Stunting, wasting and associated factors among children aged 6-24 months in Dabat health and demographic surveillance system site: A community based cross-sectional study in Ethiopia

Prevalence and determinants of pre-adolescent (5-14 years) acute and chronic undernutrition in Lay Armachiho District, Ethiopia

Background

In Ethiopia it is documented that 16% of all grade repetitions in primary school and 33.9% childhood deaths are associated with undernutrition. School aged children are often omitted from public health research. Thus, the present study was carried out to find out the prevalence and determinants of pre-adolescent (5–14 years) acute and chronic undernutrition in Lay Armachiho District.

Methods

In this community based cross-sectional study, anthropometrics, individual and household characteristics data were collected from December, 2016 to January, 2017. A total of 848 school aged children (5–14 years) were included in the study. Z-scores for height-for-age (HAZ) and body-mass-index-for-age (BAZ) were calculated to illustrate stunting (chronic undernutrition) and thinness (acute undernutrition), respectively with Anthro Plus software version 1.0.4 using the WHO 2007 growth reference standard. Finally, backward stepwise multivariable logistic regression analysis was carried out to identify factors associated with stunting and thinness, individually.

Results

The overall prevalence of stunting and thinness was 35.5 and 9.9%, respectively. The multivariable analysis showed that child age 10–14 years [AOR = 1.58, 95% CI: 1.17, 2.12] and lack of availability of a latrine at home [AOR = 1.60; 95% CI: 1.17, 2.20)] were associated with increased likelihood of stunting. Nevertheless, child’s hand washing practice before eating [AOR = 0.67; 95% CI: 0.49, 0.91] was protective against stunting. Children who consumed diversified foods [AOR = 0.64; 95% CI 0.39, 0.97] were protected from thinness.

Conclusion

In Lay Armachiho district, one-third and one in every ten of school aged children were stunted and thin, respectively. Children age 10–14 years, lack of availability of a latrine at home and hand washing practices before eating were associated with stunting, while only dietary diversity was associated with thinness. Ensuring consistent hand washing practices before eating and ensuring availability of latrine should be improved in the region, which can assist in effectively tackling undernutrition. Finally, dietary diversification should be enhanced to rectify burden of acute undernutrition.

Prevalence of malnutrition and associated factors among under-five children in Ethiopia: evidence from the 2016 Ethiopia Demographic and Health Survey

OBJECTIVE

The aim of this study was to assess the risk factors for malnutrition among children aged 0-59 months in Ethiopia. The analyzed data were obtained from the 2016 EDHS and 9495 under-5 years' children were considered in this analysis. The data was extracted, edited and analyzed by using SPSS Version 23.0. Both bivariate and multivariable binary logistic regression model was used to identify the determinants of children malnutrition.

RESULTS

The prevalence of stunting, wasting, and underweight were 38.3%, 10.1%, and 23.3%, respectively. About 19.47% of children were both stunted and underweighted, and only 3.87% of children had all the three conditions. Among the factors that considered in this study, age of a child, residence region, mothers' education level, mothers' BMI, household wealth index, sex of a child, family size, water and toilet facility were significantly associated with malnutrition in Ethiopia. The authors concluded that malnutrition among under-five children was one of the public health problems in Ethiopia. Therefore, the influence of these factors should be considered to develop strategies for reducing malnutrition in Ethiopia.

