Malnutrition and diarrhoea diseases form a vicious circle. According to World Health Organization (WHO), diarrhoea is the passage of three or more loose or liquid stools per day because of abnormally high fluid content of stool or an abnormal increase in daily stool frequency [1]. Diarrhoea diseases are infectious illnesses caused by germs such as bacteria, protozoa, viruses and fungi that enter in the body, multiply and can cause an infection [2]. These diseases are commonly transmitted by contaminated water or food especially fruits and vegetables [3]. Diarrhoea diseases remain a serious health problem which can be prevented and treated. However, it can cause dehydration, malnutrition and death among all age and especially in children under five years [1][3]. An estimated 1.7 billion of people suffer from diarrhoea each year resulting in half a million deaths. It is the second leading cause of morbidity and mortality among children aged under five resulting in approximately 525,000 children deaths each year in the global population [1]. In low and lower middle-income countries, diarrhoea is responsible for the death of more than 90% of children under five years of age [3].

Several studies have revealed that children with diarrhoea face many problems such as appetite loss, electrolyte deficit, delay in physical growth and cognitive development and malnutrition [4]. Malnutrition is estimated to contribute to more than one third of all children’s deaths, although it is rarely listed as the direct cause [5]. Malnutrition in preschool aged children is a global public health problem with 38.9 million children being overweight, 149.2 million being stunted and 45.4 million being wasted. About 45% of deaths in children aged under 5 years in developing countries are due to malnutrition, according to UNICEF in 2020 [6].

In Cameroon, about 29% of children aged under five years are stunted [7]. The latest demographic surveys revealed that 15% of children under 59 months suffered and died from diarrhoea [8]. It is one of the major and most common childhood diseases of public health concern. [9]. Generally, inappropriate maternal feeding practices were found to potentially cause diarrhoea and malnutrition in children under 59 months [10]. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get to the water source were associated with diarrhoea [4]. The feeding practice is generally influenced by the mother as the main caregiver for the child [11][12]. Children infected with diarrhoea can be treated in numerous ways (such as oral rehydration solutions, antibiotic treatments, immunization, and feeding practices) to prevent morbidities and high mortality rate [13]. Although limited research has explored knowledge, prevalence and associated factors of diarrhoea diseases in urban areas, several studies have highlighted the impact of knowledge, attitude, feeding practices and nutritional status of young children in rural and peri urban areas [14]-[16]. Global reports showed that significant progress has been made in reducing child mortality between 1991 and 2018. However, focused efforts are still needed to prevent deaths, of which diarrhoea and/or malnutrition diseases are the leading cause [8]. Therefore, the present study aimed to explore feeding practices, nutritional status and prevalence of diarrhoea among children aged 6 - 59 months in the Yaounde 6 subdivision health districts to allow the implementation of the appropriate interventions.

