Nutritional status of children aged 6–59 mo born to mothers treated for severe acute malnutrition in childhood: an observational Lwiro cohort study in Democratic Republic of Congo

Background: Severe acute malnutrition (SAM) is one of the main causes of child mortality, but little is known about the condition of the offspring of survivors. Objectives: This study aimed to describe the nutritional status of children born to mothers who were exposed to childhood SAM. Methods: This was an observational cohort study of children aged 6–59 mo drawn from the Lwiro cohort in Democratic Republic of Congo (DRC) from March to May 2019. Exposure was defined as having a mother exposed to childhood SAM or not. We measured anthropometric parameters (weight, height, middle upper arm circumference) and edema to evaluate malnutrition. Child health indicators were assessed, as well as hemoglobin, human immunodeficiency virus serology, and parasitic infestation rates. Linear, binary, and ordinal logistic regressions with clustered robust standard errors were used to analyze differences between exposed and unexposed for continuous and dichotomous variables and malnutrition, respectively. Results: A total of 178 exposed and 124 unexposed children were included. Median age of exposed and unexposed children was 27.1 mo and 24.3 mo, respectively. Females were 47.2% exposed and 54.0% unexposed (P = 0.161). Global acute malnutrition (GAM) and SAM were respectively 31.4% and 12.9% in exposed compared with 15.4% and 6.5% in unexposed [odds ratio (OR): 2.50; 95% confidence interval (CI): 1.36, 4.59; P = 0.003]. Stunting was 54.5% in exposed compared with 39.5% in unexposed (OR: 1.79; 95% CI: 1.11, 2.89; P = 0.018). Underweight was 32.0% in exposed compared with 19.4% in unexposed (OR: 2.02; 95% CI: 1.14, 3.56; P = 0.015). Adjusting for household type, age, and maternal body mass index, we observed persistence of GAM prevalence with SAM in unexposed 14.2 (95% CI: 8.3, 20.2), compared with 6.5 (95% CI: 2.9, 10.1) in unexposed, P = 0.010. No significant differences in prevalence were observed for anemia and intestinal parasitosis. Conclusions: In DRC, children whose mothers had been exposed to childhood malnutrition had a higher prevalence of malnutrition than children born to unexposed mothers. GAM and stunting exceed the extreme severity threshold set by the World Health Organization.