增加。出生体重>2.5kg降低了发育迟缓（AOR = 0.57）、体重不足（AOR = 0.41）和消瘦（AOR = 0.48）的发生率。较大的家庭（3 - 5人：AOR = 0.31；6 - 10人：AOR = 0.31；>10人：AOR = 0.41）消瘦的几率较低。
营养不良，尤其是发育迟缓，在儿童中普遍存在。男性、城市居住、母亲教育程度和种族背景（如契瓦族和瑶族）等因素会影响营养状况。文化饮食习惯、食物禁忌和宗教信仰也可能导致发育迟缓，特别是在天主教、基督复临安息日会和圣公会家庭中。
