Malnutrition in Children Under Five Years in a Squatter Settlement of Karachi; a Case-control Study

Background: Multidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have linked malnutrition strongly to poverty. Some international studies point to worse nutritional status of urban slum children compared to rural children. Not much data is available regarding the nutritional status of slums’ children in Karachi. This study aims to find characteristics of malnourished children in an urban squatter settlement of Karachi, Pakistan. Methods: A Case- Control study was done in the primary healthcare centre of a squatter settlement of Karachi, Pakistan. All children under five years visiting the primary healthcare centre were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. Controls were similar age group and but had z scores between -2SD and +2SD. Face to face interviews were carried out with the mothers included information about socio-demographic, economic and environmental and child related characteristics. Univariate and multivariate logistic regression were conducted. Crude and adjusted odds ratio were calculated with 95% confidence interval. Results: A total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion originated from low household income. After adjusting for all confounders, childhood malnutrition was significantly associated with low education of father (aOR 4.86, 95% CI 2.23-10.60), monthly income less than 25,000 PKR a month (aOR 7.13, 95% CI 1.67-30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67-7.3), less than six months exclusive breast feeding (aOR 3.578, CI (1.58-8.08), inappropriate weaning age (aOR3.71, 95% CI 1.53-9) Conclusion: Malnutrition in under five children of the community is associated with low family income, low paternal education, and poor toilet facilities as well as inappropriate breast feeding and weaning practices. Implementation of poverty reduction programmes and sanitation provision at affordable rates is needed. A community-based breast feeding and weaning education intervention is urgently needed to efficiently improve child nutritional status.