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the enumer...
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Prevalence of stunting and associated factors of children among 6 59 months age in guto gida district, east wollega zone, oromia, ethiopia

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Transcripts - Prevalence of stunting and associated factors of children among 6 59 months age in guto gida district, east wollega zone, oromia, ethiopia

  • 1. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 1 Prevalence of Stunting and Associated Factors of Children among 6-59 Months Age in Guto Gida District, East Wollega Zone, Oromia, Ethiopia Alemu Adeba1 , Sileshi Garoma2 , Habtamu Fekadu Gemede2* , Wondu Garoma2 1.NekemteTechnical and Vocational School, Ethiopia 2.Wollega University, Ethiopia Corresponding Author's E-mails: fekadu_habtamu@yahoo.com Abstract Nutrition is central and an important input to promote health and development. The request of human differ with respect to age, gender and during physiological changes such as complimentary feeding and child age. Ethiopia has a high prevalence of Acute Malnutrition, with almost half of Ethiopian children chronically malnourished. A community based cross- sectional descriptive survey and measurements of MUAC was used to investigate Prevalence of Stunting and Its Associated Factors among Children 6-59 Months of Age in Guto Gida District, East Wollega Zone, Oromia, Ethiopia. Multistage random sampling technique was used and 359 children aged between 6-59 months aged were selected from 398 enrolled children to the study. The quantitative data were analyzed using SPSS for windows version (17.0) and EPI-6. Multiple logistic regressions were run to assess factors that were associated with the dependent variable at p< 0.05 and to control the confounders. Finally, the study result shows 27.5 percentage of children were severe stunted, 41.78% less than 65% median for height meaning that stunted children. The quality of water was also one of the bottlenecks of child undernourishment at study area. Despite many efforts going on, there is a need to intersectional collaboration to address the immediate and intermediate causes of child stunting in Guto Gida districts. Moreover, it is very demanding to scale-up the interventions in terms of the quality and quantity food reaching the majority who need it. Keywords: Stunting, Associated Factors, Children, Anthropometry, Guto Gida District Introduction Nutrition is the blood of human being required with amount of energy, protein, fat and micronutrients needed for an individual to sustain a healthy life. Black and his colleagues report that more than a third of the deaths of children under the age of 5 years and disability-adjusted life-years worldwide can be attributed to under nutrition (Black et el., 2008). Malnutrition continues to be a major public health problem in Ethiopia even though in developing countries. It is the most important risk factor for the burden of disease causing about 300, 000 deaths per year directly and indirectly responsible for more than half of all deaths in children (WHO, 2005). Much of the burden of deaths resulting from malnutrition, estimated to be over half of children deaths in developing countries, can be attributed to just mild and moderate malnutrition, varying from 45% for deaths due to measles to 61% for deaths due to diarrhea( Mercedes et.al ,2004). It is estimated that 53 percent of deaths among pre-school children in the developing world including Ethiopia are due to the underlying effects of malnutrition on diseases such as measles, pneumonia, and diarrhea (Mercedes, 2004). Ethiopia had a very high level of undernourishment in 2006-08, the latest period available; 41 percent of the total population was undernourished. The number of undernourished decreased from 1990-92, benchmark period of the WFS and MDG, to 2000-02 while the proportion of undernourished decreased from 1990-92 to 2006-08 (FAO, 2011). According to Ethiopian Demographic Health survey, 29 % of children among 6-59 months of age was underweight (have low weight-for-age), and 9 % are severely underweight (EDHS, 2011). About two in five children in sub-Saharan Africa (38%) are underweight, 10.5% of the children are wasted (2.2% are severely wasted) and 46.5% of the children are stunted that half of them are severely stunted (WHO, 2011). In Oromia region prevalence of child malnutrition indicated that 41 % of the children are stunted with 21.8 sever stunting, 9.6% of the children are wasted (2.4 % severe wasting) and34.4% are underweight with 11% severe underweight (EDHS, 2010). Malnutrition among young children is one of the most widely used indicators of the extent and severity of a humanitarian crisis. There is a long history of its application in famine situations, refugee crises and complex emergencies dating back to the 1960s (Davis et el, 1992). Since that, time approaches and methods have been developed and standardized to such an extent that acute malnutrition has become one of the most standardized and reliable indicators used in emergencies (Davis et el, 1992). Food insecurity in 2011 further threatened more than 250,000 children who suffer from severe acute malnutrition (Ocha, 2011). Shortages of clean water contributed to outbreaks of acute watery diarrhea, measles and malaria,
