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Food Science & Nutrition Technology Research Article 13 min read

Prevalence of Stunting and its Associated Factors among UnderFive Children from Rural Communities with Productive Safetynet Program in South Gondar Zone, Northwest Ethiopia

Engidaw MT*, Gebremariam AD and Asnakew DT
* Corresponding author
ISSN: 2574-2701  10.23880/fsnt-16000209  Received: February 05, 2019  Published: February 27, 2020
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Keywords
Stunting Under-Five Children Safety Net Program South Gondar Zone Ethiopia
Abstract

1.1. Background: undernutrition is a major public health problem worldwide and can impair the intellectual development of a child. Stunting is the commonest nutritional public heath significant disorder among children, especially in developing countries including Ethiopia. Even if the cause is multifactorial, inadequate intake of nutrients and infection is the immediate causes of under nutrition. All these problems were more severe among children’s in the productive safety net program beneficiaries of the rural community due to low agricultural productivity and/or low socioeconomic status. So, this study aims to determine the level of stunting and its associated factors among under-five children from rural communities with productive SafetyNet program in South Gondar Zone, Northwest Ethiopia. 1.2. Methods: A community-based cross-sectional study was employed. By using simple random sampling, 769 children paired with their mother or caregivers were included into this study. The data were collected using a structured and pre-tested questionnaire. Anthropometric indices were built to determine height for age Z score. AnthroPlus and Epi info version 7.0 software’s were used for data entry and finally, the entered data were exported to SPPS version 20.0 software to carry out the further statistical analysis. Both bivariate and multivariable logistic regression models were used to explore significant variables. Finally, a P-Value ≤ 0.05 was used to declare the statistical significance of the variables. 1.3. Results: In this study, the magnitude stunting was 44.2% (95% CI (40.9%, 47.7%)). Stunted children from productive Safety Net households were 50.3%. Factors associated with the development of stunting were a birth interval (AOR: 1.61, 95% CI (1.15, 2.26)), ANC follow-up (AOR: 0.47, 95% CI (0.26, 0.87)), hand washing practice (AOR: 1.96, 95% CI (1.16, 3.31)), and family size (AOR: 4.40, 95% CI (3.20, 6.07)). 1.4. Conclusion: Stunting is a severe public health problem. And, appropriate counselling regarding birth spacing, to have antenatal care follow up, and limiting the number of children is very important for women in the reproductive age group by integrating with all other services to reduce the magnitude and burden of stunting.

Introduction

According to the Millennium Development Goals, economic growth, household living standards, and child survival are indicated by the nutritional status of children [1]. Currently, Ethiopia found with the highest population growth and remarkable economic growth and expansion of the services [2]. With this effort, poverty and food insecurity is still a major problem due to poor agricultural marketing system with poor access to transport, communications, and production technologies [3, 4].

Productive safety net program (PSNP) implemented in Ethiopia since 2005 to address chronic food security through transfers (food and or money) to chronically food-insecure households in order to prevent asset depletion. In 2009 PSNP+ was launched for small income-generating activities among households to financial services and markets in order to have self-sustainable finance [5, 6, 7]. PSNP is provided to meet consumption needs and to avoid selling productive assets because of food insecurity [5].

This day in Ethiopia, food insecurity with hunger, and under nutrition persist as a major problem in each region of the country [8]. Amhara regional state has all this problem which is reflected by the poor nutritional status of women and children [9, 10]. Stunting might be persisting due to inadequate intake, low dietary diversity, and poor food quality, inappropriate feeding practices. In addition to this, hygienic practices, and illness that lead to failure to take, and absorb sufficient essential nutrients for growth & development [11].

There is a high prevalence of stunting among children with PSNP dependent households as compared to those households without PSNP in Ethiopia [10]. Existences of stunting have a negative consequence in early and later life which follows the intergeneration life cycle. Because of this, productivity will be decreased and affects both the economic growth and development of the country at large. Food insecurity has a negative effect on school attendance and educational attainment of children and in Ethiopia too [12].

