Socio-cultural, educational, and behavioral determinants of severe acute malnutrition among children aged 6 to 59 months: a study at the Ati Nord Health Center, Chad

Child malnutrition remains a major public health challenge in low-income countries. In Chad, nearly 2.2 million people were affected by acute malnutrition in 2021, mainly children, making it the leading cause of child mortality. In the Batha province, the prevalence reached 2.4%. This study aimed to identify the socio-cultural, educational, and behavioral factors associated with severe acute malnutrition (SAM) among children aged 6 to 59 months attending the Ati Nord Health Center (Batha region, Chad). A descriptive cross-sectional study was conducted from April 18 to June 10, 2022, involving 120 malnourished children and their mothers, selected using a four-stage cluster sampling method. Data were collected through questionnaires and analyzed using Excel 2013 and SPSS 21.0 software. A child was classified as suffering from SAM when their weight-for-age Z-score was below −3 standard deviation (SD). Marasmus accounted for 81.7% of cases, affecting mostly girls, while kwashiorkor was more frequent among boys. Early weaning (65.8%), mostly occurring between 6 and 11 months, was mainly driven by closely spaced pregnancies (38.3%). The introduction of complementary foods before the age of 6 months was observed in 70% of children. Although 74.2% of mothers provided colostrum, most were unaware of its nutritional importance. Drinking water mainly came from boreholes (75.8%), but remained untreated in 80% of households. Moreover, more than half of the mothers (52.5%) first consulted a traditional healer; in 85% of families, health decisions were made exclusively by fathers. Efforts to combat SAM in Ati Nord should focus on community-based awareness strategies that actively involve healthcare workers, traditional leaders, healers, and families. A multisectoral approach is crucial for promoting sustainable changes in nutritional practices.