Prevalence and risk factors of undernutrition among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso
This paper presents findings from a cross-sectional survey on the prevalence of undernutrition and associated risk factors among schoolchildren, aged 8–14 years, from eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso. We found that undernutrition was highly prevalent among the surveyed children. Approximately a third of the children were undernourished (35.1%).
According to a study conducted in Ouagadougou in 2008/09 for the WHO’s “Nutrition Friendly School Initiative” (NFSI), the prevalence of stunting in schoolchildren (mean age of 11.5 years) was 8.8%, which is considerably lower than the prevalence of stunting among schoolchildren found in this study (29.4%) [33]. The proportion of thinness in children in our study was 11.2%, which is, however, comparable with the 13.7% found in the NFSI study [33]. Overweight children accounted for 2.1% of all children, with a higher incidence among children aged 8–11 years than among the older age group (3.2% vs. 0%), which is similar to the 2.3% reported in the NFSI study [33].
While few children were classified as thin, a considerably higher proportion of children in our study were stunted. Thinness is often associated with short-term risk factors, like seasonal climatic variations (which cause food scarcity/shortages) and increased occurrence of illnesses [34]. Our study was conducted in the post-harvest (mid-dry) season (February), before the commencement of the dry season (March-June) [35], suggesting that the cause of undernutrition was mainly of a chronic nature, associated with long-term risk factors.
The findings from multivariable mixed logistic regression analyses demonstrated a considerably higher risk of undernutrition among children older than 12 years of age. These results are in accordance with other studies, showing a higher prevalence of stunting in older children in low-income countries in Asia and Africa [36–38]. Moreover, children with moderate and severe anaemia (combined category) and with multiple helminths and intestinal pathogenic protozoa infections (“multiple pathogenic parasites”) showed significantly higher odds for undernutrition. Undernutrition and intestinal parasitic infections are intrinsically linked. While undernutrition and inadequate dietary intake lead to weight loss and weakened immunity and render a child more susceptible to infections, parasitic infections contribute to growth stunting by causing a vicious cycle of reduced food intake (loss of appetite), diarrhoea, malabsorption and/or increased nutrient wastage [39–41]. The observed association was statistically significant in our study, reinforcing evidence of the frequent coexistence of these conditions among children [40]. Moreover, while anaemia contributed to higher odds of undernutrition among children in our study, the aetiology of anaemia is multifactorial and can result from nutritional deficiencies and parasitic infections, among other things, which have been closely connected to the nutritional status of African schoolchildren [42–45].
Our questionnaire survey revealed important inadequacies in nutrition- and health-related knowledge and practices, but no clear association between undernutrition and WASH conditions or nutritional and health KAPs.
Our study has three main limitations. First, the findings presented here cannot be generalised for all of Burkina Faso. Despite the random selection of schools with a sample size large enough for children in this age range, the results are only representative of two regions. Second, the anthropometric survey has certain limitations with respect to the inaccuracy of children’s dates of birth. Indeed, we noted that a considerable number of children had their birthdays either on 31 December or on 1 January, according to the existing school records. Upon further probing in the interview, the children often did not know their exact date of birth. Hence, for these children, we took a mid-year point as the date of birth [46]. Third, only one single Kato-Katz thick smear and FEC from two stool samples from two consecutive days were examined for each participant. Our results may therefore underestimate the true prevalence of parasitic infections, due to the low sensitivity of the Kato-Katz technique and urine concentration method [47, 48].
Despite these limitations, our findings highlight a number of important issues. First, undernutrition in schoolchildren in this part of Burkina Faso is highly prevalent. We therefore suggest giving greater attention to the overall nutritional status of school-aged children. So far, comprehensive population-based data, such as the DHS, focus on adolescents over the age of 15 years for sexual and reproductive health issues or on children under 5 years of age, as they are more vulnerable and prone to disease, illness and death [1, 49–51]. Children under five are often the primary focus of strategies and actions to address malnutrition [7, 52, 53]. Despite the increased odds of survival for children after the age of five (they generally have a lower prevalence of infections when compared to children under the age of five), school-aged children have increased nutritional needs to support the adolescent growth spurt, requiring diets rich in energy and micronutrients and sufficient in both quantity and quality [54]. It is therefore crucial to address the nutritional needs of children in this age group to match their growth requirements [55].
Second, the results of our study highlight the need for a more profound understanding of how helminths and other intestinal parasites mediate pathways to undernutrition. In particular, it is important to investigate other primary factors related to the burden of undernutrition among school-aged children, such as malaria and other parasitic infections, and the bioavailability and absorption of micronutrients so as to prevent long-term effects of undernutrition [56–58].
To address the factors underlying and contributing to schoolchildren’s nutritional status, we support the growing recommendation from several agencies to enhance multidisciplinary strategies and programmes, including nutrition and WASH interventions for school-aged children, in order to ensure optimal health, growth and development continuing after the age of five [59–61]. Such measures should be reflected in the current development of targets and indicators for reaching SDG 2.