{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T20:27:49Z","timestamp":1778790469483,"version":"3.51.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nepal Health Research Council","award":["90\/2020 MT"],"award-info":[{"award-number":["90\/2020 MT"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar\/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material &amp; methods<\/jats:title>\n<jats:p>A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 664 children between the age group of 6\u201359 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding &lt;8 times\/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding &lt;8 times\/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Low economic status and frequency of breast feeding less than 8times\/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245151","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T19:25:54Z","timestamp":1612380354000},"page":"e0245151","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Determinants of severe acute malnutrition among under 5 children in Satar community of Jhapa, Nepal"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1930-8246","authenticated-orcid":true,"given":"Kajol","family":"Dahal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak Kumar","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dharanidhar","family":"Baral","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birendra Kumar","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"pone.0245151.ref001","volume-title":"Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities","author":"L Lenters","year":"2016","edition":"3"},{"key":"pone.0245151.ref002","volume-title":"Severe acute malnutrition","author":"United Nations Children\u2019s Fund","year":"2015"},{"key":"pone.0245151.ref003","unstructured":"World Health Organization\/World Food Programme\/United Nations System Standing Committee on Nutrition\/The United Nations Children\u2019s Fund, 2007."},{"issue":"9608","key":"pone.0245151.ref004","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0140-6736(07)61690-0","article-title":"Maternal and child undernutrition: global and regional exposures and health consequences","volume":"371","author":"RE Black","year":"2008","journal-title":"The Lancet"},{"key":"pone.0245151.ref005","volume-title":"Malnutrition Factsheet","author":"World Health Organization","year":"2018"},{"issue":"2","key":"pone.0245151.ref006","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1177\/15648265140352S103","article-title":"Severe Acute Malnutrition in Asia","volume":"35","author":"T Ahmed","year":"2014","journal-title":"Food Nutr Bull"},{"key":"pone.0245151.ref007","volume-title":"Levels and trends in child malnutrition: key findings of the 2018 Edition of the Joint Child Malnutrition Estimates","author":"United Nations Children\u2019s Fund","year":"2018"},{"key":"pone.0245151.ref008","article-title":"Nepal Integrated Management of Acute Malnutrition(IMAM) Guideline","author":"Government of Nepal","year":"2017"},{"key":"pone.0245151.ref009","volume-title":"Nepal Demographic and Health Survey 2016","author":"Ministry of Health, Nepal","year":"2017"},{"issue":"8","key":"pone.0245151.ref010","doi-asserted-by":"crossref","first-page":"e017084","DOI":"10.1136\/bmjopen-2017-017084","article-title":"Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case\u2013control study","volume":"7","author":"NK Pravana","year":"2017","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0245151.ref011","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1186\/s12887-020-02154-1","article-title":"Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross sectional study","volume":"20","author":"U Ghimire","year":"2020","journal-title":"BMC Pediatr"},{"key":"pone.0245151.ref012","first-page":"136","article-title":"Risk factors for severe acute malnutrition in under-five children: a case-control study in a rural part of India","volume":"142","author":"NN Ambadekara","year":"2017","journal-title":"Royal Society for Public Health"},{"issue":"4","key":"pone.0245151.ref013","article-title":"Determinants of severe acute malnutrition among under five children in rural Enebsie Sarmidr District, East Gojjam Zone, North West Ethiopia, 2016","volume":"4","author":"A Awoke","year":"2018","journal-title":"BMC Nutrition"},{"issue":"2","key":"pone.0245151.ref014","doi-asserted-by":"crossref","first-page":"260","DOI":"10.12669\/pjms.342.14977","article-title":"Determinants of severe acute malnutrition among children under five years in a rural remote setting: A hospital based study from district Tharparkar-Sindh, Pakistan","volume":"34","author":"A Sand","year":"2018","journal-title":"Pak J Med Sci"},{"issue":"1","key":"pone.0245151.ref015","first-page":"3","article-title":"Household food insecurity and nutritional status of children and women in Nepal. Food Nutr Bull","volume":"35","author":"A Singh","year":"2014"},{"key":"pone.0245151.ref016","volume-title":"2019 Global Hunger Index: The Challenge of Hunger and Climate Change","author":"K. von Grebmer","year":"2019"},{"key":"pone.0245151.ref017","first-page":"5","volume":"5","author":"United Nations Resident and Humanitarian coordinator office","year":"2011","journal-title":"Field Bulletin state of Stateless Citizen: A case study on citizenship and landlessness issues of the Santhal Community"},{"issue":"4.3","key":"pone.0245151.ref018","first-page":"347","article-title":"Prevalence of Undernutrition among Santal tribal Preschool Children of Paschim Medinipur District, West Bengal, India","volume":"2","author":"S. Bisai","year":"2014","journal-title":"International Journal of Pediatrics"},{"issue":"3","key":"pone.0245151.ref019","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4038\/sljch.v42i3.6019","article-title":"Prevalence of undernutrition