Exclusive breastfeeding failure, severe acute malnutrition and associated factors among infants aged 6 to 12 months at Mulago National Referral Hospital: A case control study

Abstract

Background: Severe Acute Malnutrition (SAM) is a persistent global burden responsible for over one million young child deaths each year. One percent of Ugandan children under 5 years are severely wasted and those aged 6-12 months are most affected. Several risk factors have been associated with SAM in children aged 6 to 59 months amongst which is exclusive breastfeeding failure (EBFF). The World health Organisation (WHO) global target of exclusive breastfeeding (EBF) in infants under six months of age is 50% by 2025 and 70% by 2030, however, EBF rates are generally low, they are at 41% worldwide, 36% in sub-Saharan Africa and 42.8% in Uganda. There is paucity of data about the relationship between EBFF and development of severe acute malnutrition in infants aged 6 to 12 months. Objectives: To compare exclusive breastfeeding failure rates between the well-nourished and severely malnourished infants aged 6 to 12 months, establish the factors associated with EBFF as well as compare the associated factors of EBFF among those with severe acute malnutrition versus those without at Mulago National Referral Hospital (MNRH). Methods: This was a hospital-based case control study among infants aged 6 to 12 months at MNRH. Participants were matched by age and sex in a ratio of 1:2 for cases to controls with 99 cases and 198 controls. Cases were infants with SAM from both the inpatient and outpatient therapeutic care clinic (OTC) of Mwana-Mugimu Nutrition Unit (MNU) whereas controls were well-nourished infants with minor childhood illness like cough and flu from the paediatric assessment center of MNRH. Data on anthropometry, demographics, duration of exclusive breastfeeding, reasons for exclusive breastfeeding failure during the first 6 months of life was collected using a questionnaire. Data was entered into Epidata Version 3.1 and analysed using STATA version 17.0. Categorical variables were summarized using frequencies and proportions. Assessing for the association between dependent and independent variables was done using conditional logistic regression analysis. Variables with P values of < 0.2 and those with biological plausibility such as age and gender were taken for multivariate conditional logistic regression. The adjusted Odds Ratios were used as the measure of association and p-values less than 0.05 were statistically significant. Results: The average age for both cases and controls was 9.1 months with standard deviations of 1.74 and 1.72 respectively. Out of the 297 infants who participated in the study, 55.6% were males. The severely malnourished infants had a higher proportion of EBFF 77 (77.8%) compared to the controls 109 (55.1%), with an Odds Ratio of 2.6 (95% CI: 1.65 – 4.95). Among the whole population, the factors associated with EBFF were staying ≥ 10km xv from the nearest health facility [adjusted OR = 3.2, 95% CI: 1.97-10.63, p = 0.046] and maternal obesity {with adjusted OR = 3.2, 95% CI: 1.21-7.29, p = 0.012}. In comparison of the factors associated with EBFF among the severely malnourished and the well-nourished, we found that well-nourished infants with obese mothers were 4.3 fold at risk of undergoing EBFF 4.3 (95% CI 1.46-12.88) when compared to their counterparts whose mothers had a normal body mass index. Conclusion: This study found that EBFF rates were markedly higher among infants with severe acute malnutrition when compared to well-nourished infants. The factors associated with EBFF included maternal obesity and staying ≥ 10km from a nearest health facility. Upon comparing the factors associated with EBFF between the severe malnourished and those who are not, the well-nourished infants whose mothers were obese were 4.3 folds at risk of experiencing EBFF when compared to their counterparts whose mothers had a normal BMI. There was no factor associated with EBFF that was specific to the severely malnourished infants.