The Interaction between Morbidity and Nutritional Status among Children under Five Years Old in Cambodia: A Longitudinal Study

Even though limited evidence is available, the relationship between morbidity and under-nutrition among children under-five is likely to be a strong two-way association. This study aims to explore this vicious cycle by employing longitudinal data of four periods within a 24 month follow-up, whereby morbidity was captured between two subsequent anthropometric measures. Malnutrition was classified according to z-scores of anthropometric measures and morbidity by number of sick days experienced inbetween. Mixed-effects models were used to assess this relation, where dependency of morbidity and nutritional status were interchanged; models were adjusted for province, age, gender, wealth index score, maternal education level, diet, and Water, Sanitation, and Hygiene indicators. Stunting and wasting prevalences were 29.9% and 8.9%, respectively, where 21.3% of the children hadmultiple anthropometric failures. Children identified as wasted were 35% more likely to experience prolonged illness periods (OR: 1.35, 95% CI: 1.02-1.56). Those experiencing high proportion of sick days were found to be 64% more likely to become stunted (OR: 1.64, 95% CI: 1.18-2.29). This study suggests that the link between wasting and stunting could be partly explained by acute illness, where wasting increases the likelihood of prolonged epiosed of illness, which increases the risk of stunting.

Determinants of the Stunting of Children Under Two Years Old in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey

Indonesia is ranked fifth among countries with the highest burden of stunting in children under five. This study aims to examine the determinants of stunting in children aged 0-2 years in Indonesia using data derived from the 2013 Indonesia Basic Health Survey. Twenty potential predictors of stunting, categorized into household and housing characteristics; maternal and paternal characteristics; antenatal care services and child characteristics were analyzed. Multilevel analyses were performed to examine the role of cluster/district/provincial differences, as well as individual/household level characteristics and stunting status. Of 24,657 children analyzed, 33.7% (95%CI: 32.8%-34.7%) were stunted. The odds of stunting increased significantly among children living in households with three or more children under five-years-old (aOR = 1.33, 95%CI: 1.03-1.72), households with five to seven household members (aOR =1.11; 95%CI: 1.03-1.20), children whose mothers during pregnancy attended less than four antenatal care services (aOR = 1.22, 95%CI: 1.08-1.39), boys (aOR = 1.33, 95%CI: 1.22-1.45), children aged 12-23 months (aOR = 1.89; 95%CI: 1.54-2.32), and children who weighed <2500 g at birth (aOR = 2.55; 95%CI: 2.05-3.15). The odds also increased significantly with the reduction of household wealth index. Integrated interventions to address environment, an individual level associated with stunting in Indonesia, from the environment- to individual-level factors are important.

Socioeconomic inequality in stunting among under-5 children in Ethiopia: a decomposition analysis

Objective

Ethiopia bears a high stunting burden. However, there is a paucity of evidence on the socioeconomic inequalities of stunting in Ethiopia. Thus, this study was aimed to determine the degree of socioeconomic inequality in stunting and decompose it to the social determinants of stunting. We used a nationally representative sample of 8855 children, aged below 5 years, from the Ethiopian demographic and health survey, conducted in 2016. Subjects were recruited following a two-stage cluster sampling. The socioeconomic status was measured by the household wealth index, categorized into quantiles. The inequality in stunting between the poorest and the richest socioeconomic groups was decomposed into its contributing social factors following the Blinder–Oaxaca decomposition approach.

Result

The overall prevalence of stunting was 38%, with a significant pro-poor socioeconomic inequality. The prevalence of stunting among the poorest and the richest socioeconomic categories was 45.1% and 26.9%, respectively. Caregivers education status was the main contributor, accounting alone for 33% of the socioeconomic inequality in stunting, followed by region of residence (11%) and birth size (6%). Equity sensitive interventions, which prioritize the vulnerable groups might help to narrow the socioeconomic inequality as well as fasten the progress towards the goal of stunting reduction.

Predictors of stunting among children 6-59 months of age in Sodo Zuria District, South Ethiopia: a community based cross-sectional study

Background

Despite the decline in the rate of stunting in Ethiopia, the prevalence is still high and needs immense efforts to achieve the target set to reduce the prevalence. It varies between localities due to individual level factors and dominant livelihood practice in the community.

Thus, the aim of this study was to determine the prevalence of stunting and identify factors associated with it in Sodo Zuria district in South Ethiopia.

