title: Malnutrition prevalence and nutrition barriers in children under 5 years: a mixed methods study in Madagascar.
abstract: BACKGROUND
  Limited data exist on malnutrition prevalence in Madagascar. We aimed to assess the point prevalence of childhood malnutrition in the Anivorano region, and to explore mothers' perceptions of barriers to proper nutrition.
  
  
  METHODS
  In a mixed methods study we measured height and weight for 313 children, aged 6 months to 5 years during summer 2011 using a recumbent measuring board and calibrated scale, and simultaneously conducted semi-structured interviews with 60 mothers of malnourished (n=19) and healthy (n=41) children. Multivitamins and high-energy supplemental food were provided to malnourished children. Mothers were trained how to prepare high-energy supplemental food.
  
  
  RESULTS
  Prevalence of wasting defined by low weight-for-height was 10.3% (31/301); stunting or low height-for-age was 36.2% (109/301). The majority of families interviewed cultivated their own rice and other crops. Major themes regarding barriers to proper nutrition included inadequate purchasing power and access issues, low health literacy and misconceptions regarding proper nutrition and malnutrition, and insufficient variety of crops produced.
  
  
  CONCLUSIONS
  Malnutrition rates are alarming. Health and nutritional education to improve health literacy and address misconceptions, and improvement in social services, are warranted. A multilateral approach with involvement of health and social service agencies and non-governmental organizations to plan effective preventative strategies, along with broader national and transnational strategies are instrumental to address the fundamental causes of lack of access to proper nutrition.
authors: Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, New York, NY 10016, USA ramin.asgary@caa.columbia.edu.
authors: Ramin
authors: R
authors: Asgary
authors: Department of Psychiatry, New York University School of Medicine, 462 First Avenue, New York, NY 10016, USA.
authors: Michelle
authors: M
authors: Liu
authors: Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, New York, NY 10016, USA.
authors: Ramesh
authors: R
authors: Naderi
authors: Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, New York, NY 10016, USA.
authors: Zoya
authors: Z
authors: Grigoryan
authors: Maventy Health International, 46 Norman Place, Tenafly, NJ, 07670, USA.
authors: Martin
authors: M
authors: Malachovsky
mesh_terms: D000293:Adolescent; D001837:Body Weights and Measures; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D009035:Mothers; D009752:Nutritional Status; D015995:Prevalence
keywords: Children under 5; Madagascar; Malnutrition