Undernutrition and associated factors among children aged 6-59 months in East Belesa District, northwest Ethiopia: a community based cross-sectional study

Epidemiology of stunting in children aged 6-59 months, an unresolved chronic nutritional problem in Ethiopia: A systematic review and meta-analysis

Background

In developing countries as well as Ethiopia, stunting continues to be a major public health burden. Thus, the aim of this systematic review and meta-analysis is to synthesize the updated pooled prevalence and its determinants of stunting in Ethiopia.

Methods

This systematic review and meta-analysis follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The protocol has been registered with the International Prospective Register of Systematic Reviews, University of York Center for Reviews, and disseminated at https://www.crd.york.ac.uk/, with the registration number (CRD42024542984). A wide-ranging literature search was carried out using PubMed/Medline, Science Direct, Hinari, AJOL, and Google Scholar. All lists of qualified study references from 2013 to 2023 were recovered. The pooled estimate with a 95% CI was calculated using a random-effects model in STATA version 13 software. I 2 and meta-bias statistics were used to assess the heterogeneity of the incorporated studies.

Results

This study included 29 articles with a total of 23,511 participants from 29 qualified studies. The current study found that the pooled prevalence of stunting among children aged 6-59 months was 43% (95% CI: 42-44). Children who were not exclusively breastfed (OR = 2.39; 95% CI: 1.61-3.54), male children (OR = 1.61; 95% CI: 1.13-2.31), children whose mothers had no antenatal care follow-up (OR = 3.03; 95% CI: 1.36-6.76), and women who had no formal education (OR = 4.55; 95% CI: 2.29-9.05) were significantly associated with stunting.

Conclusions

In Ethiopia, nearly half of the children suffer from stunting, with those who are not breastfed, the sex of the child, children whose mothers had no antenatal care follow-up, and had no formal education having higher odds of stunting. To reduce the burden, strategies must be designed to intervene and improve maternal health literacy, focusing on children's nutrition and health-care utilization.

Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia

Chronic energy deficiency (CED) in pregnant women is a condition of energy and protein deficiency that lasts for years and causes problems in the mother and fetus. Due to its significant consequences, determining the determinants associated with CED incidence is of utmost importance. The aim of this study was to determine the determinants of the incidence of CED in pregnant women in Indonesia. A cross-sectional study was conducted on pregnant women in Banyumas, Central Java, Indonesia, in 2022. Plausible determinants included maternal age, pregnancy interval, parity, educational attainment, nutritional knowledge, employment, frequency of antenatal care (ANC), and nutritional intake. The Chi-squared test followed by multivariate logistic regression were used to determine the factors associated with the incidence of CED. Our data indicated that 32% of the pregnant women had CED. Univariate analysis found that maternal age (p=0.022), pregnancy interval (p=0.009), educational attainment (p=0.012), knowledge of nutrition and CED (p=0.023), frequency of utilization of ANC services (p=0.028), energy intake (p=0.002), protein intake (p=0.006), vitamin C intake (p=0.016), folate intake (p=0.011), and calcium intake (p=0.004) were significantly associated with CED incidence in the pregnant women. Multivariate analysis indicated that extreme maternal age (OR; 3.49; 95%CI: 1.10-11.05), low educational attainment (OR: 4.12; 95%CI: 1.37-12.33), short pregnancy interval (OR; 7.30; 95%CI: 1.84-28.99), low frequency of ANC (OR: 3.06; 95%CI: 1.01-9.19) and low protein intake (OR: 6.80; 95%CI: 1.62-28.59) were associated with CED incidence. This study underscores the importance of increasing nutritional intake, frequency of ANC, and pregnancy interval among pregnant women to reduce the risk of CED and its adverse health outcomes.

Understanding the national evidence on the double burden of malnutrition in Ethiopia for the implications of research gap identifications: a scoping review

BACKGROUND

Owing to the unavoidable consequences of nutritional transition, the double burden of malnutrition (DBM) is an emerging public health problem. An increasing number of studies have found that Ethiopians face a DBM. However, country-level evidence has not yet been summarised using a scoping review study design.

OBJECTIVE

The main objective of this review was to map the national evidence on DBM in Ethiopia for the implications of research gap identifications.

ELIGIBILITY CRITERIA

The population, concept and context approach was used. All age groups, box sexes, all dates of publication and articles in English language focused on DBM conducted in Ethiopia were included.

SOURCES OF EVIDENCE

Primary research articles, systematic reviews, meta-analyses and scoping reviews searched from electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar and Google were the sources of evidence.

CHARTING METHODS

The Joanna Briggs Institute Reviewer's manual was used as a review methodology. The authors, publication year, region, study design, sample size, population group, measured outcomes and main findings were charted in a table.

RESULTS

A total of 35 articles met the inclusion criteria among 124 426 participants. The average summarised prevalence of DBM was 33.6%, with the average proportions of undernutrition and overnutrition at 21.5% and 12.1%, respectively. The major factors that influenced the DBM were categorised as child, maternal, adolescent, household and adult-related factors.

CONCLUSION

In Ethiopia, the overall prevalence of DBM is high, which makes one-third of the population affected by DBM. The foremost determinant factors that influenced the DBM were characterised as child, maternal, adolescent, household and adult-related factors. Therefore, a double-duty interventions should be used to address DBM, considering multilevel factors at the individual, community and societal levels.

PROTOCOL REGISTRATION

This review was registered on the figshare website on 28 February 2021, with DOI number https://doi.org/10.6084/m9.figshare.14131874. The review protocol was published with a DOI number http://dx.doi.org/10.1136/bmjopen-2021-050805.

Prevalence of Acute Malnutrition and Associated Factors among Children aged 6-59 months in South Wollo Zone, East Amhara, Northeast Ethiopia: a Community-based cross-sectional study

OBJECTIVE

The aim of this study is to determine the prevalence of acute malnutrition and associated factors in South Wollo zone, East Amhara, Northeast Ethiopia.

DESIGN

A community-based cross-sectional study was conducted among 504 children aged 6-59 months who were selected by using a multistage sampling technique. The mid-upper-arm-circumference and Z-scores for weight-for-height were used to determine the nutritional status of the participants. A semi-structured interview questionnaire was used to collect the data. Then data was entered into EpiData V.3.1 and exported to SPSS software V.25 for analysis. Binary logistic regression was used to identify factors associated with acute malnutrition and variables with p value<0.05 were declared as statistically significant.

SETTING

The study was conducted in South Wollo zone, Northeast Ethiopia from 1 August 2020 to 30 September 2020.

PARTICIPANTS

Children aged 6-59 months with their mothers were the study subjects.

RESULTS

The prevalence of acute malnutrition among children aged 6-59 months was 31.0%. Child aged 6-11 months (adjusted OR (AOR)=3.92; 95% CI: 1.74 to 8.82), illiterate mothers (AOR=3.01; 95% CI: 1.92 to 7.01), single mother (AOR=3.06; 95% CI: 1.32 to 7.07), lack of latrine (AOR=2.39; 95% CI: 1.12 to 5.11), diarrhoea (AOR=4.18; 95% CI: 2.02 to 8.65), respiratory tract infection (AOR=2.31; 95% CI: 1.08 to 4.94), family size (≥5) (AOR=3.29; 95% CI: 1.53 to 7.09) and cessation of breast feeding before 2 years (AOR=3.79; 95% CI: 1.71 to 8.23) were the independent predictors of acute malnutrition.

