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Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39â 9 %) and wasting (22â 2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31â 3 %), underweight (24â 0 %) and wasted (11â 8 %)]. Being a girl [AOR 0â 31; 95 % CI (0â 17, 0â 54)] in employed mothers and [AOR 0â 29; 95 % CI (0â 16, 0â 51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.
The present study was conducted in Robe town. This town is located 430 km from Addis Ababa, in the south-east of the country. The altitude is between 2510 and 2800 m above sea level. It receives rain in two seasons, with average downfalls ranging from 800 to 900 mm. The town has three kebeles with total households of 12 883 and a total population of 71 458 (36 015 males and 35 443 females) according to the 2020 projection. Likewise, there are 4452 children aged 6–23 months. In the town, there is one preparatory school, two high schools, thirteen first-cycle primary schools (grades 1–4 elementary school) and thirty-six public and private health facilities. A community-based comparative cross-sectional study was conducted in April 2020. The source population for this study was all employed and unemployed mothers who have children aged 6–23 months in the city of Bale Robe. The study population was selected with a simple random group of employed and unemployed mothers from the source population. All employed and unemployed mothers who have children aged 6–23 months and live in Bale Robe were eligible for this study. However, mother–child pairs that were severely sick and chronic patients at the time of the survey were not included in this study. The sample size was calculated using G* power software 3.1.9.7 considering the prevalence of underweight among employed mother–child dyads P2 6⋅3 % and unemployed ones P1 16⋅4(22), design effect 2⋅0 and 5 % non-response rate. The final sample size was 648 (324 employed and 324 unemployed) (Table 1). The sample size determination by using G* power software 3.1.9.7 of mother–child dyads aged 6–23 months in Bale Robe Town, Ethiopia, 2020 (n 597) A multistage sampling technique was used. Two kebeles (the lowest administrative unit) were selected from the total of three by simple random sampling. The sample frame was prepared after house-to-house listing of households with children aged 6–23 months among employed and unemployed mothers. The study participants were then randomly selected based on the sampling frame. In households with more than one child aged 6–23 months, one was selected using the lottery method (Fig. 1). Sampling procedures for selecting 648 mothers for study in Robe town, 2020. A semi-structured questionnaire was used to collect data on socio-economic and demographic characteristics, healthcare, infant and young child feeding practices (IYCF). The household food security access scale questionnaire was used to assess the state of household food security. Anthropometric measurements were taken by trained data collectors to avoid intra-observer variation using calibrated equipment and standardised techniques. A recumbent length measurement was taken to the nearest 0⋅1 cm using the short height measuring board (short productions, Woonsocket, RI, UK) with the subjects shoeless(23). Weight was measured using a UNICEF Seca electronic personal scale (Seca 881U). Women were asked to remove their children’s thick cloth during the measurements. The instrument was calibrated before each measurement. The circumference of the middle of the upper arm was measured with a measuring tape to the nearest to 0⋅1 mm(24). The child’s age was collected from the mother. It was confirmed using a birth certificate, a vaccination card and local-events calendar(23,25). The questionnaire was first developed in English and translated into the local language Afaan Oromo and then translated back to English by language experts to verify its consistency. Data collectors with experience who are fluent in the local language were recruited. The pre-test was conducted by 5 % of the sample size to check the quality of the questionnaire and make appropriate modifications before duplication of the final version on population outside the sampled kebeles. In order to minimise intra-observer errors, two measurements of height and weight for each child was registered by a single observer, and the third measurement was considered for those cases where the difference between the two measurements was greater than 0⋅5 cm or 0⋅1 kg. The completeness and consistency of the data was checked before the respondent left. Data collection was supervised daily on site by the recruited supervisors and the principal investigator. Extreme values of z-score, >5 or 0⋅05). The odds ratio with a 95 % confidence interval was reported to show the strength of the associations between the outcome and predictor variables. The statistical significance was declared at a P-value < 0⋅05. Wealth index was assessed using household assets via principal component analysis adopted from(26,27). This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Institutional Review Board of Hawassa University (Reference number: HU/IRB/215/20; dated: 13 March 2020). Informed (written) consent was obtained from mothers/caregivers with signature/fingerprint all study subjects. A letter of permission was received from the administrative district and zonal health department. A child with height/length-for-age (H/LAZ) below −2 standard errors compared with the reference group (Z-score < −2) is considered to be stunted(28). A child with weight-for-age (WAZ) below −2 standard errors compared with the reference group (Z-score < −2) is considered to be underweight(28). A child with weight-for-height/length age (WH/LZ) below −2 standard errors compared with the reference group (Z-score < −2) is considered to be wasted(28). Household food insecurity (HFI) was measured using the Household Food Insecurity Access Scale (HFIA), which has nine questions and is related to the households’ experience of food insecurity in the 12 months preceding the survey(29). Then, the HFIA prevalence indicators were categorised households into four(30) levels of HFI: food secure, mild, moderately and severely food insecure. For the present study, only two levels other Household Food Insecurity Access Scale (food secure and insecure) was used because the sample size for this study was small(31). Maternal employment was defined as the mother's report of whether or not she worked for earnings in the past week. A woman was considered to be an ‘employed’ if she had reported earning income at least three times during the past week weather formal or informal categories, with formal referring to regular wage work, such as governmental or non-governmental organisation employee permanently, and informal referring to street vending, domestic work or vending from a fixed location. A women who have no permanent work or not having any informal work category is considered as unemployed(32). The minimum acceptable diet is a composite indicator defined as the proportion of children aged 6–23 months who met both minimum dietary diversity and the minimum meal frequency during the previous 24 h(28).
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