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Under nutrition status and associated factors among Under-Five Children, Tigray,Northern Ethiopia
Mussie Alemayehu, MPH/RH, Fitiwi Tinsae, MSc, Kiday Haileslassie, MSc, OumerSeid, MSc, Gebremedhin G/egziabher, MSc, Henock Yebyo, MSc
PII: S0899-9007(15)00081-7
DOI: 10.1016/j.nut.2015.01.013
Reference: NUT 9473
To appear in: Nutrition
Received Date: 15 July 2014
Revised Date: 25 November 2014
Accepted Date: 25 January 2015
Please cite this article as: Alemayehu M, Tinsae F, Haileslassie K, Seid O, G/egziabher G, Yebyo H,Under nutrition status and associated factors among Under-Five Children, Tigray, Northern Ethiopia,Nutrition (2015), doi: 10.1016/j.nut.2015.01.013.
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Mussie Alemayehu MPH/RHa*, Fitiwi Tinsae MScb, Kiday Haileslassie MSca, Oumer Seid
MSca , Gebremedhin G/egziabher MScb, Henock Yebyo MSca
a Department of Public Health, Mekelle University, Mekelle, Ethiopia
b Department of Nursing, Dr. Tewolde College of Health Sciences, Mekelle, Ethiopia
*Corresponding author
P.O.Box:1871
Mobile: +251914749082
Email address:
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Objective: The aim of this was to assess the nutritional status and associated factors among
under five children in Medebay Zana District, Northern Ethiopia.
Methods: A community based cross sectional study was conducted in Medebay Zana district
from September 8-29/2013. A two stage cluster sampling technique was employed to select 605
under five children. Descriptive, binary and multiple logistic regression analyses were performed
using SPSS version 20.0.
Result: The level of stunting was 56.6%, underweight 45.3% and wasting 34.6%. Children from
mothers attending high school [AOR=0.75, (CI of 95% 0.09, 0.85)], providing priority food to
father [AOR= 4.32, (CI of 95% 2.10, 9.05)] and use of unprotected sources of water [AOR=
2.13, (CI of 95% 1.09, 4.14)] were predictors of stunting. In wasting, children who initiate
breastfeeding within 1-3 hrs [AOR=4.06, (CI of 95% 1.77, 9.33)], mothers who had power to
decide use of money [AOR= 0.09, (CI of 95% 0.02, 0.51)] and children who breastfeed for 12-23
months [AOR=0.07, (CI of 95% 0.01, 0.40)] were predictors of wasting. Moreover, in
Underweight, female children [AOR=1.84, (CI 95% 1.25, 2.69)], initiation of breastfeeding after
6 hrs [AOR= 12.94, (CI of 95% 4.04, 41.49)] and children with mothers who had power to
decide use of money [AOR=0.33, (CI of 95% 0.15, 0.74)] were predictors of underweight.
Conclusion: The under nutrition status among under five children was high. Children’s age
group, time initiation of breastfeeding, sex of the child, source of water, parents educational
status, type of food used for starting of complementary feeding and power of deciding money
could have an influence in under nutrition of under five children.
Key word: Under nutrition, Stunting, Underweight, Wasting, Medabay Zana, Tigray, Ethiopia
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Under nutrition is usually the result of a combination of inadequate dietary intake and infection
[1,2,3]. In children, under nutrition is synonymous with growth failure in which the
malnutrtioned child is shorter and lighter than they should be for their age, had high risk of
developing physical and mental impairment and finally ends with death [1, 2]. Worldwide over
10 million children aged less than five years die annually from preventable and treatable
illnesses. Almost all these deaths occur in poor countries including Ethiopia. Currently, 195
million under-five children are affected by under nutrition; 90% of them live in sub-Saharan
Africa and South Asia [4]. Nutritional status of under five children in Ethiopia is alarming:
almost above half (53%) of the under-five mortality rates can be attributed directly or indirectly
to under nutrition [5]. The Ethiopian Demographic Health Survey (EDHS, 2011) report shows
that nearly one in two (44%) of Ethiopian under five children are being stunted, 10% wasted and
29% underweight. According to the estimates, one in every 17 Ethiopian children dies before the
first birthday, and one in every 11 children dies before the fifth birthday [6].