Methods

A community based cross sectional study was conducted among 342 children aged 6–59 months paired with mothers/caretakers. Households were selected using systematic sampling. Structured questionnaire was used and mothers/caregivers were interviewed face to face. Standardized anthropometric measurements were used to measure length, and weight and height of a child. Data were entered into Epi Info software version 3.5.1 and exported to SPSS version 20 for analysis. Height for age Z score data were analyzed using WHO Anthro software. Multivariate logistic regression analysis was conducted to identify predictor variables. Statistical significance was considered at p < 0.05.

Results

The prevalence of stunting in this study was 24.9% with 7.9% being severely stunted. Being female (AOR = 2.8; 95% CI: 1.5, 5.3), children aged 12–23 months (AOR = 7.1; 95% CI: 2.3, 21.9), mother’s who do not use family planning (AOR = 2.5; 95% CI: 1.1,5.7), children with diarrheal morbidity (AOR = 2.5; 95% CI: 1.2,5.3), income of 750–1500 ETB and > 1500, and children who received pre-lacteal feeding (AOR = 3.8; 95% CI: 1.2–12.2) became predictors for stunting.

Conclusion

Significant proportion of stunting was found where one third of them were severely stunted. Being female, children aged 12–23 months, using family planning, children with diarrheal morbidity, income and pre-lacteal feeding became predictors for stunting. So Gender-based policies should be enacted in child feeding practice, interventions should focus on the utilization of family planning and appropriate child caring and feeding practices. Water, sanitation and hygiene interventions need to be strengthened.

Dietary and non-dietary determinants of linear growth status of infants and young children in Ethiopia: Hierarchical regression analysis

Introduction

Childhood growth faltering remains a major public health problem in developing countries. We aimed to identify the distal, underlying, and proximal dietary and non-dietary factors associated with length-for-age (LFA) of infants and young children in Ethiopia.

Methods

We used a nationally representative sample of 2,932 children aged 6–23 months from the Ethiopian demographic and health survey (EDHS) conducted in 2016. Hierarchical regression analysis was done to identify the factors associated with LFA.

Findings

Pastoral residence (adjusted β (aβ) = -0.56, 95%CI = -0.82, -0.31, P<0.001) and poorest household wealth category (aβ = -0.57, 95%CI = -0.66, -0.48, P<0.001) were the basic factors negatively associated with LFA. Among underlying factors, maternal wasting (aβ = -0.43, 95%CI = -0.58, -0.28, P<0.001), and unimproved toilet facility (aβ = -0.48, 95%CI = -0.73, -0.23, P<0.001) were negatively associated with LFA. Proximal factors found positively associated with LFA were dietary diversity (aβ = 0.09, 95%CI = 0.043, 0.136, P<0.001), meal frequency (aβ = 0.04, 95%CI = 0.00, 0.08, P = 0.042), and vitamin A supplementation (aβ = 0.16, 95%CI = 0.03, 0.29, P = 0.020). Male sex (aβ = -0.26, 95%CI = -0.39, -0.14, P<0.001), age (aβ = -0.12, 95%CI = -0.13, -0.10, P = 0.001), small birth size (aβ = -0.45, 95%CI = -0.62, -0.29, P<0.001), and not currently breastfeeding (aβ = -0.29, 95%CI = -0.47, -0.11, P = 0.003) were negatively associated with LFA.

Conclusion

LFA was associated with various influences at distal, underlying, and proximal levels. A multi-pronged approach, addressing the various factors comprehensively, would represent an important consideration to promote linear growth in early childhood in Ethiopia.

