Factors associated with severe acute malnutrition among children aged 6 to 24 months at the Regional Hospital Center (CHR) of Maradi: a case-control study

Factors associated with severe acute malnutrition among children aged 6 to 24 months at the Regional Hospital Center (CHR) of Maradi: a case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with severe acute malnutrition among children aged 6 to 24 months at the Regional Hospital Center (CHR) of Maradi: a case-control study S I ALKASSOUM, Z ABDOULAYE, O AMADOU, S DJIBO, A GONI, T EMOUD, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6972889/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Severe acute malnutrition (SAM) remains a major public health challenge in Niger, especially in the Maradi region where prevalence exceeds WHO alert thresholds. Objective: To identify factors associated of SAM among children aged 6 to 24 months admitted to the Pediatric Department II of the Regional Hospital Center of Maradi. Methods: A case-control study was conducted from November 2023 to March 2024, including 228 children: 114 cases (SAM) and 114 controls (moderate acute malnutrition). Data were collected using KoboCollect and analyzed with SPSS 16.0. Multivariate logistic regression was used to identify independent predictors. Results: Low birth weight (aOR = 8.12; p = 0.039), low paternal education level (aOR = 3.46; p = 0.010), unsanitary room conditions (aOR = 3.36; p = 0.010), poor latrine hygiene (aOR = 6.05; p < 0.001), and family history of malnutrition (aOR = 6.51; p < 0.001) were identified as significant predictors of SAM. Conclusion: The findings highlight the critical role of socio-environmental factors in the development of SAM. Targeted interventions focusing on parental education, hygiene, and neonatal monitoring are essential to prevent child malnutrition in this vulnerable age group. Severe acute malnutrition Associated factors Children 6-24 months Mardi Niger Figures Figure 1 Figure 2 Introduction Severe acute malnutrition (SAM) is a major public health concern in low-income countries, particularly in sub-Saharan Africa. The World Health Organization (WHO) defines SAM as a serious nutritional deficiency characterized by a weight-for-height z-score below -3, a mid-upper arm circumference (MUAC) below 115 mm, or the presence of bilateral pitting edema (1). This condition leads to a weakened immune system, growth retardation, long-term cognitive impairments, and increased susceptibility to infections such as diarrhea and acute respiratory illnesses (2,3). Recent estimates indicate that SAM is implicated in nearly 45% of deaths among children under five in developing countries, highlighting its critical impact on child survival (4). The primary determinants of SAM include poverty, food insecurity, low maternal education, inadequate infant feeding practices, and poor environmental conditions (5–7). In Niger, the situation is particularly alarming. According to the 2022 Demographic and Health Survey (DHS), over 2.4 million children under five suffer from malnutrition, with a substantial proportion presenting with severe forms (8). The Maradi region, characterized by high population density, low healthcare coverage, and limited access to safe drinking water, is among the most affected areas in the country (9,10). Sociocultural practices such as early weaning, delayed introduction of complementary foods, and low rates of exclusive breastfeeding further exacerbate the nutritional crisis (11). Several national studies have identified risk factors associated with SAM, including low birth weight, absence of antenatal care, maternal undernutrition, and a family history of malnutrition (12,13). However, few studies have specifically examined predictive factors of SAM among children aged 6 to 24 months. This age range represents a critical window due to dietary transition and increased exposure to infectious agents, making it a particularly vulnerable period in child development (14,15). This study aims to identify the predictive factors of severe acute malnutrition among children aged 6 to 24 months admitted to the Regional Hospital Center (CHR) of Maradi, in order to inform targeted prevention and intervention strategies tailored to local contexts. Method Study Design This was an analytical case-control study conducted from November 2023 to March 2024. Study Site The study was carried out at the Intensive Nutritional Recovery Center (CRENI) of Pediatric Unit II, which manages cases of severe acute malnutrition (SAM) with complications. Patients are referred from health districts in urban Maradi and nearby rural areas. Maradi, located in southern Niger, is one of the country’s most affected regions, characterized by high population density, limited access to healthcare services, safe drinking water, and poor environmental sanitation. Study Population The target population consisted of children aged 6 to 24 months accompanied by their biological mothers. Cases: Children with SAM, defined according to WHO criteria as weight-for-height z-score < -3, mid-upper arm circumference (MUAC) < 115 mm, or presence of bilateral pitting edema. Controls: Children of the same age group from the same geographic area, presenting with moderate acute malnutrition (weight-for-height z-score between -3 and -2, or MUAC between 115 and 125 mm, without edema). Inclusion Criteria · Children aged 6 to 24 months admitted to the CRENI of Pediatric Unit II. · Informed and voluntary consent from the biological mother to participate in the survey. Exclusion Criteria · Children with severe congenital diseases or genetic disorders. Sample Size Sample size was estimated using OpenEpi software for case-control studies. Parameters included an assumed exposure prevalence of 15% among controls, a 5% type I error (α), and 80% statistical power. The final sample consisted of 228 children (114 cases and 114 controls). Data Collection Data were collected using a structured, pre-tested questionnaire administered through individual interviews with the mothers. The questionnaire captured information on: · Parental sociodemographic characteristics; · Infant feeding and nutritional practices; · Sanitary and hygiene conditions at the household level; · Child’s medical and familial history. Anthropometric measurements (weight, length/height, MUAC) were conducted following WHO standards. Data Analysis Data were entered using KoboCollect and analyzed with SPSS version 16.0. Descriptive statistics (means, standard deviations, and frequencies) were used to summarize variable characteristics. In the univariate analysis, qualitative variables were compared using the chi-square test, and quantitative variables using Student’s t-test. Associations were quantified using crude odds ratios (ORs) and 95% confidence intervals (CIs). A stepwise multivariate logistic regression was conducted to identify independent predictors of SAM. Only variables with p < 0.05 in the univariate analysis were included in the final model. Results are presented as adjusted odds ratios (aORs) with their 95% confidence intervals. Results Among the children surveyed, 64.9% of the cases were male. Children aged 6 to 11 months accounted for 15.8% of the cases and 31.6% of the controls. The majority of deliveries occurred in a health facility, with 81.6% for the cases and 88.6% for the controls. A birth weight below 2500 g was reported in 5.3% of the cases, compared to 0.9% among the controls. Regarding maternal characteristics, 38.6% of the case group had mothers under the age of 25, compared to 50% in the control group. As for nutritional status, 14% of the mothers of the cases were classified as underweight (BMI < 18.5), compared to 2.6% of the mothers of the controls. With respect to marital status, 90.4% of mothers of the cases were married, versus 93.9% among the controls. In terms of education, 74.6% of the mothers in the case group had no formal education, compared to 36.8% in the control group. Primary education was attained by 16.7% of the mothers of the cases, compared to 30.7% of the controls. Employment status showed that 43% of mothers in the case group were engaged in some form of income-generating activity, compared to 32.5% of the controls. In terms of parity, 69.3% of mothers of the cases had five or fewer children, while 30.8% had more than five children. Lastly, 71.1% of the cases resided in rural areas, compared to 40.2% of the controls (Table 1). Table 1 : Characteristics of mothers and children aged 6 to 24 months, CHR Maradi Variables