Furthermore, having poor nutritional status of children becomes a common characteristics of
Ethiopian children, even though; the health sector has increased its efforts to enhance good
nutritional practices through health education, treatment of extremely malnourished children, and
provision of micronutrients to the most vulnerable group of the population [6]. However, dealing
about nutritional status of children is crucial since the nutritional status of children today reflects
a healthy and productive generation in the future. And in the long-run it leads to an increase in
the strength of the labor force and thereby it contributes positively to the economic growth. Thus,
a good nutrition is essential for healthy, thriving individuals, families and a nation [7]. Therefore,
the objective of this study was to assess the under nutrition status and associated factors among
under five children in Medabay Zana district.
Methods Setting and study design
A community based cross-sectional study was conducted in the Medebay Zana District from
September 8-29/2013. The total population of the area is 130,623, with 17,934 children 6-59
months and it owns 2 health centers and 20 health posts [8]. Tigraway is the dominant ethnic
group in Medebay Zana. All children aged 6-59 months were considered as source population.
To determine the sample size, a single population proportion formula with the proportion of
stunting in Tigray region, 51.4% [6], a confidence level of 95%, and a 5% degree of precision,
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calculated was 634. Two stage cluster sampling technique with design effect of 1.5 was used. On
the first stage, 4 kebeles were selected out of the total 18. Systematic random sampling was used
to select the study subjects. There total sample size was proportionally allocated to the selected
kebeles based on the available number of under five children. Based on the sample fraction,
children were selected at equal interval using systematic random sampling. Those who didn’t
fulfill the inclusion criteria were excluded and the next children fulfilling the criteria were
included. However, mothers of children who refused to participate were excluded from the study
without replacement.
Data collection instrument and quality issue
Structured and pre-tested questionnaire, guided by the interviewer was used to collect the
information. The questionnaire was adapted from different literatures and considering the local
situation of the study subjects [6 - 8]. It was first prepared in English and then translated to
Tigrigna and then translated back to English for consistency by two different language expert
individuals. Information collected included socio-demographic characteristics, child health and
caring practices, anthropometric measurement information and household information. Six
health extension workers who speak local languages were employed in the data collection
process. Two clinical nurses were selected as a supervisor. Training was given to the data
collector and supervisor for two consecutive days on the objectives of the study, the contents of
the questionnaire, anthropometric measurement and particularly on issues related to the
confidentiality of the responses and the rights of respondents. One week prior to the data
collection a pre-test was conducted in another Woreda (Wukro Maray) on 5% of the sample size.
Weight measuring scales were checked for accuracy and calibrated by using known weights
before we measuring the children. Standard techniques were used while measuring the weight
and height of the children. For instance, length is measured in recumbent position in children < 2
years old to the nearest 1mm and for children > 2 years and adults in standing position to the
nearest 0.1 cm. An assistance of two people is needed in taking the measurement. Weight
measurement is performed to the nearest 10g and 0.1 Kg for children less than and greater than 2
years, respectively.
Data analysis
Data collected were cleaned, edited, coded, entered and analyzed by using SPSS for windows
version 20.0 (SPSS Inc. version 20.Chicago, Illinois). Weight, height and age data were used to
calculate Weight-for-Age, Height-for-Age and Weight-for-Height z-scores based on the WHO
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the median value of the national center for health statistics (NCHS/WHO) international weight
for height reference. Severely wasted is defined <-3 SD. Stunting is defined as low height-for-
age at < -2 SD of median value of the NCHS/WHO international growth reference. Severely
stunted is defined as < -3 SD. Underweight is an index of weight for age represents body weight
relative to age. Underweight is defined as low weight for age at < -2 SD of the median value of
the NCHS/WHO international reference. Severely underweight is defined as < -3 SD.
Descriptive and multiple logistic regression was used to estimate the respective indicators, and
effects of factors on the malnutrition (stunting, wasting and under weight) of the under five
children. Co linearity among independent factors was checked using VIF. The sample effect size
was estimated using OR and the parameters were estimated using 95% confidence interval of the
OR. For all the analyses, P-value less than 0.05 was considered statistically significant.
The study protocol was approved by the ethical committee of Mekelle University, College of
health science research and community service committee. Written consent was obtained from
the study respondents (care givers). The right of the respondent to withdraw from the interview
or not to participate at all was assured.