CONCLUSION

Acute malnutrition is highly prevalent in the study area which is more than the national figure. Thus, improving maternal education, access to the latrine, improved breastfeeding practice, improved family planning usage and early detection and treatment of diarrhoea and respiratory tract infections will enhance children's nutritional status. In addition, nutritional diversity education needs to be strengthened.

Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren

Introduction

Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors.

Methods

This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets.

Results

Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods.

Discussion

Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.

Wasting and its associated factors among children aged from 6 to 59 months in Debre Tabor town, Amhara region of Ethiopia, 2019: a multicentre community-based cross-sectional study

OBJECTIVES

Wasting is acute malnutrition that has harmful short-term consequences for children and is determined by an inadequate diet. This study aimed to assess the prevalence and associated factors of wasting among children aged 6-59 months in Debre Tabor town, Ethiopia.

DESIGN

This study was a community-based cross-sectional.

SETTING

The study was conducted at Debre Tabor town, Ethiopia.

PARTICIPANTS

A total of 436 children aged 6-59 months participants were enrolled.

OUTCOME MEASURES

A weight-for-height z-score, which is below -2 SD of the WHO median standard curve, was used to measure wasting. Logistic regression analyses were done to see which independent variables have an association with the dependent variable and a p value of <0.05 was considered significant at the 95% CI.

RESULTS

The result revealed that wasting in children aged 6-59 months was 6.2%. Children in the age group of 6-11 months were 4.3 times more likely to have wasted than those in the age group of 24-59 months (adjusted OR (AOR): 4.3; 95% CI: 1.5 to 12.5). Similarly, parents who have poor wealth status in their family are 3.1 times more likely to have wasted children than those who have rich wealth status in their family (AOR: 3.1 (1.01 to 9.35)). Moreover, mothers who gave birth at the age group of 20-25 years were 4.3 times more likely to have wasted children than those who gave birth at an age group of greater than 30 years (AOR: 4.3 (4.3 (1.56 to 12.5)).

CONCLUSION

Wasting is still an important public health problem for children in the age group of 6-59 months. The age of the child, the wealth status of the family, and giving birth before 20 years of age were significantly associated with wasting. Therefore, the government of Ethiopia should pay further attention to the wealth status of the family; create awareness among the mothers regarding childhood undernutrition care, and design further nutritional intervention programmes.

Factors associated with wasting and stunting among children aged 06-59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study

BACKGROUND

Child undernutrition is a major public health problem in Ethiopia despite different nutrition-specific and sensitive interventions implemented by the government. However, evidence regarding the burden and responsible factors is limited in the South Ari district. Hence, this study aimed to assess factors associated with wasting and stunting among children aged 06-59 months in the South Ari district, Southern Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted from March 11 to April 11, 2021, among 717 households with at least one child aged 06-59 months. Anthropometric measurements were taken using standard procedures and were converted to height for age Z score and weight-for-height using WHO Anthro software Version 3.2.2. Data were checked and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25.0. Binary logistic regression analysis was fitted to identify predictors of wasting and stunting. A p-value < 0.05 was used to declare statistical significance.

RESULT

The prevalence of wasting and stunting among children aged 06-59 months in the district was 9.1% (95% CI: 7.07%, 11.41%) and 59.97% (95% CI: 56.28%, 63.58%), respectively. Family size (8 and above) (AOR = 3.03, 95% CI: 1.31, 7.03), family size (5 to 7) (AOR = 2.05, 95% CI: 1.11, 3.81), poor and medium wealth index (AOR = 3.69, 95% CI: 1.65, 8.26) and (AOR = 2.29, 95% CI: 1.01, 5.16), insufficient maternal knowledge on child feeding practice (AOR = 2.58, 95% CI: 1.31, 5.07), presence of diarrhea in the past two weeks (AOR = 2.05, 95% CI: 1.10, 3.85), non-exclusive breastfeeding (AOR = 2.65, 95% CI: 1.51, 4.65), and birth interval of < 24 months (AOR = 4.49, 95% CI: 2.40, 8.37) were factors significantly associated with wasting. Whereas, children in the age group of 24-59 months (AOR = 2.24, 95% CI: 1.58, 3.16), non-exclusive breastfeeding (AOR = 1.81, 95% CI: 1.24, 2.65), birth interval of fewer than 24 months (AOR = 1.54, 95% CI: 1.11, 2.14), sub-optimal child dietary diversity score (AOR = 1.59, 95% CI: 1.14, 2.22), being a non-beneficiary of productive safety-net program (AOR = 1.91, 95% CI: 1.24, 2.95), and household food insecurity (AOR = 2.60, 95% CI: 1.86, 3.64) were factors significantly associated with stunting.

CONCLUSIONS

Wasting and stunting were found to be key public health problems in the South Ari District. Hence, further interventions should consider strategies to enhance household food security and integration of productive safety net programs with primary health care services. Rigorous work is required in advocating and strengthening the provision of family planning services, child care, and integrated management of common childhood illnesses. Moreover, behavioral change communication is highly demanded to improve child feeding practices.

Undernutrition and its associated factors among children aged 6 to 59 months in Menz Gera Midir district, Northeast Ethiopia: A community-based cross-sectional study

BACKGROUND

Undernutrition can lead to impaired physical growth, restricted intellectual skills, low school performance, reduced working capacity, and rooted disability in adult life. Thus, this study was designed to assess the prevalence and associated factors of undernutrition among children aged 6 to 59 months.

METHODS

A community-based cross-sectional study was conducted among 432 children aged 6 to 59 months in the Menz Gera Midir District. A multi-stage sampling technique was applied to recruit the study participants. Socio-demographic and socio-economic variables were collected by using structured questionnaires. Anthropometric measurements of the children were measured according to the World Health Organization's recommendation. A data collection sheet was used to collect information on the types of foods and number of meals consumed by the child. A bivariable and multivariable logistic regression was performed to identify factors associated with undernutrition.

RESULT

In this study, about 11.3% (95% CI: 8.3-14.3%), 50.2% (95% CI: 45.5-55.0%), and 28% (95% CI: 23.8-32.3%) were wasted, stunted, and underweight, respectively. Children aged 12-23 months (AOR: 1.97; 95% CI: 1.01-3.87), 36-47 months (AOR: 2.05; 95% CI: 1.00-4.19), and being anemic (AOR: 2.92; 95% CI: 1.73-4.92) were found to be an independent predictor of stunting. Moreover, being anemic was found to be significantly associated with wasting (AOR: 6.84; 95% CI: 3.16-14.82).

CONCLUSION

According to the findings of this study, undernutrition was a serious public health issue among 6-59 month old children in the Menz Gera Midir District. Children's age and anemia status were significantly associated with stunting and wasting. Therefore, community-based nutrition programs are vital to reduce childhood undernutrition.

Stunting and associated factors among children aged 6–59 months from productive safety net program beneficiary and non-beneficiary households in Meta District, East Hararghe zone, Eastern Ethiopia: a comparative cross-sectional study

Background

Undernutrition is one of the major public health problems affecting children in developing settings. Despite impressive interventions like productive safety net program (PSNP), there is limited information on the association between stunting and PSNP implementation in Ethiopia.