Cases, n (%) Controls, n (%) Sex Male 74 (64.9) 68 (59.6) Female 40 (35.1) 46 (40.4) Age group (months) 6 - 11 18 (15.8) 36 (31.6) 12 - 17 36 (31.6) 42 (36.8) 18 - 24 60 (52.6) 36 (31.6) Place of delivery Health center 93 (81.6) 101 (88.6) Home / other 21 (18.4) 13 (11.4) Birth weight < 2500 g 6 (5.3) 1 (0.9) ≥ 2500 g 108 (94.7) 113 (99.1) Mother's age (years) 35 12 (10.5) 8 (7) BMI (Weight/Height²) Underweight ( 30) 1 (0.9) 0 (0) Mother's marital status Married 103 (90.4) 107 (93.9) Widow 5 (4.4) 4 (3.5) Divorced 6 (5.2) 3 (2.6) Mother's schooling Yes 29 (25.4) 72 (63.2) No 85 (74.6) 42 (36.8) Level of education Primary 19 (16.7) 35 (30.7) Secondary 8 (7) 26 (22.8) High school 2 (1.8) 9 (7.9) Higher 0 (0) 2 (1.8) Mother's occupation Employed 49 (43) 37 (32.5) Unemployed 65 (57) 77 (67.5) Parity ≤ 5 children 79 (69.3) 93 (81.6) > 5 children 35 (30.8) 21 (18.5) Residence Urban 33 (28.9) 67 (59.8) Rural 81 (71.1) 45 (40.2) The mean age of the children was significantly higher in the case group (17.2 ± 5.3 months) compared to the control group (14.8 ± 5.6 months; p = 0.0008). Similarly, children in the control group had a higher mean weight (8.1 ± 1.3 kg) than those in the case group (6.9 ± 1.2 kg; p < 0.001), as well as a significantly greater mean height (74.2 ± 5.8 cm vs. 70.4 ± 6.1 cm; p < 0.001). The mean BMI was also lower in the case group (13.8 ± 1.1) compared to the control group (14.7 ± 1.0; p < 0.001) (Table 2). Table 2 : Comparison of anthropometric characteristics between cases and controls Variables Cases (n = 114) Controls (n = 114) p-value Mean age (months) 17.2 ± 5.3 14.8 ± 5.6 0.0008 Mean weight (kg) 6.9 ± 1.2 8.1 ± 1.3 < 0.001 Mean height (cm) 70.4 ± 6.1 74.2 ± 5.8 < 0.001 Mean BMI (kg/m²) 13.8 ± 1.1 14.7 ± 1.0 < 0.001 The majority of the cases suffered from marasmus (75%), and 1% were classified as special cases (Figure 1). Table 3: Feeding Practices Among Children Aged 6 to 24 Months, CHR Maradi Variables Cases, n (%) Controls, n (%) Colostrum given at birth Yes 74 (64.9) 111 (97.4) No 40 (35.1) 3 (2.6) Breastfeeding status Currently breastfed 64 (56.1) 93 (81.6) Weaned 50 (43.9) 21 (18.4) Age at weaning ≤ 18 months 13 (26.0) 4 (19.0) > 18 months 37 (74.0) 17 (81.0) Type of breastfeeding Exclusive breastfeeding 16 (14.0) 59 (51.8) Mixed feeding 98 (86.0) 55 (48.2) Complementary feeding Yes 109 (95.6) 107 (93.9) No 5 (4.4) 7 (6.1) Age of introduction of complementary foods Before 6 months 64 (58.7) 23 (21.5) At 6 months 27 (24.8) 42 (39.3) After 6 months 18 (16.5) 42 (39.3) Meal frequency per day < 2 meals 28 (25.7) 23 (21.5) 2–3 meals 56 (51.4) 54 (50.5) More than 3 meals 25 (22.9) 30 (28.0) Dietary diversity Starches 109 (95.6) 107 (93.9) Legumes 30 (26.3) 73 (64.0) Fruits 35 (30.7) 56 (49.1) Animal-based products 20 (17.5) 30 (26.3) The intake of colostrum at birth was reported in 64.9% of cases compared to 97.4% of controls. At the time of the survey, 56.1% of the cases were still being breastfed versus 81.6% of the controls, while 43.9% of the cases had already been weaned compared to 18.4% of the controls. The age of weaning was over 18 months in 74% of the cases and 81% of the controls. Exclusive breastfeeding was practiced in 14% of the cases versus 51.8% of the controls. Complementary feeding had been introduced in 95.6% of the cases and 93.9% of the controls. Among them, 58.7% of the cases had received complementary foods before the age of 6 months, compared to 21.5% of the controls. Regarding meal frequency, 25.7% of the cases received fewer than two meals per day compared to 21.5% of the controls. In terms of dietary diversity, consumption of starchy foods was high in both groups (95.6% in cases versus 93.9% in controls). However, the consumption of legumes, fruits, and animal products was lower among the cases (26.3%, 30.7%, and 17.5%, respectively) compared to the controls (64%, 49.1%, and 26.3%) (Table 3). Table 4 : Factors Associated with Severe Acute Malnutrition (SAM) among Children Aged 6 to 24 Months, CHR Maradi Variables Cases, n (%) Controls, n (%) OR [95% CI] p-value Home delivery 59 (51.8) 13 (11.4) 1.12 [0.06 - 0.24] <0.1 Age at cessation of breastfeeding (≤ 18 months) 13 (26.0) 4 (19.0) 1.06 [0.29 - 3.86] 0.93 Introduction of complementary foods (before 6 months) 64 (58.7) 23 (21.5) 2.64 [1.83 - 3.82] <0.1 Moderate appetite 58 (50.9) 8 (7.0) 0.05 [0.02 - 0.20] 0.006 History of malnutrition among children 61 (53.5) 14 (12.3) 6.51 [3.06 - 13.87] <0.1 ANC visits < 3 70 (63.1) 52 (46.4) 1.97 [1.15 - 3.36] <0.001 Low birth weight 6 (5.3) 1 (0.9) 9.32 [1.10 - 43.57] <0.1 Maternal BMI (<18.5) 16 (14.0) 3 (2.6) 2.12 [1.06 - 4.43] 0.05 Maternal education level (Primary) 15 (13.2) 9 (7.9) 3.46 [1.67 - 7.15] 0.0007 Number of meals per day (<2) 28 (25.7) 23 (21.5) 1.21 [0.83 - 1.77] 0.33 Colostrum intake at birth 40 (35.1) 3 (2.6) 0.05 [0.015 - 0.17] <0.01 Latrine cleanliness (once per week) 54 (77.1) 9 (8.0) 6.05 [2.47 - 14.80] 0.0008 Place of residence (rural area) 81 (71.1) 45 (40.2) 3.66 [2.10 - 6.36] <0.0001 House compound cleaned < 2 times/day 113 (99.2) 78 (68.3) 52.15 [7.00 - 88.40] <0.1 Drinking water source (borehole) 49 (43.4) 11 (9.6) 0.09 [0.043 - 0.19] <0.00001 Child age group (6-11 months) 26 (22.8) 62 (54.3) 0.47 [0.29 - 0.58] <0.1 Use of mosquito nets (after childbirth) 43 (37.7) 22 (19.3) 1.00 [0.06 - 16.18] 1 Several factors were associated with the occurrence of severe acute malnutrition (SAM) among children aged 6 to 24 months. Moderate appetite was significantly less frequent among children with SAM, showing an inverse association (aOR = 0.04; 95% CI: 0.03–0.23; p = 0.03). Similarly, children aged 6 to 11 months had a lower likelihood of developing SAM compared to older children (aOR = 0.33; 95% CI: 0.17–0.68; p = 0.008). Conversely, several variables were positively associated with an increased risk of SAM. The presence of malnutrition cases among siblings was strongly associated with severe malnutrition in the index child (aOR = 7.32; 95% CI: 6.12–12.80; p = 0.006). A birth weight under 2,500 grams also significantly increased the risk of SAM (aOR = 8.16; 95% CI: 1.13–59.32; p = 0.039). Regarding maternal characteristics, a body mass index (BMI) below 18.5 was associated with more than a threefold increase in the risk of SAM in children (aOR = 3.21; 95% CI: 1.02–4.63; p = 0.002). Maternal education limited to primary level also emerged as an important predictive factor (aOR = 10.88; 95% CI: 1.22–15.15; p = 0.011). Residing in a rural area was significantly associated with SAM (aOR = 5.50; 95% CI: 3.10–7.63; p < 0.01). In addition, poor latrine hygiene - defined as cleaning only once per week - was associated with an increased risk of SAM (aOR = 1.11; 95% CI: 3.48–11.60; p < 0.001). Finally, poor domestic environmental hygiene, measured by cleaning the household surroundings less than twice a day, was also significantly associated with SAM (aOR = 3.36; 95% CI: 1.34–8.40; p = 0.010) (Table 4). In multivariate analysis, children with moderate appetite were significantly less likely to have SAM (aOR = 0.04; 95% CI: 0.03–0.23; p = 0.03). Likewise, children aged 6–11 months had a reduced risk of SAM compared to older children (aOR = 0.33; 95% CI: 0.17–0.68; p = 0.008). In contrast, several variables were positively associated with a higher risk of SAM. The presence of malnourished siblings was strongly linked to severe malnutrition (aOR = 7.32; 95% CI: 6.12–12.80; p = 0.006). A birth weight below 2500 grams also significantly increased the risk (aOR = 8.16; 95% CI: 1.13–59.32; p = 0.039). Among maternal characteristics, a body mass index (BMI) under 18.5 was associated with over a threefold increase in the risk of SAM (aOR = 3.21; 95% CI: 1.02–4.63; p = 0.002). Maternal primary education level also emerged as a significant predictive factor (aOR = 10.88; 95% CI: 1.22–15.15; p = 0.011). Living in rural areas was strongly associated with SAM (aOR = 5.50; 95% CI: 3.10–7.63; p < 0.01). Inadequate sanitation practices were also predictive of SAM. Poor latrine hygiene, defined as cleaning once per week, significantly increased the risk (aOR = 6.05; 95% CI: 3.48–11.60; p < 0.001). Lastly, suboptimal household environment cleanliness, defined as cleaning the house premises fewer than twice per day, was also significantly associated with SAM (aOR = 3.36; 95% CI: 1.34–8.40; p = 0.010) (Figure 2) . Discussion This study highlights the complexity of nutritional determinants in a Sahelian context marked by structural, social, and health-related vulnerabilities. Boys accounted for a slightly