Undernutrition is the most critical problem in the developing country. In Ethiopia, especially in the Amhara region, half of the under-five children are suffering from undernutrition [2, 20]. This study aimed to determine the prevalence of undernutrition and associated factors in East Gojjam Zone, northwest Ethiopia.
This study found that the prevalence of undernutrition among under-five children was high. Particularly, the percentage of stunting was (44.7%), underweight (15.3%) and wasting (10%) among model households. For children of non-model households, the prevalence of stunting was 52.5%, underweight (24.3%) and wasting (11.3%). In addition, significant variation was observed in the percentage of undernutrition among children between model and non-model households. The prevalence of undernutrition was higher among children in the non-model compared to children in the model families. This might be due to the difference in economic and agricultural imputes. This finding is supported by previous studies conducted in Bule Hora, Ethiopia [6], Hidabu Abote district [23], Haramaya district of Ethiopia [24], the Ethiopian Demographic Health Survey [2], in Wollo, Amhara region [14] and Tigray region [19]. Moreover, these might be due to that the study settings are similar in socio-demographic characteristics, residence and socio-economic status.
This study also showed a higher percentage of undernutrition compared with previous studies conducted in Gumbirt, northwest Ethiopia [20], in Egypt and Kenya [25]. This might be due to the difference in the sample size and study period between the current and previous studies. Moreover, the difference observed in undernutrition might be due to the difference in the socio-economic, feeding, lifestyle and socio-demographic characteristics. Similarly, Egypt [20] and Kenya [25] are better in economic development as compared with Ethiopia. The prevalence of underweight and wasting reported in this study was lower compared with the study done in Gumbirt, northwest Ethiopia [20] and Kenya [25]. This might be due to the difference in the sample size, study setting, and socio-demographic characteristics. In contrary, the current study comes with lower prevalence s of underweight as compared with a study conducted in Wollo, Amhara region [14], Tigray region [12], Hidabu Abote district [23] and Haramaya district [24] of Ethiopia. The discrepancy might be due to the difference in the study period and sample size. Similarly, lower prevalence of wasting also reported by the current study as compared with the previous study reported in Tigray, Hidabu Abote district and Haramaya district of Ethiopia [12, 23, 24]. Moreover, stunting was higher compared with the previous finding reported by Kenya [26].
This study also focused on identifying factors that have the association with undernutrition status of under-five children both among model and non-model households. In the binary variable of model households, the number of children, protected source of drinking water, daily meal frequency, complimentary food start, and fever were associated with stunting. Whereas in non-model households’ sex, protected source of drinking water, complimentary food, education on complementary food, number of children and age of caregiver were found to be associated with stunting. Moreover, the binary variable of model households, food distribution; daily meal frequency, the source of drinking water and family income were associated with underweight. Whereas, in non-model households, the power to use the money, ANC service utilization, protected source of drinking water, food distribution, child waste disposal, and solid waste disposal were associated with underweight in non-model households. In addition, the binary variable of model households, ANC service, source of drinking water, complementary feeding at 6 months, priority to feed their children and complimentary food education were significantly associated with wasting in the model household. Whereas, in non-model households, complimentary food start, breastfeeding education, ANC service, solid waste disposal, and household incomes were significantly associated with wasting.
Non-protected source of water identified as a predictor for the occurrence of under-five children under-nutrition/stunting/ among both model and non-model households. This might be that water from a contaminated source serves as a source for different parasitic and gastrointestinal infection. These infections expose children for undernutrition (stunting). According to the WHO, at least 50% of the combined undernutrition in children is related to unsafe water, inadequate sanitation or insufficient hygiene [22]. This can be supported by previous evidence observed by a study done in Medabazana district North Ethiopia [12].
Moreover, in this study daily meal frequency was also identified as a significant factor for the occurrence of undernutrition. Children who took meal frequency less than three times per day were more likely to be undernourished as compared to the counterparts. This can supported by study finding reported in Egypt [25].
Similarly, a lack of education on complementary feeding practice contributes 61% for the occurrence of under-five children under-nutrition/stunting/ among non-model households compared with their counterparts. This might be due to a mother who knows the recommended complementary feeding practice might have a better commitment to start complementary feeding on the recommended time and continue [1]. This supported by previous research conducted in the Gumbirt district northwest Ethiopia [14].
Children who start complementary feeding at 6 months were less likely to be wasted as compared with the counterpart. This finding is comparable with study finding reported in Bule Hora district south Ethiopia [15]. This similarity might be due to the similarity in socio-demographic characteristics particularly on community awareness towards timely initiation of complementary feeding. Information on complementary feeding is crucial for starting complementary food based on the recommended date [1].
Furthermore, the source of drinking water was also identified as significant predictors for an increased odd of undernutrition (stunted and underweight) among under-five children who were from both model and non-model household. Under-five children from model and non-model households, who use non-protected water, were 92 and 93% times more likely to be undernutrition as compared with their counterparts. This finding is comparable with previous study report done by Machakel district.
The timing of complementary feeding was also recognized as predictors for the high prevalence of undernutrition among model households. Children who came from model households and those who did not start complementary feeding on 6 months had a 73% (AOR = 0.27, 95%CI: 0.08, 0.89) higher odds of undernutrition/wasting/ as compared to their counterparts. Children who came from model households and those who served prior than elders had 80% (AOR = 0.20, 95%CI: 0.06, 0.67) lower odds of undernutrition as compared to their counterparts.
Antenatal care service and solid waste disposal system were also identified as factors for the increased odds of undernutrition among children in non-model households. Non-model households, who had no ANC follow up had 80% (AOR = 0.20, 95%CI: 0.06, 0.67) higher odds of undernutrition compared to their counterparts. Similarly, children from non-model households and those who had no solid waste disposal were 58% (AOR = 0.420, 95%CI: 0.19, 0.91) times more likely to be undernutrition compared with the counterpart. This fact supported well by research findings reported by Nigeria [27]. This might be due to those women who have antenatal follow-up provided education on focusing on the recommended infant feeding practice. As a result, she can feed her child based on the information gained from health facilities. Moreover, most of the time women who have ANC follow-up are those with higher education and economic status.