Results of the multivariate analysis between the dietary diversity score and the explanatory variables, Morondava district: Final model.

<p>Results of the multivariate analysis between the dietary diversity score and the explanatory variables, Morondava district: Final model.</p

Frequency of consumption of the food groups in the two study areas.

<p>Light gray bar: Moramanga. Dark gray bar: Morondava. First two bars: Eggs. Second two bars: Dairy. Third two bars: Legumes and nuts. Fourth two bars: Meat, poultry and fish. Fifth two bars: Other fruits and vegetables. Sixth two bars: Vitamin A-rich fruits and vegetables. Seventh two bars: Cereals, roots and tubers.</p

Characteristics of the children included in the study.

<p>Characteristics of the children included in the study.</p

Proportion of children with a low dietary diversity score who consumed each food group.

<p>Light gray bar: Moramanga Dark gray bar: Morondava First two bars: Cereals, roots and tubers Second two bars: Eggs Third two bars: Meat, poultry and fish Fourth two bars: Other vegetables and fruits Fifth two bars: Vitamin A-rich fruits and vegetables Sixth two bars: Dairy Seventh two bars: Legumes and nuts.</p

Results of the multivariate analysis between the dietary diversity score and the explanatory variables, Moramanga district: Final model.

<p>Results of the multivariate analysis between the dietary diversity score and the explanatory variables, Moramanga district: Final model.</p

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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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 <i>Trichuris trichiura</i> (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).</p><p>Conclusion</p><p>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.</p></div

Characteristics of children included in the case-control study in Moramanga and Morondava.

<p>Characteristics of children included in the case-control study in Moramanga and Morondava.</p

Flowchart describing the recruitments of participants.

<p>1a.Name of the 2 study areas, 1b.Number of children under five years in the 2 study areas, 1c. Number of children who participated in the anthropometric measurements in the 2 study areas, 1d. Number of children who participated in the anthropometric measurements and with valid measures in the 2 study areas, 1e. Number of excluded children among those with valid measures in the 2 study areas 1f. Number of stunted and non-malnourished children in the 2 study areas, 1g. Number of stunted and non-malnourished children randomly selected and included in the case-control study in the 2 study areas.</p

Final model estimates for determinants of stunting in children 6 to 59.9 months, municipalities of Bemanonga-Morondava (n = 932).

<p>Final model estimates for determinants of stunting in children 6 to 59.9 months, municipalities of Bemanonga-Morondava (n = 932).</p

Parasitic carriage of children included in the case-control study in Moramanga and Morondava.

<p>Parasitic carriage of children included in the case-control study in Moramanga and Morondava.</p