Prevalence of wasting and associated factors among children aged 6-59 months in Wolkite town of the Gurage zone, Southern Ethiopia, 2020. A cross-sectional study

Background Undernutrition among children is one of the leading major public health problems and about 49.5 million children were wasted worldwide. Asia and African countries contributed 69% and 27.2% of wasting respectively. In Ethiopia, 7% of children were wasted and 1% was severely wasted. Although Ethiopia has achieved remarkable progress in reducing underfive mortality and designed multi-dimensional approaches to address malnutrition, the data on acute malnutrition among children in the study setting is limited. Therefore, this study was aimed to assess the prevalence of acute malnutrition and associated factors among 6- 59-month-old children. Methods Community-based cross-sectional study design was conducted at Gurage Zone, Southern Ethiopia. A total of 293 study participants were selected using a systematic sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires by face-to-face interview. Data entry and analysis were made using Epi Data version 4.6 and Statistical Package for Social Science (SPSS) version 24 respectively. Descriptive statistical analysis and some of the statistical tests like the odds ratio were carried out. Both Bivariable and multivariable logistic regression analysis with 95% confidence interval was carried out to identify associated factors and variables with P value < 0.05 were taken as statistically significant. Results The prevalence of wasting among children aged from 6-59 months in this study was 14.7% (95% CI: 10.9, 18.8). After controlling for all possible confounding factors, the result revealed that age of children between 6-11 months [AOR = 2.78(95% CI: 1.67, 6.19)], caregivers who were unable to read and write [AOR = 2.23 (95% CI: 1.04, 5.34)], presence of diarrheal disease in the past two weeks [AOR = 1.68 (95% CI: 1.23, 5.89)] and mothers who had a history of poor handwashing practice before food preparation and child feeding [AOR = 2.64(95% CI: 1.52, 4.88)] were found to be significantly associated with wasting. Conclusions The study findings indicate that respondents' wasting was mainly affected by age of the child, educational status of caregivers, presence of diarrheal disease and hand washing practice of the mother. Providing acceptable, quality and honorable care for all children is very crucial to prevent child wasting and proper handwashing during breastfeeding and food handling is recommended and interventions aimed at improving maternal health and access to health care services for children are urgently needed. Community-based cross-sectional study design was conducted from December to January 2020/2021 in Wolkite town, Southern Ethiopia. Wolkite is the administrative center of the zone and is found 158 kilometers far from the capital city (Addis Ababa) in the Southern region of Ethiopia. It has a total population of 70,796 people of these 53% were males and 47% were females. The proportions of the under-five population were 2,169 populations. The town has five Kebele (Menaheriya, Edigetchora, Selamber, Adishiwot, and Edigetber). The total populations of the two Kebele (Menaheriya and Edigetber) were 13,359 with a total of 2,618 households. The source populations of this study were all 6–59 months old children (paired with their mothers or caregivers) whereas all randomly selected 6–59 months old children (paired with their mothers or caregivers) during the study period were considered as the study population. Mothers who reside for at least six months in the study area having a child aged 6–59 months were included in the study. Whereas, children with evidence of physical impairment, seriously ill, mentally impaired and those mothers’/caregivers who were unable to communicate were excluded. The sample size was determined using the single population proportion formula by considering the following assumptions; Proportion of prevalence of acute undernutrition (wasting) of 28.2% (P = 0.282) [17], 95% confidence level, the margin error of 5% (d = 0.05). The sample size for the second objective (factors) was also determined by using the double population proportion formula for cross-sectional study by considering the following assumptions as Power = 80%, CI = 95% and Ratio = 1:1. The largest sample size from those samples was taken and the final sample size was calculated to be 311 children paired with their mother/caregivers. From five Kebele of the town, 2 Kebele ((Meneheriya (1458 households) and Edigetber (1160 households)) were selected randomly. To select study participants systematic sampling technique was used. Those eligible participants who did not avail themselves during the data collection period in selected Kebele were revisited three times and if not avail after three visits the data collector skip that house and interview the next household to substitute. To select a total of 311 respondent’s proportional allocation to population size was used in each Kebele. The first participant was selected randomly and every 8th participant who had under-five children were interviewed. Wasting (Yes/No) Sociodemographic variables. Child age, Child sex, maternal educational status, maternal occupation, Family size, Religion, Ethnicity, Household food security. Child caring practice and health characteristics. Exclusive breastfeeding, Dietary diversity score, Meal frequency, Vaccination status, History of diarrheal in the past two weeks, ever used family planning, Place of delivery. Environmental health-related variables. Availability of latrine, Hand washing practice, Solid waste disposal, Availability of liquid waste disposal pit. The child weight-for-height