Risk Factors for Clinical Marasmus: A Case-Control Study of Bangladeshi Children

Abstract

A case-control study of risk factors of clinical marasmus was undertaken to guide intervention efforts in rural Bangladesh. Cases were children whose mid-upper arm circumference measured 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1–4 years were studied. The effects of various demographic, socioeconomic, environmental, and health factors, reported by mothers, were investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.33–4.74), and children who consumed formula foods (OR=16.41, 95% CI: 3.39–79.36). Higher maternal education was associated with reduced risk of marasmus, compared with no education, the OR for <5 years of schooling=0.57, 95% CI: 0.23–1.41; OR for ≥5 years of schooling=0.34, 95% CI: 0.15–0.76. The strong association of childhood marasmus with mother's education and child spacing supports the notion that non-nutritional factors should be essential components of efforts to reduce severe malnutrition in Bangladesh.