Result
Socio-demographic and economic characteristics
A total of 605 under five children were included in the study with a response rate of 95.4%.
Majority of the children were males 297(49.4%) and had a mean of age 32.14 (±17.29) months.
The participant was from a family who had an average of 5.44 (±2. 19) and 1.68 (±0. 62) family
size and under-five children, respectively. The majority of the mothers 421 (70%) were illiterate,
house wife 562 (93.3%), orthodox followers 597 (99.3%) and married 569 (94.7%). Fathers were
the head of household 509 (84.7%) and had the power to use the money 481 (80%). Five
hundred twenty (86.6%) earn a monthly income less than 26.1$ [Table1].
Nutritional Status of children
Out of the total children, 56.6% were found stunting, underweight 45.3% and wasting, 34.6%.
Moreover, severe malnutrition was found among the child stunting (22%), underweight (23.3%)
and wasting (12%).
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counseling on EBF, having an animal, head of HH, and monthly income were not significantly
associated with stunting malnutrition. However, children from mothers attending high school
were less likely stunted as compared with children, their mother illiterate [AOR= 0.75, (CI of
95% 1.10, 12.85)]. Providing priority food to the father in the child's household was 4 times
more likely stunted as compared with a family who had equal food distribution among family
member [AOR=4.32, (CI of 95% 2.10, 9.05)]. Fathers educational level was negatively
associated with having stunting children; primary school, high school and college were less
likely stunted [AOR= .041, (CI of 95% 0.23, 0.71)], [AOR= 0.30 (CI of 95% 0.10, 0.90)] and
[AOR=0.14, (CI of 95% 0.03, 0.68)] respectively as compared illiterate fathers. Using
unprotected sources of water in the household of children were 2 times more likely stunted as
compared with those who got protected water [AOR= 2.13, (CI of 95% 1.09, 4.14)]. Stunting
was more likely among children in the age group of 12-23 month and 24-35 months [AOR=2.
06, (CI of 95% 1.09, 3.95)] and [AOR= 4.01, (CI of 95% 1.87, 8.57)] as compared to age group
of 6-11 months. On the other hand, female children’s were less likely stunted [AOR= 0.47, (CI
of 95% 0.31, 0.72)] as compared to male children. Initiation of breastfeeding after 6 hrs d after
birth was 4 times more likely stunted as compared to initiation of breastfeeding within 1hr
[AOR=4.34,(CI 95% 1.41, 13.34)]. Children in the family size of 10-13 person in a single
household were 12 times more likely stunted [AOR= 12.43, (CI of 95% 2.70, 57.26)] as
compared to household who had a family size of 2-5 [Table 2].
Factors associated with Under Weight
Multiple logistic regression showed that the sex of the child, time of BF initiation after birth,
child’s age group, having toilet household, power to use money in the household and type of
food given at time of weaning were significantly associated with underweight. The analysis
showed that female children were 2 times more likely to be underweight as compared to male
children [AOR=1.84, (CI of 95% 1.25, 2.69)]. Initiation of breastfeeding after 6hrs after birth
were 13 times more likely underweight as compared with children who feed, breastfeeding
within 1hr [AOR= 12.94, (CI of 95% 4.04, 41.49)]. Children of household who didn’t have toilet
was more likely underweighted as compared with toilet owner [AOR= 1.51, (CI of 95% 1.02,
2.23)]. Children in the age group of 12-23 months were 3 times more likely underweight as
compared to 6-11 months age group [AOR=2.58, (CI of 95% 1.37, 4.85)]. Children started
weaning with cereal gruel [AOR= 0.28, (CI of 95% 0.12, 0.61)] and porridge [AOR=0.36, (CI of
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Children with mothers who had the power to decide the use of money was less likely
underweight [AOR= 0.33, (CI of 95% 0.15, 0.74)] as compared to fathers who had the power to
decide [Table 3].