Methods

Community-based comparative cross-sectional study design was used among systematically selected 1555 children and their mothers/caregivers from households enrolled in PSNP and not, respectively, in Meta District east Ethiopia from 5th–20th of March 2017. Data were collected using pretested structured questionnaire. Measuring board was used to measure length/height of children. Length/height for age Z-score was generated using World Health Organization (WHO) Anthro version 3.2.2. Descriptive statistics was used to describe all relevant variables. Bivariable and multivariable logistic regression analyses were used to identify predictors of stunting. Odds ratio along with 95% confidence intervals were estimated to measure the strength of association. The statistical significance was declared at p value less than 0.05.

Results

The prevalence of stunting was 47.7%, 95% CI (44.1%, 51.5%) and 33.5%, 95% CI (29.9%, 36.9%) among children from households enrolled in PSNP and non-PSNP ones, respectively. Lack of maternal education [AOR = 3.39; 95% CI (1.12, 5.11)], women’s empowerment [AOR = 3.48; 95% CI (2.36, 5.12)] and fourth antenatal care visit [AOR = 4.2, 95% CI (2.5, 6.8)], practicing hand washing [AOR = 0.46; 95% CI (0.28, 0.76)], living in mid-land [AOR = 1.94, 95% CI (1.12, 3.35)] and low-land[AOR = 0.27: 95% CI (0.16, 0.45)] agro-ecological zones, PSNP membership [AOR = 1.82, 95% CI (1.14, 2.89)], childhood illness [AOR = 8.41; 95% CI (4.58, 12.76)], non-exclusive breastfeeding [AOR = 3.6; 95% CI (2.30, 4.80)], inadequate minimum dietary diversity [AOR = 4.7; 95% CI (3.0, 7.40)], child’s sex [AOR = 1.73, 95% CI (1.18, 2.53)] and age (24–59 months) [AOR = 3.2; 95% CI (1.6, 6.3)] were independent predictors of stunting.

Conclusions

The prevalence of stunting was high among children from households enrolled in PSNP. Stunting was significantly associated with maternal- and child-related factors. Therefore, women empowerment on household’s issues and improving infant and young child feeding practices could reduce the prevalence of stunting and its adverse consequences.

Association between exposure to intimate partner violence and the nutritional status of women and children in Nigeria

Background

Globally, intimate partner violence (IPV) epitomizes a greater proportion of the violence experienced by women, with more than a third of women (41.3%) in sub-Saharan Africa reporting IPV during their lifetime. This study examined the association between exposure to IPV and the nutritional status of women and their children in Nigeria.

Methods

The study analyzed secondary data obtained from the 2018 Nigeria Demographic and Health Survey. Data on women’s lifetime experience of psychological, physical, and sexual IPV, as well as demographic and socioeconomic characteristics, were collected. We used regression models to determine the association between exposure to IPV and women and child nutrition indicators. A weighted sample of 4,391 women aged 15–49 years and 2,145 children 6–59 months were analyzed.

Results

The lifetime experience of IPV in the study was 35.31% (95% CI: 33.35, 37.33), 30.43% (95% CI: 28.54, 32.38) experienced psychological IPV, 19.43% (95% CI: 17.79, 21.19) experienced physical IPV, and 6.03% (95% CI: 5.12, 7.09) experienced sexual IPV. After adjusting for a range of characteristics, maternal lifetime exposure to IPV was associated with underweight (ARRR = 0.63; 95% CI: 0.44, 0.91) and overweight/obesity (ARRR = 1.28; 95% CI: 1.04, 1.58). We also found that, children whose mothers experienced IPV were less likely to be underweight compared to their counterparts (ARRR = 0.69; 95% CI: 0.50, 0.96).

Conclusions

Overall, IPV against women, particularly psychological, physical, and sexual IPV, is common in Nigeria and has an association with the nutritional status of affected women and their children. According to the study, women with a lifetime experience of IPV were more likely to be overweight. On the other hand, affected women’s children were less likely to be underweight. A far-reaching effort is required to curb IPV against women, particularly policies, programs, and laws are needed to protect women and children from the unfavourable effects of IPV to reduce the prevalence and impact of such violence.

Effect of nutritional education on anthropometric deficits among pre-school aged children in south West Ethiopia: quasi-experimental study

BACKGROUND

Under-nutrition is a global problem and one of the most serious public health issues. Globally, 156 million under-five children were stunted, and 50 million were wasted in 2016. Malnutrition among preschool-age children is caused by low socioeconomic status, food insecurity, poor feeding practices, and infectious diseases. This intervention aimed to evaluate the effect of nutrition education delivered through trained health professionals in improving the nutritional status of preschool -aged children.

METHODS

A quasi-experimental design among 588 preschool -aged children was used. A multistage sampling technique followed by a systematic random sampling technique was used to identify caregivers with preschool-aged children. Structured questionnaires were used to collect data. The baseline difference in demographic and socioeconomic characteristics between the two groups was examined using a chi-square test and an independent sample t-test was used to determine the mean difference in under-nutrition between the intervention and control groups. Generalized estimating equations (GEE) were used to determine the change in the difference in outcome between the intervention and control groups as well as the association of predictors with under-nutrition in children. The Adjusted odds ratio (AOR) with the corresponding 95% confidence intervals was reported to show the strength of the association. Variables with a p-value of less than 0.05 were considered statistically significant in multivariable analysis.

RESULTS

In this study, the nutritional status of preschool age children was significantly associated with nutrition education intervention [AOR = 0.566, 95% CI: (0.347, 0.923)], place of delivery [AOR = 0.724, 95% CI: (0.551, 0.951)], ARI in the last 2 weeks [AOR = 1.823, 95% CI: (1.226, 2.710)], source of drinking water [AOR = 0.624, 95% CI: (0.484, 0.805)] and household food security [AOR = 1.311, 95% CI: (1.030, 1.669)] .

CONCLUSIONS

Findings of this study showed that nutrition education can effectively reduce the magnitude of under-nutrition among preschool children. Under-nutrition was e significantly associated with nutritional education, place of delivery, ARI in the last 2 weeks, source of drinking water, and food security. Therefore, both government and non-government should consider the impacts of nutrition education to alleviate under-nutrition and improve the health status of preschool-age children.

