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  • Research article
  • Open Access
  • Open Peer Review

Predictors of stunting among children 6–59 months of age in Sodo Zuria District, South Ethiopia: a community based cross-sectional study

  • 1Email author,
  • 2,
  • 3,
  • 3 and
  • 1
BMC Nutrition20195:23

https://doi.org/10.1186/s40795-019-0287-6

  • Received: 16 October 2018
  • Accepted: 25 February 2019
  • Published:
Open Peer Review reports

Abstract

Background

Despite the decline in the rate of stunting in Ethiopia, the prevalence is still high and needs immense efforts to achieve the target set to reduce the prevalence. It varies between localities due to individual level factors and dominant livelihood practice in the community.

Thus, the aim of this study was to determine the prevalence of stunting and identify factors associated with it in Sodo Zuria district in South Ethiopia.

Methods

A community based cross sectional study was conducted among 342 children aged 6–59 months paired with mothers/caretakers. Households were selected using systematic sampling. Structured questionnaire was used and mothers/caregivers were interviewed face to face. Standardized anthropometric measurements were used to measure length, and weight and height of a child. Data were entered into Epi Info software version 3.5.1 and exported to SPSS version 20 for analysis. Height for age Z score data were analyzed using WHO Anthro software. Multivariate logistic regression analysis was conducted to identify predictor variables. Statistical significance was considered at p < 0.05.

Results

The prevalence of stunting in this study was 24.9% with 7.9% being severely stunted. Being female (AOR = 2.8; 95% CI: 1.5, 5.3), children aged 12–23 months (AOR = 7.1; 95% CI: 2.3, 21.9), mother’s who do not use family planning (AOR = 2.5; 95% CI: 1.1,5.7), children with diarrheal morbidity (AOR = 2.5; 95% CI: 1.2,5.3), income of 750–1500 ETB and > 1500, and children who received pre-lacteal feeding (AOR = 3.8; 95% CI: 1.2–12.2) became predictors for stunting.

Conclusion

Significant proportion of stunting was found where one third of them were severely stunted. Being female, children aged 12–23 months, using family planning, children with diarrheal morbidity, income and pre-lacteal feeding became predictors for stunting. So Gender-based policies should be enacted in child feeding practice, interventions should focus on the utilization of family planning and appropriate child caring and feeding practices. Water, sanitation and hygiene interventions need to be strengthened.

Keywords

  • Stunting
  • 6–59 months
  • Child
  • Predictors
  • Sodo-zuria

Background

Stunting (low height-for-age) is a sign of chronic undernutrition that reflects failure to receive adequate nutrition over a long period. Children are regarded as stunted when their height-for-age Z-score (HAZ) is below minus two standard deviations (−2SD) from the median of the reference population [1]. Stunting reflects failure to get adequate nutrition over a long period of time and it can be affected by recurrent and chronic illness [2].

Malnutrition leads to serious public health and economic risks, and improvements in nutrition will contribute significantly to reducing poverty, and to achieving health, education, and employment goals [3]. Child undernutrition is highly prevalent in low and middle-income countries and substantially increases mortality and overall disease burden [4]. Globally, 161 million (25%) children under-5 years of age were estimated to be stunted and one third of all stunted children lived in Africa [2]. The highest prevalence of stunting is reported in South Asia (36%) and Sub-Saharan Africa (34%) [5]. In Ethiopia the prevalence of stunting is 38% [1], ranking the country among the top both in sub Saharan Africa and the World.

The World Health Organization [WHO] adopted a resolution with a target to reduce the number of stunted children under-five by 40% in 2025. However, at current rates of progress, stunting level will decrease by 26% in 2025 [6]. Similarly, despite the decline in the rate of stunting from 47% (2005) [7] to 38% (2016) [1] in Ethiopia, the prevalence is still high and needs immense efforts to achieve the target set to reduce the prevalence to 26% in 2020 [8]. Childhood stunting varies between localities due to individual and community-level factors [9, 10] and the factors associated with stunting vary by the dominant livelihood practice in the community [11]. However, there are no documented studies to identify the factors associated with stunting in the study area. Thus, the aim of this study was to determine the prevalence of stunting and identify factors associated with it in Sodo Zuria district in South Ethiopia.