Factors Associated With Wasting
Multiple logistic regressions showed that, time of initiation BF after birth, the power to use
money in the household and duration of breastfeeding were significantly associated with wasting
of children. The analysis showed that child who initiate breastfeeding within1-3hrs and after 6
hrs of the child after birth were more likely wasted [AOR=4.06, (CI of 95% 1.77, 9.33)] and
[AOR= 13.97, (CI of 95% 4.20, 46.41)] respectively as compared with children who initiate feed
breast milk within 1hr. The finding also showed that a household with mothers who had the
power to decide to use money was less likely wasted [AOR= 0.09, (CI of 95% 0.02, 0.51)] as a
father. Children who breastfeed for 12-23 months were less likely wasted [AOR= 0.07, (CI of
95% 0.01, 0.40)] as compared with the duration of breastfeeding 6-11 months [Table 4].
Discussion
The prevalence for stunting, underweight and wasting in this study was 56.6%, 45.3% and
34.6%, respectively. Regarding information about severe under nutrition revealed that stunting
was found in 22% of children, underweight (23.3%) and wasting (12%). The result of multi
variable logistic regressions indicates that, time of initiation BF after birth, power to use money
in household and duration of breastfeeding were significantly associated with wasting of
children. Moreover, children from mothers attending high school, giving priority food to father
in the household, father’s educational level, source of water, sex of child, time of initiation of
breast feeding and age group of children were significantly associated with stunting. Finally, sex
of the child, time of BF initiation after birth, child’s age group, having toilet and power to use
money in the household, and type of food given at time of weaning were significantly associated
with underweight.
The poor nutritional status of children has been a serious problem in Ethiopia for many years [6].
Moreover, the latest reports of EDHS 2011, in Tigray regions revealed that, stunting (51%) and
sever stunting (22.4%) [6]. However, there is a still higher proportion of malnutrition stunting
(56.6%) and severe stunting (22%) in this study. This implies that the government should work
more on minimizing the chronic malnutrition problem through inter-sectoral collaboration so as
have a productive generation. Moreover, the health sector should increased its efforts to enhance
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children, and provision of micronutrients to the most vulnerable group of the population, that is,
mothers and children. In addition, the Health Extension Program (HEP) has included nutrition as
part of their health package
This study revealed that the prevalence of underweight was 45.3%.And this was consistent with
a study done West Gojam Zone Amhara region, reported that 49.2% [9].However, it was higher
as compared with a report of EDHS,2011(29%) and studies done in Gumbrit of Amhara region
(28.5%), and 38.3% four rural communities’ zones of Tigray region(38.3%) [6,10,11]. And this
is consistent with a study done m This difference may be due to the attribution of season
variation in which the data of this study was collected in September-October when most rural
areas of the Ethiopian farmers have shortage of food during this season.
The proportion of wasting in different studies ranges from 10-14.8% [6, 11, 12]. However, the
findings of this study reveled that high proportion of wasting (34.6%) and sever wasting
(23.3%).The possible reason for this huge difference might be due to season variation in which
the data collection of this study was from September – October, when most rural areas have
shortage of food during this season. And in the EDHS 2011 report indicates that rural children
are more likely to be underweight (30 %) than urban children (16 %) [6].This implies that
government should bring an alternative mechanism like expansion irrigation service for the
farmers to increase their food consumption and to reach food security.
A studies done in Gumbrit, West Gojjam and Pakistan [10, 12, 13] shown that male children
were at higher risk of stunting than female children. Similarly this study revealed that female
children were less likely stunted [AOR=0.74, (C of I95% 0.31, 0.72)] as compare to males.
These sex-related differences require further study. One report from Ghana suggested that boys
were more influenced by environmental stress [14]. This is also supported by the report of
EDHS, 2011 indicated that male children are slightly more likely to be stunted than female
children (46 % and 43%, respectively [6].
The mother’s level of education generally has an inverse relationship with stunting levels. And a
report from EDHS, 2011 indicates that children of mothers with more than secondary education
are the least likely to be stunted (19%), while children whose mothers who did not have
education are most likely to be stunted (47%) [6]. This is also supported by our result showed
that children from mothers who attend high school educational level of mother [AOR=0.75, (CI
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finding is contradict with as study done in Gumbrit, Amhara region [10].This might be due to the
fact that educational status has a direct impact on practicing of prevention aspect of disease as
well as lower fertility and more child-centered caring practices. So this implies that the
government should empowered women in education, employment and political areas.