Methodology and Materials

Study Design and Setting

A community-based cross-sectional study was employed in South Gondar Zone, Amhara regional state. In this zone there are five Woredas (Layi gayint, Tachgayint, Simada, Ebinat and Libokemkem) with known food insecurity. In these Woreda, based on the household assets the hos holds were selected for productive Saftey Net program. Two Woredas were randomly (Tach Gayint and Libokemekem) selected for this study. The districts have relative high temperature and relatively low amount of annual rainfall. The Woredas have a single rainy season and agricultural activities (commonly from June to September). Cereals and grains are the main cash crops. The total population of Libokemekem in 2010 was 198,951 of which 100,951 were males and 97,423 females and the number of households in the Woreda with productive safety net program was 4887. The total numbers of children less than 5 years were expected to be 34,986. Based on the 2007 national census conducted by the Central Statistical Agency of Ethiopia (CSA), Tach Gayint woreda has a total population of 101,956, of whom 51,041 are men and 50,915 women and the number of households in the Woreda with productive safety net program was more than 5000. The total numbers of children less than 5 years were expected to be over 25,000. The data were collected from May to June, 2016.

Study Population

All children (06 to 59 months of age) with their caregiver/ parents in the rural community of Lerbo – Kemkem Woreda during data collection periods were included. But, children with a physical disability, guests, and newcomers were excluded.

Sample Size Determination and Sampling Procedure

For this study, 769 children’s data were included after excluding incomplete dates with the absence of physical measurements, age of the child and flagged cases. We were selected 4 kebeles from Tach Gayint and 5 from Libokemekem Woredas.

After selecting 09 rural Kebeles randomly (lottery method), a multistage sampling method was employed to get all study participants. The sample size was allocated for each selected Kebeles. After obtaining the list of children from the Health Extension workers’ family folder record, children were selected by using simple random sampling until we got the required amount of sample size. During data collection, in the case of two or more children within a single household lottery method was used to select one.

Measurements and Tools for Data Collection

Well-structured and pretested Amharic version questionnaires were used after translated into Amharic from the English language in order to check its consistency. The questionnaire had socioeconomic, anthropometry and dietary habit. The dietary habit data was collected by asking the children’s mother to recall all the foods consumed by the child within the past 24 hours.

The weights were measured after take-off the shoe, and wearing a possible light close and for children less than 2 years the panty bag was used. The wooden board used to take the height as well as the length for children’s less than 2 years interchangeably. The height/length was measured by placing the participants into the Frankfurt position.

Data Quality Assurance

The questionnaire contained demographic, socioeconomic and behavioral factors and prepared in a simple and easily understandable way in the Amharic language. Six data collectors (a team of two individuals), three supervisors and principal investigators were involved in data collection process after intensive training of 02 days on how the data collectors and supervisors interview the mothers, fill the questionnaire and taking physical measurements by using standard instruments of weighing scale and height/ length board. Pretested was done on 20 participants of adjacent Woredas before actual data collection.

To obtain the appropriate age and to reduce recall bias; prominent local events, Baptism cards, and immunization cards were employed.

Weighing scales were calibrated by using 1kg of standard weight before every measurement of each day and three consecutive measurements were taken to ensure accuracy. Weight and lengths/height were recorded into the nearest 0.1kg and 0.1cm respectively. All forms were reviewed every night by the supervisors and investigator to communicate with problems.

Definitions of Terms

Stunting: when a child height for age Z-score was <-2SD of the median value of the NCHS/WHO curve [13]. Households with PNSPs: households identified as chronically food insecure and currently they are a part of cash transfer or asset-building program [14, 15].

Dietary diversity score (DDS):- is the consumed food by the child within 24 hours and was categorized as low (consumed <4 food groups) and good (consumed ≥4 food groups) dietary diversity scores [16].

Data Processing and Analysis

The age, sex, height/length and weight of children entered into Anthro Plus software to build height for age based on growth reference of NCHS. All the data entered by using EPI info version 7.0 and then exported into SPSS version 20.0 for windows for cleaning of data, descriptive and analytical analysis of variables. Binary and multivariable analysis was done to saw independent and multivariable effects height for age. Finally, p-value ≤ 0.05 was used to declare statistical significance. An odds ratio (OR) values with 95 % of the confidence interval were computed to saw the levels of association.

Ethical Consideration

Ethical clearance was obtained from the Institutional Review Committee of Debre Tabor University. An official letter was obtained from Zonal Health Department and respective Woreda health offices. Oral consent was obtained from each study participant’s mother or caregiver after they were included in this study. First, the purpose of the study was explained to them and we assured the privacy and confidentiality of the information throughout the data collection and after. Lastly, they got information about the rights to interrupt and to refuse the interview process at any time. After analyzing the final data, we assured that the final result of the study will be published in an international scientific journal. Weight and height of children were measured as much as possible without posing discomfort. All caregivers who had stunted children were counseled about the importance of appropriate feeding and health education and advice on the spot.

