Local determinants of malnutrition study in Burundi

The purpose of this formative research study was to identify determinants of malnutrition in children under five using a community-based assessment tool, enabling the development of specific behavior change communication messages.

Study methodology used a case-control design with in-depth interviews. 46 mothers of Positive Deviant (PD) children and 48 mothers of malnourished children, all from low-resource environments, were interviewed. The questionnaire consisted of 78 closed- and open-ended questions exploring feeding practices, child care practices, health care seeking practices, worldview, psychosocial factors, and hygiene practices. Mothers were classified into two groups according to their child's weight-for-age Z score (WAZ). Children with a WAZ > -1 were classified as PDs, and children with a WAZ < -2 were classified as malnourished.

Results showed striking and important differences between the groups. In terms of specific foods consumed by the child, mothers of PD children were more likely to mention: -Salt (PDs were seven times more likely to receive salt, OR = 0.14, p=0.04); -Taro (37% of PDs vs. 12% Malnourished, OR = 0.23, p=0.004); -Organ Meats (PDs were 2.6 times more likely to receive, p = 0.04).

In addition, mothers of PD children were more likely to initiate immediate breastfeeding, consume specific nutrient-rich foods while breastfeeding, encourage their non-hungry child to eat, have an illness free child, and have a child who defecates in a proper place. Messages targeted at these key determinants are now being incorporated into health promotion materials, such as curriculum for mothers' groups and radio spots.