A study conducted in Ethiopia showed that household who drinks water from unprotected source
was associated with more stunted as compared with their counterparts [15]. The same is true in
this study in which children from household who drinks water from unprotected source were
more likely to be stunted [AOR=2.13, (CI of 95% 1.09, 4.14)] as compared with those family
who got their water from protected source.
Children from families that used cereal-based complementary foods had statistically higher
WAZ scores than those who did not [11]. The same was true in this result cereal gruel
complementary food used child was less likely underweight [AOR=0.28, (CI of 95% 0.12, 0.61)]
as compare cow’s milk user.
A study done in India showed that the prevalence of protein energy malnutrition (PEM) was
associated with family size; one (21.56 %), two (30.55%), three (36.28%) and four and above
(45.11%) [16]. This is also supported by our finding in which household who had a family size
of 10-13 person per household were more likely to be stunted [AOR=12.43, CI of95% 2.70,
57.26)] as compared to 2-5 person in a household. This might be due to lack of food resources
(imbalance need and supply) of food in the household. This implies that the government should
work more on family planning by providing good method mix and appropriate counseling for the
mothers.
Age of the children has different effect on the nutritional status (stunting and underweight) of the
children. The prevalence of stunting increases as the age of a child increase [6, 17]. Moreover,
our study also supports this finding in which children with the age group of 12-23 and 24-35
months were more likely to be stunted as compared with children in the youngest age group of 6-
11 months. This implies the government should create awareness of the community in which
malnutrition can occur at any age and in all aspect of the household. However, as the age of the
children increased there appeared a kind of decreasing trend in the level of underweight [6, 10,
18]. This may be explained by the fact that foods for weaning are typically introduced to children
in the older age group, thus increasing their exposure to infections and susceptibility to illness.
This tendency, coupled with inappropriate or inadequate feeding practices, may contribute to
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is a relationship of age and underweight. The same result was obtained in this study; underweight
reach peak level during 12-23 months more likely underweight [AOR=2.58, (CI of 95% 1.37,
4.85)] as compared 6-11 months age children.
Early initiation of breast feeding within one hour is currently recommended for children to
promote their nutritional status. The first liquid (colostrum) provides natural immunity to the
infant and .it also has an input in reduction of hypoglycemia and hypothermia which in turn have
a devastating effect on the health status of the infant [6]. Initiation of breastfeeding within one
hour after birth was associated with less stunted and underweight [17,18]. The same is true in
this finding, initiation of breastfeeding after 6 hrs was more likely to be stunted [AOR=4.34, (CI
of 95% 1.41, 13.34)] and underweight [AOR=12.94, CI of95% 4.04, 41.49)] as compared with
initiated breast feeding within one hour after child birth.. This might be early initiation of
breastfeeding is important for the child. This implies the health care providers should counsel
mother on early initiation of breast feeding.
Sex of the child has also different effect on the nutritional status of the children. Being male are
at high risk of developing stunting [10, 12, 13] and underweight [6, 14, 18]. Similarly this study
revealed that female children were less likely stunted [AOR=0.74, (CI of 95% 0.31, 0.72)] as
compare to males. These sex-related differences require further study. One report from Ghana
suggested that boys were more influenced by environmental stress [14]. This is also supported by
the report of EDHS, 2011 indicated that male children are slightly more likely to be stunted than
female children (46 % and 43%, respectively [6]. However, our finding is inconsistent in case of
underweight; Female children were significantly less underweight than male]. But in this study
female children were more likely underweight [AOR=1.84, (CI of 95% 1.25, 2.69)] as compare
male children.
The study faces the following limitations: Since the study employ cross-sectional study it is
difficult to establish cause effect relationship. Respondent might have not told us real
information about their socio economic status, because of high dependency on the need to get
support. Some measurements may not be accurate due to subjective responses and recall biases.
Not including mothers’ nutritional factors in this study, because nutritional status of mother can
be influence child nutritional status.
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The under nutrition status among under five children was high. Time of initiation BF after birth,
power to use money in the household and duration of breast feeding could influence wasting of
children. Moreover, children born from mothers attending high school, Giving priority food to
father in the children household, fathers educational level, source of water, sex of child, time of
initiation of breast feeding and age group of children could influence stunting of the children.