Methods

Study design and setting

A community based cross sectional study was conducted from May to June 2017. Sodo Zuria is 380 km south of Addis Ababa and it has 30 kebeles (lowest administrative units) with a projected population of 394,772; 24,647 were children 6–59 months of age.

Population and sampling

The study population were randomly selected children, 6–59 months of age paired with their mothers/caregivers who resided in the district for at least 6 months. Children with physical disability who are not eligible for anthropometric measurements were excluded from the study. A sample size of 380 was calculated with 95% confidence level, 5% margin of error, an expected stunting prevalence of 38% [1] and non response rate of 5%. Sampling frame was developed for the randomly selected 4 kebeles and the total sample was proportionally allocated to the selected kebeles. Systematic sampling was used to select households and a child was selected randomly in households with more than one eligible children.

Variables

Outcome variable

Stunting which was computed with height for age z-score (HAZ) of less than − 2 standard deviation (SD).

Exposure variables

Socio demographic and economic variables: Maternal age, marital status, religion, ethnicity, maternal education, paternal education, maternal occupation, paternal occupation, household income in Ethiopian birr (ETB), family size, decision making on household resource utilization and age of the child.

Obstetric and other maternal characteristics: Place of delivery, gestational age at birth, birth weight, birth order, pregnancy interval, age at first birth, antenatal care (ANC) follow up, one or more additional meal consumption than usual and utilization of family planning.

Child morbidity

Diarrhea, fever, acute respiratory infections and measles.

Child caring practice

Breast feeding, pre lacteal feeding, complementary feeding, dietary diversity and child vaccination.

Environmental health characteristic

Source and distance of drinking water, availability of latrine, hand washing practice, household waste disposal.

Data collection

Data collectors with prior experience of data collection interviewed mothers/caregivers face to face using pretested and structured questionnaire. The data collectors were trained on the procedures of data collection and were standardized on obtaining anthropometric measurements. A horizontal wooden length board was used to measure the length of children 6–23 months of age. On the other hand, a vertical wooden height board was used to measure the height of children aged 24–59 months. Digital seca weight scale was used to measure the weight of the children and read to the nearest 0.1 kg. All measurements were taken twice and the mean was used for analysis. The data collection was supervised and errors were corrected on spot in the field.

Data analysis

Epi Info software version 3.5.1 was used to enter data and the data were analyzed using SPSS version 20. WHO Anthro software was used to analyze HAZ data and it was compared with NCHS reference standard. Crude association was determined with bivariate analysis and a cut-off point of p < 0.25 was used to consider variables for multivariate analysis where confounders were controlled and predictor variables were identified.

Results

Socio-demographic characteristics

The response rate of this study was 90%. From the study participant mothers/caregivers, Majority 299 (87.43%) of the mothers/caregivers were married and 246 (71.93%) were protestant in their religion. About two third 224 (65.50%) of mothers and 183 (53.51%) fathers cannot read and write. About 239 (69.88%) of mothers and 244 (71.34%) of fathers were farmers. More than half 188 (54.97%) of the respondents had a family size of above five. Most 294 (85.97%) of the decision on use of money was made jointly (by husband and wife) (Table 1).
Table 1

Socio-demographic characteristics of study participants in Sodo Zuria district, South Ethiopia, June 2017

Variables (n = 342)

 

Frequency

Percentage

Maternal Age

15–19

9

2.63

20–29

192

56.14

30–39

121

35.38

≥40

20

5.85

Marital status

Currently married

299

87.43

Currently unmarrieda

43

12.57

Ethnicity

Wolaita

336

98.25

Othersb

6

1.75

Religion

Protestant

246

71.93

Orthodox

87

25.44

Othersc

9

2.63

Maternal education

Can’t read and write

224

65.50

Read and write

7

2.05

Primary education (1–8)

