Childhood malnutrition during the Bosnian conflict: Four linked cross-sectional studies

In the first years of the Bosnia conflict (1992–1995), a number of small local studies failed to confirm the expected widespread malnutrition that was the basis of humanitarian appeals. At the request of relief agencies, four population surveys from 1994 to 1997 measured childhood malnutrition during and immediately after the conflict as well as potential risk factors. The four surveys visited a random sample of clusters from population registers in Bosnia and Herzegovina (BiH) and the Republica Srpska (RS). All surveys measured mid-upper arm circumference (MUAC) in children 6–59 months old in 31 BiH clusters and in 10 RS clusters (last three surveys). An administered questionnaire documented potential risk factors, including breastfeeding, receipt of food aid and socio-economic variables. Analysis relied on a cluster-adjusted multivariate Mantel–Haenszel procedure. In BiH, the proportion of children with MUAC less than 125 mm increased between 1994 and 1997: 5.5%, 6.8%, 14.2% and 8.6% (χ2 = 23.2; 2 d.f.); using z-scores (>−2SD), the increase was 2.8%, 5.6%, 7.5% and 5.7% (χ2 = 11.9; 2 d.f.). In the third year of life, the risk of malnutrition was significantly higher in children from households receiving food aid (ORa = 2.38, 95% CIca = 1.36–4.15), whereas in the fourth year of life the risk of malnutrition was higher among children in male-absent households (ORa = 4.42, 95% CIca = 1.99–9.83). The risk of malnutrition was not related to ethnicity, sex of the child or urban/rural residence. The increased childhood malnutrition between 1994 and 1997 confirms increased vulnerability of some segments of the Bosnian population over the last years of the war, despite the humanitarian aid programme.