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Obasohan PE, Walters SJ, Jacques RM, Khatab K. The Intersection of a Child's Demographics and Household Socioeconomic Status in the Multimorbidity of Malaria, Anaemia, and Malnutrition among Children Aged 6-59 Months in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:645. [PMID: 38791859 PMCID: PMC11120798 DOI: 10.3390/ijerph21050645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child's demographic variables and household socioeconomic (HSE) disparities with a child's health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children's sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6-59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6-59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child's sex and household wealth status; model 2 is the interaction between the child's sex and age; model 3 is the interaction between the child's age and household wealth status; model 4 has the three two-way interactions of the child's sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child's sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a 'none of the three diseases' outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had 'only one of the diseases', and 48.3% (4918/10,184) had 'two or more' MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child's age and household wealth status are significant predictors in the model. Children aged 36-47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6-59 months in Nigeria.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- School of Medicine and Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, Bida 912231, Nigeria
| | - Stephen J. Walters
- School of Medicine and Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
| | - Richard M. Jacques
- School of Medicine and Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK;
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Rivera A, Marín V, Romaní F. Concurrence of anemia and stunting and associated factors among children aged 6 to 59 months in Peru. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002914. [PMID: 38564615 PMCID: PMC10986945 DOI: 10.1371/journal.pgph.0002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Anemia and stunting are two health problems in the child population; therefore, their concurrence needs to be quantified. We estimated the prevalence of concurrent anemia and stunting (CAS) in children aged 6-59 months and identified the factors associated with this condition. The data came from the Demographic and Health Survey of Peru (DHS), 2022. The study design was cross-sectional and included 19,191 children. Height and hemoglobin measurement followed the specifications of National Health Institute of Peru. To reduce error in measures, the anthropometry personnel was training, the quality of measuring equipment was ensuring, and protocolized techniques and procedures was applying. Hemoglobin concentration was measured in capillary blood using the Hemocue model Hb 201+. Stunting was defined as a height-for-age Z-score less than minus two standard deviations (SD) from the median, following the 2006 WHO child growth standard. Anemia was classified into mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), severe (< 7.0 g/dL), and no anemia (11.0 to 14.0 g/dL). We performed a bivariate analysis to evaluate factors associated with CAS. To include variables in the multivariate analysis, we applied a statistical criterion (p < 0.10 in the crude analysis) and an epidemiological criterion. We used a binary logistic hierarchical regression model. The prevalence of CAS was 5.6% (95%CI: 5.2 to 5.9). The modifiable factors associated with higher odds of CAS were: "poorest" (aOR: 3.87, 95%CI: 1.99 to 7.5) and "poorer" (aOR: 2.07, 95%CI: 1.08 to 3.98) wealth quintiles, mother with no formal education or primary (aOR: 2.03, 95%CI: 1.46 to 2. 81), father with no formal education or primary (aOR: 1.55, 95%CI: 1.16 to 2.07), no improved water source (aOR: 1.36, 95%CI: 1.10 to 1.68), no roof with improved material (aOR: 1.49, 95%CI: 1.12 to 1.98) and low birth weight (aOR: 7.31, 95%CI: 4.26 to 12.54). In Peru, five out of every 100 children suffer from anemia and stunting simultaneously; there are modifiable factors that, if addressed, could reduce their prevalence.
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Affiliation(s)
| | - Víctor Marín
- Faculty of Human Medicine, Universidad de Piura, Lima, Peru
| | - Franco Romaní
- Faculty of Human Medicine, Universidad de Piura, Lima, Peru
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Gebeye LG, Dessie EY, Yimam JA. Predictors of micronutrient deficiency among children aged 6-23 months in Ethiopia: a machine learning approach. Front Nutr 2024; 10:1277048. [PMID: 38249594 PMCID: PMC10796776 DOI: 10.3389/fnut.2023.1277048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Micronutrient (MN) deficiencies are a major public health problem in developing countries including Ethiopia, leading to childhood morbidity and mortality. Effective implementation of programs aimed at reducing MN deficiencies requires an understanding of the important drivers of suboptimal MN intake. Therefore, this study aimed to identify important predictors of MN deficiency among children aged 6-23 months in Ethiopia using machine learning algorithms. Methods This study employed data from the 2019 Ethiopia Mini Demographic and Health Survey (2019 EMDHS) and included a sample of 1,455 children aged 6-23 months for analysis. Machine Learning (ML) methods including, Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), Neural Network (NN), and Naïve Bayes (NB) were used to prioritize risk factors for MN deficiency prediction. Performance metrics including accuracy, sensitivity, specificity, and Area Under the Receiver Operating Characteristic (AUROC) curves were used to evaluate model prediction performance. Results The prediction performance of the RF model was the best performing ML model in predicting child MN deficiency, with an AUROC of 80.01% and accuracy of 72.41% in the test data. The RF algorithm identified the eastern region of Ethiopia, poorest wealth index, no maternal education, lack of media exposure, home delivery, and younger child age as the top prioritized risk factors in their order of importance for MN deficiency prediction. Conclusion The RF algorithm outperformed other ML algorithms in predicting child MN deficiency in Ethiopia. Based on the findings of this study, improving women's education, increasing exposure to mass media, introducing MN-rich foods in early childhood, enhancing access to health services, and targeted intervention in the eastern region are strongly recommended to significantly reduce child MN deficiency.