higher proportion among cases (64.9%) than controls (59.6%), consistent with previous observations indicating increased vulnerability of boys to severe forms of malnutrition in rural African areas, possibly due to biological and social differences in exposure to risk factors [16]. Children aged 18 to 24 months represented the majority of cases (52.6%), whereas controls were predominantly in the 6–11 month age group, suggesting an increased risk with age, potentially linked to weaning practices and prolonged exposure to deleterious environmental conditions [17]. In terms of perinatal factors, a low birth weight (< 2500 g) was observed in 5.3% of cases compared to 0.9% of controls, underscoring the importance of intrauterine nutrition. Moreover, a higher proportion of deliveries outside healthcare facilities was observed among cases (18.4%) than controls (11.4%), pointing to inequalities in access to obstetric care. Regarding maternal characteristics, mothers of cases were more often unschooled (74.6% vs. 36.8%) and predominantly resided in rural areas (71.1% vs. 40.2%), two factors known to negatively influence nutritional practices and access to health information [18]. Maternal BMI also revealed disparities, with 14% of case mothers classified as underweight (BMI < 18.5) compared to 2.6% of control mothers. Feeding practices showed lower rates of colostrum administration among cases (64.9% vs. 97.4%), reduced prevalence of exclusive breastfeeding (14% vs. 51.8%), and earlier introduction of complementary foods (58.7% before 6 months vs. 21.5%). In addition, children in the case group received a less diversified diet, especially in legumes, fruits, and animal products. These findings are consistent with WHO and FAO guidelines recommending timely and progressive introduction of complementary foods from 6 months, alongside breastfeeding [19]. Several factors were significantly associated with SAM, reflecting the multifactorial nature of the condition in resource-limited settings. Low birth weight emerged as a major risk factor (aOR = 8.16; 95% CI: 1.13–59.32; p = 0.039), corroborating findings from sub-Saharan and Central African studies indicating increased vulnerability to SAM among low birth weight infants[20,21]. This highlights the importance of prenatal care and maternal support as essential levers for prevention. Maternal undernutrition (BMI < 18.5) was also a significant predictor of SAM in children (aOR = 3.21; 95% CI: 1.02–4.63; p = 0.002), confirming the well-established link between maternal and child nutritional health. Underweight mothers not only have limited physiological reserves but also face challenges in sustaining exclusive breastfeeding. Large-scale analyses in 13 West African countries demonstrated that children born to underweight mothers had increased risks of stunting and underweight. Likewise, studies by Alaofè and Asaolu in Benin showed that maternal undernutrition significantly impacts child growth outcomes[ 22,23]. These findings underscore the importance of targeted nutritional interventions among women of reproductive age, particularly in rural and disadvantaged settings, to break the intergenerational cycle of malnutrition. Maternal education level was another strong predictor, with children of mothers who had only primary education facing a significantly higher risk of SAM (aOR = 10.88; 95% CI: 1.22–15.15; p = 0.011). Studies by Makoka and Masibo in Malawi, Tanzania, and Zimbabwe revealed that low maternal education was linked to higher levels of malnutrition, indicating a protective threshold effect only achieved beyond primary education [24]. Similarly, Fotso et al. in Kenya reported higher stunting rates among children of less educated mothers, emphasizing that maternal education plays a critical role in understanding nutritional needs, adopting proper feeding practices, and accessing health services [25 ]. Domestic hygiene was also significantly associated with SAM. Poor household sanitation, defined as cleaning the home compound fewer than twice per day, increased SAM risk (aOR = 3.36; 95% CI: 1.34–8.40; p = 0.01). Latrine cleanliness, when limited to once per week, was strongly linked to SAM (aOR = 6.05; 95% CI: 3.48–11.60; p < 0.001). These findings echo those from 3ie in West Africa, which found that children living in households with inadequate sanitation were more likely to suffer from malnutrition due to the high prevalence of diarrheal and parasitic diseases [26]. Oloruntoba et al.’s systematic review on WASH (Water, Sanitation, and Hygiene) practices in Africa also confirmed the predictive role of poor hygiene in childhood malnutrition [27]. Living in rural areas was another independent predictor of SAM (aOR = 5.50; 95% CI: 3.10–7.63; p < 0.01), likely reflecting poorer health service access and environmental conditions. This aligns with findings by Tadesse et al., who found rural residence significantly associated with higher SAM risk [28]. Finally, moderate appetite and younger age (6–11 months) appeared as protective factors, which should be interpreted cautiously. These children may have benefited from earlier healthcare engagement or less exposure to harmful weaning practices. Conclusion The results of this study show that SAM among children aged 6 to 24 months in Maradi is associated with a range of individual, maternal, and environmental factors. These findings highlight the intersection of socioeconomic vulnerability, inadequate nutritional practices, and poor environmental conditions. Addressing SAM requires a multisectoral approach that integrates improvements in living conditions, women’s empowerment, nutrition education, and hygiene promotion to sustainably reduce the prevalence of severe acute malnutrition in Niger. Declarations Ethics approval and consent to participate The study was submitted and approved by the National ethics committee (CNE) and is registered under “DELIBERATION N°25/2023/CNERS” Consent for publication Not applicable Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Competing interests The authors declare no competing interests Clinical trial number Not applicable Funding None Authors' contributions ASI was responsible for conceptual design and all authors were involved in data analysis. ASI drafted the manuscript and all authors revised and approved the final manuscript. ASI is the corresponding author and guarantor of the paper. Acknowledgements The authors thank the CHR de Maradi officers at the various levels especially those involved in the management of malnutrition. 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Trop Med Health. 2024 Oct 9;52(1):68. doi: 10.1186/s41182-024-00614-3. PMID: 39385262; PMCID: PMC11463047. Anchamo Anato. Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia. Heliyon 2022.e107.DOI: 10.1016/j. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6972889","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484512097,"identity":"950133ae-2951-46aa-a99a-15c20d91ac34","order_by":0,"name":"S I 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ADEHOSSI","email":"","orcid":"","institution":"Université Abdou Moumouni, FSS","correspondingAuthor":false,"prefix":"","firstName":"E","middleName":"","lastName":"ADEHOSSI","suffix":""}],"badges":[],"createdAt":"2025-06-25 09:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6972889/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6972889/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87028052,"identity":"b849aa32-b985-45e3-884b-b9d8bde7689b","added_by":"auto","created_at":"2025-07-18 12:29:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18160,"visible":true,"origin":"","legend":"\u003cp\u003edistribution of children aged 6 to 24 months according to the form of malnutrition, CHR Maradi\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6972889/v1/050448a71daf9bb7b8a367a2.png"},{"id":87028053,"identity":"c396a93a-1cc3-4296-b1b8-d2d0826cfe66","added_by":"auto","created_at":"2025-07-18 12:29:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":81718,"visible":true,"origin":"","legend":"\u003cp\u003eResults of multivariate logistic regression of factors associated with SAM among children aged 6 to 24 months, CHR of Maradi.