Measuring Local Determinants of Acute Malnutrition in Chad: A Case-Control Study

In 2010, Guéra District, Chad, recorded a prevalence of global acute malnutrition of 16.1 percent and SAM of 4.9 percent—both signs of a critical nutritional situation. To improve malnutrition, a problem-tree analysis is normally used to propose causal factors. For this study, the IRC employed a case-control study and qualitative methods to determine causes of SAM and their effect sizes with an aim of providing evidence for programming. A matched case-control study was conducted within a coverage assessment (the semi-quantitative evaluation of access and coverage) of a therapeutic feeding program. Qualitative information on the determinants of SAM was translated into hypotheses and standardized indicators to be evaluated in the case-control study. The odds of reporting fever and diarrhea in the previous 2 weeks were eight and eleven times higher among SAM cases. Diarrhea and fever represent multiple causes that contribute, with other factors, to the development of SAM and warrant a specific focus for programs. Preventative recommendations include hygiene promotion and the routine use of bed nets for under-five year olds. Identification of the timing of the onset of disease and malnutrition is difficult and we may only show association and not cause. The ability of the matched study to detect differences among factors that do not vary at the community level (e.g., use of an unprotected water source) needs to be considered.