90

26.31

Secondary education (9–12)

9

2.63

Above secondary

12

3.51

Paternal education

Can’t read and write

183

53.51

Read and write

15

4.38

Primary education (1–8)

113

33.04

Secondary education (9–12)

11

3.22

Above secondary

20

5.85

Maternal occupation

Housewife

25

7.31

Farmer

239

69.88

Merchant

46

13.45

Othersd

32

9.36

Paternal occupation

Farmer

244

71.34

Government employee

25

7.31

Merchant

42

12.28

Otherd

31

9.06

Monthly Income

<750 ETB

258

75.44

750–1500 ETB

68

19.88

>1500 ETB

16

4.68

Decision making on income

Husband

10

2.92

Spouse

38

11.11

Jointly

294

85.97

Family size

≤5

154

42.03

>5

188

54.97

Child sex

Male

164

47.95

Female

178

52.05

Child age (in months)

6–23

104

30.41

24–59

238

69.59

awidowed, separated, divorced bAmhara, Gurage, Oromo cMuslim, Catholic dnon government employee, self employee, student

Obstetric, maternal and child morbidity related characteristics

Two third 229 (66.96%) of the children were born at term and majority 272 (79.53%) were born in the health facility. Two hundred fifty seven (75.15%) of the children had a normal birth weight. Forty eight (14.03%) mothers were in the age of < 20 years during their first delivery, 286 (83.63%) mothers had ANC follow up, 263 (76.90%) of the mothers did not take any additional meal than usual during their pregnancy and half 172 (51.30%) of the mothers did not use any type of family planning. More than one fourth 89 (26.02%) of the children had diarrheal morbidity in 2 weeks prior to this study, 23 (6.73%) had fever and 20 (5.85%) had cough during the study period (Table 2).
Table 2

Obstetric, child morbidity and other maternal characteristics of study participants in Sodo Zuria district, South Ethiopia, June 2017

Variables (n = 342)

 

Frequency

Percentage

Place of delivery

Health facility

272

79.53

Home

70

20.47

Gestational age at birth

<9 months

14

4.09

At 9 month

229

66.96

>9 month

99

28.95

Birth weight

<2500 g

10

2.92

2500–4000 g

257

75.15

>4000

75

21.93

Birth order

1

66

19.30

2–4

160

46.78

>4

116

33.92

Birth interval from previous

<24 months

69

20.17

24 months

224

65.50

>24 months

49

14.33

Still breast feeding

Yes

202

59.07

No

140

40.93

Reason for not breast feeding

Maternal health problem

19

13.57

Child refusal

88

62.86

Pregnancy

33

23.57

Diarrheal morbidity in the last 2 weeks

Yes

89

26.02

No

253

73.98

Fever

Yes

23

6.73

No

319

93.27

Cough

Yes

20

5.85

No

322

94.15

Measles

Yes

8

2.34

No

334

97.66

Maternal age at first birth

15–19

48

14.03

20–29

213

62.28

30–39

70

20.47

≥40

11

3.22

ANC follow up

Yes

286

83.63

No

56

16.37

Additional meal during pregnancy/lactation

Yes

79

23.10

No

263

76.90

Family planning method used

Yes

170

49.70

No

172

51.30

What type of family planning

Pills

34

20.00

Depo-Provera

131

77.06

Othersa

5

2.94

aNorplant, Condom, Intrauterine device

Child caring practice and environmental health characteristics

Two hundred and twenty eight (66.67%) of the children were initiated on breastfeeding within 1 hour after birth and nearly all 334 (97.66%) of the children were given colostrums. More than half of the children 195 (57.02%) were commenced on complementary feeding at 6 months of age and 264 (77.19%) eat 3 times a day. Source of drinking water for two hundred sixty nine (78.66%) of the households was protected well/spring. Two hundred forty nine households (72.81%) have latrine and 116 (33.92%) dispose waste in open field (Table 3).
Table 3

