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. 2025 May 30;11(1):106.
doi: 10.1186/s40795-025-01096-0.

Food insecurity, feeding practices and associated factors of acute malnutrition among children under 5 years of age in a post-conflict context in the Kasai region, Democratic Republic of Congo: a community-based case-control study

Victoire Hubert  1   2 , K Phelan  3 , L I Bozama  4 , H Boubacar  5 , G Tshibangu Sakubu  6 , B Tshiala  4 , Mathilde Savy  7 , R Becquet  8 , C Cazes  8
Affiliations

Food insecurity, feeding practices and associated factors of acute malnutrition among children under 5 years of age in a post-conflict context in the Kasai region, Democratic Republic of Congo: a community-based case-control study

Victoire Hubert et al. BMC Nutr. .

Abstract

Background: The Kasai region in the Democratic Republic of Congo suffered a violent conflict in 2016-17 and has been facing high household food insecurity and acute malnutrition (AM) in under 5 children ever since. This study aims to describe food security and feeding practices in a rural health district of this region in which the clinical randomised control trial OptiMA was implemented, and to assess the associated factors of AM among children aged 6 to 59 months in the aftermath of the conflict.

Methods: A community-based matched case-control study was nested in the OptiMA trial. Cases (n = 91) were children aged 6 to 59 months suffering from AM enrolled in the trial. Two neighbourhood controls (n = 181) were randomly selected per case, matched on age. The required sample size, based on the Household Hunger Score (HHS) in the area, was 81 pairs of cases and controls. Of the 282 heads of households interviewed, 272 were included in the analyses. The heads of household and the children's caregivers were interviewed on household, caregiver, and child acute malnutrition risk factors. A conditional logistic regression was used to fit a model of wasting risk factors.

Results: A total of 91% of households faced severe food insecurity and 33% severe hunger. Dietary diversity of both children and mothers was low with no mothers and only 5 children in the controls group reaching minimum dietary diversity. The mean diet diversity of mothers and children in both groups was only comprised between 2 and 2.5 out of 10 and 8 food groups, respectively in the classification. The HHS (AOR 2.9, 95% CI 1.6 to 5.6) and both moderate and severe stunting (AOR 10.2, 95% CI 3.2 to 32.2 and AOR 11.0, 95% CI 3.5 to 34.9, respectively) were strongly associated with acute malnutrition in the adjusted model.

Conclusions: The dire food security and hunger described in this study calls for multi-sectoral actions to improve food access and evidence-based preventive actions for all types of undernutrition in the area.

Trial registration: The trial in which this ancillary study is embedded was registered on clinicaltrials.gov under the number NCT03751475 on November, 23rd 2018.

Keywords: Child; Democratic republic of congo; Food insecurity; Growth disorders; Hunger; Malnutrition; Post-conflict; Risk factors; case-control studies.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. The study was nested in a trial whose protocol was approved by the DRC national ethics committee (CNES) (94/CNES/BN/PMMF/2018) and by the Ethics Evaluation Committee of Inserm, the French National Institute for Health and Medical Research (Comité d’Evaluation Ethique de l’Inserm) (18–545). In November 2019, the CNES performed a field visit at each of the study sites and then renewed approval (152/CNES/BN/PMMF/2019) for the continuation of the trial. After an initial explanation by the enumerator in Tshiluba, asking questions and receiving an information sheet, all participants gave written consent. If the participant was unable to read and write, he chose a witness that could sign for him/her (usually the village community health worker). Consent for publication: Not required. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Seasonal agriculture calendar of the Kamwesha area (Kasai, Democratic Republic of Congo). S = Sowing season; H = Harvest season
Fig. 2
Fig. 2
Flow chart of children included in the case-control study. ATFC = Ambulatory Therapeutic Feeding Center; MUAC = Mid-Upper Arm Circumference
See this image and copyright information in PMC

References

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