Ethiopia’s high childhood undernutrition explained: analysis of the prevalence and key correlates based on recent nationally representative data

Abstract

ObjectiveTo examine the contribution of child, maternal and household factors in stunting, wasting and underweight among children under 5 years in Ethiopia.DesignQuantitative cross-sectional design based on nationally representative data.SettingUrban and rural areas of Ethiopia.ParticipantsYounger (0–24 months; n 4199) and older age groups (25–59 months; n 5497), giving a total of 9696 children.ResultsAmong the younger age group, 29 % were stunted, 14 % were wasted and 19 % were underweight; and among the older age group, the prevalence of stunting, wasting and underweight was 47, 8 and 28 %, respectively. Being female, intake of multiple micronutrients, household having a piped source of drinking-water, high maternal BMI, higher household wealth and higher maternal education were associated with decreased odds of at least one form of undernutrition in both groups. On the other hand, children who were anaemic, had low birth weight, drank from a bottle, and children of stunted or wasted or working mothers were more likely to be stunted, wasted or underweight in both groups (P<0·05). While most predictors and/or risk factors followed a similar pattern across the two age groups, child factors had higher leverage in the younger than the older group across the three forms of undernutrition.ConclusionsMultiple set of factors predicted childhood undernutrition in Ethiopia. The study underscores the importance of intervening in the first 1000 days through promoting maternal education, maternal–child health services, mother’s nutrition and improving intrahousehold food distribution.

Determinants of diarrhoeal diseases and height-for-age z-scores in children under-five years of age in rural central Tanzania

“…We did not find any significant association between sanitation, water source and hygiene variables with HAZ in children under five years of age, which contradicts observations in other studies [ 46 , 47 ]. The lack of a true control group, having participating households with similar characteristics (all from resource-poor settings), and a relatively small sample size of the current study make it more difficult to assess such associations, compared to those involving socio-economically diverse study populations and larger sample sizes [ 48 , 49 ]. Use of a small sample size from a localised area has been mentioned as a potential reason for non-significant results from improved toilet and water sources, compared to other studies that used larger sample size and more than one population from different settings [ 37 ].…”

Drivers of stunting reduction in Ethiopia: a country case study

“…Climate change, namely rainfall, drought, and temperature change, does predict some of the variation in child stunting in Ethiopia ( 18 , 76 ), whereas the limited evidence of the impact of food shocks on stunting outcomes tends to show a lack of association ( 78 , 79 , 80 ). Increased wealth was found to be positively associated with HAZ and thus negatively associated with stunting in a large number of studies ( 16 , 17 , 19–21 , 23–27 , 29 , 31 , 34 , 37 , 38 , 47 , 60 , 66 , 77 , 81 , 82 , 83 , 96 ), whereas some found no association ( 30 , 48 , 64 , 84 , 85 ). Women's empowerment was difficult to quantify, and studies examining this variable suggested that the impact of proxies such as households being headed by women ( 23 , 25 , 30 , 32 , 47 ), women's autonomy ( 85 ), and mothers’ employment ( 26 , 37 , 48 , 86 ) had conflicting or no association with HAZ in Ethiopia.…”

“…Increased wealth was found to be positively associated with HAZ and thus negatively associated with stunting in a large number of studies ( 16 , 17 , 19–21 , 23–27 , 29 , 31 , 34 , 37 , 38 , 47 , 60 , 66 , 77 , 81 , 82 , 83 , 96 ), whereas some found no association ( 30 , 48 , 64 , 84 , 85 ). Women's empowerment was difficult to quantify, and studies examining this variable suggested that the impact of proxies such as households being headed by women ( 23 , 25 , 30 , 32 , 47 ), women's autonomy ( 85 ), and mothers’ employment ( 26 , 37 , 48 , 86 ) had conflicting or no association with HAZ in Ethiopia. Parental education has been shown to be positively associated with HAZ and negatively associated with stunting in the vast majority of both national ( 16–21 ) and subnational studies ( 22–27 , 29–32 , 96 , 103 ), although some studies found no association ( 22 , 34 , 38 , 47 , 48 , 59 , 64 , 82 , 86 ).…”

“…Much literature exists on the reasons behind the stunting decline in Ethiopia, and findings point to several key drivers: parental education ( 16–33 ); health care interventions, such as delivery by a skilled birth attendant (SBA) ( 17 , 34–36 ), antenatal care ( 16 , 17 , 26 , 34 , 37–44 ), and postnatal care ( 45 , 46 ); improvements in water, sanitation, and hygiene (WASH), including access to improved water sources ( 21 , 32 , 37 , 39 , 40 , 45 , 47–58 ), reduced distance to fetch water ( 59 ), access to improved sanitation ( 17 , 20 , 21 , 23 , 27 , 29 , 39 , 40 , 45 , 51 , 60–63 ), and reductions in open defecation ( 19 , 27 ); and child feeding indicators ( 19 , 30 , 37 , 38 , 60 , 64–70 ) ( Panel 1 , Supplemental Appendix 2 ) ( 16–98 , 99–118 , 119–142 ). Although we found a wealth of national and subnational studies exploring factors related to stunting in Ethiopia, the overwhelming majority were cross-sectional in design which precludes causality.…”

“…The majority of studies in our review found that childhood immunizations have a protective effect against stunting outcomes ( 28 , 39 , 40 , 50 , 93–95 ), although some found no association ( 23 , 38 , 45 , 51 , 97 , 98 ). Health care interventions such as delivery by an SBA ( 17 , 34–36 ), antenatal care ( 16 , 17 , 26 , 34 , 37–44 ), and postnatal care ( 45 , 46 ) have been found to be associated with reduced stunting outcomes in most studies, although some found no association ( 16 , 19 , 22 , 27 , 30 , 35 , 42 , 45 , 49 , 60 , 64 , 71 , 86 ). Vitamin A supplementation is a promising initiative shown to be associated with a decreased risk of stunting, although variation in findings exists ( 40 , 60 , 61 , 67 , 99–102 ).…”