Malnutrition prevalence and nutrition barriers in children under 5 years: a mixed methods study in Madagascar

Background: Limited data exist on malnutrition prevalence in Madagascar. We aimed to assess the point prevalence of childhood malnutrition in the Anivorano region, and to explore mothers' perceptions of barriers to proper nutrition.

Methods: In a mixed methods study we measured height and weight for 313 children, aged 6 months to 5 years during summer 2011 using a recumbent measuring board and calibrated scale, and simultaneously conducted semi-structured interviews with 60 mothers of malnourished (n=19) and healthy (n=41) children. Multivitamins and high-energy supplemental food were provided to malnourished children. Mothers were trained how to prepare high-energy supplemental food.

Results: Prevalence of wasting defined by low weight-for-height was 10.3% (31/301); stunting or low height-for-age was 36.2% (109/301). The majority of families interviewed cultivated their own rice and other crops. Major themes regarding barriers to proper nutrition included inadequate purchasing power and access issues, low health literacy and misconceptions regarding proper nutrition and malnutrition, and insufficient variety of crops produced.

Conclusions: Malnutrition rates are alarming. Health and nutritional education to improve health literacy and address misconceptions, and improvement in social services, are warranted. A multilateral approach with involvement of health and social service agencies and non-governmental organizations to plan effective preventative strategies, along with broader national and transnational strategies are instrumental to address the fundamental causes of lack of access to proper nutrition.