Results

Socio-Demographic Characteristics

The response rate for this study was 94.5%. The average age ± SD the respondent (mothers/caregivers) was 30.11 + 5.16yrs. All of them were Orthodox religion followers. From the total, one-fourth of the households are under the safety net program. The average age in month ± SD the child was 31.30±20.512 months and near to 55% found between 23 – 59 months of age as shown in the table below (Table 1).

CategoriesFrequencyPercent
Current maternal Age (Yrs )15 – 19121.6
Current maternal Age (Yrs )20 – 24769.9
Current maternal Age (Yrs )25 – 2926734.7
Current maternal Age (Yrs )30 – 3425232.8
Current maternal Age (Yrs )35 – 3910713.9
Current maternal Age (Yrs )40 – 44557.2
Current maternal Age (Yrs )45 – 49091.2
Household headHusband73495.4
Household headWife354.6
Enrolled in Safety net programYes19525.4
Enrolled in Safety net programNo57474.6
Marital statusSingle597.7
Marital statusMarried63081.9
Marital statusSeparated8010.4
Respondent’s educational statusunable to read and write59176.9
Respondent’s educational statusable to read and write17823.1
Husband’s educational statusunable to read and write42755.5
Husband’s educational statusable to read and write31440.8
Husband’s educational statusprimary education and above283.7
Respondent’s occupationHousewife38550.0
Respondent’s occupationDaily laborer354.6
Respondent’s occupationFarmer34945.4
Husband’s occupationDaily laborer364.7
Husband’s occupationFarmer73395.3
Age of the child6 – 11 months14218.5
Age of the child12 – 23 months30039
Age of the child24 – 59 months32742.5
Sex of the childMale37448.6
Sex of the childFemale39551.4

Table 1: Socio-demographic and economic characteristics of the children 6 – 59 months of age in South Gondar Zone, Northwest Ethi

Magnitude and Factors Associated with Stunting

The mean age ± SD was 23.38 ±13.20 months. The mean ± SD of weight and height of the child was 10.05 ± 2.54Kg and 81.12 ± 14.49m respectively. The mean ± SD of HFA was -1.28±2.73. The magnitude of stunting (HFA) was

44.2% (95% CI (40.4%, 47.7%)) and from this 28.0% (95% CI, (24.7%, 31.2%)) was very severe. In bivariate logistic regression; maternal education, enroll in PSN, birth interval, ANC follow-up, vaccination history, having diarrhea, hand washing practice, family size, and sex of the child were significant variables. Then, all these significant variables were fitted into multivariable logistic regression analysis and birth interval, ANC follow-up, hand washing practice, and family size were the associated factors for the development of stunting among under-five children as shown in the table below (Table 3).

Variable
Yes		StuntingCOR (95% CI)AOR (95% CI)
No
Maternal educationUnable to read & write3432480.67(0.48, 0.94)0.76(0.53, 1.11)
able to read & write869211
Enrol in SNPYes97981.38(1.00, 1.92)1.29(0.89, 1.88)
No33224211
Birth interval<2 years1541291.92(1.43, 2.59)1.61(1.15, 2.26) *
≥2 years18630011
ANC follow-upYes31638111
No24480.60(0.36, 1.01)0.47(0.26, 0.87) *
Vaccination historyYes30941111
No31182.29(1.26, 4.17)1.80(0.92, 3.52)
Having diarrhoea
within 2wks		Yes107861.83(1.31, 2.54)1.30(0.85, 1.98)
No23334311
Hand washing prac-
tice		Yes24738211
No66471.96(1.30, 2.93)1.96(1.16, 3.31) *
Family size (mean)≤49928811
>42411414.97(3.65, 6.77)4.40(3.20, 6.07) *
Sex of the childFemale1432310.62(0.47, 0.83)0.74(0.54, 1.02)
Male1971981

Table 3: Logistic regression analysis results of factors associated with stunting among children of 6 -59 months of age in South

Children who had low birth intervals were 1.6 times (AOR: 1.61, 95% CI (1.15, 2.26)) stunted as compared to the highest birth interval. Children from a mother with ANC follow up were 53% less likely to be stunted (AOR: 0.47, 95% CI (0.26, 0.87)). Mothers who had no practice of handwashing were 2 times (AOR: 1.96, 95% CI high to had stunted child (1.16, 3.31)). Children from the highest family size were 4 times more likely to develop stunting (AOR: 4.40, 95% CI (3.20, 6.07)).