Feeding Practices and Undernutrition in 6⁻23-Month-Old Children of Orthodox Christian Mothers in Rural Tigray, Ethiopia: Longitudinal Study

Fasting period and fasting status affect the feeding practices and nutritional status of Ethiopian Orthodox mothers. Even if children are exempted from fasting, some mothers do not prepare their food from animal sources as it could contaminate utensils for cooking family foods. Therefore, the objective of this study was to assess feeding practices and undernutrition in 6⁻23-months old children whose mothers are Ethiopian Orthodox religion followers during lent fasting and non-fasting periods in rural Tigray, Northern Ethiopia, and to identify associated factors. A community-based longitudinal study was carried out in Ethiopian Orthodox lent fasting and non-fasting periods. Using a multi-stage systematic random sampling technique, 567 and 522 children aged 6⁻23 months old participated in the fasting and non-fasting assessments, respectively. Statistical analyses were done using logistic regression, an independent sample t-test, Wilcoxon signed-rank (WSRT) and McNemar's tests. The prevalences of stunting, underweight and wasting were 31.6⁻33.7%, 11.7⁻15.7% and 4.4⁻4.8%, respectively. The weight-for-height (WHZ) and height-for-age (HAZ) values for children of fasting mothers were significantly lower (p < 0.05) compared to those of non-fasting mothers. Likewise, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly higher in non-fasting than in fasting periods. A small proportion of children (2.3⁻6.7%) met the minimum acceptable diet (MAD) in the study population, but these measures were significantly increased (p < 0.001) in the children of non-fasting mothers. Mother's fasting during lactation period of the indexed child was amongst the independent factors common in child stunting, underweight and wasting. Nutritional status and feeding practices of 6⁻23-month-old children are affected by maternal fasting during the fasting period. Therefore, without involvement of religious institutions in the existing nutritional activities, reduction of undernutrition would not be successful and sustainable.

Stunting and anemia among children 6-23 months old in Damot Sore district, Southern Ethiopia

BACKGROUND

Stunting and anemia are long-standing public health challenges which adversely affects the cognitive development and physical wellbeing of children in low income settings. The aim of this study was to assess the prevalence and associated factors of stunting and anemia among 6-23 months old children in Damot Sore District, Southern Ethiopia.

METHODS

Cross-sectional survey was conducted among 477 children aged 6-23 months, which were living in Damot Sore District, in April 2017. A multistage sampling technique was used. Villages were randomly selected and systematic random sampling method was used to select study participants. Data on socio-demographic, anthropometric, dietary, blood samples for hemoglobin were collected. Data were entered into EPI Data V. 3.1 and exported into SPSS Version 21.0 for analysis. A principal component analysis (PCA) was done to generate wealth score of households. Binary logistic regression model was used to identify factors associated with the outcome variables (stunting and anemia) separately, those variables having less than a p-value of 0.25 were chosen as candidate for multivariable analyses and finally multivariable logistic regression model was used to identify independent variables of each outcomes, with statistical significance set at p < 0.05 (95% confidence interval (CI)).

RESULTS

Out of 477 children studied, 31.7% were stunted and 52% were anemic. In the multivariable analyses, the number of under five children within a household (AOR = 4.18, 95% CI: 2.65-6.57), drinking water from unsafe source (AOR = 4.08, 95% CI: 1.33-12.54) and anemia (AOR = 3.13, 95% CI 2.00-4.92) were factors significantly associated with stunting. On the other hand, independent variables of anemia were early initiation of complementary feeding (AOR = 2.96, 95% CI: 1.23-4.85), poor dietary diversity (AOR = 2.95, 95% CI: 1.78-4.91), poor breast feeding practice (AOR = 2.94, 95% CI: 1.63-5.32) and stunting (AOR = 3.65, 95% CI: 2.15-6.19).

CONCLUSION

This study revealed higher level of stunting and anemia among children aged 6-23 months than WHO (world health organization) criteria of public health importance. Sustainable promotion of diversified diet, optimal complementary feeding, optimal and complementary breast feeding practices, improving sanitation infrastructure are measures needed to tackle these severe public health challenges.

Iodine status five years after the mandatory salt iodization legislation indicates above requirement: a cross sectional study in Northwest Ethiopia

Background

Iodine deficiency is one of a major nutritional problem. The study aimed to assess the iodine status of populations in Dabat district using median urinary iodine concentration (UIC) in school-age children (6–12 years) and compared the results with goiter prevalence.