Risk Factors of Stunting and Wasting among Children Aged 6–59 Months in Household Food Insecurity of Jima Geneti District, Western Oromia, Ethiopia: An Observational Study

Undernutrition is the most difficult and widespread public health concern in low-income nations including Ethiopia. Therefore, this study aimed to investigate the associated risk factors of stunting and wasting among children aged 6–59 months in Jima Geneti district, Western Oromia, Ethiopia. A community-based cross-sectional study was conducted on 500 children from December 1 to 28, 2020. A multiple-stage sampling method was performed to select children from each kebele. Anthropometric measurements were taken, and the nutritional status was generated using WHO Anthro v. 3.2.1. Data analysis was performed using the SPSS version 20.0. Bivariate and multivariate logistic regression analyses were carried out to identify the associated risk factors of stunting and wasting among children in the study area. Statistical significance was set at p < 0.05. The study results showed that the prevalence of stunting and wasting among children was 27% and 11.8%, respectively. The findings of this study also revealed that the prevalence of household food insecurity and poor dietary diets was 19.6% and 52.2%, respectively. Low wealth status (AOR = 2.5; 95% CI: 1.1, 5.55) and poor dietary diets (AOR = 4.7; 95% CI: 2.5, 8.83) were associated risk factors for stunting. However, child meal frequency (AOR = 3.9; 95% CI: 1.23, 12.6), and children who did feed leftover food (AOR = 2.75; 95% CI: 1.02, 7.44) were associated risk factors for wasting. Poor dietary diets (AOR = 2.65; 95% CI: 1.06, 6.66) were also associated risk factors for wasting. The findings of this study concluded that the prevalence of stunting and wasting was high in the study area. Therefore, addressing family-level risk factors which are major drivers of children's nutritional status is crucial to ensure the nutritional status of children.

Undernutrition and Associated Factors Among Children Aged 6-23 Months in Dessie Town, Northeastern Ethiopia, 2021: A Community Based Cross-Sectional Study

BACKGROUND

Globally about 159, 101, and 52 million children are stunted, underweight, and wasted, respectively. According to the 2016 Ethiopian Demographic and Health Survey, about 38% of Ethiopian children are stunted and 46, 28.4, and 9.8% of children in Amhara Region are stunted, underweight and wasted, respectively. This study aimed to assess undernutrition and associated factors among children aged 6-23 months old at Dessie town, 2021.

METHOD

A community-based cross-sectional study was conducted from October - November 2021 in Dessie Town. A total of 421 Mothers/caregivers with children aged 6-23 months old were selected by a systematic sampling method from the health extension registration book. Epi-data 3.01 was used for data entry, SPSS version 20 for statistical analysis, and WHO Anthro version 3.2.2 software for calculating the z scores. Binary logistic regression and multivariate logistic regression were used to analyze the data. AOR with 95% CI and P-values less than 0.05 were considered to see the statistical significance.

RESULTS

A total of 421 mothers or care givers paired with 6-23 months old children participated in the study. The prevalence of stunting, underweight, wasting were 36.8% (95% CI: 32%, 41.6%), 27.6% (95% CI: 23.6%, 32.2%), and 11.5% (95% CI: 8.4%, 14.7%) respectively. Sex of the child (AOR = 1.55; 95% CI: 1.02, 2.34), handwashing practice (AOR = 2.32; 95% CI: 1.05, 5.11) and maternal family planning use (AOR = 0.39; 95% CI: 0.19, 0.77) were significantly associated with stunting. Age of child 12-17 months (AOR = 4.62; 95% CI: 2.65, 8.06) and sex of the child (AOR = 1.93; 95% CI: 1.21, 3.07) were associated with underweight. Age of child 12-17 months (AOR = 2.25; 95% CI: 1.06, 4.78) and treatment of drinking water (AOR = 0.21; 95% CI: 0.07, 0.59) were associated with wasting.

CONCLUSION AND RECOMMENDATION

In this study, the prevalence of undernutrition among children aged 6-23 months was higher for stunting (36.8%), underweight (27.6%) and wasting (11.5%) compared to WHO classification. Improved access to water, hygiene and sanitation, family planning services, avoiding gender discrimination during child feeding, and age-appropriate feeding practices are recommended. Moreover, implementation of public policies on food and nutrition is required for children 6-23 months of age.

Anthropometric failures and its associated factors among preschool-aged children in a rural community in southwest Ethiopia

Background

In 2019, 144 million under-five-year-old children were stunted, and 47 million were wasted globally. In Ethiopia, approximately 350,000 children are estimated to die each year. Preschool aged children need focused attention because this age group not only has special needs, but also forms the platform for growth and development of all children. Under nutrition among preschool children is the result of a complex interplay of diverse elements, such as birth weight, household access to food, availability and use of drinking water. This study aimed at determining the anthropometric failures and associated factors using composite indictors.

Methods

A community-based cross-sectional study design was used among randomly selected 588 caregivers with pre-school aged children. Under-nutrition of pre-school aged children was computed by using the composite index of anthropometric failure. A multi-stage sampling technique followed by a systematic random sampling technique was used to select study participants. Structured questionnaires were used to collect data. WHO Anthro software was used to calculate height for age, weight for age and weight for height. The overall prevalence of anthropometric failure (CIAF). Both bivariable and multivariable binary logistic regressions were used to identify factors associated with under-nutrition.

Results

The overall prevalence of under-nutrition among pre-school children was 50.8%, which was significantly associated with being a female (AOR = 1.51, CI: 1.076, 2.12), being from a large family (AOR = 1.78, CI: 1.19, 2.663), having acute respiratory infection (AOR = 1.767, CI: 1.216, 2.566), lack of improved source of drinking water (AOR = 1.484 CI: 1.056, 2.085) and poor dietary diversity score (AOR = 1.5, CI: 1.066, 2.112).

Conclusions

The study area has a high prevalence of CIAF in pre-school aged children. The CIAF was found to be significantly associated with the sex of the child, family size, ARI within the last two weeks, and dietary diversity score. To promote the use of family planning and the prevention of infectious diseases, health education is required. The government should adapt CIAF as a metric for assessing children’s nutritional status.

Mapping the national evidence on double burden of malnutrition in Ethiopia: a protocol of scoping review

INTRODUCTION

Currently, the double burden of malnutrition (DBM) is an emerging public health problem due to the inevitable consequences of nutritional transition. An increasing number of studies have reported the DBM in Ethiopian populations. However, organised and summarised national evidence is not yet available. Therefore, the main aim and research question of this scoping review is to map the national evidence on the DBM in the last decades in Ethiopia.

METHODS

This scoping review will be mapping the national evidence on the DBM in different population groups of Ethiopia including all ages and both sexes from 1 January 2021 to 30 September 2021. The Joanna Briggs Institute Reviewer's Manual will be used as the methodology of review for this review. The search strategy will be conducted using electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar, and grey literature sources and reference lists of key studies to identify studies appropriate for inclusion in the review. Two independent reviewers will be screened independently with all abstracts and full-text studies for inclusion. Data will be abstracted into tables and logically organised according to the items addressed in the specific research questions.

ETHICS AND DISSEMINATION

The data will be used from publicly available secondary sources. Therefore, no ethical review and approval will be required for this review. Dissemination of results will be sought through peer-reviewed publications, conference presentations and stakeholder meetings. Regarding registration, this review protocol is registered on the figshare website on 28 February 2021, with the DOI number https://doiorg/106084/m9figshare14131874.

Trends in inequalities in childhood stunting in Ethiopia from 2000 to 2016: a cross sectional study

BACKGROUND

The decrease in the magnitude of stunting over the past 20 years has been slow in Ethiopia. To date, in Ethiopia, the trends in and extent of inequality in stunting have not been investigated using methods suitably developed for disparity studies. This paper investigated both the extent and overtime dynamics of stunting inequality in Ethiopia over the last 17 years.

