Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania

Malnutrition has long been associated with poor diet and inadequate access to health and sanitation services. Malnutrition remains a major public health problem particularly in the developing countries where it accounts for more than 90 % of all nutritional related conditions with two third of all cases originating from Sub Saharan Africa, and morbidity and mortality due to malnutrition is high among children under 5 years of age [1]. Several studies have reported that poverty, inadequate access to a balance diet and underlying diseases (tuberculosis, malaria, diarrhea, etc.) contribute to high levels of malnutrition [2–4]. Death and disease in developing countries are often primarily a result of malnutrition (Rice [5]), and malnutrition remains the underlying cause of one out of every two such deaths [5–7]. A recent study by the World Health Organization (WHO) also demonstrates that child death and malnutrition have a substantial unequal, global distribution [8].

Malnutrition remains a key global health issue and a nutritional related condition in Tanzania. It is often assessed through anthropometric analyses that examine weight, stunting and wasting. For the purposes of this paper, the UNICEF definitions were applied as follows. ‘Underweight’ was defined as either moderate or severe, with moderate being below two standard deviations from median weight for age of reference population and severe being below three standard deviations from median weight for age reference population. ‘Wasting’ can be either moderate or severe and is defined as being below two standard deviations from median weight for height of reference population. Finally, ‘stunting’ can be either moderate or severe and is defined as being two standards deviations from median height for age of the reference population.

More importantly, though, there is currently a gap in literature on malnutrition in Tanzania examining populations presenting to hospitals and facilities. All information found for Pwani, Tanzania on malnutrition were household surveys providing only a statistical average for the region. Where the Integrated Management of Childhood Illness (IMCI) program has been well established in Tanzania since 1996 throughout the majority of districts, it is clear that malnutrition remains an issue within Tanzania. However, there is still limited, if any, information for sub-regional data populations and how those populations differ from the aggregated regional population in terms of malnutrition. The objective of this study was to examine the status of malnutrition among male and female children aged 6–59 months in rural and urban areas of Bagamoyo District, Tanzania, specifically that population presenting to the Reproductive and Child Health (RCH) clinic at BDH and surrounding facilities at Kiwangwa (55 km), Fukayosi (45 km), and Yombo (25 km) from Bagamoyo. Populations were presenting mainly for well-child visits, illnesses, and a malaria vaccine trial being conducted by the Ifakara Health Institute. At BDH, a child’s weight measurement is charted according to the child’s age, and his or her progress is marked as one of three categories: green?=?normal progress; yellow?=?alert – child at risk; and red?=?danger – child needs referral. Each child is provided a map of his/her growth. At BDH and surrounding facilities, the nutritional intervention for those children at risk is limited to counselling that advises the caregivers to provide a balanced diet for the child. Culturally appropriate examples of a balanced diet, including porridge with peanuts, rice with meat and or vegetables and fruits, is provided for caregivers. If the child is labelled as “red,” the child is referred to Muhimbili National Hospital in Dar es Salaam, which has a Nutritional Rehabilitation Unit where the child is given additional nutritional supplementation.

It is important, therefore, to further understand and classify the prevalence and status of malnutrition in hospital and facility-based populations, as studies focusing on community prevalence cannot provide us with sub-population data allowing us to determine whether hospital and facility-based nutrition interventions would reach malnourished children. Where larger data sets examine district wide rates of malnutrition (e.g. Tanzania Demographic and Health Survey), this study investigated how rates of malnutrition remain higher than desired even within hospital and facility-presenting populations, which suggests increased nutrition efforts at centralized hospital and facilities locations could benefit overall population nutrition efforts.