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Background: Ethiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly. Methods: Ethiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI). Result: The prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition. Conclusion: The burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target. Copyright:
This analysis was based on data from the Ethiopian Demographic and Health Survey (EDHS) 2016conducted by Central Statistical Agency (CSA) of Ethiopia and ICF international conducted the survey. We extracted the required variables for the study from IPUMS DHS [16] All nine regional states and two administrative cities in Ethiopia were included in the survey. Data were collected from January 18, 2016, to June 27, 2016. The sample was stratified and pulled in two-stages. The sampling frame for the first-stage was based on the Ethiopia Population and Housing Census (PHC) conducted in 2007. In this stage, a total of 645 enumeration areas (EAs) (443 in rural areas and 202 in urban areas) were selected with probability proportional to EA size. In the second stage, using equal probability, systematic selection 28 households were selected from each cluster. For all children younger than five years and their mother’s in the selected household, anthropometric data were collected. In this study we analysed data that the survey team obtained after they screened the children for eligibility critera and excluded some children (12%) from final report because of the misclassification and errors. Finally, 8,757 unweighted (9,464 weighted) mother-child pairs were considered for this study. Fig 1 shows the selection process of the mother-child pair at the household level. The details of the sampling and methodology of the EDHS 2016 were provided in the report of the survey[17]. The CSA received the ethical clearance for the survey (EDHS 2016) from Ethiopian Health and Nutrition Research Institute (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology, the Institutional Review Board of ICF International, and the CDC. The Central statistical agency obtained written informed consents from the parents of the children for the data obtained from the children, and the permissions for variables regarded with households were granted from the respondents. Voluntary participation was ensured during interviews. We received the survey data from Measure DHS upon submission of a proposal. After data access is authorized from Measure DHS, we have maintained the confidentiality. The dependent variables were stunting (height-for-age), underweight (weight-for-age), and wasting (weight-for-height). Measurements of height and weight were obtained for under-five children in the selected households. We extracted the raw variable exprecing the standard diviation of each measurement and then we classified the findings to get each undernutrition. Classifications of child undernutrition were made based on WHO Child Growth Standards[18]. Stunting: expressed as a binary outcome, category 0 not stunted if height-for-age Z (HAZ) standard deviations (SD) is greater than −2 and category 1 stunted if Z (HAZ) less than −2SD. Underweight: categorized as 0 no underweight if the weight for age Z (WAZ) is greater than −2 SD and category 1 underweight if Z (WAZ) less than −2SD. Wasting: expressed as category 0 no wasting if the weight-for-height Z (WHZ) is higher than −2 SD and category 1 wasting if Z (WHZ) less than −2SD. We have also reported the prevalence of moderate (between -2SD and -3SD) and severe (less than -3SD) for stunting, underweight and wasting respectively. The independent variables were identified based on a conceptual framework developed by UNICEF[19] and previous studies in the area of undernutrition among children (Fig 2). The variables were grouped into three categories which include: community factors, household and environmental factors, and individual factors (Fig 2). Community level factors involve the place of residence (urban-rural status), and administrative regions. The administrative regions were further grouped into six categories based on socioeconomic status and urbanity for this study. Afar, Somali, Benshangul Gumuz, and Gambela are commonly known as developing regional states in Ethiopia because of their lower socioeconomic status and thus grouped. Administrative regions with a predominantly urban population, such as Addis Ababa, Dire Dawa and Harari were also grouped together. However, Oromia, SNNPR, Tigray and Amhara were not grouped. Household and environmental factors included socio-demographic factors (household wealth index, mother’s education, work status, marital status and the number of under-five children in the house), environmental factors (source of drinking water and type of toilet facility) and media exposure (reading newspaper, listening to the radio and watching television). The individual factors included maternal factors (age and body mass index) and child factors (gender, age, the recent history of diarrhea and acute respiratory infections). Data analysis was performed after adjusting for sampling design (stratification and clustering) using ‘svy’ command in Stata 14.2. Descriptive characteristics were computed and presented by nutritional status (underweight, stunting and wasting). We reported the prevalence of underweight, stunting and wasting along with confidence interval. Generalized linear latent and mixed models (gllamm)[20] with the logit link and binomial family that adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. We first conducted bivariable regressions with each potential risk factor, and the decision to retain the potential risk factor in the final multivariable model was made based on P-value < 0.25. Three multilevel multivariable logistic regression models, one model for each form of undernutrition (stunting, underweight and wasting) were constructed. The adjusted risk of independent variables was assessed by calculating the odds ratios with 95% confidence interval and those with p-value 0.05 were reported from the final model.
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