Stunting and Associated Factors among Children Aged 6-59 Months in Lasta Woreda, North East Ethiopia, 2015: A Community Based Cross Sectional Study Design

Special Article – Public Health

J Fam Med. 2017; 4(3): 1112.

Stunting and Associated Factors among Children Aged 6-59 Months in Lasta Woreda, North East Ethiopia, 2015: A Community Based Cross Sectional Study Design

Birhanu A¹, Mekonen S¹, Atenafu A¹ and Abebaw D²*

¹University of Gondar, Collage of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, Ethiopia

²Department of Research and Training, Amanuel Mental Specialized Hospital, Ethiopia

*Corresponding author: Dessie Abebaw, Department of Research and Training, Amanuel Mental Specialized Hospital, Ethiopia

Received: February 09, 2017; Accepted: March 03, 2017; Published: March 10, 2017

Abstract

Background: Stunting refers to low height-for-age as a result of chronic malnutrition. Globally, 165 million under five year’s children were stunted annually, which was associated with 10.6 million deaths. Although stunting is increasingly being recognized as a widespread problem, precise data on the magnitude and associated factors of stunting was not available at the study area which was highly influenced by the local geo-cultural factor, custom and context.

Objective: The aim of this study was to assess prevalence and factors associated stunting among children aged 6-59 months in Lasta Woreda, North East Ethiopia.

Methods: A community based cross sectional study was conducted from March-April, 2015. A multistage sampling strategy with simple random sampling approach was used with total sample size units of 825. Data were collected Using validated questionnaire through interviewing parents or caregivers and Anthropometric measurement. EPI INFO version 7 software was used for data entry. For Analysis SPSS version 20 statistical software was used. Principal component Analysis was applied to compute wealth index. Z-Score of the children were calculated using SMART software (ENA2011). To identify the association and significant predictors, binary logistic regression was employed.

Results: A total of 759 study participants were included in the study giving response rate of 92%. The overall prevalence stunting was 49.7% (95% CI: 46.1-53.3). Among this 57.7%; (95% CI: 50.9-60.4) were male and 42.3% (95% CI: 36.8-47.6) were female. The proportion of moderate and sever stunting among study population was 31.7% and 18.0% respectively. Being male AOR= 1.90; (95% CI; 1.29-2.82), increasing age (AOR = 8.38; (95% CI: 3.78-15.6)), large family size (AOR=1.78; (95% CI; 1.19-2.65)), poor wealth status (AOR = 2.64; (95% CI; 1.58-4.41)), illiterate mother (AOR = 4.02; (95% CI: 2.3-7.04)), leftover food (AOR=1.94; (95% CI: 1.30-2.90)), living in rural area (AOR = 2.08; (95% CI: 1.10-4.19)) and less frequency of feeding (AOR = 2.13; (95% CI: 1.18- 3.82)) were significantly associated with stunting.

Conclusion: This study shows that, the prevalence of stunting among children aged 6-59 months in Lasta Woreda is higher as compared to the national figures (MEDHS, 2014). Being male, increasing age, large family size, giving leftover food, poor wealth status, and illiterate parents were factors associated with stunting. Urgent, therapeutic and targeted supplementary feeding programs need to be considered for chronically malnourished children in Lasta Woreda to reduce stunting. Factors associated to stunting as identified with this study need to be considered for the intervention plan.

Keywords: Stunting; 6-59 months children; Lasta Woreda; Ethiopia

Background

Stunting refers to low height-for-age as a result of chronic malnutrition. Stunting in children under five is defined as a height for age less than Z-scores below minus two standard deviations (−2SD) of the World Health Organization (WHO) child growth standards median [1,2]. Stunting has negative consequence for a child’s physical and mental development. Children who are stunted tend to achieve lower scores on intelligence and are more likely to become affected by infections [3,4]. Improved nutrition with adequate feeding and care develop the intellectual ability of the children [5].

Globally under nutrition, cause 45% of all deaths of children younger than five years, which is equivalent to 3.1 million deaths [6,7]. Worldwide out of four children, one is stunted and in developing countries one in three and specifically in Africa two out of five children’s suffered with stunting [5,8].

In Ethiopia, more than 2 out of every 5 children stunted, educational achievement of these stunted children is 1.1 years later than non stunted children and 16% of all repetitions in primary school are associated with stunting [9].

In Ethiopia 40% of children under age five were stunted and 18% of children were severely stunted with regional variation such as in South Nation Nationality Peoples 44.3%, Afar 49.2%, Tigray 44.4%, Amhara National Region State 42.4% children under five were stunted [10]. Stunting reduce a child’s chance of survival, hindering optimal health and growth and associated with suboptimal brain development, which is likely to have long-lasting harmful consequences for cognitive ability, school performance and future earnings [11].

