Dietary diversity of 6- to 59-month-old children in rural areas of Moramanga and Morondava districts, Madagascar.

BACKGROUND: A dietary imbalance or a disregard for the nutritional needs of children during early childhood can affect their growth. From the age of six months, breast milk is no longer able to meet the energy and micronutrient needs of children; the consumption of adequate complementary foods is therefore essential. Various indicators have been used to assess the quality of children's diets, and the dietary diversity score is a good indicator of children's diets. The objective of this study was to describe the dietary practices of children in rural areas of Moramanga and Morondava, Madagascar, and to identify the determinants of low dietary diversity to prioritize nutritional interventions. METHODS: We collected dietary data in 2014 on children aged 6-59 months in a study on the determinants of chronic malnutrition using the 24-hour recall method. Data on the characteristics of households and mothers were also collected. We carried out bivariate and multivariate analyses to identify the determinants of low dietary diversity scores for children. RESULTS: We included 1824 children: 893 from Moramanga and 931 from Morondava. Approximately 42.1% [95% CI: 39.0-45.4] of the children from Moramanga and 47.6% [95% CI: 44.4-50.8] of those from Morondava had a poorly diversified diet, consisting mainly of foods rich in carbohydrates and poor in meat products. Poor maternal education was associated with a high likelihood of having a non-varied diet in both study areas; the adjusted odds ratios were 2.2 [95% CI: 1.3-3.8] and 4.0 [95% CI: 2.5-6.4] for children from mothers with lower education levels for Moramanga and Morondava, respectively. For children recruited in Morondava, having low household socioeconomic status (adjusted OR: 1.8, 95% CI: 1.2-2.8) and belonging to a household without livestock was associated with a low dietary diversity score (adjusted OR: 1.8, 95% CI 1.2-2.7). CONCLUSION: Our results show the need to improve girls' education, adapt nutrition education programs for mothers based on their level of education, and strengthen poverty reduction programs.

Correction: The importance of public health, poverty reduction programs and women's empowerment in the reduction of child stunting in rural areas of Moramanga and Morondava, Madagascar.

[This corrects the article DOI: 10.1371/journal.pone.0186493.].

The importance of public health, poverty reduction programs and women's empowerment in the reduction of child stunting in rural areas of Moramanga and Morondava, Madagascar.

BACKGROUND: Malnutrition accounts for 45% of mortality in children under five years old, despite a global mobilization against chronic malnutrition. In Madagascar, the most recent data show that the prevalence of stunting in children under five years old is still around 47.4%. This study aimed to identify the determinants of stunting in children in rural areas of Moramanga and Morondava districts to target the main areas for intervention. METHODS: A case-control study was conducted in children aged from 6 to 59.9 months, in 2014-2015. We measured the height and weight of mothers and children and collected data on child, mother and household characteristics. One stool specimen was collected from each child for intestinal parasite identification. We used a multivariate logistic regression model to identify the determinants of stunting using backwards stepwise methods. RESULTS: We included 894 and 932 children in Moramanga and in Morondava respectively. Stunting was highly prevalent in both areas, being 52.8% and 40.0% for Moramanga and Morondava, respectively. Stunting was most associated with a specific age period (12mo to 35mo) in the two study sites. Infection with Trichuris trichiura (aOR: 2.4, 95% CI: 1.1-5.3) and those belonging to poorer households (aOR: 2.3, 95% CI: 1.6-3.4) were the major risk factors in Moramanga. In Morondava, children whose mother had activities outside the household (aOR: 1.7, 95% CI: 1.2-2.5) and those perceived to be small at birth (aOR: 1.6, 95% CI: 1.1-2.1) were more likely to be stunted, whereas adequate birth spacing (≥24months) appeared protective (aOR: 0.4, 95% CI: 0.3-0.7). CONCLUSION: Interventions that could improve children's growth in these two areas include poverty reduction, women's empowerment, public health programmes focusing on WASH and increasing acceptability, and increased coverage and quality of child/maternal health services.