Prevalence Of Malnutrition Among Children Under Five Years In Saidu Sharif Teaching Hospital, Swat, Pakistan: A CrossSectional Study

Abstract

Background: Malnutrition accounts for nearly half of all child deaths worldwide. Pakistan has one of the highest burdens of child undernutrition globally, with stunting affecting 40.2% and wasting 17.7% of children under five years (Government of Pakistan & UNICEF, 2019). However, subnational variations, particularly in conflictaffected regions such as the Malakand division, remain poorly characterized. This study aimed to determine the prevalence and associated factors of malnutrition among children aged 6–59 months attending a tertiary care hospital in Swat, KhyberPakhtunkhwa (KPK), Pakistan. Methods: A hospitalbased crosssectional study was conducted from July to August 2021 at Saidu Sharif Teaching Hospital, Swat. A total of 120 mother–child pairs (children aged 6–59 months) were enrolled using systematic random sampling. Data were collected using a structured, pretested questionnaire and anthropometric measurements (weight, height/length). Malnutrition was defined using World Health Organization (WHO) Zscores: underweight (weightforage <2 SD), stunting (heightforage <2 SD), and wasting (weightforheight <2 SD) (WHO, 2006). Data were analyzed using SPSS version 22.0, employing descriptive statistics and binary logistic regression to identify factors associated with malnutrition. Results: The prevalence of underweight was 73.3% (88/120), wasting 13.3% (16/120), and stunting 2.5% (3/120). Severe underweight (Zscore <3 SD) was observed in 55.8% (67/120) of children. Prelacteal feeding was given to 72.5% of children, and 58.3% had diarrhea in the two weeks preceding the study. Maternal illiteracy was 77.5%, and only 42.5% of deliveries occurred in a health facility. On multivariable analysis, prelacteal feeding (AOR = 3.2, 95% CI: 1.6–6.4, p < 0.01) and diarrhea in the preceding two weeks (AOR = 2.8, 95% CI: 1.3–5.9, p < 0.01) were independent predictors of underweight. Conclusions: Underweight and wasting are highly prevalent among underfive children attending Saidu Sharif Teaching Hospital, with prevalence rates substantially exceeding national averages. The exceptionally low prevalence of stunting, inconsistent with national and regional estimates, likely reflects hospitalbased sampling bias and the dominance of acute over chronic malnutrition in this population. Urgent communitybased nutrition interventions, improved maternal education, and strengthened health systems are needed to address this crisis.

Keywords: Malnutrition, underfive children, stunting, wasting, Pakistan, crosssectional study