The present study aimed to explore feeding practices, nutritional status and prevalence of diarrhoea and determinants of children aged under five years in the Yaounde 6 subdivision health districts. The study highlighted inappropriate feeding practices, low food diversity score, no knowledge about appropriate complementary feeding, high prevalence of acute and chronic malnutrition and diarrhoea. Diarrhoea was mainly caused by yeast in children aged 6 to 59 months. Electrolyte disorders were frequently observed in children suffering from diarrhoea. Sixty-two percent (62.21%) of the children started their food diversification before 6 months (0 - 3 months). This high frequency of early initiation of complementary foods could be explained by the fact that in this study, the majority of mothers (more than 65%) have a job, which would reduce the time to take care of the baby, including the practice of exclusive breastfeeding according to WHO recommendations. Most of the mothers were forced to entrust the feeding of their children to someone else. However, multivariate analysis indicated a protective odds ratio (OR = 0.285, 0.464, 0.836) in favor of the person who fed the children (nanny or neighbors) in the mother’s absence, the mother’s age and a family size at 6 persons respectively. These data suggested that, the choice of the person to look after the children in the parents’ absence is a very important factor in the care of young children. On the other hand, the larger of the family, the more support and help there is for the mother when she is unavailable. The present findings are consistent with the results from the studies conducted in Eastern Algeria [18] and the mother and infant and young child in Kumbotso local Government area, Kano state, Nigeria [19]. However, the percentage of good feeding practices observed in this study were lower than those of the mothers in the Buea, Tiko and Limbe health Districts in Cameroon [9] as well as the percentage reported in the rural Bangladesh [20]and Western Rwanda [21]. Furthermore, at this age (0 - 6 months), the infants have an immature digestive system, therefore early dietary diversification would expose them to nutritional deficiencies due to nutrient absorption disorders and hydro-electrolytic disorders or diarrhoea [22]. Findings from this study indicate that there is still a lack of awareness about good complementary feeding practices among mothers. The children’s diets were mainly composed of staple foods, root and tuber cereals (91.24%) and legumes (58.99%) and are low in meat and dairy products (22.12%), fruits and vegetables (23.04%). This could be justified by the fact that most of the mothers bought infant formulas for the nutrition of their children, which are generally made up of cereals such as rice, pasta, corn, millet and sorghum. In addition, most of the mothers revealed that they didn’t cook particular meals for their children as they preferred ready to eat food. This aligns with the findings of Sobze et al. (2019) [23] in the Mayo-Danay department of Cameroon, who found that children under five years were fed at 98.9%, with cereals, roots and tubers, 51.6% had a non-diversified diet and 48.8% received three meals during the past 24 hours. Regarding the food diversity score of the children, it was characterized by a low score (62.67%). These results can likely to be attributed to several factors, such as the fact that the majority of mothers were workers (65%) so as a result, they don’t have enough time to prepare balanced meals. On the other hand, most mothers still lacked adequate knowledge (70.97%) about complementary food. Additionally, the high cost of living does not always allow mothers to provide balanced meals for their children. Likely, previous studies demonstrated unhealthy feeding practices among young children aged 6 - 23 months in five sub-Saharan African regions [24], the main food consumed were cereals. Furthermore, a low food diversity score could predispose children to risks of nutritional deficiencies that can affect physical growth, cognitive development and overall health of children [25].

The study of complementary feeding indicators and feeding practices revealed that the mothers had inappropriate feeding practices leading to increased risk of child malnutrition. Food frequency and food diversity score both in children are key indicators of optimum feeding practices [26]. The results revealed that the prevalence of stunting was critical, affecting approximately 23.96% of children. Stunting rates were higher in boys (16.1%) than in girls (7.8%) and higher in children aged 12 to 23 months (13.82%). These findings are closed to the 23.6% prevalence of stunting obtained by Kojom et al. (2021) [27] on the prevalence, patterns and determinants of malaria and malnutrition in children under 5 years of age in the city of Douala (Cameroon). Regarding sex and age, the prevalence of stunting found in this study is lower than that obtained by Tchapda et al. (2022) [28] in a study conducted in Ayos (Eastern Cameroon) among children in the same age group. Stunting is a form of malnutrition that results in a height below normal in relation to the child’s age. When it occurs in children under 24 months, it can have adverse consequences on their health, such as cognitive disorders that can persist into adulthood. This high rate of stunting would be linked to an early or too late introduction of complementary foods that are not well assimilated by children [12]. Additionally, there is strong evidence that infants under 6 months of age who consume foods other than breast milk tend to have diarrhoea problems, which could reduce the absorption of nutrients, including some minerals from breast milk [29]. The overall prevalence of underweight reflected acute malnutrition among infants and young children. However, severe underweight was low (4.14%). Underweight is associated with insufficient nutrition due to the large family size or to irregular food intake attributable to the mother’s occupation. Higher prevalence of underweight (25.8%) among young children have been previously reported in the city of Douala in Cameroon [11]. Wasting which reflects acute malnutrition among children was low (9.2%) according to WHO criteria [3]. Conversely, a study in the Tole Health district in the South West region of Cameroon [30] reported a low prevalence of wasting due to household size. Household with 2 - 4 people had 7.8% for wasting while those with 5 - 7 people had 5.3%. Those with more than 8 members in the house, had zero prevalence of wasting and the difference in wasting with respect to household size was statistically significant. Overweight and obesity were less prevalent among males (4.6%) compared with females (3.2%) among the children under five years. Comparable findings were reported by Hossain et al. (2020) [31] in their study. Additionally, it was previously observed a high prevalence of overweight among females (2.86%) compared with males (2.09%) in peri-urban area in Cameroon [14]. The prevalence of stunting, underweight and wasting weakens children’s immune systems. This exposes them to diarrhoea diseases [32].