METHODS

Using the World Health Organization's Health Equity Assessment Toolkit software, data from the Ethiopia Demographic and Health surveys (EDHS) were analyzed between 2000 and 2016. The inequality analysis consisted of disaggregated rates of stunting using five equity stratifiers (economic status, education, residence, region and sex) and four summary measures (Difference, Population Attributable risk, Ratio and Absolute Concentration Index). A 95% uncertainty interval was constructed around point estimates to measure statistical significance.

RESULTS

The study showed that both absolute and relative inequalities in stunting exist in all the studied years in Ethiopia. The inequality disfavors children of mothers who are poor, uneducated and living in rural areas and specific regions such as Amhara. The pro-rich (R = 1.2; 1.1, 1.3 in 2000 to R = 1.7; 1.4, 2 in 2016) and pro-educated (R = 1.6; 95%UI = 1.3, 1.9 in 2000 and R = 2.3; 95%UI = 1.5, 3 in 2011) inequalities slightly increased with time. Male children bear a disproportionately higher burden of stunting, and the disparity increased between the first and the last time points (PAR = -1.5 95%UI = -2.5, -0.6 in 2000 and PAR = -2.9 95%UI = -3.9, -1.9) based on complex measures but remained constant with simple measures (R = 1; 95%UI = 0.9, 1.1 in 2000 and R = 1.1 95%UI = 1, 1.2 in 2016). Similarly, both the sub-national regional and residence-related stunting disparities generally widened over time according to some of the inequality measures.

CONCLUSIONS

Stunting appeared to be highly prevalent among certain sub-groups (i.e. poor, uneducated and living in rural regions). The subpopulations experiencing excessively high stunting prevalence should be the focus of policy makers' attention as they work to achieve the WHO 40% reduction in stunting target by 2025 and the UN Agenda 2030 for Sustainable Development Goals.

Camel milk consumption is associated with less childhood stunting and underweight than bovine milk in rural pastoral districts of Somali, Ethiopia: a cross-sectional study

Undernutrition is a major global health problem. Various types of animal milk are used for feeding children at early ages; however, associations of camel milk (CaM) and bovine milk (BM) with the nutritional status of children have not been explored. A comparative community-based cross-sectional study was conducted among pre-schoolers in rural pastoral districts of Somali, Ethiopia. Children were selected from households with lactating camels or cows. Anthropometric measurements followed standard procedures for height-for-age, weight-for-age and weight-for-height scores. Independent sample t-tests identified significant differences in anthropometric indices based on the type of milk consumed. Multivariable logistic regression was used to examine associations between milk consumption and other predictors of growth failures. The prevalence of stunting was 24⋅1 % [95 % confidence interval (CI) 20⋅5, 28⋅3] of pre-schoolers, 34⋅8 % (95 % CI 29⋅9, 39⋅6) were wasted and 34⋅7 % (95 % CI 30⋅1, 39⋅9) were underweight. Higher proportions of BM-fed children were severely stunted, wasted and underweight compared with CaM consumers. Using logistic regression models, children who consumed BM [adjusted odds ratio (AOR): 2⋅10; 95 % CI 1⋅22, 3⋅61] and who were anaemic (AOR: 4⋅22; 95 % CI 2⋅23, 7⋅98) were more likely to be stunted than their counterparts, while girls were less likely to be stunted than boys (AOR: 0⋅57; 95 % CI 0⋅34, 0⋅94). Similarly, children who consumed BM (AOR: 1⋅97; 95 % CI 1⋅20, 3⋅24), who were anaemic (AOR: 2⋅27; 95 % CI 1⋅38, 3⋅72) and who drank unsafe water (AOR: 1⋅91; 95 % CI 1⋅19, 3⋅07) were more likely to be underweight than their counterparts. In conclusion, CaM consumption was associated with lower prevalence of stunting and underweight than BM. Promoting CaM in pastoralist areas may help to curb the high level of undernutrition.

Prevalence and Determinants of Undernutrition among 6- to 59-Months-Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross-Sectional Study

Background

Undernutrition is the most dominant form of malnutrition among children in developing countries. Studies conducted in Tanzania have reported high levels of undernutrition among children below five years of age. However, there is limited information on differences in stunting prevalence across agroecological zones. This study aimed to determine the prevalence of undernutrition and its determinants in the lowland and highland areas in Kilosa District, Tanzania.

Methods

A cross-sectional study was conducted in a sample of 200 randomly selected households from the lowland and 141 from the highland areas of Kilosa District in Morogoro Region, Tanzania. Sociodemographic, feeding practices, hygiene, and sanitation data were collected using a structured questionnaire. Weight and height of children were measured using a standard procedure, and age was calculated from the birth date obtained from the child growth card. Anthropometric data were analyzed by using Emergency Nutrition Assessment (ENA) software. The logistic regression model was used to explore the determinants of undernutrition.

Results

Prevalence of stunting, underweight, and wasting was 41.0%, 11.5%, and 2.5% in lowland and 64.5%, 22.0%, and 1.4% in highland areas, respectively. The prevalence of stunting and underweight was higher in the highland compared to the lowland areas (p < 0.001). Significant determinants of underweight were areas of residence (AOR 4.21, 95% CI: 1.62–10.9), age of the children (AOR 5.85, 95% CI: 1.81–18.97), and child birth weight (AOR, 4.98 95% CI: 1.65–15.05), while determinants of stunting were the area of residence (AOR, 2.77 95% CI: 1.43–5.36), maternal age (AOR, 0.33 95% CI: 0.14–0.79), sex of a child (AOR, 1.89 95% CI: 1.03–3.50), and child birth weight (AOR, 3.29 95% CI: 1.21–8.97).

Conclusion

The prevalence of undernutrition, especially stunting and underweight, was high in the study areas. Determinants of stunting differed between highlands and lowland areas, highlighting the needs of having properly integrated interventions based on the geographical location.

Prevalence and determinants of concurrent wasting and stunting and other indicators of malnutrition among children 6-59 months old in Kersa, Ethiopia

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6-59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross-sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height-for-age, weight-for-height and weight-for-age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6-17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12-2.75) compared with those aged 36-59 months, whereas children aged 18-35 months (aOR 2.4, 95% CI 1.65-3.47) and 36-59 months (aOR 1.6, 95% CI 1.07-2.37) had higher odds of stunting compared with those aged 6-17 months. Similarly, children aged 18-35 months (aOR 1.6, 95% CI 1.07-2.37) and 36-59 months (aOR 2.2, 95% CI 1.52-3.10) had higher odds of underweight compared with children aged 6-17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16-9.27) and stunting (aOR 1.9, 95% CI 1.31-2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m² and maternal BMI between 18.5 and 25 kg/m² were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point-of-use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community-based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended.

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia

BACKGROUND

Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices.

METHODS

A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used.

RESULTS

A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition.

CONCLUSIONS

Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

Background

Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies' qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger's test, and Begg's test were used to assess publication bias. The I² statistic, forest plot, and Cochran's Q-test were used to deal with heterogeneity.

Results

In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I² = 97.6%, p < 0.001, Q = 1461.93). However, no publication bias was detected (Egger's test p=0.26 and Begg's test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I² = 63.8%, p < 0.001, Q = 44.21 and I² = 78.3%, p < 0.001, Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg's test, p > 0.05).

Conclusions

The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.

