Determinants of Stunting among Children Aged 6-23 Months of Age in Pastoral Community, Afar Region, Ethiopia: Unmatched Case-Control Study

Authors

  • Getahun Fentaw Mulaw Department of Public Health, College of Medical and Health Sciences, Samara University, Samara
  • Omer Seid Adem Department of Nutrition, School of Public Health, College of Health Sciences, Mekelle University, Mekelle
  • Abate Bekele Belachew Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University

DOI:

https://doi.org/10.6000/1929-4247.2020.09.04.6

Keywords:

Afar, Case-control, Children aged 6-23 months, Ethiopia, Golina district, Pastoralist, Stunting.

Abstract

Background: Globally, stunting is a public health concern, more of in developing counties, including Ethiopia. Once occurred, in the first two years of life, it is irreversible and has long-lasting harmful consequences. Exploring the determinants has pivotal importance for evidence-based interventions. Therefore, the rationale of this study was to identify determinants of stunting among children aged 6-23 months in the pastoralist community, Afar region, Ethiopia.

Method: A community-based unmatched case-control study was conducted among 381 (cases=126, controls 255) study participants from February 15/2017 to March 30/2017. Cases and controls were identified consecutively using the world health organization growth monitoring chart.

Data was collected by interviewer-administered questionnaires and anthropometric measurements. Statistical significance was declared at p-value < 0.05 in the final multivariable logistic regression model.

Result: Maternal education (AOR:0.34, 95% CI: 0.16, 0.77), maternal under-nutrition (AOR:2.91, 95% CI:1.51, 5.60), number of under-five children within the household (AOR:2.66, 95% CI: 1.38, 5.10), latrine ownership (AOR:0.28, 95% CI:0.15, 0.55), minimum Dietary Diversity score of children (AOR:0.41, 95% CI:0.22, 0.75), child age (AOR:1.76, 95% CI:1.01, 3.09), colostrum intake (AOR:3.03, 95%CI:1.62, 5.66), and exclusively breastfeed for the first six months (AOR:3.20, 95% CI:1.72,5.95) were found to be determinants of stunting.

Conclusion: This study found that determinants of childhood stunting are multifactorial. Maternal, household and child-related characteristics are associated with childhood stunting. Therefore, to improve childhood nutritional status, inter-sectoral collaboration and commitment are vital.

