Risk factors for severe acute malnutrition among children aged 6-59 months enrolled in CMAM Program Al-Sabeen Hospital, Sana'a City _Yemen

Background SAM is one of the leading causes of morbidity and mortality in Yemen. The reasons behind persistently high prevalence of SAM in Yemen are still poorly understood. Aims To assess Risk factors for severe acute malnutrition among children aged 6–59 months enrolled in CMAM Program Al-Sabeen Hospital, Sana'a City _Yemen. Methodology: Unmatched case-control study was conducted on 194 (65 cases and 129 controls) children aged 6–59 months with their parents enrolled in CMAM program in Al-Sabeen hospital, Sana’a. The sample for this study was selected using convenience sampling method. Data were collected by using questionnaire as a face-to-face interview. The data collection tool was consisted of the potential risk factors (Children demographic, health care services, comorbidities, dietary, parent's socio-demographic, household environment and food security factors). Controls were matched to their cases on sex and on age. Data were analyzed using IBM SPSS. Binary regression was used to analyses the association of independent variables with SAM with a significance level of p  < 0.05. Results At the comorbidities risk factors, SAM was significantly associated with diarrhoea (AOR = 3.8, 95% CI = 1.976–7.666; p < 0.05), anorexia (AOR = 10.5, 95% CI = 3.987–27.590; p < 0.05), intractable vomiting (AOR = 6.3, 95% CI = 2.829–13.936; p < 0.05)., gastroenteritis (AOR = 3.4, 95% CI = 1.533–7.776; p < 0.05), ARI (AOR = 4.5, 95% CI = 1.810-11.376; p < 0.05) and anemia (AOR = 5.6, 95% CI = 1.885–16.730; p < 0.05). For dietary factors, SAM was associated with exclusive breastfeeding (AOR = 2.4, 95% CI = 1.287- 4.400; p < 0.05), duration of exclusive breastfeeding (AOR = 2.8, 95% CI = 1.246–6.588; p < 0.05), types of foods included in the child's diet on a typical day (AOR = 2.9, 95% CI = 1.459–6.012; p < 0.05), legumes/pulses (AOR = 2.2, 95% CI = 1.108–4.287; p < 0.05), dairy products (AOR = 3.2, (95% CI = 1.696–6.039; p < 0.05). For household environment and food security factors, household food availability (AOR = 4.3, 95% CI = 1.269–15.163; p < 0.05), latrine availability (AOR = 5.3, 95% CI= .998-28.063; p < 0.05), caretaker’s hand washing before preparing food (AOR = 4.2, 95% CI = 1.469–11.873; p < 0.05), caretaker’s hand washing before eating (AOR = 5.0, 95% CI = 1.484–16.998; p < 0.05), and caretaker hand washing after managing child feces (AOR = 6.7,95% CI = 1.760-25.882; p < 0.05). For healthcare services factors, vaccination (OR < 1 which means the children who received vaccination were protective against SAM) and regular access to healthcare services (AOR = 7.8, 95% CI = 2.434–25.081; P < 0.05). For demographic factors among children, age 12–23 months (AOR = 2.8, 95% CI = 1.044–7.509; P < 0.05) and 24–59 months (AOR = 4.1, 95% CI = 1.020–4.792; P < 0.05), place of residence (AOR = 5.1, 95% CI: 02.436–10.536; P  < 0.001), birth weight (AOR = 3.7, 95% CI = 1.909–7.220; p < 0.001). For socio-demographic factors of parents, father occupation (AOR = 2.9, 95% CI: 1.561–5.758; P  < 0.001) and family income (AOR = 2.0, 95% CI: 1.561–5.758; P  < 0.05). Conclusion The present study identified the need to concern both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, along with increasing household food diversity are likely to lead to improved nutritional status of children aged 6–59 months.