Child caring practice and environmental health characteristics of study participants in Sodo Zuria district, South Ethiopia, June 2017

Variables (n = 342)

 

Frequency

Percentage

Initiation of breast feeding

<1 h after delivery

228

66.67

1–24 h

105

30.70

After 24 h

9

2.63

Colostrums feeding

Yes

334

97.66

No

8

2.34

Pre lacteal food/liquid

Yes

41

11.99

No

301

88.01

Type of pre lacteal food/drink

Water with sugar

10

24.39

Butter

4

9.76

Cow’s milk

27

65.85

Age at initiation of complementary food

1–3 months

32

9.36

4–5 months

77

22.51

At 6 months

195

57.02

After 6 months

38

11.11

Frequency of feeding

<3 times a day

31

9.07

3 times a day

264

77.19

>3 times a day

47

13.74

Method of feeding

Hand

156

45.61

Spoon

124

36.26

Cup

40

11.70

Bottle

22

6.43

Variety of food

2 food items

235

68.71

>2 food items

107

31.29

Leftover food in the household

Given to children

247

72.22

Given to others

55

16.08

Throw away

40

11.70

Ever fed child meat

Yes

92

26.90

No

250

73.10

Completed Vaccination

Yes

327

95.61

No

15

4.39

Source of drinking water

Protected well/spring

269

78.66

Unprotected well/spring

35

10.23

Pipe water

7

2.05

River

31

9.06

Availability of latrine

Yes

249

72.81

No

93

27.19

Materials used for hand washing

Water only

21

6.14

Use soap often

279

81.58

Use soap always

42

12.28

Waste disposal

Open field

116

33.92

In pit

138

40.35

Use as compost

88

25.73

Prevalence of stunting and its predictors

The prevalence of stunting in this study was 24.9%; 7.9% were severely stunted. The odd of being stunted was about three times higher for females (AOR = 2.8; 95% CI: 1.5, 5.3) and seven times higher for children aged 12–23 months (AOR = 7.1; 95% CI: 2.3, 21.9) compared with children 6–11 months. Children born from mother’s who do not use family planning and children with diarrheal morbidity in the last 2 weeks prior to the study had 2.5 times higher chance of being stunted (AOR = 2.5; 95% CI: 1.1,5.7) and (AOR = 2.5; 95% CI: 1.2,5.3). Children from households with an income of 750–1500 ETB and > 1500 ETB had less chance of being stunted. Children who received pre-lacteal feeding had 3.8 times higher chance of being stunted (AOR = 3.8; 95% CI: 1.2–12.2) (Table 4).
Table 4

Factors associated with stunting in Sodo Zuria district, South Ethiopia, June 2017

Variables (n = 342)

Stunting

COR

AOR

Yes

No

(95% CI)

(95% CI)

Child sex

    

 Male

30

148

1

1

 Female

55

109

1.6 (1.2–2.2)

2.8 (1.5–5.3)*

Child age

    

 6–11 months

4

28

1

1

 12–23 months

20

52

3.8 (2.1–7.2)

7.1 (2.3–21.9)*

 24–35 months

22

55

4.2 (2.2–8.1)

6.4 (2.1–19.2)*

 36–47 months

21

56

3.8 (2.1–7.0)

3.1 (1.1–9.1)*

 48–59 months

18

66

2.6 (1.2–4.7)

2.8 (0.9–7.8)

Educational status of mothers

    

 Can’t read and write

55

169

1

 

 Read and write

3

4

0.6 (0.2–1.6)

 

 Primary education (1–8)

19

71

0.7 (0.5–0.9)

 

 Secondary education (9–12)

4

5

0.9 (0.4–2.0)

 

 Above secondary

4

8

0.3 (0.1–0.7)

 

Monthly income of the household

    