Discussion

In Ethiopia, still undernutrition is a significant public health problem and individual and community-level factors were significant determinants of childhood under-nutrition [17, 18].

In this study, the overall prevalence of stunting was 44.2% (95% CI (40.4%, 47.7%)). This result shows that the prevalence of stunting in Lebo – Kemkem Woreda is higher when compared with the national prevalence reported by EDHS 2016 (38%) [18]. This variation partly could be due to the difference in sample size as compared to the national data. The prevalence of stunting in this study is in line with a result reported from Wondogenet District, Sidama Zone, Southern Ethiopia which was 45.5% [19]. In this study, the magnitude of stunting and wasting were also compared with a study conducted at Jigjiga Town in Somalia Regional State, Ethiopia, and the prevalence of stunting was found to be 34.9% which is low as compared to our finding [20]. The possible reason for this difference may be due to socioeconomic variations, educational status of parents regarding nutrition, and food culture or dietary habit differences.

Children from who had low birth interval were 1.6 times (AOR: 1.61, 95% CI (1.15, 2.26)) stunted as compared to the highest birth interval which is in line with a study in Tehsil Zarghoon Town, Pakistan that showed short birth interval between children predisposes them to stunning [21]. The possible reason may be due to when there are many children who are closely spaced in the family; there could be limited overall health care, food, and nutrition that end the child to be undernourished. Children from a mother with ANC follow up and hand washing practices were significant variables strongly associated with stunting which are similar to a study done in Sebeta, Hawas District, Oromia, Ethiopia [22]. This result revealed that also children from the highest family size were 4 times more likely to develop stunting (AOR: 4.40, 95% CI (3.20, 6.07)) which is similar to findings from a study in Bule Hora District, Southern Ethiopia [23].

The study was limited in linking stunting to some specific variables like diseases without signs and symptoms, unable to establish any possible causal link and long-time exposures before, during and after delivery like chronic food insecurity.

Conclusions and Recommendations

In this study, the prevalence of stunting was a severe public health problem. Factors associated with the development of stunting were a birth interval, ANC follow-up, hand washing practice, and family size. Maternal education during ANC follow up and immunization by health care provider about the hygienic practice, maternal and childcare is very important to reduce the problem.

Acknowledgments

We deeply acknowledge all the study participants, the staff of Lebo Kemekem Woreda Health office, Debre Tabor University, supervisors and data collectors for their cooperation and commitment during the data collection period.

Authors’ contributions

MTE: made the draft of the proposal, and acquisition, analysis of data and on the interpretation or discussion of results and the whole parts of the manuscript. ADG and DTA: worked on the analysis of data, on the interpretation or discussion of results and revising the whole manuscript. All the authors read and approved the final manuscript.

Funding

All the authors didn’t receive a specific fund for this research.

Availability of Data and Materials

The datasets are available from the corresponding author.

Competing Interests

We declare that there is no competing interest with anyone else.

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@article{engidaw2020,
  title   = {Prevalence of Stunting and its Associated Factors among UnderFive Children from Rural Communities with Productive Safetynet Program in South Gondar Zone, Northwest Ethiopia},
  author  = {Engidaw MT, Gebremariam AD and Asnakew DT},
  journal = {Food Science & Nutrition Technology},
  year    = {2020},
  volume  = {5},
  number  = {1},
  doi     = {10.23880/fsnt-16000209}
}
Engidaw MT, Gebremariam AD and Asnakew DT (2020). Prevalence of Stunting and its Associated Factors among UnderFive Children from Rural Communities with Productive Safetynet Program in South Gondar Zone, Northwest Ethiopia. Food Science & Nutrition Technology, 5(1). https://doi.org/10.23880/fsnt-16000209
TY  - JOUR
TI  - Prevalence of Stunting and its Associated Factors among UnderFive Children from Rural Communities with Productive Safetynet Program in South Gondar Zone, Northwest Ethiopia
AU  - Engidaw MT, Gebremariam AD and Asnakew DT
JO  - Food Science & Nutrition Technology
PY  - 2020
VL  - 5
IS  - 1
DO  - 10.23880/fsnt-16000209
ER  -