Psychosocial determinants of nutritional neglect in a developing country.

OBJECTIVE To determine the demographic features and psycho-social and economic determinants of nutritional neglect in order to suggest interventional strategies. STUDY DESIGN Cross-sectional, observational study. PLACE AND DURATION OF STUDY Department of Paediatrics, Dow University of Health Sciences (DUHS) and Civil Hospital Karachi (CHK), from January 2009 to December 2010. METHODOLOGY All children suffering from nutritional neglect suggested by weight and height less than the third centile for age, and their mothers were recruited in the study through non-probability consecutive sampling. A team comprising of paediatrician, psychologist, medical social worker and social motivator interviewed the mothers and children suffering from nutritional neglect. Information about demographic, social, economic and psychological factors was obtained. The results were analyzed and described as frequency distribution and percentage. RESULTS A total of 658 children suffering from nutritional neglect were inducted. Around 75% of children were below 5 years of age, 51% were females. Other determinants of nutritional neglect were, large family size (family of > 5 members (84%), young mother (60%), uneducated parents (67% father and 77% mothers being illiterate), low income (77% earning less than Rs. 7000/month), addiction (23%), tobacco smoking (50%) and non-nutritive substance use (51%). Psychological indicators identified in mothers were depression (70%), anxiety (73%), helplessness (70%), displaced aggression (50%) and insecurity (36%). Psychological factors identified in children as a secondary outcome were aggression (80%), rebellious behaviour (75%), lack of confidence (70%), lack of social interaction (70%) and paranoid tendencies (60%). CONCLUSION Psycho-social and economic factors are important determinants of neglect. A holistic approach and intervention at multiple levels is required to address these issues.