Exploring the determinants of undernutrition among children aged 6-59 months old in Malawi: Insights on religious affiliation, ethnicity, and nutritional status using the 2015-2016 Malawi demographic and health survey.

INTRODUCTION

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.

METHODS AND MATERIALS

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.

RESULTS

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.

CONCLUSION

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.