Risk factors for SAM (nutritional causal analysis) - Study from Chad

  • aangioletti
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Risk factors for SAM (nutritional causal analysis) - Study from Chad

Dear Members of the WG12,

I am pleased to share with you an article about a study carried out in Chad on individual and household-level risk factors for SAM among under-five children in Mao health district.

You can find the study at the following link:


Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study

Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6–59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.

Best Regards,
Andrea Angioletti

WASH Advisor / Référent Technique EHA
République Démocratique du Congo (RDC) | République Centrafricaine (RCA) | Cameroun | Tchad
14/16 Boulevard Douaumont - CS 80060 75854 PARIS CEDEX 17
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  • arno
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Re: Risk factors for SAM (nutritional causal analysis) - Study from Chad

Thanks for informing us about this study. I can see from the results that the highest AORs*related to the SAM symptoms at the individual level were diarrhea (10.7), fever (8.4) and vomiting (7.6). At the household level the AORs were lower eg caretaker’s hand washing habits (1.9) and absence of a toilet (1.9). But one factor stands out from all others at the household level and that is the marriage status of the caretaker (7.7) with a wide range of 2.2-30. Do you have an explanation for this variable as it relates to risk for infection? Is this more related to the age of the caretaker whereby children taking care of babies present the highest risk? Is marriage related to learning about infection?

A methodology question - you report AORs and not ORs. Aren't AORs adjusted based on a combination of variables? What then were the variables that are being co-factored into the results? Can one combine improved water source, presence of a toilet and hand-washing in order to get an overall impact of WASH interventions?

* for more on OR: www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/


Arno Rosemarin PhD
Stockholm Environment Institute
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Current project affiliation: www.susana.org/en/resources/projects/details/127
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