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Affiliation(s)
- Leykun Getaneh Gebeye
- Department of Statistics, College of Natural Science, Wollo University, Dessie, Ethiopia
| | - Eskezeia Yihunie Dessie
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Jemal Ayalew Yimam
- Department of Statistics, College of Natural Science, Wollo University, Dessie, Ethiopia
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Sahiledengle B, Mwanri L, Blumenberg C, Agho KE. Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey. BMC Public Health 2023; 23:2040. [PMID: 37853384 PMCID: PMC10585928 DOI: 10.1186/s12889-023-16907-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia. METHODS The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition. RESULTS The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted. CONCLUSION Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide Campus, SA, 5000, Australia
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Kundu RN, Borah J, Bharati S, Bharati P. Regional Distribution of the Anthropometric Failure among Under-five Children and Its Determinants in India. Ethiop J Health Sci 2023; 33:479-490. [PMID: 37576171 PMCID: PMC10416325 DOI: 10.4314/ejhs.v33i3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/23/2023] [Indexed: 08/15/2023] Open
Abstract
Background Undernutrition in children seems to be one of the major health issues in developing nations including India. Stunting, underweight, and wasting are the three most often used anthropometric indicators to evaluate childhood undernutrition. Children who exhibit one or more indicators of undernutrition are considered as anthropometric failure (AF). The present study aims to determine the distribution and determinants of anthropometric failure in children under the age of five in different regions of India. Methods NFHS-5 data, collected between 2019 and 2021, were utilized for the study. Pearson's chi-square (χ2) test was used to look into the association between categorical variables. Binary logistic regression was used to find the explanatory factors that influence anthropometric failure. Results More than half of the under-five children (52.18%) in India are suffering from anthropometric failure, out of these West (57.88%), East (56.58%), and Central (53.94%) regions have covered half of the total occurrence. State-wise, Bihar (61.66%), followed by Gujarat (60.26%), and Jharkhand (58.05%) have recorded the highest rates of anthropometric failure. Anthropometric failure is higher among anemic children, boys, parent not alives, the higher number of birth order, lower educated mothers, rural dwellers, belonging to scheduled tribes and scheduled castes communities, living in nuclear families, and having lower household wealth indexes than their other counterparts. Conclusion These aspects imply that regional determinants should be taken into consideration when implementing child nutrition development programs.
