Maternal Functional Difficulty and Child Undernutrition in Malawi: A Nationally Representative Cross-Sectional Study(2024 DHS)

Abstract Background Maternal disability can reduce the ability to provide adequate care and increase the likelihood of undernutrition among children. In Malawi, over one third of under-five children are affected by stunting. There has been no study that assessed the association between maternal functional difficulty and undernutrition among children in Malawi. The objective was to assess if maternal functional difficulty is associated with stunting, underweight, and wasting in children in Malawi. Methods Data were extracted from the nationally representative cross-sectional Malawi 2024 Demographic and Health Survey (MDHS). Mother-child dyads were included for mothers aged 15-49 years and children aged ≤ 59 months, with valid anthropometric z-scores. Maternal functional difficulty was assessed using the Washington Group Short Set on six domains (seeing, hearing, walking, cognition, self-care, communication) and classified as severe vs. no difficulty. Child undernutrition was defined as height-for-age z-score (HAZ) < −2 (stunting), weight-for-age z-score (WAZ) < −2 (underweight), and weight-for-height z-score (WHZ) < −2 (wasting). Survey-adjusted multivariable logistic regression models were fitted, accounting for complex sampling design whilst population attributable fraction was calculated. Results A total of 4,361 mother-child dyads were analyzed for this study. The overall weighted prevalence of maternal functional difficulty was 3.74% (SE 0.35). There was a reported 36.4% prevalence for child stunting, 8.7% for underweight and 1.7% for wasting. Maternal functional difficulty was not associated with child stunting (AOR 0.85, 95% CI: 0.55-1.33), underweight (AOR 1.06, 95% CI: 0.55-2.02) and wasting (AOR 0.96, 95% CI: 0.26-3.53) after adjustments for confounders. The population-attributable fractions were also found to be negligible for all three nutrition outcomes. Maternal height ≥ 150 cm showed strong protective effect against child stunting (AOR 0.29, 95% CI: 0.16-0.54) as well as belonging to the richest wealth quintile (AOR 0.61, 95% CI: 0.42-0.89). In conclusion, there was no statistically significant association between maternal functional difficulty and child undernutrition in Malawi. The family and community support networks in Malawi may be buffering the nutritional effects of maternal disability on children. To reduce child undernutrition in Malawi, efforts should focus on maternal height, household wealth and the first 1,000 days interventions.