among Santal children of Birbhum District, West Bengal, India","volume":"42","author":"JR Ghosh","year":"2013","journal-title":"Sri Lanka Journal of Child Health"},{"issue":"2","key":"pone.0245151.ref020","first-page":"179","article-title":"Pal, S and Bose K. Prevalence of Under nutrition among Santal Preschool Children of Two Districts of West Bengal","volume":"8","author":"B Mahapatra","year":"2019","journal-title":"India. Human Biology Review"},{"key":"pone.0245151.ref021","first-page":"5","volume":"5","author":"United Nations Resident and Humanitarian coordinator office","year":"2011","journal-title":"Field Bulletin state of Stateless Citizen: A case study on citizenship and landlessness issues of the Santhal Community"},{"key":"pone.0245151.ref022","volume-title":"WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children's Fund","author":"WHO","year":"2009"},{"key":"pone.0245151.ref023","volume-title":"Case-control studies, design, conduct, analysis","author":"J.J. Schlesselman","year":"1982"},{"key":"pone.0245151.ref024","volume-title":"Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide","author":"J Coates","year":"2007"},{"key":"pone.0245151.ref025","first-page":"2015","volume-title":"FAQs: Global Poverty Line Update","author":"World Health Organization"},{"key":"pone.0245151.ref026","unstructured":"InfluentialPoints. Conditional Logistic regression [Internet]. https:\/\/influentialpoints.com\/Training\/conditional_logistic_regression.htm."},{"key":"pone.0245151.ref027","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3389\/fpubh.2018.00057","article-title":"Unconditional or Conditional Logistic Regression Model for Age-Matched Case\u2013Control Data?","volume":"6","author":"C-L Kuo","year":"2018","journal-title":"Front. Public Health"},{"issue":"1","key":"pone.0245151.ref028","article-title":"Prevalence and outcome of severe malnutrition in children less than ive-year- old in Omdurman Paediatric Hospital","volume":"16","author":"SOH Kanan","year":"2016","journal-title":"Sudan. Sudanese Journal of Paediatrics"},{"issue":"1","key":"pone.0245151.ref029","doi-asserted-by":"crossref","first-page":"46","DOI":"10.18203\/2349-3291.ijcp20185064","article-title":"Study of social and demographic determinants of severe acute malnutrition in children aged 6\u201359 months in a tertiary care centre of Odisha, India","volume":"6","author":"P Jena","year":"2019","journal-title":"International Journal of Contemporary Pediatrics"},{"issue":"206","key":"pone.0245151.ref030","doi-asserted-by":"crossref","DOI":"10.31729\/jnma.3141","article-title":"Effect of Maternal Socio-demographic Factors and Child Feeding Practice on Wasting Among Under Five Years Children in Slum Area of Rupandehi District in Nepal","volume":"56","author":"S Guatam","year":"2017","journal-title":"J Nepal Med Assoc"},{"key":"pone.0245151.ref031","doi-asserted-by":"crossref","DOI":"10.4172\/2161-0509-3-T1-001","article-title":"Prevalence of Malnutrition and Associated Factors Among Children Aged 6\u201359 Months at Hidabu Abote District, North Shewa, Oromia Regional State","volume":"1","author":"K Mengistu","year":"2013","journal-title":"Journal of Nutritional Disorders & Therapy"},{"issue":"4","key":"pone.0245151.ref032","doi-asserted-by":"crossref","first-page":"264","DOI":"10.3126\/kumj.v12i4.13732","article-title":"Malnutrition Status Among Under\u20145 Children in a Hill Community of Nepal","volume":"12","author":"K Gaurav","year":"2015","journal-title":"Kathmandu University Medical Journal"},{"issue":"4","key":"pone.0245151.ref033","article-title":"Risk Factors for Severe Acute Malnutrition in Children under the Age of Five Year in Sukkur.Pakistan Journal of Medical Research","volume":"51","author":"B Jamro","year":"2012"},{"key":"pone.0245151.ref034","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jpeds.2016.01.023","article-title":"Risk factors for child malnutrition in Bangladesh: a multilevel analysis of a nationwide population-based survey","volume":"172","author":"MR Chowdhury","year":"2016","journal-title":"The Journal of Pediatrics"},{"key":"pone.0245151.ref035","article-title":"Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study","author":"KI Mishra","year":"2013","journal-title":"Indian Journal of Pediatrics"},{"key":"pone.0245151.ref036","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1007\/s10995-010-0670-z","article-title":"Influence of maternal education on child immunization and stunting","volume":"15","author":"BA Abuya","year":"2011","journal-title":"Kenya. Maternal and Child Health Journal"},{"key":"pone.0245151.ref037","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s12887-015-0496-3","article-title":"Factors affecting malnutrition in children and the uptake of interventions to prevent the condition","volume":"15","author":"EMA Tette","year":"2015","journal-title":"BMC Pediatrics"},{"issue":"1","key":"pone.0245151.ref038","first-page":"105","article-title":"Socio-economic Determinants of Severe and Moderate Stunting among Under-Five Children of Rural Bangladesh","volume":"17","author":"SMM Kamal","year":"2011","journal-title":"Malaysian Journal of Nutrition"},{"issue":"6","key":"pone.0245151.ref039","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.12669\/pjms.336.13689","article-title":"Impact of maternal education, employment and family size on nutritional status of children","volume":"33","author":"A Iftikhar","year":"2017","journal-title":"Pakistan Journal of Medical Sciences"},{"issue":"2","key":"pone.0245151.ref040","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/16070658.2018.1448503","article-title":"Undernutrition among children under five in the Bandja village of Cameroon","volume":"32","author":"LD Nzefa","year":"2019","journal-title":"Africa. 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