Factors associated with malnutrition in children < 5 years in western Kenya: a hospital-based unmatched case control study

BACKGROUND

Globally, under-nutrition accounts for > 3 million deaths annually among children < 5 years, with Kenya having ~ 35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya.

METHODS

We conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height ≤ -2SD or ≥ +2SD; weight-for-age ≤ -2SD or ≥ +2SD; or height-for-age ≤ -2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses.

RESULTS

A total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR = 7.9; 95% CI: 1.5-41.2), deworming (OR = 0.8; 95% CI: 0.4-1.2), and pre-lacteal feeding (OR = 1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR = 13.9; 95% CI: 2.8-68.6); low birth weight (AOR = 3.3; 95% CI: 1.4-7.6), and paternal lack of formal education (AOR = 4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition.

CONCLUSION

Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

Level of Undernutrition and Its Determinants Among Children Aged 12-59 Months in Wolaita District, Ethiopia

Background

Undernutrition remains one of the most common causes of morbidity and mortality among children throughout the world particularly in developing countries. The present study aimed to assess the magnitude and associated factors of undernutrition among children aged 12–59 months.

Methods

A community-based cross-sectional study was conducted in Wolaita district from May to June 2015. Multi-stage stratified systematic random sampling procedure was used. Data were collected using a pretested interviewer-administered questionnaire from 626 children aged 12–59 months. Height and weight were measured by trained data collectors and WHO Anthro version 3.2.2 software was used. Data were entered into Epi Info version 3.3.5 and were exported and analyzed using SPSS version 21. Multivariable logistic regression model with a step-wise method was used to determine the predictors of undernutrition.

Results

One third (34.1%; 95% CI 30.4–37.9%) of children were stunted while 6.9% and 11.9% of them were wasted and underweight, respectively, based on WHO Z score <-2. Children live in mother-headed households which often use unprotected sources of water and children who did not get minimum dietary diversity were more likely to be stunted compared to their counterparts. Children residing in rural residences, being a male child, having less power for mother decision-making, presence of diarrhea in the last 2 weeks of the survey and who did not get the minimum dietary diversity were found to be significant determinants of underweight. Children living rural, male sex, their order of birth being 5th and above and who had not got the minimum meal frequency were more likely to be wasted than their counterparts.

Conclusion and Recommendation

Undernutrition has a high prevalence in under-5-year-old children of Wolaita district. Under nutrition was associated with female-headed households, unprotected sources of water, below the minimum dietary diversity, rural residence, participation of mother in decision-making, presence of diarrhea, and minimum meal frequency. Thus, nutritional intervention programs in Wolaita district in Ethiopia should focus on these factors.

Prevalence of Stunting and Its Associated Factors among Children of 6-59 Months in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia: A Community-Based Cross-Sectional Study

Methods

The community-based cross sectional study was conducted in the Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. The simple random sampling method was used to recruit 656 mother-child pairs. Height for age Z score was computed using WHO Anthro version 3.2.2 software. Multivariable logistic regression model was fitted, and adjusted odds ratio (AOR) at p value <0.05 was used to determine statistically significant association between predictors and outcome variable.

Result

The prevalence of stunting among children of 6–59 months in the study area was 47.9% (95% CI; 44.0–51.7). The likelihood of stunting was significantly higher among children who live in households with medium (AOR 2.20, 95% CI: 1.43–3.37) and poor (AOR 2.87, 95% CI: 1.72–4.81) wealth status. In addition, children who were not exclusively breast fed (AOR 1.55, 95% CI: 1.07–2.24), whose mothers had not participated in decision of major household purchases (AOR 2.27, 95% CI: 1.21–4.26), and whose mothers lacked decision on freedom of mobility (AOR 1.96, 95% CI: 1.05–3.66) were significantly stunted compared with counterparts.

Conclusion

Stunting is a severe public health problem in the area. Therefore, efforts should be taken to enhance maternal empowerment, household wealth, and infant and young child feeding practice for reducing stunting among children.

Maternal employment and child nutritional status in Uganda

Nearly half of all deaths among children under five (U5) years in low- and middle-income countries are a result of under nutrition. This study examined the relationship between maternal employment and nutrition status of U5 children in Uganda using the 2016 Uganda Demographic and Health Survey (UDHS) data. We used a weighted sample of 3531 children U5 years born to working women age 15-49. Chi-squared tests and multivariate logistic regressions were used to examine the relationship between maternal employment and nutritional outcomes while adjusting for other explanatory factors. Results show that children whose mothers had secondary education had lower odds of stunting and underweight compared with children whose mothers had no formal education. Children who had normal birth weight had lower odds of stunting, wasting and being underweight compared with children with low birth weight. Children whose mothers engaged in agriculture and manual work had higher odds of stunting compared with those whose mothers engaged in professional work. Additionally, children whose mothers were employed by nonfamily members had higher odds of wasting and being underweight compared with children whose mothers were employed by family members. Other determinants of child nutritional status included region, age of the mother, and age and sex of the child. Interventions aimed at improving the nutritional status of children of employed women should promote breastfeeding and flexible conditions in workplaces, target those of low socio-economic status and promote feeding programs and mosquito net use for both mothers and children.

The epidemiology of undernutrition and its determinants in children under five years in Ghana

BACKGROUND

Understanding the burden and contextual risk factors is critical for developing appropriate interventions to control undernutrition.

METHODS

This study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. Single multiple logistic regressions were used to identify the factors associated with underweight, wasting and stunting. The study involved 2720 children aged 0-59 months old and mother pairs. All analyses were done in STATA/IC version 15.0. Statistical significance was set at p<0.05.

RESULTS

The prevalence of underweight, wasting and stunting were 10.4%, 5.3%, and 18.4% respectively. The age of the child was associated with underweight, wasting and stunting, whereas the sex was associated with wasting and stunting. Normal or overweight/obese maternal body mass index category, high woman's autonomy and middle-class wealth index were associated with a lower odds of undernutrition. The factors that were associated with a higher odds of child undernutrition included: low birth weight (<2.5 kg), minimum dietary diversity score (MDDS), a higher (≥4th) birth order number of child, primary educational level of husband/partner and domicile in the northern region of Ghana.

CONCLUSION

There is still a high burden of child undernutrition in Ghana. The age, sex, birth weight, birth order and the MDDS of the child were the immediate factors associated with child undernutrition. The intermediate factors that were associated with child undernutrition were mainly maternal related factors and included maternal nutritional status and autonomy. Distal level factors which were associated with a higher odds of child undernutrition were the wealth index of the household, paternal educational status and region of residence. We recommend that interventions and policies for undernutrition should address socioeconomic inequalities at the community level while factoring in women empowerment programmes.

Chronic Malnutrition Among Under Five Children of Ethiopia May Not Be Economic. A Systematic Review and Meta-Analysis

BACKGROUND

Ethiopia is one of the four low income countries in achieving MDG4, however, minimizing child undernutrition became critical undertaking thus far. This review aimed at identifying the predictors of under-5 children nutrition in Ethiopia.

