Study area, period and design
A community-based cross-sectional study was conducted in Wonago town, Gedeo zone, South Nation Nationality and People Region (SNNPR), Ethiopia from October 1 to October 30, 2021. The numbers of population in Wonago town is around 156,481. Wonago is located 102, 13, and 377 kms from the zonal, regional and national capitals Hawassa, Dilla, and Addis Ababa, respectively. is bounded by southwest by Yirgachefe District, northwest by the Oromia region, northeast by Dilla Zuriya District, and southeast by Bule District. The town has three Kebeles in which 1737 children aged 2–5 years is found.
Study population
Source population
All children aged 2-5 years living in Wonago district.
Study population
Selected children aged 2–5 years paired with their mother/care givers living in Wonago district.
Study Unit.
Selected children aged 2-5 years paired with their mother/care givers living in Wonago district and participated in actual response during data collection period.
Eligibility All 2–5 children paired with their mother/care givers living in Wonago district.
Sampling technique and procedure
Sample size determination
The sample size was calculated using single population proportion formula by considering the following assumptions: p = 0.476 proportion of wasting in Bulle Hora town with the level of confidence = 95%, level of significance = 5% and margin of error (d) =5%. Therefore, the final total sample size including the non-response rate was 421.
Sampling procedure
A systematic random sampling technique was used. Based on the proportional allocation formula 421 study participants were distributed to the three kebele of wonago town and the kth value was calculated (Kth = 4) (Fig. 1). The first house hold with 2–5 years child in each kebeles was selected randomly from 1 to 5 households by lottery method then the rest was selected every respected 4 household until the total sample size was achieved.
Operational definitions
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Wasted:- A child weight for height z score < −2sd [16]
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Not wasted: A child weight for height z score= > −2sd [16]
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Caregiver: is a mother, father, any family member or paid person that knows about the child in detail and help the child with feeding, dressing, undressing, and with hygiene.
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Food-insecurity: Exists when all people, at all times, lack secure access to sufficient amounts of safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life [17].
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Mildly food insecure (access) household Worries about not having enough food sometimes or often and/or is unable to eat preferred foods [17].
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Moderately food insecure household Sacrifices quality more frequently, by eating a monotonous diet or undesirable foods sometimes or often [17].
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A highly food insecure household Experience forced cutting back on meal size or number of meals often, and/or experiences any of the three most severe conditions [17]. Data Collection Procedures and data quality control
Data collection tool and procedure
A semi-structured interview administered questionnaire, which includes all the relevant information to meet the objectives of the study was used to collect the participants’ Socio-economic factors (child age, family size, income, maternal/ paternal education, Household food insecurity), recurrent illness, Child caring practice (feeding, immunization, Dietary diversity), Maternal characteristics: (age of mother, number of children, ANC visit, age at first pregnancy), environmental health conditions, and dietary diversity practice. The tool was adapted from the world health organization instrument for stepwise surveillance of (WHO steps) child malnutrition. In accordance with the steps manual, a few additional questions were added to supplement the questionnaire and to reflect the local context of Ethiopia. It was first written in English, translated into Amharic then to Gede’offa (local language), and was translated back into English by professionals who speak both languages for keeping consistency. Lastly, a survey was conducted with the help of health extension professionals checking intra and inter-professional reliability following the selection of eligible households.
Data quality control
Data was gathered by 15 data collectors who had been trained. Supervisors examined the obtained data on a daily basis for completeness and consistency. Those who can take anthropometric measurements of a child gathered the data. Before measuring, the child’s shoes, braids, and hair clips were removed to reduce measurement mistakes. For height and weight measurements, a stadiometer and a digital weighing machine were utilized. The child was in a standing position throughout the anthropometric measurements. With their feet together and flat on the ground, their heels pressed against the stadiometer’s back plate, their legs straight, buttocks against the backboard, scapula against the backboard, and arms at their sides. Body weight was measured to the nearest 0.1 kg using a stadiometer. The ‘Technical Error of the Measurements’ was calculated by estimating the average difference between the expert’s measurements and those of the trained data collectors, as well as the difference between the data collectors’ first and second measurements (TEM). The relative TEMs for inter and intra examiners relative values for height and weight were greater than 0.95, the suggested cut-off, indicating that the measurements in the study were highly accurate.
Before the actual data collection took place, pretest was done on the sample of 5% of the sample size, which was in adjacent Woreda to ensure the validity and reliability of methodology and survey tools. Based on the findings of the pretest, the tool was modified. After checking for completeness, the collected data was edited to exclude errors, re-organized, coded and entered into epidata version 4.6 for double data entry verification (to identify data consistency), then was exported to STATA version 20 for windows for cleaning and statistical analysis.
Data processing and analysis
Epidata version 4.6 was used to enter the data. It was examined for completeness, consistency, and coding using STATA version 20 before any statistical analysis. The WHO Antero plus 2021 version 3.2 software was used to convert anthropometric data into z-scores for the indices stunting HAZ (height for age z-score), underweight WAZ (weight for age z-score), and wasting WHZ (weight for height z-score), and then exported to STATA version 20 for further analysis.
STATA was used to describe the study population using descriptive statistics such as frequency distribution, mean, and proportion. The presence of connections between the various independent predictors and the dependent variable was investigated using bivariate and multivariable logistic regressions. In the bivariate analysis, variables having a p-value of less than 0.25 [18] were put into multivariable logistic regression. Variables with a p-value of less than 0.05 in the multivariate analysis were declared statistically linked with wasting in children aged 2 to 5. Finally, conclusions were drawn based on the findings.
Ethical consideration
The study was conducted after ethical clearance was obtained from the DU review board. Oral consent was gained from the study participants before they were enrolled in the study and anybody involved in this study was informed that she or he has full right to leave the study. The information collected from the respondents were used only for the study purpose.