Finally, sex of the child, time of BF initiation after birth, child’s age group, presence of toilet at
the household, power to use money in the household and type of food given at time of weaning
could influence underweight of the children.
Acknowledgement It gives us a great reputation and opportunity to thank University of Mekelle for financial support
and our earnest thanks to study participants, data collector and supervisors who spent their
valuable time responding to the questionnaire accordingly.
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Table 1: Socio-demographic and socioeconomic characteristics of study population, Medebay
Zana District, 2013
Variables Number Percent Sex of children Male 297 49.4 Female 304 50.6 Age of children 6-11 months 100 16.6 12-23 months 136 22.6 24-35 months 80 13.3 36-47 months 84 14.0 48-59 months 201 33.4 Religion Orthodox 597 99.3 Muslim 4 0.7 Mothers’ age 15-24 years 180 30.0 25-34 years 197 32.8 35-44 years 212 35.3 > 44 years 12 2.0 Family size 2-5 person 356 59.2 6-9 person 225 37.4 10-13 person 20 3.3 Mothers’ marital status Single 16 2.7 Married 569 94.7 Divorced 12 2.0 Widowed 4 0.7 Mothers’ occupation House wife 562 93.3 Governmental employee 40 6.7 Maternal education Illiterate 421 70.0 Primary school 72 12.0 Junior high school 32 5.3 High school 52 8.7 College and above 24 4.0 Paternal education Illiterate 369 61.4 Primary school 108 18.0 Junior high school 20 3.3 High school 56 9.3 College and above 48 8.0 Head of household
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Table 2: Factors associated with stunting of under nutrition on selected variables, Medebay Zana
Wereda, 2013.
Variable Stunted Bivariate Multivariate Yes (%) No (%) COR(95% CI) AOR (95%CI) Mothers education Illiterate 248 (72.9%) 173(66.3%) 1.00 1.00 Primary school 36 (10.6%) 36(13.8%) 0.70(0.42,1.15) 0.61(0.31,1.23) Junior high school 20(5.9%) 12(4.6%) 1.16(0.55, 2.44) 2.525(0.91, 6.99) High school 28 (8.2%) 24(9.2%) 0.81(0.46, 1.45) 0.75(0.09,0.85)* College & above 8(2.4%) 16(6.1%) 0.35(0.15, 0.83)* 0.90(0.18, 4.51) ANC service received during pregnancy
Yes 248(72.9%) 221(84.1%) 1.00 1.00 No 92 (27.1%) 40(15.3%) 2.05(1.36, 3.09)* 1.51(0.85, 2.68) Education on exclusive breastfeeding
Yes 134(39.4%) 139(53.3%) 1.00 1.00 No 206(60.6%) 122(46.7%) 1.752(1.26,2.43)* 1.55(0.96, 2.51) Food distribution in household
Equal in all 32(9.4%) 60(23%) 1.00 1.00 Priority to father 80(23.5%) 44(17%) 3.41(1.94,5.99)* 4.32(2.1,9.04)*** Priority to child 228(67.1%) 157(60%) 2.723(1.69, 4.38)* 5.86(.09,11.08) Educational of father Illiterate 232(68.2%) 137(52.5%) 1.00 1.00 Primary school 48(14.1%) 60(23%) 0.47(0.31, 0.73)* 0.41(0.23, 0.71)** Junior high school 12(3.5%) 8(10.8%) 0.89(0.35, 2.22) 1.02(0.34, 3.05) High school 28(8.2%) 28(10.7%) 0.59(0.34, 1.04) 0.29(0.10, 0.88)* College & above 20(5.9%) 28(10.7%) 0.42(0.23, 0.78)* 0.14(0.03, 0.68)* Animal owner in household