METHODS

Databases searched were Med Line, HINARY, MedNar and Embase. Furthermore, gray literatures were also sought. All papers selected for inclusion in the review were subjected to a rigorous critical appraisal using standardized critical appraisal instruments from the Joanna Briggs Institute. Quantitative papers were pooled for statistical analysis and narrative synthesis. Odds ratios and their 95% confidence intervals were calculated for analysis. Papers of optimal quality but without optimal data set for meta-analysis were subjected for narrative synthesis.

RESULTS

Nonadherence towards Optimal feeding recommendations was the most reported predictor of stunting and wasting, while, maternal education and 'Water, Sanitation and Hygiene' factors were the second. The findings of the Meta-analysis showed no evidence of association between household income/wealth and stunting of children in Ethiopia (OR=1.14, 95% CI= 0.97, 1.34), heterogeneity test: i2 = 92%, df = 20, (P < 0.00001). On the other hand, children in low income/wealth group were 1.73 times more likely to have wasting compared to children of the higher income/wealth households (OR=1.73, 95% C I= 1.51, 1.97) heterogeneity test: i2 = 71%, df = 20, (P < 0.00001).

CONCLUSION

An over-reliance on macroeconomic growth as a solitary factor towards undernutrition should not be the way forward. Supplementary and more focused nutrition specific and sensitive interventions are needed in Ethiopia.

Dietary diversity and nutritional status among children in rural Burkina Faso

Background

Burkina Faso has a seasonal malnutrition pattern, with higher malnutrition prevalence during the rainy season when crop yields are low. We investigated the association between dietary diversity and nutritional status among children aged 6-59 mo during the low crop yield season in rural Burkina Faso to assess the role of dietary diversity during the lean season on childhood nutritional status.

Methods

Caregivers reported the dietary diversity of the past 7 d, consisting of 11 food groups, summed into a scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores were calculated based on 2006 WHO standards. Stunting, wasting and underweight were defined as HAZ, WHZ and WAZ <-2 SD, respectively. Multivariable regression models adjusting for potential confounders including household food insecurity and animal ownership were used to assess the relationship between anthropometric indices and dietary diversity.

Results

Of 251 children enrolled in the study, 20.6% were stunted, 10.0% wasted and 13.9% underweight. Greater dietary diversity was associated with greater HAZ (SD 0.14, 95% CI 0.04 to 0.25) among all children. There was no association between dietary diversity and wasting or mid-upper arm circumference in this study.

Conclusions

Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.

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.

Prelacteal feeding and associated factors in Ethiopia: systematic review and meta-analysis

Background

Prelacteal feeding can be defined as giving any solid or liquid foods other than breast milk during the first three days after birth. It affects timely initiation of breastfeeding and exclusive breastfeeding practices. Even though the issue was investigated in Ethiopia, fragmented and inconsistent findings were reported. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of prelacteal feeding and associated factors in Ethiopia.

Methods

The preferred reporting items for systematic reviews and meta-analyses guideline was followed. Articles were systematically searched through different searching mechanisms. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment of each individual study. The total of 28 studies were included and analyzed. The random effect model was used to estimate the pooled prevalence; subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. Both Egger’s, and Begg’s test were used to check publication bias. The effects between associated factor variables, and prelacteal feeding practices were tested.

Results

A total of 492 studies were retrieved and 28 studies were included in the meta-analysis. The pooled prevalence of prelacteal feeding practice in Ethiopia was 25.29% (95% Confidence Interval [CI] 17.43, 33.15) with severe heterogeneity (I² = 99.7, p < 0.001) and no publication bias. Antenatal care (Odds Ratio [OR] 0.25, 95% CI 0.09, 0.69), counselling on infant feeding (OR 0.37, 95% CI 0.22, 0.63), timely initiation of breastfeeding (OR 0.28, 95% CI 0.21, 0.38) and an urban residence (OR 0.47, 95% CI 0.26, 0.86) had lower odds, while home birth had higher odds (OR 3.93, 95% CI 2.17, 7.10) of prelacteal feeding in Ethiopia.

Conclusions

In Ethiopia, one in four children were given prelacteal foods. Mothers who gave birth at home are more prone to give prelacteal foods. Whereas, antenatal care, timely initiation of breastfeeding, counseling on infant feeding and an urban residence decreases prelacteal feeding practices in Ethiopia. Therefore, the government and health institutions should focus to increase maternal health service utilization and promote infant and young child feeding practices according to the guideline.

Magnitude of prelacteal feeding practice and its association with place of birth in Ethiopia: a systematic review and meta-analysis, 2017

BACKGROUND

Prelacteal feeding is one of the commonest inappropriate child feeding practice which exposes to malnutrition, infection, and neonatal mortality. However, there is no systematic review and meta-analysis that estimates the pooled prevalence of prelacteal feeding and its association with place of birth in Ethiopia. Therefore, this study aimed at investigating the magnitude of prelacteal feeding practice and its association with home delivery in the country.

METHODS

Primary studies were accessed through, HINARI and PubMed databases. Additionally, electronics search engines such as Google Scholar, and Google were used. The Joana Briggs Institute quality appraisal checklist was used to appraise the quality of studies. Data were extracted using Microsoft Excel spreadsheet. Heterogeneity between the studies was examined using the I2 heterogeneity test. The DerSimonian and Liard random-effect model was used. The random effects were pooled after conducting subgroup and sensitivity analyses. Publication bias was also checked.

RESULTS

A total of 780 primary studies were accessed. However, about 24 studies were included in the qualitative description and quantitative analysis of the prevalence of prelacteal feeding. To examine the association between home delivery and prelacteal feeding practice, only six studies were included. The prevalence of prelacteal feeding ranged from 6.1-75.8%. The pooled prevalence of prelacteal feeding among Ethiopian children was 26.95% (95% CI: 17.76%, 36.14%). The highest prevalence was observed in the Afar region. The pooled odds of prelacteal feeding among women who gave birth at home was increased by 5.16 (95% CI: 3.7, 7.2) folds as compared to those who gave birth at Health institutions.

CONCLUSION

Prelacteal feeding practice in Ethiopia was found to be high. Home delivery was strongly associated with prelacteal feeding practice. Therefore, promoting institutional delivery and strengthening of the existing child nutrition strategies are recommended.

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 and associated factors of underweight among children 6-59 months of age in Takusa district, Northwest Ethiopia

BACKGROUND

Most of the nearly 104 million underweight children in the world lived in South East Asia and sub-Saharan Africa in 2010. According to the 2014 Ethiopian Demographic and Health Survey (EDHS) report, 24 and 7% of children aged 6-59 months were underweight and severely underweight, respectively. Although appropriate child feeding and nutritional interventions reduce child illness and death, malnutrition remains a leading public health problem in Ethiopia. As literature on the issue is scarce in northwest Ethiopia, this study aimed at determining the prevalence of under-weight and associated factors in children 6-59 months of age in Takusa district, northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted from January to February, 2017, at Takusa district, northwest Ethiopia. A total of 645 subjects were selected using the multi-stage sampling technique. Anthro software version 2.02 was used to determine the nutritional status of the children. A multivariable logistic regression analysis was used to investigate factors associated with underweight. Adjusted Odds Ratios (AOR) with the corresponding 95% Confidence Interval (CI) were used to show the strength of associations, and variables with P-values of < 0.05 were considered statistically significant.

