Abstract:
Background: Severe wasting affects 16 million under 5's and carries an immediate risk of
death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a
high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian
infants.
Methods: We undertook a case-control study from November 2014 to June 2015, in rural
Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < -3 on at least 1
occasion in infancy. Controls with a WLZ > -3 in the same interval, matched on age,
gender, village size and distance from the clinic were selected. Standard questionnaires
were used to assess maternal socioeconomic status, water sanitation and hygiene and
maternal mental health. Conditional logistic regression using a multivariable model was
used to determine the risk factors for severe wasting. Qualitative in depth interviews
were conducted with mothers and fathers who were purposively sampled. A thematic
framework was used to analyse the in-depth interviews.
Results: Two hundred and eighty (77 cases and 203 controls) children were recruited. Indepth interviews were conducted with 16 mothers, 3 fathers and 4 research staff
members. The mean age of introduction of complementary feeds was similar between
cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe
wasting were associated with increased frequency of complementary feeds (range 1-8)
[adjusted OR 2.06 (95%: 1.17-3.62), p = 0.01]. Maternal adherence to the recommended
infant care practices was influenced by her social support networks, most importantly her
husband, by infant feeding difficulties and maternal psychosocial stressors that include
death of a child or spouse, recurrent ill health of child and lack of autonomy in child
spacing.
Conclusion: In rural Gambia, inappropriate infant feeding practices were associated with
severe wasting in infants. Additionally, adverse psychosocial circumstances and infant
feeding difficulties constrain mothers from practising the recommended child care
practices. Interventions that promote maternal resilience through gender empowerment,
prioritising maternal psychosocial support and encouraging the involvement of fathers in
infant and child care promotion strategies, would help prevent severe wasting in these
infants.