 <750 ETB

55

203

1

1

 750–1500 ETB

25

43

0.5 (0.3–0.7)

0.2 (0.1–0.5)*

 >1500 ETB

3

13

0.2 (0.1–0.4)

0.1 (0.3–0.5)*

Gestational age at birth

    

 <9 months

10

4

1

 

 At 9 months

44

185

0.1 (0.3–1.2)

 

 After 9 months

31

68

0.4 (0.2–0.8)

 

Use of family planning

    

 Yes

41

129

1

1

 No

42

130

1.4 (0.8–2.2)

2.5 (1.1–5.7)*

Distance to obtain drinking water

    

 <15 min’ walk

61

184

1

 

 15–30 min’ walk

20

64

0.7 (0.5–0.9)

 

 >30 min’ walk

4

9

0.5 (0.2–1.1)

 

Diarrheal morbidity in the last 2 weeks

    

 Yes

60

193

2.0 (1.4–2.7)

2.5 (1.2–5.3)*

 No

25

64

1

1

 Family size

    

 <5

14

140

1

 

 ≥5

71

117

1.8 (1.4–2.4)

 

Pre-lacteal feeding

    

 Yes

75

226

1.2 (0.8–1.9)

3.8 (1.2–12.2)*

 No

10

31

1

1

*Significant at p < 0.05 for AOR

Discussion

The prevalence of stunting documented in this study was 24.9%, which is lower than the national prevalence (38%) and the prevalence level of South Ethiopia (39%) [1]. Higher prevalence levels were reported in Eastern Ethiopia (45.8%) [12], Northwest Ethiopia (38.3%) [13], Nigeria (36.7%) [14] and Nepal (38%) [15]. This difference might be because we used NCHS growth standard and those studies used WHO growth standard (which is known to increase the prevalence of under nutrition specially stunting as compared to NCHS growth standard) [16].

Unlike many other study findings, this study documented that the odds of being stunted was higher for females as compared to males. This finding is different from other study findings from Ethiopia, Nigeria, Tanzania and Uganda where males have higher risk of being stunted [14, 1719]. On the other hand, in favor of our finding a study from Eastern Ethiopia reported that females had higher chance of being stunted [20]. This may be due to cultural issues, gender preference and differential feeding practice which neglects girls [2123]. Girls are more likely than boys to experience food insecurity due to selective availability of the limited food for boys than girls in Ethiopia [24]. However, a study in India and Pakistan found no statistically significant association between gender and stunting [25, 26].

We have found that the odd of being stunted was higher for children above 12 months as compared to children 6–11 months. Other similar studies conducted in Nigeria, Ethiopia and Pakistan reported that stunting was significantly associated with age above 12 months [2629]. The trend of stunting peaks for each group of children age up to 35 months and then declines for children 36–47 months of age. The possible explanations are when children are becoming mobile; they are exposed to contaminants in water, food and soil and they ingest them. Inappropriate complementary feeding and introducing children directly to household diet is another possible reason.

Children from middle- and high-income households had less chance of being stunted. This was in agreement with similar study findings in Southwest Ethiopia [30], Northwest Ethiopia [28, 31], Tanzania [18], Nigeria [14] and Nepal [30] where children from the poor wealth quintile had higher odds of being stunted compared with children from the rich wealth quintiles. Children from poorest households had a higher risk of being stunted compared to those from middle- and high-income households [18, 27, 31, 32]. Increased income improves dietary diversity, which in turn improves nutrient intake and nutritional status [33]. Poor wealth status also negatively affects household food access, sanitation and availability of improved water sources.

Children born to mothers who do not use family planning methods had a higher odds of being stunted compared to those mothers who use family planning methods. Mothers who do not use family planning will have large family size and a short birth interval. Studies from South and Southwest Ethiopia [30, 34], Northern Ethiopia [35], Mozambique [36] and Ghana [37] documented that children living in large family size had an increased risk of being stunted as compared to those from small family size. The possible explanations are that having large family size affects intra-household availability of resources and child caring practice. Short birth interval also has an adverse effect on child nutrition and quality of care. It also leads to intrauterine growth retardation, preterm birth and low birth weight which in turn lead to stunting.