Z-score (WHZ) is <-2 SD from the median WHO reference values is wasting, WHZ ≥ −3SD & < −2SD is Moderate Wasting and WHZ < −3SD is Severe wasting [20]. MUAC below 12.5 cm indicates acute undernutrition, MUAC ≥ 11.5 cm & < 12.5 cm indicates moderate acute undernutrition and MUAC < 11.5 cm indicates severe acute undernutrition [20]. Defined as having three or more loose of watery stools in 24 hours in the two weeks before the survey [21]. Foods that are required by the child, after six months of age in addition to sustained breastfeeding [1]. Measured whether the respondent worries that the household would not lack have enough food for the past four weeks [2]. If the respondent does not worry that the household would lack enough food for the past weeks [2]. Rarely worry about food (once or twice in the past four weeks) [2]. Sometimes worry about food (three to ten times in the past four weeks) [2]. Often (more than ten times in the past four weeks) [2]. If the respondent washes hand before and/ or after actions (before cooking, before eating, after latrine visit, after child cleaning, before child feeding…) [3]. Children 12–15 months of age who continued breastfeeding after the age of 1 year [3]. Children 20–23 months of age who continued breastfeeding after his/ her 23 months of age [3]. An English version semi-structured interviewer-administered questionnaire was developed by reviewing different works of literature, current national and international guidelines of child nutrition. The tool consisted of socio-demographic characteristics, child-caring practice and health characteristics and environmental health-related characteristics of respondents. Ten Bachelors of Science in midwives and one Master of Science in midwife were recruited to support data collection. Recumbent length was assessed for all children under 24 months of age while standing height was measured for older children. Children were weighed having lightly clothing, without shoes and with empty pockets. Mid Upper Arm Circumference (MUAC) was measured using non-stretchable tape on the left mid-upper arm to the nearest 1 mm. One day of training was given for data collectors and supervisors on objectives and the standard procedures of MUAC measurement. A height measuring length board that has a scale and sliding headpiece and a 2 meters measuring capacity, with a precision of 0.1 cm was used for measuring the height. UNICEF’s digital weighing scale (SECA) which has a capacity of 150 kg and with a precision of 0.1 kg was used for measuring weight. By considering 5% of the total sample size pretest was conducted one week before the start of actual data collection in the Endiber town which was not part of this study. Then the questionnaire was assessed for its clarity, length, completeness and the necessary correction was done accordingly. Throughout the data collection, interviewers were supervised, regular meetings were held between the data collectors and the principal investigator together in which problematic issues arising from interviews during the data collection and any challenges found were discussed. The completeness of the data was evaluated by field supervisors daily. The collected data were again reviewed and checked for its completeness before data entry. The data entry format template was prepared and programmed by the investigators. After data collection was completed, the data were checked for completeness and then recoding and categorization were done. Data entry and analysis were done using Epi Data version 4.6 and SPSS version 24 respectively. Software program WHO AnthroPlus was used to convert nutritional data from anthropometric measurement into Z-score of the indices: weight for height, considering sex using WHO reference curves. WHZ was calculated for each child using the WHO growth reference standards and WHZ <-2 SD is categorized as wasting [20]. Descriptive statistical analysis was carried out to identify frequency, percentage and mean for continuous independent variables. Before the analysis, the assumptions of the chi-square test were checked. Binary logistic regression analysis was used to ascertain the association between the dependent and independent variables. Variables with a significant association at P < 0.2 in the binary analysis were entered into multivariable analysis using the enter method to determine the factors associated with wasting and those variables P<0.05 were considered to be statistically significant. Hosmer- Lemeshow tests for goodness of fit were carried out and found p = 0.889(>0.05). A Multi-collinearity test was carried out to see the correlation between independent variables by using collinearity statistics (Variance inflation factor (VIF) >10 and standard error >2 was considered as suggestive of the existence of multi co-linearity). Finally, the results were presented in texts, tables and graphs and it was discussed using the odds ratio and 95% confidence interval. Ethical clearance was obtained from the Research and Ethical Review Committee of Wolkite University, College of Medicine and Health sciences. Permission to conduct the study was also obtained from Gurage Zone administrative office. The study purpose, procedure, duration, rights of the respondents and data safety issues, possible risks and benefits of the study were clearly explained to each participant using the local language. Then before the commencement of the study, all subjects gave their informed written consent. Participation in this study was purely voluntary and there was no monetary gain. No compensation was offered for participation in the study. All the participants’ response was kept confidential by using the information only for the study and storing the study in a closed file.