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6972889/v1/8f04dc3eea1f40b39dbd5737.png"},{"id":87579680,"identity":"f4c391ee-125c-4276-99f1-771f909b9852","added_by":"auto","created_at":"2025-07-25 12:24:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":868876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6972889/v1/24df52ea-1cc5-4533-a3b4-a6e7b0c64ee2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors associated with severe acute malnutrition among children aged 6 to 24 months at the Regional Hospital Center (CHR) of Maradi: a case-control study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSevere acute malnutrition (SAM) is a major public health concern in low-income countries, particularly in sub-Saharan Africa. The World Health Organization (WHO) defines SAM as a serious nutritional deficiency characterized by a weight-for-height z-score below -3, a mid-upper arm circumference (MUAC) below 115 mm, or the presence of bilateral pitting edema (1). This condition leads to a weakened immune system, growth retardation, long-term cognitive impairments, and increased susceptibility to infections such as diarrhea and acute respiratory illnesses (2,3).\u003c/p\u003e\n\u003cp\u003eRecent estimates indicate that SAM is implicated in nearly 45% of deaths among children under five in developing countries, highlighting its critical impact on child survival (4). The primary determinants of SAM include poverty, food insecurity, low maternal education, inadequate infant feeding practices, and poor environmental conditions (5\u0026ndash;7).\u003c/p\u003e\n\u003cp\u003eIn Niger, the situation is particularly alarming. According to the 2022 Demographic and Health Survey (DHS), over 2.4 million children under five suffer from malnutrition, with a substantial proportion presenting with severe forms (8). The Maradi region, characterized by high population density, low healthcare coverage, and limited access to safe drinking water, is among the most affected areas in the country (9,10).\u003c/p\u003e\n\u003cp\u003eSociocultural practices such as early weaning, delayed introduction of complementary foods, and low rates of exclusive breastfeeding further exacerbate the nutritional crisis (11). Several national studies have identified risk factors associated with SAM, including low birth weight, absence of antenatal care, maternal undernutrition, and a family history of malnutrition (12,13).\u003c/p\u003e\n\u003cp\u003eHowever, few studies have specifically examined predictive factors of SAM among children aged 6 to 24 months. This age range represents a critical window due to dietary transition and increased exposure to infectious agents, making it a particularly vulnerable period in child development (14,15).\u003c/p\u003e\n\u003cp\u003eThis study aims to identify the predictive factors of severe acute malnutrition among children aged 6 to 24 months admitted to the Regional Hospital Center (CHR) of Maradi, in order to inform targeted prevention and intervention strategies tailored to local contexts.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was an analytical case-control study conducted from November 2023 to March 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Site\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out at the Intensive Nutritional Recovery Center (CRENI) of Pediatric Unit II, which manages cases of severe acute malnutrition (SAM) with complications. Patients are referred from health districts in urban Maradi and nearby rural areas. Maradi, located in southern Niger, is one of the country’s most affected regions, characterized by high population density, limited access to healthcare services, safe drinking water, and poor environmental sanitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe target population consisted of children aged 6 to 24 months accompanied by their biological mothers.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u003cstrong\u003eCases:\u003c/strong\u003e Children with SAM, defined according to WHO criteria as weight-for-height z-score \u0026lt; -3, mid-upper arm circumference (MUAC) \u0026lt; 115 mm, or presence of bilateral pitting edema.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Controls:\u003c/strong\u003e Children of the same age group from the same geographic area, presenting with moderate acute malnutrition (weight-for-height z-score between -3 and -2, or MUAC between 115 and 125 mm, without edema).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e· Children aged 6 to 24 months admitted to the CRENI of Pediatric Unit II.\u003c/p\u003e\n\u003cp\u003e· Informed and voluntary consent from the biological mother to participate in the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e· Children with severe congenital diseases or genetic disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size was estimated using OpenEpi software for case-control studies. Parameters included an assumed exposure prevalence of 15% among controls, a 5% type I error (α), and 80% statistical power. The final sample consisted of 228 children (114 cases and 114 controls).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a structured, pre-tested questionnaire administered through individual interviews with the mothers. The questionnaire captured information on:\u003c/p\u003e\n\u003cp\u003e· Parental sociodemographic characteristics;\u003c/p\u003e\n\u003cp\u003e· Infant feeding and nutritional practices;\u003c/p\u003e\n\u003cp\u003e· Sanitary and hygiene conditions at the household level;\u003c/p\u003e\n\u003cp\u003e· Child’s medical and familial history.\u003c/p\u003e\n\u003cp\u003eAnthropometric measurements (weight, length/height, MUAC) were conducted following WHO standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered using KoboCollect and analyzed with SPSS version 16.0. Descriptive statistics (means, standard deviations, and frequencies) were used to summarize variable characteristics. In the univariate analysis, qualitative variables were compared using the chi-square test, and quantitative variables using Student’s t-test. Associations were quantified using crude odds ratios (ORs) and 95% confidence intervals (CIs). A stepwise multivariate logistic regression was conducted to identify independent predictors of SAM. Only variables with p \u0026lt; 0.05 in the univariate analysis were included in the final model. Results are presented as adjusted odds ratios (aORs) with their 95% confidence intervals.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the children surveyed, 64.9% of the cases were male. Children aged 6 to 11 months accounted for 15.8% of the cases and 31.6% of the controls. The majority of deliveries occurred in a health facility, with 81.6% for the cases and 88.6% for the controls. A birth weight below 2500 g was reported in 5.3% of the cases, compared to 0.9% among the controls.\u003c/p\u003e\n\u003cp\u003eRegarding maternal characteristics, 38.6% of the case group had mothers under the age of 25, compared to 50% in the control group. As for nutritional status, 14% of the mothers of the cases were classified as underweight (BMI \u0026lt; 18.5), compared to 2.6% of the mothers of the controls.\u003c/p\u003e\n\u003cp\u003eWith respect to marital status, 90.4% of mothers of the cases were married, versus 93.9% among the controls. In terms of education, 74.6% of the mothers in the case group had no formal education, compared to 36.8% in the control group. Primary education was attained by 16.7% of the mothers of the cases, compared to 30.7% of the controls.\u003c/p\u003e\n\u003cp\u003eEmployment status showed that 43% of mothers in the case group were engaged in some form of income-generating activity, compared to 32.5% of the controls. In terms of parity, 69.3% of mothers of the cases had five or fewer children, while 30.8% had more than five children. Lastly, 71.1% of the cases resided in rural areas, compared to 40.2% of the controls \u003cstrong\u003e(Table 1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 :\u003c/strong\u003e Characteristics of mothers and children aged 6 to 24 months, CHR Maradi\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e74 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e68 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e40 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e46 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAge group (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;6 - 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e18 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e36 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;12 - 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e36 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e42 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;18 - 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e60 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e36 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePlace of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Health center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e93 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e101 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Home / other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e21 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e13 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt; 2500 g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026ge; 2500 g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e108 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e113 (99.