References

[1] World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development: World Health Organization; 2006.
[2] Micha R, Mannar V, Afshin A, Allemandi L, Baker P, Battersby J, et al 2020 Global nutrition report: action on equity to end malnutrition 2020.
[3] Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Rockville, Maryland, USA: EPHI and ICF Available from: https://www.unicef.org/ethiopia/reports/2019-ethiopia-mini-demographic-and-health-survey.
[4] Save the Children. Nutrition in the first 1,000 days: State of the World's Mothers 2012. Save the Children Fairfield; 2012.
[5] Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS Medicine 2016; 13(11): e1002164.
https://doi.org/10.1371/journal.pmed.1002164
[6] Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The human microbiome and child growth–first 1000 days and beyond. Trends in Microbiology 2019; 27(2): 131-47.
https://doi.org/10.1016/j.tim.2018.09.008
[7] Unicef. Improving child nutrition: the achievable imperative for global progress. New York: UNICEF 2013: 1-14.
[8] Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet 2013; 382(9890): 452-77.
https://doi.org/10.1016/S0140-6736(13)60996-4
[9] Shekar M, Kakietek J, D'Alimonte MR, Rogers HE, Eberwein JD, Akuoku JK, et al. Reaching the global target to reduce stunting: an investment framework. Health Policy and Planning 2017; 32(5): 657-68.
https://doi.org/10.1093/heapol/czw184
[10] Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatrics and International Child Health 2014; 34(4): 250-65.
https://doi.org/10.1179/2046905514Y.0000000158
[11] Dewey KG, Begum K. Long?term consequences of stunting in early life. Maternal & Child Nutrition 2011; 7: 5-18.
https://doi.org/10.1111/j.1740-8709.2011.00349.x
[12] Woldehanna T, Behrman JR, Araya MW. The effect of early childhood stunting on children’s cognitive achievements: Evidence from young lives Ethiopia. Ethiopian Journal of Health Development 2017; 31(2): 75-84.
[13] World Health Organization. Global nutrition targets 2025: Stunting policy brief. World Health Organization; 2014.
[14] Ethiopian Ministry of Health. Seqota Declaration Implementation Plan (2016 – 2030): Summary Programme Approach Document. Available from: https://lavasoft. gosearchresults.com/?q=Seqota+declaration+implamentation+plan%282016- 1030%29&tt=vmn__webcompa__1_0__ go__lvs__webcompa__1_0__go__ch_ WCYID10422_ 191023__yrff__yrff&pid=5ac784309091147a162b4431.
[15] Yisak H, Gobena T, Mesfin F. Prevalence and risk factors for undernutrition among children under five at Haramaya district, Eastern Ethiopia. BMC Pediatrics 2015; 15(1): 212.
https://doi.org/10.1186/s12887-015-0535-0
[16] Teshome B, Kogi-Makau W, Getahun Z, Taye G. Magnitude and determinants of stunting in children under five years of age in food surplus region of Ethiopia: the case of west gojjam zone. Ethiopian Journal of Health Development 2009; 23(2).
https://doi.org/10.4314/ejhd.v23i2.53223
[17] Tamiru MW, Tolessa BE, Abera SF. Under nutrition and associated factors among under-five age children of Kunama ethnic groups in Tahtay Adiyabo Woreda, Tigray Regional State, Ethiopia: Community based study. Int J Nutr Food Sci 2015; 4(3): 277-88.
https://doi.org/10.11648/j.ijnfs.20150403.15
[18] WHO | Indicators for assessing infant and young child feeding practices [Internet]. WHO. [Cited 2019, December 4]. Available from: http://www.who.int/nutrition/publications/ infantfeeding/9789241599290/en/.
[19] Kennedy G, Ballard T, Dop M. Guidelines for Measuring Household and Individual Dietary Diversity; Food and Agriculture Organization of the United Nations: Rome, Italy, 2011.
[20] Fentaw R, Bogale A, Abebaw D. Prevalence of child malnutrition in agro-pastoral households in Afar Regional State of Ethiopia. Nutrition Research and Practice 2013; 7(2): 122-31.
https://doi.org/10.4162/nrp.2013.7.2.122
[21] Wolde T, Adeba E, Sufa A. Prevalence of chronic malnutrition (stunting) and determinant factors among children aged 0–23 months in Western Ethiopia: a cross-sectional study. Journal of Nutritional Disorders & Therapy 2014; 4(4): 148-54.
https://doi.org/10.4172/2161-0509.1000148
[22] Semali IA, Tengia-Kessy A, Mmbaga EJ, Leyna G. Prevalence and determinants of stunting in under-five children in central Tanzania: remaining threats to achieving Millennium Development Goal 4. BMC Public Health 2015; 15(1): 1153.
https://doi.org/10.1186/s12889-015-2507-6
[23] Nkurunziza S, Meessen B, Korachais C. Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national cross-sectional household survey, 2014. BMC Pediatrics 2017; 17(1): 176.
https://doi.org/10.1186/s12887-017-0929-2