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Affiliation(s)
- Ramendra Nath Kundu
- Research Associate-I, Indian Council of Medical Research - Centre for Ageing & Mental Health, Kolkata, West Bengal, India
| | - Juri Borah
- Assistant Professor and Head, Department of Anthropology, Gurucharan College, Silchar, Assam
| | - Susmita Bharati
- Former Scientist, Sociological Research Unit, Indian Statistical Institute, Kolkata, West Bengal, India
| | - Premananda Bharati
- Former Professor and Head, Biological Anthropology Unit, Indian Statistical Institute, Kolkata, West Bengal, India
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Sahiledengle B, Agho KE, Petrucka P, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Mwanri L. Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects modelling. MATERNAL & CHILD NUTRITION 2023; 19:e13483. [PMID: 36757269 PMCID: PMC10019057 DOI: 10.1111/mcn.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Kingsley E. Agho
- School of Health SciencesWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research Institute, School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- African Vision Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | | | - Abera Kumie
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Girma Beressa
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Daniel Atlaw
- Department of Human AnatomyMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Yohannes Tekalegn
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Demisu Zenbaba
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Fikreab Desta
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Lillian Mwanri
- Torrens University AustraliaAdelaideSouth AustraliaAustralia
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Risk Factors Associated with Multimorbidity among Children Aged Under-Five Years in Sub-Saharan African Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1377. [PMID: 36674135 PMCID: PMC9859535 DOI: 10.3390/ijerph20021377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND/PURPOSE Globally, the prevalence of multimorbidity (defined as the cooccurrence of two or more diseases in an individual without reference to an index disease) is greater than 33%. Consequently, childhood multimorbidity, a growing public health concern in Low- and Middle-Income-Countries (LMICs), frequently has an impact on children's health. Therefore, the aim of this scoping review was to locate and describe studies that investigate the association between socioeconomic, demographic, and environmental factors and the prevalence of multimorbidity among children aged under five years in Sub-Saharan Africa (SSA). METHODS/DESIGN We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Scopus, and Web of Science for papers written in English, and published between January 1990 and March 2022. The search included papers that focused on children aged under five years with multimorbidity from Sub-Saharan Africa and used classical regression methods in their analysis. RESULTS A total of 261 articles were identified. Out of the 66 articles selected for full-text reading, 60 were removed for various reasons. Therefore, data from a sample of six articles were finally extracted and reported in this study. The sample size for the 6 studies included ranged from 2343 to 193,065 children under five years of age. There were six distinct disease conditions (Pneumonia, diarrhoea, malaria, being overweight, stunting, and anaemia) analysed in the included studies. One of the studies had three concurrent diseases, while the other five studies had two current diseases as their multimorbidity outcome of interest. The prevalence of multimorbidity in these six studies ranged from 1.2% to 24.8%. CONCLUSIONS The relatively few studies found in this research area is an indication of an evidence deficit/knowledge gap yearning to be filled to help policymakers in coming up with integrated multimorbidity care for children in SSA.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4AD, UK
- Department of Liberal Studies, College of Business and Administrative Studies, Niger State Polytechnic, Bida Campus, Bida 912231, Nigeria
| | - Stephen J. Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4AD, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4AD, UK
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
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Determinants of undernutrition among young children in Ethiopia. Sci Rep 2022; 12:20945. [PMID: 36470914 PMCID: PMC9722653 DOI: 10.1038/s41598-022-25160-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Ethiopia is one of the countries in sub-Saharan Africa with the highest burden of childhood undernutrition. Despite the high burden of this scourge, little is known about the magnitude and contributing determinants to anthropometric failure among children aged 0-23 months, a period regarded as the best window of opportunity for interventions against undernutrition. This study examined factors associated with undernutrition (stunting, wasting, and underweight) among Ethiopian children aged 0-23 months. This study used a total weighted sample of 2146 children aged 0-23 months from the 2019 Ethiopian Mini Demographic and Health Survey. The data were cleaned and weighted using STATA version 14.0. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. Multilevel mixed-effects logistic regression models adjusted for cluster and survey weights were used. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were estimated. Statistical significance was declared at p < 0.05. The overall weighted prevalence of stunting, wasting, and underweight respectively were 27.21% [95% CI (25.32-29.18)], 7.80% [95% CI (6.71-9.03)], and 16.44% [95% CI (14.90-18.09)] among children aged 0-23 months in Ethiopia. Female children were less likely to be associated with stunting [AOR: 0.68, 95% CI (0.54-0.86)], wasting [AOR: 0.70, 95% CI (0.51, 0.98)], and underweight [AOR: 0.64, 95% CI (0.49, 0.83)] than their male counterparts. Conversely, older children aged 12-17 months [AOR: 2.22, 95% CI (1.52, 3.23)] and 18-23 months [AOR: 4.16, 95% CI (2.75, 6.27)] were significantly at an increased odds of becoming stunted. Similarly, the likelihood of being underweight was higher in older age groups: 6-11 months [AOR: 1.74, 95% CI (1.15, 2.63)], 12-17 months [AOR: 2.13, 95% CI (1.40, 3.24)], and 18-23 months [AOR: 4.08, 95% CI (2.58, 6.44)] compared with the children younger than 6 months. Lower wealth quintile was one of the other significant determinants of stunting and underweight. The study's findings indicated that the most consistent significant risk factors for undernutrition among children aged 0-23 months are: male sex, older age groups and lower wealth quintile. These findings emphasize the importance of strengthening nutrition-specific and sensitive interventions that address the immediate and underlying drivers of childhood undernutrition in early life, as well as targeting low-income households with male children, in order for Ethiopia to meet the Sustainable Development Goals (SDGs) 1,2 and 3 by 2030.
