This study sought to determine the prevalence and associated factors of undernutrition in children under five years of age in the Northwest Region of Cameroon. This study revealed that the prevalence of undernutrition was 36.1%, which is higher than the national incidence of 28.9% reported in the 2018 DHS (3). However, this prevalence is lower than the 40% observed in the 2021 SMART survey in the North region (14). The Far North, North, and Adamawa regions of Cameroon have been exposed to armed conflicts for a long time, including the East region, which is host to many Central African refugees. These regions have made significant contributions to the high prevalence of undernutrition in Cameroon. The prevalence of undernutrition observed in this study is already approaching the percentages in those northern regions. This suggests that the Northwest region is facing a significant problem of undernutrition, which might be attributed to ongoing conflict, which has resulted in several types of displacement, food insecurity, loss of livelihood and constrained access to healthcare, and the situation might worsen if interventions are not intensified (4).
Male children were nearly twice as likely as female children to be undernourished. This finding aligns with the results of previous research that has consistently shown that boys are at a greater risk of undernutrition than girls are during conflict, with some studies in Buea Cameroon and a meta-analysis indicating that this risk is twice as high (15, 16). This gender disparity is particularly pronounced in some regions, such as rural China (17). The reasons for these differences are complex and multifaceted, with both biological and social factors playing a role. It is thought that gender bias in care practices, such as feeding and healthcare, may contribute to this difference. Another possibility is that boys have higher energy requirements than girls due to their higher physical activity levels (16). These findings underscore the need for targeted interventions to address the specific nutritional needs of boys, particularly in low-income and rural settings.
The present study revealed a greater incidence of undernutrition among children aged 6–11 months. This finding aligns with findings from a study in Northwest Ethiopia and another in a conflict area in Yemen suggesting that children in this age group may be particularly susceptible to contracting COVID-19 due to transitioning from exclusive breastfeeding to complementary foods, which may be inadequate in quantity or quality (18, 19). This finding contradicts those obtained from a study in India in which children aged one to two years were the most at risk (20). This difference might be due to the small sample size of 133 participants in that study compared to the 1279 participants in this study.
The finding that the risk of undernutrition is nearly double among third-born or later children born compared to firstborns is supported by studies in India and Bangladesh (21, 21). This association may be due to factors such as limited resources and competing attention for mothers in larger families, potentially leading to inadequate nutritional care for some children, as suggested by a study in Kenya (22).
This study revealed that non-enrolled children were 2.6 times more likely to be undernourished than were those who were enrolled. This aligns with findings from studies in Kenya and Tanzania (22, 23). This association could be explained by limited access to school-based feeding programs and increased exposure to infections for children who are not enrolled (24). Therefore, ensuring access to education for all children is crucial in combating undernourishment.
The finding of a 71% increased risk of undernutrition among children with incomplete vaccination compared to fully vaccinated children perfectly aligns with results from a recent analysis of DHS data from 16 countries that stated that children who have not received all vaccinations for their age had a 71% greater risk of undernutrition than fully vaccinated children (25). This finding is further supported by studies in Indonesia, which revealed that children with incomplete or no immunization coverage had a greater incidence of severe underweight, stunting, and diarrhea (26). In Nigeria, the use of certain vaccines was associated with a lower likelihood of stunting, highlighting the potential role of vaccination in improving long-term nutritional outcomes (27). This association likely reflects the link between inadequate vaccination coverage and increased vulnerability to infections, which can negatively impact nutritional status. The finding that children who were fully vaccinated were less likely to be undernourished is consistent with the well-established link between vaccination and improved health outcomes, including nutritional status (28).
The finding of a double risk of undernutrition among children with known worm infections compared to those without a history of worm infections aligns with studies from Ghana and Uganda (28–30). This association is likely due to the negative impact of worm infections on nutrient absorption and utilization, which contributes to undernutrition. These findings underscore the importance of deworming and integrated efforts to address undernutrition and parasitic infections in children (28).
Children who received antibiotics within two weeks prior to the interview were three times more likely to be undernourished than children who did not use any antibiotics. Research has shown a complex relationship between antibiotic use and undernutrition. While some studies have shown that antibiotic use in low-resource settings can lead to increased weight in children (31), others have highlighted the need for longer-term solutions to address the risk of death in this population (32). However, the routine use of antibiotics to promote animal growth has been found to have little impact on protein undernutrition in the developing world (33). These findings raise significant concerns about the potential negative consequences of antibiotic overuse in paediatric populations and suggest that the relationship between antibiotic use and undernutrition is multifaceted and may vary depending on the specific context and population.
Approximately 2.5 times more children who experienced diarrhea in the last 2 weeks were at risk of undernutrition. The association observed in this study between diarrhea and undernutrition aligns with extensive research highlighting the detrimental impact of diarrhea on child health and nutritional status, including one from Indonesia that identified diarrhea as a risk factor for undernutrition (34). Diarrhoeal episodes can lead to dehydration, electrolyte imbalance, and nutrient malabsorption, ultimately contributing to weight loss and impaired growth or undernutrition (35).
Approximately 2.5 times more children who experienced vomiting in the last 2 weeks were at risk of undernutrition than were those without vomiting. This contradicts the results of a retrospective hospital-based study in Bangladesh in which vomiting was not directly identified as a risk factor for undernutrition, which showed that vomiting can be associated with severe malnutrition and an increased risk of death in children with diarrhea and severe malnutrition (36). These differences in results might be due to differences in study designs and methodologies. Vomiting may be indicative of underlying respiratory or gastrointestinal infections that can interfere with nutrient absorption and utilization. Therefore, while vomiting itself may not be a direct risk factor for undernutrition, it can be a symptom of underlying conditions that may contribute to undernutrition in children.
While this study revealed no statistically significant associations between several child-related factors, such as gestational age, twin status, low birth weight, or HIV status, and undernutrition, these factors have medical significance for undernutrition and need not be overlooked during the design of interventions.
Limitations of the study
This study, because of its cross-sectional design, can establish only associations, not causation. Participants may underreport socially undesirable behaviors or overreport socially desirable behaviors. The incidence of undernutrition may vary depending on the season, and a single study may not capture this variation.
Strengths of the study
This study provides valuable data on the prevalence and associated factors of undernutrition in the Northwest Region of Cameroon, which has been understudied. The use of standardized anthropometric measurements and questionnaires ensured the quality of the data and allowed comparison with the findings of other studies. This study will contribute to the body of knowledge needed to address undernutrition effectively in Northwest Region of Cameroon.