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMother\u0026apos;s age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e44 (38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e57 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;25 - 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e58 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e49 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt; 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e12 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e8 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBMI (Weight/Height\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Underweight (\u0026lt; 18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e16 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Normal (18.5 - 24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e92 (80.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e106 (92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Overweight (25 - 29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e5 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Obesity (\u0026gt; 30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMother\u0026apos;s marital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e103 (90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e107 (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e5 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMother\u0026apos;s schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e29 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e72 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e85 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e42 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e19 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e35 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e8 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e26 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e9 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMother\u0026apos;s occupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e49 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e37 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e65 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e77 (67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026le; 5 children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e79 (69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e93 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt; 5 children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e35 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e21 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e33 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e67 (59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Rural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e81 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e45 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;The mean age of the children was significantly higher in the case group (17.2 \u0026plusmn; 5.3 months) compared to the control group (14.8 \u0026plusmn; 5.6 months; p = 0.0008). Similarly, children in the control group had a higher mean weight (8.1 \u0026plusmn; 1.3 kg) than those in the case group (6.9 \u0026plusmn; 1.2 kg; p \u0026lt; 0.001), as well as a significantly greater mean height (74.2 \u0026plusmn; 5.8 cm vs. 70.4 \u0026plusmn; 6.1 cm; p \u0026lt; 0.001). The mean BMI was also lower in the case group (13.8 \u0026plusmn; 1.1) compared to the control group (14.7 \u0026plusmn; 1.0; p \u0026lt; 0.001) \u003cstrong\u003e(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 :\u003c/strong\u003e Comparison of anthropometric characteristics between cases and controls\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases (n = 114)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls (n = 114)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMean age (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e17.2 \u0026plusmn; 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14.8 \u0026plusmn; 5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMean weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6.9 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMean height (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e70.4 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e74.2 \u0026plusmn; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMean BMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e13.8 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14.7 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe majority of the cases suffered from marasmus (75%), and 1% were classified as special cases\u003cstrong\u003e\u0026nbsp;(Figure 1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Feeding Practices Among Children Aged 6 to 24 Months, CHR Maradi\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eColostrum given at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e74 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e111 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e40 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBreastfeeding status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eCurrently breastfed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e64 (56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e93 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eWeaned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e50 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e21 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAge at weaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026le; 18 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e13 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026gt; 18 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e37 (74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e17 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eType of breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eExclusive breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e16 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e59 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMixed feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e98 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e55 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eComplementary feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e109 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e107 (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e5 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e7 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAge of introduction of complementary foods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBefore 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e64 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e23 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAt 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e27 (24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e42 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAfter 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e18 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e42 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMeal frequency per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026lt; 2 meals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e28 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e23 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e2\u0026ndash;3 meals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e56 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e54 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eMore than 3 meals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e25 