Prevalence and associated factors for malnutrition among children under 6 years of age in Hunan province

Objective: To analyze the prevalence and associated factors of malnutrition among children under 6 years of age in Hunan province. Methods: This study was a cross-sectional study. A combination of multistage stratified cluster sampling and systematic sampling approach was used to recruit 10 442 children aged 0-71 months from 144 communities (villages) across 48 streets(towns) in 24 districts(counties) from Hunan province between August and November 2019. Data concerning the children and their mothers, caregivers, and family conditions was collected using unified questionnaire, with the lengths/heights and weights of the children being measured using unified instruments. The length/height for age, weight for age, weight for length/height, and body mass index for age Z scores were calculated and used to evaluate the prevalence of children's stunting, underweight, and wasting. The chi-square test was used to compare the prevalence of malnutrition among children with different characteristics. The multivariate Logistic regression model was used to conduct multivariate analysis for childrens' malnutrition. Results: The prevalence of protein-energy malnutrition (PEM) among children under 6 years of age was 6.8% (710/10 442), and the prevalence of stunting, underweight, and wasting were 3.1% (328/10 442), 2.7% (280/10 442), and 3.3% (343/10 442), respectively. Rural areas (OR=1.60), older age of children (compared with children of 0-11 months, the OR for 12-23, 24-35, 36-47, 48-59, and 60-71 months were 1.42, 1.75, 1.55, 1.70, and 1.88, respectively), low birth weight (OR=2.72), caregivers of minority ethnicity (OR=1.95), and large family size (OR=1.25) were risk factors for children's PEM. Rural areas and low birth weight were risk factors for stunting in children (OR=2.13 and 3.28). Rural areas, low birth weight, caregivers of minority ethnicity, and large family size were risk factors for underweight in children (OR=2.57, 3.34, 1.86, and 1.32). Rural areas (OR=1.43), older age of children (compared with children of 0-11 months, the OR for 24-35, 36-47, 48-59, and 60-71 months were 1.63, 1.80, 1.84 and 2.17, respectively), low birth weight (OR=2.36), caregivers of minority ethnicity (OR=2.88), and large family size (OR=1.42) were risk factors for children's wasting. Higher education level of caregivers was a common protective factor for PEM, stunting, and underweight (OR=0.85, 0.76, and 0.82). Conclusions: The prevalence of stunting, underweight, and wasting among children under 6 years of age in Hunan province were all at a low level. Nevertheless, the urban-rural differences still existed, with these prevalence being affected by children age, birth weight, ethnicity of caregivers, education level, and family size.