In consistence with studies from Nigeria, South and Northwest Ethiopia, children with diarrheal morbidity 2 weeks prior to the study had a higher chance of being stunted [14, 19, 38, 39]. Diarrhea results in poor appetite, digestion problem and malabsorption and malnutrition children on the other hand have severe episodes of diarrhea.

We have found that pre-lacteal feeding was a predictor of stunting. This is consistent with a study from Southern and Northern Ethiopia [19, 39, 40]. The plausible reason may be stunted children are less likely to be introduced to complementary feeding at appropriate age [18]. The other likely reason is that pre-lacteal feeding has a negative effect on breastfeeding which in turn places children at higher risk of under-nourishment.

Limitations

This study used cross-sectional data. The estimate might be better representative if a longitudinal follow-up data were used. Certain level of recall bias was expected in age estimate of children; the data collectors used different local events to reduce the recall bias.

Conclusion

The magnitude of stunting in the current study was low. Stunting was significantly associated with being female, age above 12 months, low household income status, mother’s not using family planning and pre-lacteal feeding. Gender-based policies should be enacted in child feeding practice. Interventions should focus on the utilization of family planning and appropriate child caring and feeding practices should be implemented according to the infant and young child feeding recommendations. Water, sanitation and hygiene interventions need to be strengthened to reduce the occurrence of diarrheal morbidity and poverty alleviation interventions should be implemented.

Abbreviations

ANC: 

Antenatal care

AOR: 

Adjusted odds ratio

BMI: 

Body mass index

CI: 

confidence interval

COR: 

Crudes odds ratio

ETB: 

Ethiopian Birr

HAZ: 

height-for-age Z-score

NCHS: 

National child health

SD: 

Standard deviation

SPSS: 

statistical package for social sciences

WHO: 

World health organization

Declarations

Acknowledgements

We would like to thank Wolaita Sodo University for ethical clearance, Sodo Zuria office for facilitating the data collection and nurses for data collection and processing.

Funding

The funding for this study was personal cost from investigators.

Availability of data and materials

The data that support the findings of this study are available. Anyone interested can get upon reasonable online request by writing to efifit@yahoo.com.

Authors’ contributions

SK, EG: Conceived the study, SK, FS, HA, TM, and EG: Participated in the design of the study and performed the statistical analysis, SK, HA, EG: Interpreted the data: HA: Obtained ethical clearance and permission for study: FS: Supervised data collectors: SK, FS, HA, TM, EG: Drafting the article or revisiting it critically for important intellectual content. All authors read and approved the final manuscript.

Ethics approval and consent to participate

We received ethics clearance from the ethical review committee at Wolaita Sodo University in Ethiopia. The committee justified for verbal informed consent since uneducated or less educated caretakers would face difficulty in reading and comprehending the consent form. Thus informed verbal consent was obtained from the study participants. The parents/caretakers also provided consent on behalf of the children.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
College of Health Sciences and Medicine, School of Public Health, Department of Reproductive Health and Nutrition, Wolaita Sodo University, Sodo, Ethiopia
(2)
College of Health Sciences and Medicine, School of Medicine, Department of Medical Laboratory, Wolaita Sodo University, Sodo, Ethiopia
(3)
College of Health Sciences and Medicine, School of Medicine, Wolaita Sodo University, Sodo, Ethiopia

