Severe Acute Malnutrition of Children in Slums of Dhaka City, Bangladesh

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Introduction: The risk of malnutrition among children of urban slums is higher due to socio-economic deprivation and inadequate healthcare access. Transition from exclusive breastfeeding to weaning in the first year of life is critical, whereby caregivers' lack of knowledge and inappropriate feeding practices can lead to severe acute malnutrition (SAM). This study aims to identify human factors associated with SAM among children aged 12-18 months living in slums of Dhaka city. Methods: A case-control study in slums of Dhaka from January to August 2017 enrolled as cases, children aged 12-18 months with mid-upper arm circumference (MUAC) <11.5 cm or bilateral pitting oedema and controls as children of same age with MUAC >12.5 cm and no oedema. Using a 1:2 ratio, we purposively selected participants and interviewed their caregivers. We calculated odds ratios (OR) and 95% confidence intervals (CI). We applied multivariable logistic regression and calculated adjusted odds ratios (AOR) to adjust for confounders. Results: We visited 56 slums in Dhaka and interviewed 193 cases and 386 controls in the study. Mean age of children was 15 months. Gender distribution was similar among cases and controls. Incomplete vaccination (AOR:2.2, 95%:1.6–3.8), absence of exclusive breastfeeding (AOR:2.2, 95%:1.4–3.4), smoking inside home (AOR:2.2, 95%: 1.3–3.3), maternal age <18 years (AOR:3.1, 95%:1.3–7.8), and recent diarrhoea history (AOR:1.9, 95%:1.7–2.9) were significantly increased risk of SAM. Although not statistically significant, other factors included poor maternal nutritional knowledge, lack of time for feeding, and unsafe water consumption. Conclusion: This study reinforces findings from previous research, showing that severe acute malnutrition in Dhaka slums was driven by preventable factors such as young maternal age, lack of exclusive breastfeeding, incomplete vaccination, indoor smoking, and recent diarrhoea. Targeted, community-based interventions based on these findings were recommended to prevent malnutrition and improve child outcomes.

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