Yes 208(61.2%) 117(44.8%) 1.00 1.00 No 132(38.8%) 144(55.2%) 0.52(0.37, 0.72)* 0.53(0.33, 1.85) Sources of drink water Pipe water/protected 280(82.4%) 237(90.8%) 1.00 1.00 Well water/not protected 60(17.6%) 24(9.2%) 2.12(1.28, 3.50)* 2.13(1.09, 4.14)* Head of HH Father 300(88.2%) 209(80.%) 1.00 1.00 Mother 40(11.8%) 52(20%) 0.54(0.34, 0.84)* 0.61(0.33, 1.13) Sex Male 180(52.9%) 117(44.8%) 1.00 1.00 Female 160(47.1%) 144(55.2) 0.72(0.52, 0.99)* 0.47(0.31, 0.72)*** Time of BF after birth Before 1 hr 104(30.6%) 81(31%) 1.00 1.00 1-3hrs 80(23.5%) 72(27.6) 0.87(0.56,1.33) 1.674(0.955,2.932)
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ACCEPTED MANUSCRIPT4-6hrs 124(36.5%) 100(38.3) 0.97(0.65,1.43) 1.560(0.854,2.851) After 6hrs 32(9.4%) 8(3.1%) 3.12(1.36, 7.13)** 4.34(1.41,13.34)* Child age 6-11 months 48(14.1%) 52(19.9%) 1.00 1.00 12-23 months 80(23.5%) 56(21.5%) 1.55(0.92, 2.60) 2.06(1.08, 3.95)* 24-35 months 56(16.5%) 24(9.2%) 2.53(1.36, 4.69)** 4.01(1.87, 8.57)*** 36-47 months 52(15.3%) 32(12.3%) 1.76(0.98, 3.18) 1.998(0.939, 4.251) 48-60 months 104(30.6%) 97(37.2%) 1.16(0.72, 1.88) 1.111(0.616, 2.002) Household family size 2-5 person 208(61.2%) 148(56.7%) 1.00 1.00 6-9 person 116(34.1%) 109(41.8%) 2.85(0.93,8.69) 0.701(0.434, 1.133) 10-13 person 16(4.7%) 4(1.5%) 3.78(1.22, 11.59)** 12.43(2.70, 57.26)** Household monthly income
< 26.1 birr 300(88.2%) 221(84.7%) 1.00 1.00 26.1-76.3$ 24(7.1%) 16(6.1%) 1.11(0.57, 2.13) 1.91(0.70,5.16) >76.3 $ 16(4.7%) 24(9.2%) 0.49(0.26, 0.95)* 2.03(0.55,7.49) N.B *(P<0.05), ** (P<0.01) & *** (P<0.001), 1.00= reference category, 1$=19.64 ETB
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ACCEPTED MANUSCRIPTTable 3: Factors associated with underweight under nutrition on selected variables Medebay Zana District, 2013.
Under weight Bivariate Multivariate Variable Yes(%) No(%) COR(95% CI) AOR (95% CI) Mothers occupation
House wives 264(97.1%) 297(90.3%) 1.00 1.00 Governmental worker 8(2.9%) 32(9.7%) 0.28(0.13,0.62)* 0.88(0.36, 2.73)
Time of breastfeeding initiation after birth
Before 1hr 72(26.5%) 113(34.3%) 1.00 1.00 1-3hrs 68(25.0%) 84(25.5%) 1.27(0.82, 1.96) 1.68(0.99, 2.85) 4-6hrs 96(35.3%) 128(38.9%) 1.18(0.79, 1.75) 1.14(0.69, 1.89)
After 6hrs 36(13.2%) 4(1.2%) 14.13(4.82,41.36)* 12.94(4.04,41.49)*** ANC service received
yes 196(72.1%) 273(83%) 1.00 1.00 No 76(27.9%) 56(15%) 1.89(1.28, 2.79)* 1.16(0.71,1.90)
Head of household father 244(89.7%) 265(80.5%) 1.00 1.00
Mother 28(10.3%) 64(19.5%) 0.48(0.30, 0.77)* 1.55(0.71, 3.35) Power to use money in household
Father 240(88.2%) 241(73.3%) 1.00 1.00 Mother 32(11.8%) 88(26.7%) 0.37(0.24, 0.57)** 0.33(0.15, 0.74)**