References

  1. CSA, ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA ICF; 2016.Google Scholar
  2. Notes H. World hunger and poverty facts and statistics; 2016.Google Scholar
  3. Organization WH. Globan Nutrition Report 2014.Google Scholar
  4. Black R, Allen LH, Bhutta ZA, Caulfield LE, Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.PubMedPubMed CentralGoogle Scholar
  5. UNICEF. The state of the World’s children 2017.Google Scholar
  6. de Onis M, Dewey KG, Borghi E, Onyango AW, Blossner M, Daelmans B, et al. The World Health Organization's global target for reducing childhood stunting by 2025: rationale and proposed actions. Matern Child Nutr. 2013;9(Suppl 2):6–26.PubMedGoogle Scholar
  7. CSA, Macro O. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia, and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro; 2006.Google Scholar
  8. Ethiopia FDRo. National Nutrition Program II. In: Body NNC, editor. Addis Ababa, Ethiopia 2016.Google Scholar
  9. Haile D, Azage M, Mola T, Rainey R. Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis. BMC Pediatr. 2016;16:49.PubMedPubMed CentralGoogle Scholar
  10. Adekanmbi VT, Uthman OA, Mudasiru OM. Exploring variations in childhood stunting in Nigeria using league table, control chart and spatial analysis. BMC Public Health. 2013;13:361.PubMedPubMed CentralGoogle Scholar
  11. Woodruff BA, Wirth JP, Bailes A, Matji J, Timmer A, Rohner F. Determinants of stunting reduction in Ethiopia 2000–2011. Matern Child Nutr. 2017 Apr;13:2.Google Scholar
  12. Yisak H, Gobena T, Mesfin F. Prevalence and risk factors for undernutrition among children under five at Haramaya district, Eastern Ethiopia. BMC pediatrics. 2015;15:212.PubMedPubMed CentralGoogle Scholar
  13. Motbainor A, Worku A, Kumie A. Stunting is associated with food diversity while wasting with food insecurity among Underfive children in east and West Gojjam zones of Amhara region. Ethiopia PLoS One. 2015;10(8):e0133542.PubMedGoogle Scholar
  14. Akombi BJ, Agho KE, Hall JJ, Merom D, Astell-Burt T, Renzaho AM. Stunting and severe stunting among children under-5 years in Nigeria: a multilevel analysis. BMC Pediatr. 2017;17(1):15.PubMedPubMed CentralGoogle Scholar
  15. Dorsey JL, Manohar S, Neupane S, Shrestha B, Klemm RDW, West KP, Jr. Individual, household, and community level risk factors of stunting in children younger than 5 years: Findings from a national surveillance system in Nepal. Matern Child Nutr. 2018 Jan;14(1).Google Scholar
  16. Md O, Onyango AW, Borghi E, Garza C, Yang H. Comparison of the World Health Organization (WHO) child growth standards and the National Center for Health Statistics/WHO integrated reference: implications for child health programmes. Public Health Nutr. 2006;9(7):942–7.Google Scholar
  17. Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia. BMC Public Health. 2015;15:41.PubMedPubMed CentralGoogle Scholar
  18. 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 Pediatr. 2015;15:165.PubMedPubMed CentralGoogle Scholar
  19. Bukusuba J, Kaaya AN, Atukwase A. Predictors of stunting in children aged 6 to 59 months: a case-control study in Southwest Uganda. Food Nutr Bull. 2017;38(4):542–53.PubMedGoogle Scholar
  20. Ma'alin A, Birhanu D, Melaku S, Tolossa D, Mohammed Y, Gebremicheal K. Magnitude and factors associated with malnutrition in children 6–59 months of age in Shinille Woreda, Ethiopian Somali regional state: a cross-sectional study. BMC Nutr. 2016;2:44.Google Scholar
  21. Koohi-Kamali F. Intrahousehold inequalities and child gender Bias in Ethiopia: policy research working paper 4755. In: Department TWBARPRaEM, editor.2008.Google Scholar
