# Maternal Undernutrition in Focus: Determinants among pregnant and lactating women in Kurrum District, Pakistan: A Community-based Study

## TL;DR

This study examines the causes of maternal undernutrition in Kurrum, Pakistan, finding it is linked to young age, low education, and poor sanitation.

## Contribution

The study identifies specific socioeconomic and demographic factors contributing to maternal undernutrition in a tribal district of Pakistan.

## Key findings

- 16.3% of pregnant and lactating women in Kurrum were undernourished based on MUAC measurements.
- Younger maternal age and low educational status were strongly associated with undernutrition.
- Households with one earning member and those using water treatment had higher undernutrition rates.

## Abstract

Undernutrition during pregnancy and lactation affects infant growth, development, and resistance to infection. This study aimed to assess maternal undernutrition in the tribal district of Kurrum, Khyber Pakhtunkhwa, Pakistan, and its various contributing factors.

We conducted a community-based cross-sectional study nested within our registered trial (ISRCTN94319790) in Upper Kurrum (January 2018 to December 2020). Pregnant and lactating women were selected through two-stage stratified random sampling. Trained enumerators collected socioeconomic and demographic data using a pre-tested questionnaire. MUAC was measured with standardized tapes, and multivariate regression was performed in STATA 14.

The mean MUAC measurement of 2,195 PLWs was 26.37 cm (+- 3.49 SD). The overall prevalence of MUAC based undernutrition was 16.3% (95% CI: 14.8%–17.9%) and significantly associated with younger maternal age (p-value <0.001), low educational status (p-value <0.001), and open drainage toilet used (p-value 0.04) in the household. On multivariate regression analysis there was an increased likelihood of undernutrition in PLWs with lower maternal age i.e. <=20 (OR 0.38, 0.27-0.54 95% CI). Undernutrition was more likely among PLWs belonging to households with only one earning member (OR 1.63, 95% CI 1.19, 1.98) and using water treatment facility compared to none (OR 1.95, 95% CI 1.49, 2.55).

Maternal undernutrition in Kurrum exceeds national averages and is strongly influenced by maternal age, socioeconomic vulnerability, sanitation, and education. Strengthening maternal nutrition programs, improving WASH conditions, and addressing economic barriers are essential for reducing undernutrition in high-burden districts.