[24] Adnan N, Muniandy ND. The relationship between mothers' educational level and feeding practices among children in selected kindergartens in Selangor, Malaysia: A cross-sectional study. Asian Journal of Clinical Nutrition 2012; 4(2): 39.
https://doi.org/10.3923/ajcn.2012.39.52
[25] Hackett M, Melgar-Quiñonez H, Álvarez MC. Household food insecurity associated with stunting and underweight among preschool children in Antioquia, Colombia. Revista Panamericana de Salud Pública 2009; 25: 506-10.
https://doi.org/10.1590/S1020-49892009000600006
[26] Darteh EKM, Acquah E, Kumi-Kyereme A. Correlates of stunting among children in Ghana. BMC Public Health 2014; 14(1): 504.
https://doi.org/10.1186/1471-2458-14-504
[27] Olayemi AO. Effects of family size on household food security in Osun State, Nigeria. Asian Journal of Agriculture and Rural Development 2012; 2(393-2016-23999): 136-41.
[28] Derso T, Tariku A, Biks GA, Wassie MM. Stunting, wasting and associated factors among children aged 6–24 months in Dabat health and demographic surveillance system site: A community based cross-sectional study in Ethiopia. BMC Pediatrics 2017; 17(1): 96.
https://doi.org/10.1186/s12887-017-0848-2
[29] Saaka M, Wemakor A, Abizari A-R, Aryee P. How well do WHO complementary feeding indicators relate to nutritional status of children aged 6–23 months in rural Northern Ghana? BMC Public Health 2015; 15(1): 1157.
https://doi.org/10.1186/s12889-015-2494-7
[30] Dewey KG, Adu?Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition 2008; 4: 24-85.
https://doi.org/10.1111/j.1740-8709.2007.00124.x
[31] Olatidoye O. Effect of maternal employment on nutritional status of pre-school children from low income households area of Oyo State. Electronic Journal of Environmental, Agricultural and Food Chemistry (EJEAFChe) 2011; 10(7): 2574-80.
[32] Chirande L, Charwe D, Mbwana H, Victor R, Kimboka S, Issaka AI, et al. Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey. BMC Pediatrics 2015; 15(1): 165.
https://doi.org/10.1186/s12887-015-0482-9
[33] Allen LH. B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. Advances in Nutrition 2012; 3(3): 362-9.
https://doi.org/10.3945/an.111.001172
[34] Fikadu T, Assegid S, Dube L. Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia: a case-control study. BMC Public Health 2014; 14(1): 800.
https://doi.org/10.1186/1471-2458-14-800
[35] Sujendran S, Senarath U, Joseph J. Prevalence of stunting among children aged 6 to 36 months, in the eastern province of Sri Lanka. J Nutr Disorders Ther 2015; 5(1).
https://doi.org/10.4172/2161-0509.1000154
[36] Liben ML, Abuhay T, Haile Y. The role of colostrum feeding on the nutritional status of preschool children in Afambo District, Northeast Ethiopia: descriptive cross sectional study. Eur J Clin Biomed Sci 2016; 2(6): 87-91.
https://doi.org/10.11648/j.ejcbs.20160206.15
[37] Ergin F, Okyay P, Atasoylu G, Beser E. Nutritional status and risk factors of chronic malnutrition in children under five years of age in Aydin, a western city of Turkey. Turkish Journal of Pediatrics 2007; 49(3): 283.
[38] Rah JH, Akhter N, Semba RD, De Pee S, Bloem MW, Campbell AA, et al. Low dietary diversity is a predictor of child stunting in rural Bangladesh. European Journal of Clinical Nutrition 2010; 64(12): 1393-8.
https://doi.org/10.1038/ejcn.2010.171
[39] Nti CA. Dietary diversity is associated with nutrient intakes and nutritional status of children in Ghana. Asian Journal of Medical Sciences 2011; 2(2): 105-9.
https://doi.org/10.3126/ajms.v2i2.4179
[40] Moursi MM, Arimond M, Dewey KG, Treche S, Ruel MT, Delpeuch F. Dietary diversity is a good predictor of the micronutrient density of the diet of 6-to 23-month-old children in Madagascar. The Journal of Nutrition 2008; 138(12): 2448-53.
https://doi.org/10.3945/jn.108.093971
[41] Busert LK, Neuman M, Rehfuess EA, Dulal S, Harthan J, Chaube SS, et al. Dietary diversity is positively associated with deviation from expected height in rural Nepal. The Journal of Nutrition 2016; 146(7): 1387-93.
https://doi.org/10.3945/jn.115.220137
[42] Kismul H, Acharya P, Mapatano MA, Hatløy A. Determinants of childhood stunting in the Democratic Republic of Congo: further analysis of Demographic and Health Survey 2013–14. BMC Public Health 2018; 18(1): 74.
https://doi.org/10.1186/s12889-017-4621-0
[43] Spears D, Ghosh A, Cumming O. Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts. PloS One 2013; 8(9): e73784.
https://doi.org/10.1371/journal.pone.0073784
[44] Gilmartin AA, Petri Jr WA. Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response. Philosophical Transactions of the Royal Society B: Biological Sciences 2015; 370(1671): 20140143.
https://doi.org/10.1098/rstb.2014.0143

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2020-11-25

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