Stunting is affected by many factors such as: poverty, low parental education, lack of sanitation, low food intake, poor feeding practices, inadequate breastfeeding, repeated infections, family size and birth interval [12,13]. Comprehensive knowledge about the risk factors of stunting in local context is vital to reduce stunting rate, to develop prevention strategies and strengthen nutrition intervention programs.

Moreover, the stunting status of children is a manifestation of a host factors, including household access to food and the distribution of this food within the household, availability and utilization of health services and the care provided to the child [14]. Though there is progress from government to improve the nutritional status of the children, stunting among children is still very high according to Ethiopian Demographic Health survey figure (40%) and hence, there is a limitation of information on associated factors of stunting. Therefore the purpose of this study was to assess prevalence and factors associated with stunting among children aged 6-59 months in Lasta Woreda, North East Ethiopia.

Justification of the study

Stunting is a well-established risk marker of poor child development, measure of linear growth and a condition reflecting the cumulative effect of chronic malnutrition [14].

Although stunting is increasingly being recognized as a widespread problem, to my knowledge precise data on the magnitude and associated factors of stunting was not available at the study area which was highly influenced by the local geo-cultural factor, custom and context. For this more comprehensive study was needed to asses prevalence and associated factors of stunting.

Therefore, this Study assessed the prevalence and associated factors of stunting among children aged 6 to 59 months in Lasta Woreda. The study will help and provide evidence for different stakeholders who are working on child nutrition, to plan appropriate and the most effective nutrition intervention in the study setting.

Objective

General objective

The aim of this study was to ass’s prevalence and factors associated with stunting among children aged 6-59 months in Lasta Woreda, North East Ethiopia, 2015.

Specific objectives

Methodology

Study design

Community based cross sectional study was employed.

Study area and period

This study was conducted in Lasta Woreda which is found in North Wollo Zone, North East Ethiopia in Amhara national regional state. The district has 24 rural Kebeles with a total population of 115880.00 and 14925 of the child are aged 6-59 months of old and 26949 households, which are projected from 2007 Central Statistics Agency (CSA) census. There are 6 Cluster Health Centers and 24 health posts in Lasta Woreda and one Hospital in Lalibela Town. The data collection period was from March 22 –April 30/2015.

Source population

The source populations were all children aged 6-59 months who are living in Lasta Woreda.

Study population

The study populations were children aged 6-59 months in Lasta Woreda from selected kebeles.

Inclusion and exclusion criteria

Inclusion criteria: All children aged 6-59 months who were living in Lasta Woreda were included in this study.

Sample size and Sampling procedure

Sample size determination: Sample size was calculated using single population proportion formula, assuming A Z- value of 1.96 was used at 95% CI and d of 5%. Where (n= sample size, p= prevalence, d= margin of error, Z = level of confidence (1.96)2) and taking the prevalence (p) of stunting was 42.4% in ANRS among under five children [10].

n= ( Z α 2 ) 2 × p( 1p ) ( d ) 2 MathType@MTEF@5@5@+=feaaguart1ev2aqatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLnhiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=xfr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamOBaiabg2da9maabmaabaGaamOwamaaBaaaleaadaWcaaqaaiabeg7aHbqaaiaaikdaaaaabeaaaOGaayjkaiaawMcaamaaCaaaleqabaGaaGOmaaaakiabgEna0oaalaaabaGaamiCamaabmaabaGaaGymaiabgkHiTiaadchaaiaawIcacaGLPaaaaeaadaqadaqaaiaadsgaaiaawIcacaGLPaaadaahaaWcbeqaaiaaikdaaaaaaaaa@4885@

n= ( 1.96 ) 2 × 0.424( 10.424 ) ( 0.05 ) 2 MathType@MTEF@5@5@+=feaaguart1ev2aqatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLnhiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=xfr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamOBaiabg2da9maabmaabaGaaGymaiaac6cacaaI5aGaaGOnaaGaayjkaiaawMcaamaaCaaaleqabaGaaGOmaaaakiabgEna0oaalaaabaGaaGimaiaac6cacaaI0aGaaGOmaiaaisdadaqadaqaaiaaigdacqGHsislcaaIWaGaaiOlaiaaisdacaaIYaGaaGinaaGaayjkaiaawMcaaaqaamaabmaabaGaaGimaiaac6cacaaIWaGaaGynaaGaayjkaiaawMcaamaaCaaaleqabaGaaGOmaaaaaaaaaa@4F4F@

By using 2 design effect 375*2= 750 and Adding 75 contingency for non response, therefore the final sample size used were = 825 (Table 1).