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e30 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eDietary diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eStarches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e109 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e107 (93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLegumes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e30 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e73 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eFruits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e35 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e56 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAnimal-based products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e20 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e30 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe intake of colostrum at birth was reported in 64.9% of cases compared to 97.4% of controls. At the time of the survey, 56.1% of the cases were still being breastfed versus 81.6% of the controls, while 43.9% of the cases had already been weaned compared to 18.4% of the controls. The age of weaning was over 18 months in 74% of the cases and 81% of the controls. Exclusive breastfeeding was practiced in 14% of the cases versus 51.8% of the controls. Complementary feeding had been introduced in 95.6% of the cases and 93.9% of the controls. Among them, 58.7% of the cases had received complementary foods before the age of 6 months, compared to 21.5% of the controls. Regarding meal frequency, 25.7% of the cases received fewer than two meals per day compared to 21.5% of the controls. In terms of dietary diversity, consumption of starchy foods was high in both groups (95.6% in cases versus 93.9% in controls). However, the consumption of legumes, fruits, and animal products was lower among the cases (26.3%, 30.7%, and 17.5%, respectively) compared to the controls (64%, 49.1%, and 26.3%) \u003cstrong\u003e(Table 3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 :\u003c/strong\u003e Factors Associated with Severe Acute Malnutrition (SAM) among Children Aged 6 to 24 Months, CHR Maradi\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHome delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e59 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e13 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.12 [0.06 - 0.24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAge at cessation of breastfeeding (\u0026le; 18 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e13 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e4 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.06 [0.29 - 3.86]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eIntroduction of complementary foods (before 6 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e64 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e23 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.64 [1.83 - 3.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eModerate appetite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e58 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0.05 [0.02 - 0.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHistory of malnutrition among children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e61 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e14 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e6.51 [3.06 - 13.87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eANC visits \u0026lt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e70 (63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e52 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.97 [1.15 - 3.36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLow birth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9.32 [1.10 - 43.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMaternal BMI (\u0026lt;18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e16 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.12 [1.06 - 4.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMaternal education level (Primary)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e15 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e9 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3.46 [1.67 - 7.15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.0007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eNumber of meals per day (\u0026lt;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e28 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e23 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.21 [0.83 - 1.77]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eColostrum intake at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e40 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0.05 [0.015 - 0.17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLatrine cleanliness (once per week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e54 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e9 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e6.05 [2.47 - 14.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003ePlace of residence (rural area)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e81 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e45 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3.66 [2.10 - 6.36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHouse compound cleaned \u0026lt; 2 times/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e113 (99.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e78 (68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e52.15 [7.00 - 88.40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eDrinking water source (borehole)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e49 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e11 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0.09 [0.043 - 0.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eChild age group (6-11 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e26 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e62 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0.47 [0.29 - 0.58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eUse of mosquito nets (after childbirth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e43 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e22 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.00 [0.06 - 16.18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSeveral factors were associated with the occurrence of severe acute malnutrition (SAM) among children aged 6 to 24 months. Moderate appetite was significantly less frequent among children with SAM, showing an inverse association (aOR = 0.04; 95% CI: 0.03\u0026ndash;0.23; p = 0.03). Similarly, children aged 6 to 11 months had a lower likelihood of developing SAM compared to older children (aOR = 0.33; 95% CI: 0.17\u0026ndash;0.68; p = 0.008).\u003c/p\u003e\n\u003cp\u003eConversely, several variables were positively associated with an increased risk of SAM. The presence of malnutrition cases among siblings was strongly associated with severe malnutrition in the index child (aOR = 7.32; 95% CI: 6.12\u0026ndash;12.80; p = 0.006). A birth weight under 2,500 grams also significantly increased the risk of SAM (aOR = 8.16; 95% CI: 1.13\u0026ndash;59.32; p = 0.039). Regarding maternal characteristics, a body mass index (BMI) below 18.5 was associated with more than a threefold increase in the risk of SAM in children (aOR = 3.21; 95% CI: 1.02\u0026ndash;4.63; p = 0.002). Maternal education limited to primary level also emerged as an important predictive factor (aOR = 10.88; 95% CI: 1.22\u0026ndash;15.15; p = 0.011). Residing in a rural area was significantly associated with SAM (aOR = 5.50; 95% CI: 3.10\u0026ndash;7.63; p \u0026lt; 0.01). In addition, poor latrine hygiene - defined as cleaning only once per week - was associated with an increased risk of SAM (aOR = 1.11; 95% CI: 3.48\u0026ndash;11.60; p \u0026lt; 0.001). Finally, poor domestic environmental hygiene, measured by cleaning the household surroundings less than twice a day, was also significantly associated with SAM (aOR = 3.36; 95% CI: 1.34\u0026ndash;8.40; p = 0.010) \u003cstrong\u003e(Table 4).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, children with moderate appetite were significantly less likely to have SAM (aOR = 0.04; 95% CI: 0.03\u0026ndash;0.23; p = 0.03). Likewise, children aged 6\u0026ndash;11 months had a reduced risk of SAM compared to older children (aOR = 0.33; 95% CI: 0.17\u0026ndash;0.68; p = 0.008).