Methods

The study used a cross-sectional study design. The study was conducted in Dabat district, northwest Ethiopia in May 2016. Spot urine samples were used for the determination of UIC. Manual examination of the thyroid gland was performed to assess presence of goiter. The MBI international Rapid Test Kits (RTK) were used to determine the level of salt iodine content. Children aged 6–12 years were recruited from schools using a multistage stratified sampling. One-way Analysis of Variance (ANOVA) was used to compare mean of log-transformed UIC values among key variables. Significant was determined at P-value less than 0.05.

Results

A total of 358 school age children enrolled to the study. The mean age of children was 10.8((Standard Deviation (SD) = 1.45) years and 56.7% were males. The median UIC was 235 μg/l ((Inter Quartile Range (IQR): 161, 320]. Excessive iodine intake and inadequate iodine intake was observed on 29.1 and 8.7% of school aged children, respectfully. The coverage of iodized salt use in school-age children were 66.8%. The UIC was higher in urban children than rural counterparts and in those used adequately iodised salt than inadequately iodized salt (P < 0.05). Thirty-four percent of school-age children had a goiter. The prevalence of grade 1 and grade 2 goiter was 26.5 and 7.5%, respectively. There was a poor agreement between UIC and goiter (k = 0.1) in classifying iodine status of populations.

Conclusions

The study population is classified as above requirements by median UIC in school-age children but severe iodine deficiency by goiter prevalence. Further research investigating the agreement between UIC and goiter prevalence in classifying iodine status of populations with various iodine status is warranted.

Undernutrition and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia: a cross-sectional study

BACKGROUND

Many people, especially in developing countries such as Ethiopia, are migrating to cities. The majority of these people have settled in slum areas, which often have poor sanitation and housing conditions. Therefore, this study was conducted to gather evidence on nutritional status and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia.

METHODS

A community-based cross-sectional study was carried out from 3 to 28 May 2017. A total of 593 children from the slum areas aged 6-59 months were included in the study. Bivariable and multivariable logistic regression analyses were carried out to identify the independent determinants of stunting and wasting.

RESULTS

The overall prevalences of stunting and wasting were 42.3% (95% CI 38.34, 46.3%) and 7.3% (95% CI 5.3, 9.4%), respectively. Poor wealth status (adjusted odds ratio [AOR] =1.79; 95% CI 1.19, 2.70) and age of child 24-35 months (AOR=2.56; 95% CI 1.32, 4.96), 36-47 months (AOR=2.27; 95% CI 1.14, 4.54) and 48-59 months (AOR=2.69; 95% CI 1.35, 5.32) were independently associated with stunting. Similarly, presence of a fever in the previous 2 weeks (AOR=2.29; 95% CI 1.20, 4.38) and paternal control over resources (AOR=3.66; 95% CI 1.12, 11.04) were associated with wasting. Children of uneducated mothers (AOR=3.30; 95% CI 1.29, 8.46) were also more likely to be wasted.

CONCLUSION

This study illustrates that undernutrition is prevalent in the slum areas of Gondar city and is a critical public health problem. Therefore, attention should be targeted at economically disadvantaged children living in slum areas. In addition, there is a need to improve medical awareness of families with young children in these areas and increase the health-seeking behavior of these families, primarily by focusing on maternal education. Increasing women's decision-making autonomy over household resources is also recommended to address the problem.

Prevalence of stunting and its associated factors among children 6-59 months of age in Libo-Kemekem district, Northwest Ethiopia; A community based cross sectional study

Background

Children in developing countries are highly vulnerable to impaired physical growth because of poor dietary intake, lack of appropriate care, and repeated infections. This study aimed at assessing the prevalence of stunting and associated factors among children 6–59 months of age in Libo-kemekem district, northwest Ethiopia.