  22. Belachew T, Hadley C, Lindstrom D, Gebremariam A, Michael KW, Getachew Y, et al. Gender differences in food insecurity and morbidity among adolescents in Southwest Ethiopia. Pdiatrics. 2011;127(2):398–405.Google Scholar
  23. Hadley C, Lindstrom D, Tessema F, Belachew T. Gender Bias in the food insecurity experience of Ethiopian adolescents. Soc Sci Med. 2008;66(2):427–38.PubMedGoogle Scholar
  24. Belachew T, Hadley C, Lindstrom D, Gebremariam A, Michael KW, Getachew Y, et al. Gender differences in food insecurity and morbidity among adolescents in Southwest Ethiopia. Pediatrics. 2011;127(2):e398–405.PubMedPubMed CentralGoogle Scholar
  25. Deshmukh PR, Sinha N, Dongre AR. Social determinants of stunting in rural area of Wardha, Central India. Med J Armed Forces India. 2013;69(3):213–7.PubMedGoogle Scholar
  26. Adekanmbi VT, Kayode GA, Uthman OA. Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis. Matern Child Nutr. 2013;9(2):244–59.PubMedGoogle Scholar
  27. Mushtaq MU, Gull S, Khurshid U, Shahid U, Shad MA, Siddiqui AM. Prevalence and socio-demographic correlates of stunting and thinness among Pakistani primary school children. BMC Public Health. 2011;11:790.PubMedPubMed CentralGoogle Scholar
  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 Pediatr. 2017;17(1):96.PubMedPubMed CentralGoogle Scholar
  29. Hagos S, Hailemariam D, WoldeHanna T, Lindtjorn B. Spatial heterogeneity and risk factors for stunting among children under age five in Ethiopia: a Bayesian geo-statistical model. PLoS One. 2017;12(2):e0170785.PubMedPubMed CentralGoogle Scholar
  30. Assefa H, Belachew T, Negash L. Socio-demographic factors associated with underweight and stunting among adolescents in Ethiopia. The Pan African medical journal. 2015;20:252.PubMedPubMed CentralGoogle Scholar
  31. Tariku A, Biks GA, Derso T, Wassie MM, Abebe SM. Stunting and its determinant factors among children aged 6-59 months in Ethiopia. Ital J Pediatr. 2017;43(1):112.PubMedPubMed CentralGoogle Scholar
  32. Tiwari R, Ausman LM, Agho KE. Determinants of stunting and severe stunting among under-fives: evidence from the 2011 Nepal demographic and health survey. BMC Pediatr. 2014;14:239.PubMedPubMed CentralGoogle Scholar
  33. Taruvinga A, Muchenje V, Mushunje A. Determinants of rural household dietary diversity: the case of Amatole and Nyandeni districts, South Africa. Journal of Development and Sustainability. 2013;2(4):2233–47.Google Scholar
  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;14:800.PubMedPubMed CentralGoogle Scholar
  35. Gebregyorgis T, Tadesse T, Atenafu A. Prevalence of thinness and stunting and associated factors among adolescent school girls in Adwa town, North Ethiopia. Int J Food Sci. 2016;2016:8323982.PubMedPubMed CentralGoogle Scholar
  36. Cruz LMG, Azpeitia GG, Suarez DR, Rodriguez AS, Ferrer JFL, Serra-Majem L. Factors associated with stunting among children aged 0 to 59 months from the central region of Mozambique. Nutrients. 2017;12:9(5).Google Scholar
  37. Darteh EK, Acquah E, Kumi-Kyereme A. Correlates of stunting among children in Ghana. BMC Public Health. 2014;14:504.PubMedPubMed CentralGoogle Scholar
  38. Darsene H, Geleto A, Gebeyehu A, Meseret S. Magnitude and predictors of undernutrition among children aged six to fifty nine months in Ethiopia: a cross sectional study. Archives of Public Health. 2017;75:29.PubMedPubMed CentralGoogle Scholar
  39. Teshome B, Kogi-Makau W, Getahun Z, Zeleke G. Magnitude and determinants of stunting in children under- five years of age in food surplus region of Ethiopia: The case of West Gojam Zone 2010.Google Scholar
  40. Tessema M, Belachew T, Ersino G. Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. The Pan African medical journal. 2013;14:75.PubMedPubMed CentralGoogle Scholar

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