\u003c/p\u003e\n\u003cp\u003eIn contrast, several variables were positively associated with a higher risk of SAM. The presence of malnourished siblings was strongly linked to severe malnutrition (aOR = 7.32; 95% CI: 6.12\u0026ndash;12.80; p = 0.006). A birth weight below 2500 grams also significantly increased the risk (aOR = 8.16; 95% CI: 1.13\u0026ndash;59.32; p = 0.039). Among maternal characteristics, a body mass index (BMI) under 18.5 was associated with over a threefold increase in the risk of SAM (aOR = 3.21; 95% CI: 1.02\u0026ndash;4.63; p = 0.002). Maternal primary education level also emerged as a significant predictive factor (aOR = 10.88; 95% CI: 1.22\u0026ndash;15.15; p = 0.011). Living in rural areas was strongly associated with SAM (aOR = 5.50; 95% CI: 3.10\u0026ndash;7.63; p \u0026lt; 0.01). Inadequate sanitation practices were also predictive of SAM. Poor latrine hygiene, defined as cleaning once per week, significantly increased the risk (aOR = 6.05; 95% CI: 3.48\u0026ndash;11.60; p \u0026lt; 0.001). Lastly, suboptimal household environment cleanliness, defined as cleaning the house premises fewer than twice per day, was also significantly associated with SAM (aOR = 3.36; 95% CI: 1.34\u0026ndash;8.40; p = 0.010) \u003cstrong\u003e(Figure 2)\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the complexity of nutritional determinants in a Sahelian context marked by structural, social, and health-related vulnerabilities. Boys accounted for a slightly higher proportion among cases (64.9%) than controls (59.6%), consistent with previous observations indicating increased vulnerability of boys to severe forms of malnutrition in rural African areas, possibly due to biological and social differences in exposure to risk factors [16]. Children aged 18 to 24 months represented the majority of cases (52.6%), whereas controls were predominantly in the 6\u0026ndash;11 month age group, suggesting an increased risk with age, potentially linked to weaning practices and prolonged exposure to deleterious environmental conditions [17].\u003c/p\u003e\u003cp\u003eIn terms of perinatal factors, a low birth weight (\u0026lt;\u0026thinsp;2500 g) was observed in 5.3% of cases compared to 0.9% of controls, underscoring the importance of intrauterine nutrition. Moreover, a higher proportion of deliveries outside healthcare facilities was observed among cases (18.4%) than controls (11.4%), pointing to inequalities in access to obstetric care.\u003c/p\u003e\u003cp\u003eRegarding maternal characteristics, mothers of cases were more often unschooled (74.6% vs. 36.8%) and predominantly resided in rural areas (71.1% vs. 40.2%), two factors known to negatively influence nutritional practices and access to health information [18]. Maternal BMI also revealed disparities, with 14% of case mothers classified as underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5) compared to 2.6% of control mothers.\u003c/p\u003e\u003cp\u003eFeeding practices showed lower rates of colostrum administration among cases (64.9% vs. 97.4%), reduced prevalence of exclusive breastfeeding (14% vs. 51.8%), and earlier introduction of complementary foods (58.7% before 6 months vs. 21.5%). In addition, children in the case group received a less diversified diet, especially in legumes, fruits, and animal products. These findings are consistent with WHO and FAO guidelines recommending timely and progressive introduction of complementary foods from 6 months, alongside breastfeeding [19].\u003c/p\u003e\u003cp\u003eSeveral factors were significantly associated with SAM, reflecting the multifactorial nature of the condition in resource-limited settings. Low birth weight emerged as a major risk factor (aOR\u0026thinsp;=\u0026thinsp;8.16; 95% CI: 1.13\u0026ndash;59.32; p\u0026thinsp;=\u0026thinsp;0.039), corroborating findings from sub-Saharan and Central African studies indicating increased vulnerability to SAM among low birth weight infants[20,21]. This highlights the importance of prenatal care and maternal support as essential levers for prevention.\u003c/p\u003e\u003cp\u003eMaternal undernutrition (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5) was also a significant predictor of SAM in children (aOR\u0026thinsp;=\u0026thinsp;3.21; 95% CI: 1.02\u0026ndash;4.63; p\u0026thinsp;=\u0026thinsp;0.002), confirming the well-established link between maternal and child nutritional health. Underweight mothers not only have limited physiological reserves but also face challenges in sustaining exclusive breastfeeding. Large-scale analyses in 13 West African countries demonstrated that children born to underweight mothers had increased risks of stunting and underweight. Likewise, studies by Alaof\u0026egrave; and Asaolu in Benin showed that maternal undernutrition significantly impacts child growth outcomes[ 22,23].\u003c/p\u003e\u003cp\u003eThese findings underscore the importance of targeted nutritional interventions among women of reproductive age, particularly in rural and disadvantaged settings, to break the intergenerational cycle of malnutrition.\u003c/p\u003e\u003cp\u003eMaternal education level was another strong predictor, with children of mothers who had only primary education facing a significantly higher risk of SAM (aOR\u0026thinsp;=\u0026thinsp;10.88; 95% CI: 1.22\u0026ndash;15.15; p\u0026thinsp;=\u0026thinsp;0.011). Studies by Makoka and Masibo in Malawi, Tanzania, and Zimbabwe revealed that low maternal education was linked to higher levels of malnutrition, indicating a protective threshold effect only achieved beyond primary education [24]. Similarly, Fotso et al. in Kenya reported higher stunting rates among children of less educated mothers, emphasizing that maternal education plays a critical role in understanding nutritional needs, adopting proper feeding practices, and accessing health services [25 ].\u003c/p\u003e\u003cp\u003eDomestic hygiene was also significantly associated with SAM. Poor household sanitation, defined as cleaning the home compound fewer than twice per day, increased SAM risk (aOR\u0026thinsp;=\u0026thinsp;3.36; 95% CI: 1.34\u0026ndash;8.40; p\u0026thinsp;=\u0026thinsp;0.01). Latrine cleanliness, when limited to once per week, was strongly linked to SAM (aOR\u0026thinsp;=\u0026thinsp;6.05; 95% CI: 3.48\u0026ndash;11.60; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings echo those from 3ie in West Africa, which found that children living in households with inadequate sanitation were more likely to suffer from malnutrition due to the high prevalence of diarrheal and parasitic diseases [26]. Oloruntoba et al.\u0026rsquo;s systematic review on WASH (Water, Sanitation, and Hygiene) practices in Africa also confirmed the predictive role of poor hygiene in childhood malnutrition [27].\u003c/p\u003e\u003cp\u003eLiving in rural areas was another independent predictor of SAM (aOR\u0026thinsp;=\u0026thinsp;5.50; 95% CI: 3.10\u0026ndash;7.63; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), likely reflecting poorer health service access and environmental conditions. This aligns with findings by Tadesse et al., who found rural residence significantly associated with higher SAM risk [28].\u003c/p\u003e\u003cp\u003eFinally, moderate appetite and younger age (6\u0026ndash;11 months) appeared as protective factors, which should be interpreted cautiously. These children may have benefited from earlier healthcare engagement or less exposure to harmful weaning practices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study show that SAM among children aged 6 to 24 months in Maradi is associated with a range of individual, maternal, and environmental factors. These findings highlight the intersection of socioeconomic vulnerability, inadequate nutritional practices, and poor environmental conditions. Addressing SAM requires a multisectoral approach that integrates improvements in living conditions, women\u0026rsquo;s empowerment, nutrition education, and hygiene promotion to sustainably reduce the prevalence of severe acute malnutrition in Niger.