Title: Are orphans at increased risk of malnutrition in Malawi?
Study Location: Malawi
Type of Paper: Original Article
Purpose: To compare the health and nutritional status of children living in orphanages with orphans living with families and non-orphaned children living in the same communities and to identify the factors associated with malnutrition.
Measures: Weight, length/height, weight-for-age, height-for-age, weight-for-height, age, gender, previous illness, duration of stay in orphanage or family, age of guardian, and number of children in family.
Participants: 76 orphans living in three children’s homes, 137 orphans living in families, and 78 non-orphans from the communities.
Methods: Volunteer field workers identified all orphans under 15 years old in two villages, and recruited non-orphans in nearby households. Orphanage children were studied in three children’s homes in Blantyre, Malawi. Anthropometrics were obtained from all participating children. Interviews were conducted with orphanage caregivers and guardians of orphaned and non-orphaned children. Children were excluded from the study if they were over 15 years old or lacked a clearly recorded birth date.
Results: The prevalence of underweight in children under 5 years old was 54.8% in orphanage children, 33.3% in orphans in families, and 30% in non-orphans. Severe underweight was seen in 38.7% of orphanage children, compared to 6.7% and 16.7% of non-orphan and orphans in families, respectively. The prevalence of stunting in children <5 years was 64.5% in orphanage children, 50% in orphans in families, and 46.4% in non-orphans. The prevalence of wasting in children <5 years was 9.7% in orphanage children, 12.5% in orphans in families, and 0% in non-orphans. In children over 5 years old, however, the prevalence of underweight was 6.8% in orphanage children, 23.9% in orphans in families and 20.8% in non-orphans. The prevalence of stunting in children >5 years was 9.1% in orphanage children, 30.4% in orphans in families, and 34% in village children. The prevalence of wasting in children >5 years was 0% in orphanage children, 5.3% in orphans in families, and 2.3% in non-orphans. Illnesses reported over a 4 week period included 35% by orphanage children, 37% by orphans in families and 51% by non-orphans. Of the illnesses report, diarrhea was highest among non-orphans. Underweight was present in 42% of orphanage children who had a history of illness over the previous 4 week period, compared to 18.8% of children who had no reported illness. No association was found between malnutrition and gender, age, duration of stay, or illness among orphans in families. However, orphans in families with more than 3 children were nearly three times as likely to be malnourished compared to orphans in families with 3 children or less. Among orphanage children, girls were more likely to be malnourished than boys, and children who stayed less than 1 year at the orphanage were more likely to be malnourished than those who stayed one year or more.
Conclusions and Implications: Children under 5 years old in the orphanage were more malnourished than orphans in families and non-orphans of the same age. This is likely due to malnutrition being one of the admission criteria for orphanages. Children may have already been chronically malnourished upon arrival to the orphanage. However, orphanage children over 5 years old were less stunted and wasted than orphans in families and non-orphans. This suggests children in orphanages may have greater long-term food security. Illness was reported more frequently among non-orphans, which could imply that biological parents report illness more due to increased attention and concern paid to their children. The association between number of children and malnutrition among orphans in families suggests living in a larger family can lead to inadequate food distribution and less individual attention.
Limitations: Non-orphans were not randomly selected. Additionally, there were a smaller proportion of children under 5 years old in orphans in families compared to non-orphaned children.
Citation/Reference: Panpanich, R., Brabin, B., Gonani, A. & Graham, S. Are orphans at increased risk of malnutrition in Malawi? Annals of Tropical Paediatrics. 1999; 19: 279-285. http://www.ncbi.nlm.nih.gov/pubmed/10715715