RESULTS

In this study, the overall prevalence of underweight was 19.5% (95% CI: 16.4-22.8). According to the multivariate analysis, urban residence (AOR = 0.60; 95% CI: 0.38-0.95), no antenatal care (ANC) follow up (AOR = 1.59; 95% CI 1.01-2.52), and mothers age (over 35 years) (AOR = 0.62; 95% CI: 0.38-0.99) were significantly associated with lower odds of underweight.

CONCLUSION

In the study community, the prevalence of underweight was lower than the findings of different studies in Ethiopia. Advanced maternal age (> 35 years), no antenatal follow up during pregnancy, and rural residence were significantly associated with underweight. Therefore, interventions targeting community management of acute malnutrition might be appropriate to manage the problem of underweight; efforts should also be intensified to reduce under-weight by focusing on identified determinants.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia

BACKGROUND

Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices.

METHODS

A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty.

RESULTS

Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty.

CONCLUSION

Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Determinants of stunting among children aged 6-59 months at Kindo Didaye woreda, Wolaita Zone, Southern Ethiopia: Unmatched case control study

Background

Stunting is a well-established risk marker of poor child development. Globally in 2017, 155 million children under 5 were estimated to be stunted. While different activities are being done to reduce the burden of stunted growth, the problem is overwhelming in Africa; it was increased by 24%. Therefore, identifying determinants of stunting among children aged 6–59 would help to set priorities for action and to the design of stunting reduction plan at a grassroots level.

Methods

The unmatched case-control study was conducted in randomly selected 8 rural kebeles of Kindo Didaye woreda, Ethiopia from February to April, 2016 to identify the determinants of stunting among children aged 6–59 months. The sampling frame was identified by enumeration of 6–59 months of age children in the entire households of the study area. From which 155 as cases and 310 as controls were chosen using anthropometric measurement based on the median of WHO 2006 reference population. The anthropometric data were analyzed by WHO Anthro 2010 software to generate Z-score values. Odds Ratio along with 95% confidence interval was estimated to identify determinants of stunting using the multivariable logistic regression.

Results

Drinking water from unsafe source (AOR = 7.06, 95% CI; 4.40–20.42),occasionally eating animal source food (AOR = 0.51, 95% CI; 0.02–0.68), ARI in the past two weeks (AOR = 3.04, (95% CI; 1.04–13.35), late initiation of breastfeeding after one hours after birth (AOR = 5.16, 95% CI; 2.24–15.90) and lack of vaccination (AOR = 6.38, 95% CI; 2.54–17.10)were significantly associated with stunting.

Conclusions

Factors like exposure to diarrhea disease, exposure to acute respiratory infection, late initiation of breast milk after child breath, squeeze out of 1^st breast milk, lack of vaccination, animal source of food, and unsafe source of water for drinking could be used to set priorities for action and to the design of Kindo Didaye woreda plan for stunting reduction down to grassroots level. Therefore, zonal health department and Kindo Didaye woreda health office should promote the importance of colostrums feeding. Drinking water should be decontaminated. Expansion of vaccination program to enhance herd immunity at the community level is important.

High Prevalence of Undernutrition among Children in Gondar Town, Northwest Ethiopia: A Community-Based Cross-Sectional Study

OBJECTIVE

To assess undernutrition and associated factors among children aged 6-59 months in Gondar Town, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted in 2014. Multistage sampling method was used to select study participants. Structured interviewer administered questionnaire and anthropometric measurements were used. Binary logistic regression was fitted to identify associated factors.

RESULTS

The prevalences of wasting and stunting were 6.8% and 45.7%, respectively. Higher odds of wasting were observed among children whose fathers were daily laborers (AOR = 2.63), children who had eating problem (AOR = 2.96), and those who were not exclusively breast-fed for the first six months (AOR = 5.63). Similarly, higher odds of stunting were found among female children (AOR = 1.65), children who lived in households having four to six families (AOR = 2.14), and children who did not start breast-feeding within one hour of birth (AOR = 0.67).

CONCLUSION

Childhood undernutrition was a significant problem. Child eating problem, paternal occupation, and exclusive breast-feeding were associated with wasting, whereas family size, child sex, and breast-feeding initiation time were associated with stunting. Therefore, strengthening of early initiation and exclusive breast-feeding, promoting healthcare seeking behavior, and designing social support programme for poor family are recommended to reduce undernutrition.

Individual and community level factors with a significant role in determining child height-for-age Z score in East Gojjam Zone, Amhara Regional State, Ethiopia: a multilevel analysis

Background

In Ethiopia, child undernutrition remains to be a major public health challenge and a contributing factor for child mortality and morbidity. To reduce the problem, it is apparent to identify determinants of child undernutrition in specific contexts to deliver appropriately, targeted, effective and sustainable interventions.

Methods

An agroecosystem linked cross-sectional survey was conducted in 3108 children aged 6–59 months. Multistage cluster sampling technique was used to select study participants. Data were collected on socio-demographic characteristics, child anthropometry and on potential immediate, underlying and basic individual and community level determinants of child undernutrition using the UNICEF conceptual framework. Analysis was done using STATA 13 after checking for basic assumptions of linear regression. Important variables were selected and individual and community level determinants of child height-for-age Z score were identified. P values less than 0.05 were considered the statistical level of significance.

Results

In the intercept only model and full models, 3.8% (p < 0.001) and 1.4% (p < 0.001) of the variability were due to cluster level variability. From individual level factors, child age in months, child sex, number of under five children, immunization status, breast feeding initiation time, mother nutritional status, diarrheal morbidity, household level water treatment and household dietary diversity were significant determinants of child height for age Z score. Also from community level determinants, agroecosystem type, liquid waste disposal practice and latrine utilization were significantly associated with child height-for-age Z score.

Conclusion

In this study, a statistical significant heterogeneity of child height-for-age Z score was observed among clusters even after controlling for potential confounders. Both individual and community level factors, including the agroecosystem characteristics had a significant role in determining child height-for-age Z score in the study area. In addition to the existing efforts at the individual levels to improve child nutritional status, agroecosystem and community WASH related interventions should get more attention to improve child nutritional status in the study area.

Associated factors of malnutrition among African children under five years old, Bom Jesus, Angola

ABSTRACT Objective: To identify the determinants of wasting and stunting in children under five years old in the commune of Bom Jesus, Angola Methods: A population-based cross-sectional study was conducted with 742 children in 2010, and nutritional deficits were defined by World Health Organization criteria. Prevalence ratios and associated factors of wasting and stunting were estimated using Poisson regression with robust variance, using a conceptual hierarchical model Results: For both deficits, there were significant differences in the prevalence ratios according to the children's neighborhood and age. Boys and those children living in households whose water supply came from the river or lake, as well those with recent expulsion of parasites and infections were more likely to present stunting. Children of fathers with higher number of children or that which the fathers were not living at home and whose mothers were 25-34 years old were less likely to have wasting Conclusion: It was identified independent variables from different levels of determination of malnutrition, standing out the basic sanitation conditions and family structure as important predictors of the nutritional deficits. The knowledge of the associated factors of malnutrition may contribute for subside public policies in planning interventions to improve the childhood nutrition status in Bom Jesus and communes with similar characteristics in Angola.