Methods

A community based cross sectional study was conducted in Libo-Kemekem from October 15 to December 15, 2015. The multistage sampling technique was employed to select 1,320 children aged 6-59months. Data were collected by trained community health extension workers under regular supervision. Data were entered into EPI-Info version 3.5.1, and height for age was converted to Z-score with ENA-SMART software. Data were then exported to SPSS version 20 for descriptive and binary logistic regression analysees. The significance of associations was determined at p<0.05.

Results

Out of 1287 children included in the analysis, 49.4% (95% CI: 46.7%–52.3%) were found to be stunted. In the multivariate analysis, increased child age [AOR = 6.31, 95%CI: (3.65, 10.91)], family size of six and above [AOR = 1.77, 95%CI: (1.35, 2.32)] were positively associated with stunting, while, fathers with secondary school education [AOR = 0.50, 95%CI: (0.30, 0.81)], farmers as household heads [AOR = 0.56, 95%CI: (0.38, 0.84)] and self-employed parents as household head [AOR = 0.45, 95% CI: (0.28, 0.72)] were found to be preventive factors.

Conclusion

The prevalence of stunting was high in the study area. We found that stunting was significantly correlated with child age, occupational status of household head, family size, and fathers’ education. Therefore, intervention focusing on supporting housewives, family planning, and education on child feeding and nutrition should be implemented.

Maternal parity and exclusive breastfeeding history are significantly associated with stunting in children aged 12-59 months

Objectives: To determine the relationship between maternal parity and exclusive breastfeeding history with stunting among children aged 12-59 months.Materials and Methods: Observational method with case control approach. Sampling method used purposive sampling was conducted in 118 children. Data were collected by observation and interview using questionnaire. Chi square test used to bivariate analysis and logistic regression used to multivariate analysis with 5% significance limit and 95% confidence level.Results: Multivariate analysis results that maternal parity and exclusive breastfeeding history was significantly associated with stunting (OR 3,419 (CI 95%: 1.433-8.156); OR 3,706 (CI 95%:1.430-9.605). External variable significantly associated with stunting is maternal occupation OR 2,972 (CI 95%: 1.285-6.874).Conclusion: Maternal parity and exclusive breastfeeding history are significantly associated with stunting in children aged 12-59 months.

Nutritional Assessment of the Children of the Beta Israel Community in Ethiopia: A 2017 Update

BACKGROUND

Malnutrition is a common phenomenon worldwide and a major public health problem, particularly in developing poorer countries like Ethiopia. Although malnutrition can affect any age group, children are at a higher risk and it is associated with an increased morbidity and mortality. The aim of this study was to update and assess the nutritional status of children of the Beta Israel community in the Gondar area of Ethiopia.

METHODS

This was a community-based cross-sectional anthropometrical study of all the children of the community age 0-60 months. A structured questionnaire was used to collect sociodemographic data, nutritional history, and clinical parameters. Nutritional indices weight for age, height for age, and weight for height were used to define the nutritional status of the children. The 2006 World Health Organization (WHO) growth curves served as reference parameters. Statistical analysis included binary logistical regression analysis.

RESULTS

A total of 489 children, representing over 90% of the community's children were studied with the mean age and standard deviation of 36.5 and 18 months, respectively. The overall prevalence of malnutrition was found to be 39.1% with wasting, underweight, and stunting occurring in 22.1%, 26.2%, and 18.4% of the children, respectively. Severe wasting, severe underweight, and severe stunting occurred in 8.4%, 8.2% and 5.3% of the children, respectively. Multivariate analysis showed that age was significantly associated with the occurrence of malnutrition with younger children being at a higher risk (p = 0.044). Gender of child, family income, maternal education, presence of illness in the month preceding data collection, and household size did not show any association with malnutrition prevalence.

CONCLUSION

The prevalence of malnutrition as measured by stunting, underweight, and wasting has remained high among children younger than 5 years of the Beta Israel community in Gondar. Moreover, younger children were found to be more malnourished than older children.