RISK FACTORS OF SEVERE ACUTE MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS OF AGE ADMITTED IN THE INDIRA GANDHI CHILD HEALTH AND MIWAND HOSPITALS OF KABUL CITY, AND PARWAN PROVINCIAL HOSPITAL OF AFGHANISTAN.

Background: Severe Acute Malnutrition among children 0-59 months of age is a serious public health problem in Afghanistan, the 2013 National Nutrition Survey data reviled high wasting rates of 9.5 % (WHZ<-2) (4% of them are severely wasted WHZ<-3) among children under five at the national level, while the data at provincial level is fluctuating for higher and lower than national figures, which is the leading causes of mortality and morbidity among children under five years of age. This study was conducted in three Therapeutic Feeding Unites located in two tertiary hospital of Kabul city (Indira Gandhi Child Health and Miwand Hospitals) and one provincial hospital in Parwan province of Afghanistan. The objective of the study was to identify the risk factors contributing to severe acute malnutrition among children 0-59 months of age. Method: This cross-sectional hospital based study was conducted on 301 children with severe acute malnutrition hospitalized in three mentioned therapeutic feeding unites during 4 month (March-June 2017) period. The WHO classifications for severe acute malnutrition (weight for height <-3 z-score or bilateral petting edema) were used to identify children 0-59 months of age with severe acute malnutrition. Results: out of 301 children under five years with severe acute malnutrition 53.8 % (n= 162) were boys and 46.2 % (n= 139) were girls. Most of the children (40 %) were with the age of =<6 month, and 60.1% (n=184) of them were delivered at home. About 46.2 % (n=139) of children had birth weight less than 2500 grams which indicting low birthweight, about 84.1 % of children (n= 253) were wasted (severe acute malnutrition with weight for height <-3 ZScore), while only 15.9 % of them (n=48) with bilateral petting edema (which is more severe than the first one). 88.4% (n=266) of children were breastfed during the first 6 months of age (any time) and 11.6 % (n=35) were reported never breastfeed. Over all 44.5 % (n= 134 ) children reported start complementary feeding during the first 3 month of age , 26.9 % (n= 81) started between 4-5 months ,8.6%(n=26) between 9-12 months, and only 19.9 %(n=60) of children started complementary feeding with the age of 6-8 months which is appropriate time. About 16.3 % had diarrhea, 5.3 % Pneumonia and 1 % Congenital Heart Disease. 60.5 % (n=182) of mothers reported had not completed expected child routine vaccinations. About 34.2 %( n=103) of mothers had young age (less than 21 year old), and about 83.1 % (n=250) of mothers were illiterate. 72.8% (n= 219) of mothers had less than 3 or no antenatal visits at all during her pregnancy with the current hospitalized child. The mother knowledge about health and nutrition topics were very low, among all only 17.3% (n=52) of mothers had information /education about diarrhea, 21.9 %( n=66) about breastfeeding and.13.3 % (n=40) about healthy eating. 25% (n=75) of mothers reported their household income source is from regular wage /salary, and 49.2 % (n=148) of mothers reported their household monthly income were between 6001-10000 Afs( 89 - 150 USD). Out of 301 mothers interviewed, 44.2 % (n=133) reported 7-9 family members depended on the monthly income in the household, while 14 %( n=42) reported 10-12 people are dependent in the household monthly income. Around 29.6 % (n=89) mothers reported using stream water for drinking and preparing of foods. Conclusion: according to the finding of study, mother?s education level, access to health care services, mother?s knowledge on breastfeeding and starting timely complementary feeding and family income may be the main risk factors contributing on development of severe acute malnutrition among children less than 5 years of age.