Accordingly, the study revealed that the prevalence of diarrhoea was 23.04% with those aged 6 to 11 months being the most affceted age group (13.01%). This high rate could be explained by the poor hygiene rules and feeding practices among children under five years old. Most of the children ate the family meal and there were no age appropriate foods. In addition, mothers did not wash their hands with soap before feeding their children. Interestingly, this study showed that over 40% of the children drank water not safe for consumption and most mothers had access to latrines. Latrine is a hole in the ground and a toilet is a modern toilet that uses a pour-flush system [16]. This result was lower compared to the results obtained from Efoulan Health district, Yaounde-Cameroon (26.1%) [33], but higher compared to a study carried out in Eastern Ethiopia where the prevalence of diarrhoea among children was 7.4% [34]. This is supported by the fact that diarrhoea leads to hydro electrolytic imbalance between different ions in the body. Additionally, these findings could be attributed to water and electrolyte losses due to vomiting, stools, urine, and sweating during diarrhoea [35]. Microscopic examination of the different pathogens revealed that diarrhoea in children was mainly caused by yeasts followed by Entamoeba histolytica, Entamoeba coliandGuardialambia. Several hypotheses can be put forward to explain the presence of yeast in children’s stools: diarrhoea may be caused by infant porridges, which is mostly made from fermented maize, which may contain high levels of yeast and other micro-organisms if the fermentation is not controlled. On the other hand, inappropriate complementary feeding and poor hygiene may also explain this result. Consequently, according to many authors, high levels of yeast or other bacteria lead to general intestinal inflammation, chronic intestinal or extra-intestinal amoebiasis, an inflammatory reaction of the liver (liver abscess) and respiratory failures that can lead to death [17]. Nearly 60% of children with diarrhoea had a positive CRP (greater than 6 mg/L). C-reactive protein is an early, sensitive and specific marker of the inflammatory reaction released by the liver, and proportional to its intensity. Thus, the predominant positive C-reactive protein in the study population would indicate the presence of an infection, particularly by yeasts or other pathogens responsible for diarrhoea in children [36]. In the same line, the family size (>6) and the age of mother (25 - 30 years) were independent factors associated with childhood malnutrition onset.

The present finding demonstrated that stunting, wasting, underweight and diarrhoea remained public health problem. The nutritional problems observed in children under five years were mainly due to poor knowledge and inappropriate complementary feeding practices of mothers/caregivers. It would be necessary, and indeed advisable, to set up nutritional intervention programmes focusing on hygiene training for those responsible for children in the absence of their parents, as well as practical nutritional advice for working mothers.

Even though this study has some strengths, it is not without limitations. The weaknesses of the study were essentially due to the cross-sectional design being unable to establish the temporal relationship between diarrhoea and its determinants. Additionally, the data were collected only once from each mother child pair, which made it difficult to assess a direct link between the quality of the food served to the children and occurrence of diarrhoea. It is necessary to perform a PCR test on the children’s stools in order to determine the characteristics of the bacteria involved.

The authors are grateful to the Saint Martin de Porres Hospital of Mvog-Betsi, the District Medical Center of Mendong and the District Medical Center of Obili also in Yaounde 6 subdivision for allowing us to lead this study within their institutions. We also thank Mrs NDINGA Priscille for the edition of the language.