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Sahiledengle B, Petrucka P, Kumie A, Mwanri L, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Agho KE. Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach. BMC Public Health 2022; 22:1943. [PMID: 36261797 PMCID: PMC9583486 DOI: 10.1186/s12889-022-14309-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. Methods A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. Results The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child’s stool, or improved household flooring and child wasting. Conclusion The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14309-z.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Ababa, Ethiopia
| | - Lillian Mwanri
- Torrens University Australia, Adelaide Campus, 5000, Adelaide, SA, Australia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia
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10
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Negash WD, Fetene SM, Shewarega ES, Fentie EA, Asmamaw DB, Teklu RE, Aragaw FM, Belay DG, Alemu TG, Eshetu HB. Multilevel analysis of undernutrition and associated factors among adolescent girls and young women in Ethiopia. BMC Nutr 2022; 8:104. [PMID: 36123733 PMCID: PMC9484180 DOI: 10.1186/s40795-022-00603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background The consequences of undernutrition have serious implication for the health and future reproductive periods of adolescent girls and young women aged 15–24 years. Inspite of this, they are neglected age groups and there is limited information about the nutritional status of this age group in Ethiopia. Therefore, estimating the extent and associated factors of undernutrition among adolescent girls and young women in a national context using multilevel analysis is essential. Methods Secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016. A total sample weight of 5362 adolescent girls and young women was included in this study. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was fitted to determine the associated factors of undernutrition among adolescent girls and young women in Ethiopia. Finally, the odds ratios along with the 95% confidence interval was generated to determine the individual and community level factors of undernutrition. A p-value less than 0.05 was declared as the level of statistical significance. Results Overall, 25.6% (95%CI: 24.5–26.9) of adolescent girls and young women were undernourished. Statistically significant individual level factors includes adolescent girls and young women aged 15–19 years (AOR: 1.53, 95%CI: 1.32–1.77), individual media exposure (AOR: 0.82, 95%CI: 0.69–0.97), and unprotected drinking water source (AOR: 1.24, 95%CI: 1.04–1.48). Whereas, Southern Nations, Nationalities, and Peoples' Region (AOR: 0.33, 95%CI: 0.13–0.83) and rural residence (AOR: 1.69, 95%CI: 1.24–2.32), were community level factors for adolescent girls and young women undernutrition. Conclusion One quarter of the Ethiopian adolescent girls and young women were undernourished. Therefore, the Ethiopian government should better engage this age group in different aspects of the food system. To improve nutritional status, public health interventions such as increased media exposure for rural residents and interventions that improve access to protected water sources will be critical.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Roba AA, Assefa N, Dessie Y, Tolera A, Teji K, Elena H, Bliznashka L, Fawzi W. Prevalence and determinants of concurrent wasting and stunting and other indicators of malnutrition among children 6-59 months old in Kersa, Ethiopia. MATERNAL AND CHILD NUTRITION 2021; 17:e13172. [PMID: 33728748 PMCID: PMC8189198 DOI: 10.1111/mcn.13172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6-59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross-sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height-for-age, weight-for-height and weight-for-age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6-17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12-2.75) compared with those aged 36-59 months, whereas children aged 18-35 months (aOR 2.4, 95% CI 1.65-3.47) and 36-59 months (aOR 1.6, 95% CI 1.07-2.37) had higher odds of stunting compared with those aged 6-17 months. Similarly, children aged 18-35 months (aOR 1.6, 95% CI 1.07-2.37) and 36-59 months (aOR 2.2, 95% CI 1.52-3.10) had higher odds of underweight compared with children aged 6-17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16-9.27) and stunting (aOR 1.9, 95% CI 1.31-2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m2 and maternal BMI between 18.5 and 25 kg/m2 were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point-of-use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community-based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended.
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Affiliation(s)
- Aklilu Abrham Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Abebe Tolera
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Kedir Teji
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Hemler Elena
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Lilia Bliznashka
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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