Toilet owner in household Yes 152(55.9%) 213(64.7%) 1.00 1.00 No 120(44.1%) 116(35.3%) 1.45(1.043, 2.015)* 1.506(1.016, 2.233)*
Food aid received Yes 104(38.2%) 97(29.5%) 1.00 1.00 No 168(61.8%) 232(70.5%) 0.68(0.48, 0.95)* 0.724(0.476, 1.103)
Sex Male 116(42.6%) 181(55%) 1.00 1.00
Female 156(57.4%) 148(45%) 1.65(1.19, 2.27)* 1.84(1.25, 2.69)** Child age(months)
6-11 40(14.7%) 60(18.2%) 1.00 1.00 12-23 76(27.9%) 60(18.2%) 1.90(1.13, 3.21)* 2.58(1.37, 4.85)* 24-35 36(13.2%) 44(13.4%) 1.23(0.68, 2.23) 1.17(0.57, 2.42) 36-47 44(16.2%) 40(12.2%) 1.65(0.92, 2.97) 1.75(0.87, 3.51) 48-59 76(27.9%) 125(38%) 0.91(0.56, 1.49) 0.73(0.41, 1.32)
Commonly type of complementary food
Cow’s milk 24(9.2%) 20(6.2%) 1.00 1.00 Cereal gruel 44(16.9%) 84(26.2%) 0.44(0.22, 0.88)* 0.28(0.12, 0.61)** Injera /bread 132(50.8%) 109(34%) 1.01(0.53, 1.92) 0.75(0.35, 1.61)
Porridge 60(23.1%) 108(33.6%) 0.46(0.24, 0.91)* 0.36(0.16, 0.81)*
N.B *(P<0.05), **(P<0.01) & ***(P<0.00 , 1.00= reference category
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ACCEPTED MANUSCRIPTTable 4 Factors associated with wasting of under nutrition of selected variables, Medebay Zana district, 2013.
Variable Wasting Bivariate Multivariate Yes (%) No (%) COR(95% CI) AOR (95% CI) Time of B/F initiation after birth
Before 1 hr 48(23.1%) 137(34.9%) 1.00 1.00 1-3hrs 64(30.8%) 88(22.4%) 2.08(1.31, 3.29)* 4.06(1.77, 9.33)** 4-6 hrs 64(30.8%) 160(40.7%) 1.14(.74, 1.78) 0.92(0.41, 2.07) After 6hrs 32(15.4%) 8(2.0%) 11.42(4.9,26.5)* 13.97(4.20, 46.41)*** ANC service received Yes 152(73.1%) 317(80.7%) 1.00 1.00 No 56(26.9%) 76(19.3%) 1.54(1.04, 2.28)* 2.25(0.99, 5.08) Head of household Father 188(90.4%) 321(81.7%) 1.00 1.00 Mother 20(9.6%) 72(18.3%) 0.48(0.28,0.80)* 1.93(0.45, 8.31) Power of decide to use money in household
Father 184(88.5%) 297(75.6%) 1.00 1.00 Mother 24(11.5%) 96(24.4%) 0.40(0.25, 0.66)* 0.09(0.02, 0.51)** Toilet owner in household Yes 108(51.9%) 257(65.4%) 1.00 1.00 No 100(48.1%) 136(34.6%) 1.75(1.24, 2.46)* 1.51(0.81, 2.79) EBF 1st 6 months Yes 192(92.3%) 341(86.8%) 1.00 1.00 No 16(7.7%) 52(13.2%) 0.55(0.30, 0.98)* 0.477(0.104, 2.18) Household family size 2-5 person 132(63.5%) 224(57.0%) 1.00 1.00 6-9 person 64(30.8%) 161(41.0%) 0.68(0.47, 0.97)* 0.57(0.30, 1.05) 10-13 person 12(5.8%) 8(2.0%) 2.55(1.01,6.39)* 1.31(0.07, 25.63) Fever within 2wks Yes 8(3.8%) 53(13.5%) 1.00 1.00 No 200(96.2%) 340(86.5%) 3.90(1.82,8.37)* 1.93(0.49,7.67) Total time of Breastfeeding 6-11months 8(61.5%) 5(2.1%) 1.00 1.00 12-23months 16(19.5%) 66(28.1%) 3.73(1.01,13.78)* 0.07(0.01,0.40)** 24-35months 64(32.0%) 136(57.9%) 0.57(0.24,1.35)* 0.31(0.07,1.50) 36-47months 12(30.0%) 28(11.9%) 1.10(0.53,2.30) 0.25(0.04,1.36)
N.B *(P<0.05), ** (P<0.01) & *** (P<0.001) 1.00= reference category