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was submitted and approved by the National ethics committee (CNE) and is registered under “DELIBERATION N°25/2023/CNERS”\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eASI was responsible for conceptual design and all authors were involved in data analysis. ASI drafted the manuscript and all authors revised and approved the final manuscript. ASI is the corresponding author and guarantor of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the CHR de Maradi officers at the various levels especially those involved in the management of malnutrition. The authors are grateful for the contribution to the translation of the document into English received from Ibrahim ML and Adehossi E\u003c/p\u003e"},{"header":" References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Guideline: updates on the management of severe acute malnutrition in infants and children [Internet]. Geneva: WHO; 2013 [cited 2025 May 31]. Available from: https://www.who.int/publications/i/item/9789241506328\u003c/li\u003e\n\u003cli\u003eBlack RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. \u003cem\u003eLancet\u003c/em\u003e. 2008;371(9608):243-260.\u003c/li\u003e\n\u003cli\u003ePrendergast AJ, Humphrey JH. The stunting syndrome in developing countries. \u003cem\u003ePaediatr Int Child Health\u003c/em\u003e. 2014;34(4):250-265.\u003c/li\u003e\n\u003cli\u003eWorld Bank. World Development Report: The Changing Nature of Work. Washington DC: World Bank; 2019.\u003c/li\u003e\n\u003cli\u003eBlack RE, Victora CG, Walker SP, Bhutta ZA, et al.; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013 Aug 3;382(9890):427-451\u003c/li\u003e\n\u003cli\u003eRuel MT, Alderman H; Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? 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Disponible sur: https://www.exemplars.health/-/media/files/n-mmr/niger/15-niger-enafeme-2021.pdf\u003c/li\u003e\n\u003cli\u003eIssoufou A, Sitou L, Ramatoulaye A M, Mawa Soro Kolo. Facteurs de persistance de la malnutrition dans la r\u0026eacute;gion de Maradi au Niger. J. Appl. Biosci. 2020. 55 : 16016 - 16033 https://doi.org/10.35759/JABs.155.6\u003c/li\u003e\n\u003cli\u003eINS. Enqu\u0026ecirc;te SMART nationale 2022. Niamey : INS/UNICEF ; 2022.\u003c/li\u003e\n\u003cli\u003eINS. Enqu\u0026ecirc;te qualitative sur les connaissances, les pratiques et les comportements en mati\u0026egrave;re d\u0026rsquo;alimentation et de nutrition des enfants de moins de cinq (5) ans dans la r\u0026eacute;gion de Maradi. [Internet] Maradi ; 2022 [cit\u0026eacute; le 31 mai 2025] Disponible sur : https://pnin-niger.org/pnin-doc/web/uploads/documents/118/Doc-20221227-104642.pdf\u003c/li\u003e\n\u003cli\u003eAlflah YM, Alrashidi MA. Severe Acute Malnutrition and Its Consequences Among Malnourished Children. J Clin Ped Res. 2023;2(1):1-5\u003c/li\u003e\n\u003cli\u003eDe Onis M, et al. The World Health Organization\u0026apos;s global growth standards. Public Health Nutr. 2012 ;15(1) :160-166.\u003c/li\u003e\n\u003cli\u003eSingh, Seema, and Vimla Dunkwal. A Study on Feeding Practices of Severe Acute Malnourished Infants Aged 06-24 Months Admitted in Malnutrition Treatment Centre of Bikaner, Rajasthan. \u003cem\u003eJournal of Pharmacognosy and Phytochemistry\u003c/em\u003e. 2020 ; 9(1) : 137\u0026ndash;41.\u003c/li\u003e\n\u003cli\u003eDewey KG. The challenge of meeting the micronutrient needs of infants and young children during the period of complementary feeding. Paediatr Perinat Epidemiol. 2013 ;27(4):371-372.\u003c/li\u003e\n\u003cli\u003eThurstans S, Opondo C, Seal A, et al. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis. BMJ Glob Health. 2022;7: e009742.\u003c/li\u003e\n\u003cli\u003eBhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013 ;382(9890):452-477.\u003c/li\u003e\n\u003cli\u003eUNICEF. Am\u0026eacute;liorer la nutrition des enfants, des adolescents et des femmes : strat\u0026eacute;gie 2020-2030. [Internet]. New York : Fonds des Nations Unies pour l\u0026apos;enfance ; 2020. Disponible sur : https://www.unicef.org/fr/reports/strategie-nutrition-2020-2030\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Malnutrition [Internet]. Geneva: WHO; 2020 [cited 2025 May 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition\u003c/li\u003e\n\u003cli\u003eMaty D C, Bou D, Mbathio D, Jean AT et al., Study of Factors Associated with Low Birth Weight in the Bounkiling Health District in 2020 (Senegal) ; World Journal of Public Health 9(1):74-85 DOI: 10.11648/j.wjph.20240901.20 \u003c/li\u003e\n\u003cli\u003eKangulu IB, Umba EK, Nzaji MK, Kayamba PK. Facteurs de risque de faible poids de naissance en milieu semi-rural de Kamina, R\u0026eacute;publique D\u0026eacute;mocratique du Congo. Pan Afr Med J. 2014 Mar 20;17:220. French. doi: 10.11604/pamj.2014.17.220.2366. \u003c/li\u003e\n\u003cli\u003eKofi A, Roland A, Christian S, Ngianga-Bakwin K. Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa, European Journal of Clinical Nutrition 78(9). DOI: 10.1038/s41430-024-01453-5 \u003c/li\u003e\n\u003cli\u003eAlaof\u0026egrave;, H. and Asaolu, I. Maternal and Child Nutrition Status in Rural Communities of Kalal\u0026eacute; District, Benin: The Relationship and Risk Factors. Food and Nutrition Bulletin, (2019) 40, 56-70. \u003cbr\u003e https://doi.org/10.1177/0379572118825163 \u003c/li\u003e\n\u003cli\u003eMakoka D, Masibo PK. Is there a threshold level of maternal education sufficient to reduce child undernutrition? Evidence from Malawi, Tanzania and Zimbabwe. BMC Pediatr. 2015; 15:96\u003c/li\u003e\n\u003cli\u003eFotso JC, Madise N, Baschieri A, Cleland J, Zulu E, Mutua MK, Essendi H. Child growth in urban deprived settings: does household poverty status matter? At which stage of child development? Health Place. 2012 Mar;18(2):375-84. doi: 10.1016/j.healthplace.2011.12.003. \u003c/li\u003e\n\u003cli\u003eie. L\u0026apos;acc\u0026egrave;s aux latrines et autres interventions WASH r\u0026eacute;duisent-ils la malnutrition infantile ? Note de r\u0026eacute;ponse rapide. 2021. Disponible sur : https://www.3ieimpact.org/sites/default/files/2023-01/Access-Latrines-WACIE-RR-brief-FR.pdf\u003c/li\u003e\n\u003cli\u003eOkesanya OJ, Eshun G, Ukoaka BM, Manirambona E, Olabode ON, Adesola RO et al,. Water, sanitation, and hygiene (WASH) practices in Africa: exploring the effects on public health and sustainable development plans. Trop Med Health. 2024 Oct 9;52(1):68. doi: 10.1186/s41182-024-00614-3. PMID: 39385262; PMCID: PMC11463047.\u003c/li\u003e\n\u003cli\u003eAnchamo Anato. Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia. Heliyon 2022.e107.DOI: 10.1016/j. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Severe acute malnutrition, Associated factors, Children 6-24 months, Mardi, Niger","lastPublishedDoi":"10.21203/rs.3.rs-6972889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6972889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSevere acute malnutrition (SAM) remains a major public health challenge in Niger, especially in the Maradi region where prevalence exceeds WHO alert thresholds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo identify factors associated of SAM among children aged 6 to 24 months admitted to the Pediatric Department II of the Regional Hospital Center of Maradi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA case-control study was conducted from November 2023 to March 2024, including 228 children: 114 cases (SAM) and 114 controls (moderate acute malnutrition). Data were collected using KoboCollect and analyzed with SPSS 16.0. Multivariate logistic regression was used to identify independent predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Low birth weight (aOR = 8.12; p = 0.039), low paternal education level (aOR = 3.46; p = 0.010), unsanitary room conditions (aOR = 3.36; p = 0.010), poor latrine hygiene (aOR = 6.05; p \u0026lt; 0.001), and family history of malnutrition (aOR = 6.51; p \u0026lt; 0.001) were identified as significant predictors of SAM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings highlight the critical role of socio-environmental factors in the development of SAM. Targeted interventions focusing on parental education, hygiene, and neonatal monitoring are essential to prevent child malnutrition in this vulnerable age group.\u003c/p\u003e","manuscriptTitle":"Factors associated with severe acute malnutrition among children aged 6 to 24 months at the Regional Hospital Center (CHR) of Maradi: a case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 12:29:39","doi":"10.21203/rs.3.rs-6972889/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6ccba91-e9af-4f3d-bc35-ed23ab105955","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-25T12:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 12:29:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6972889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6972889","identity":"rs-6972889","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}