  • 2. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 2 which were exacerbated by poor access to health services, particularly in Afar and Somali regions. Drought also led to 87,000 school dropouts and closure of more than 300 schools, primarily in Afar, Oromia and Somali regions (Ocha, 2011). According to the 2011 EDHS, the under-five mortality rate was 88 per 1000, stunting prevalence was 44.4%, and underweight prevalence was 28.7%. These rates have decreased quite a bit in the past decade, most notably with mortality almost halving. Additionally, at the current rate of 1.22 percentage points per year, Ethiopia is finally on track to meet the first Millennium Development Goal (MDG1) target of halving the number of underweight children under five years of age. However, Ethiopia still needs a concerted effort to accelerate reductions in under nutrition. Underweight is reflected by wasting, stunting, or a combination of the two, and therefore MDG1 can be achieved by decreasing the prevalence of either or both (Richard, 2011). In Ethiopia, stunting prevalence increases rapidly after six months of age through two years. Highlighting the need for more resources devoted to preventing under nutrition during the critical window from conception to two years of age (also known as the first 1000 days), after which it is almost impossible to recover from the developmental deficits (Hoddinott et el ,2008 & Alderman, 2006). In addition to the basic or environmental factors, multiple underlying factors contribute to child malnutrition. Along with disease, quantity and quality (in terms of nutrient adequacy) of diet are the most proximal (UNICEF, 1990). According to the 2011 EDHS, nearly half of infants less than six months of age are still not exclusively breastfed. Timely initiation of complementary foods remains low and the quality of older infants’ diets is extremely poor, with only 3% of children 6-23 months having a minimally acceptable diet and only 4% meeting the minimum dietary diversity threshold of four food groups. Despite of several national programmed the nutritional status of children remains almost same as of previous years. Lack of food is not the sole cause of child malnutrition among Guto Gida; there are many Socio- demographic factors, which seem to be important contributory factors in determining the nutritional status of children in rural areas. Hence, this study was under gone to investigate the prevalence of Stunting and its associated factors of children among 6-59 months age and to evaluate the association between dependent and independent variables. Statements of the problem In Ethiopia, child malnutrition rate is one of the most serious public health problem and the highest in the world. High stunting rates in the country pose a significant obstacle to achieve better child health outcomes. Stunting and Underweight rates among young children are the highest in sub-Saharan Africa. About 46.5% of the children are stunted out of them half of them are severely stunted (WHO, 2011). Other earlier studies in specific localities also indicated that prevalence of wasting; 12-13, stunting; 45-46.7 and underweight; 42-44 percents. In Oromia region prevalence of child undernourishment indicated that 34.4% are underweight with 11% severe underweight, 9.6% of the children are wasted (2.4 % severe wasting) and 41 % of the children are stunted with 21.8 sever stunting (EDHS, 2010). Tackling child malnutrition remains a pressing challenge that requires improved food security, behavioral and attitudinal changes and improvements to basic services. (Save the Children, 2012). Problems can be actually be inevitable when a certain activity is in place since the child mal nutrition is still the major public health problem in Ethiopia; it is believed to be influenced by some factors. This study was partly seeing problem associated with it. Hence, this research tried to answer the following questions: What are the associated factors of Child Stunting in Guto Gida District? To what extent prevalence’s of stunting and indicators child-malnutrition obtained at the study area? General objective The general objective of the study was to investigate the prevalence of Stunting and its associated factors among 6-59 months age in Guto Gida district, East Wollega Zone, Oromia, Ethiopia from March to June 2013. Specific Objectives To determine the prevalence of stunting at the study area. To identify associated factors of stunting among children 6-59 months age in the study area. Material and Methods Descriptions of study Area This study was conducted independently in Guto Gida District; East Wollega Zone located at about 328 kilometers far from Addis Ababa possessing a total area of 901.80 km2 and provided the baseline information to determine the impact of this population-based intervention on anthropometric indices. It is contiguous with Sibu Sire and Wayyu Tuka in the east, Sasiga, Digga and Benshengul Gumuz in the west, Gida Ayana, Abe Dongoro and Gudaya Bila in the north and Wayyu Tuka and Leka Dulecha to the south. It was divided in to 21 farmers associations and one urban center namely Nekemte. Regarding to a health facility in the district there are two health centers, 24 health posts under government ownership providing health services for the community. In addition, there are 11 clinics under private ownership. The numbers of government primary schools are 31 of which 15 are first cycle, 16 are second cycle, and there is one senior secondary school.
  • 3. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 3 Study designs A community based quantitative cross-sectional survey design was conducted to assess the prevalence of Stunting and its associated factors among children 6-59 months aged in Guto Gida district, Oromia regional state, western Ethiopia. In addition, the data designed to in well-structured way and anthropometry measurement taken. By conducting survey, the magnitude of child under nutrition and other nutritional status related condition identified. Sample size determination By using single proportion population formula, 29 percent of children among 6-59 months of age was underweight (have low weight-for-age), and 9 percent are severely underweight (EDHS, 2011), totally 38 % of underweight proportion were sampled with 95% confidence level, and 5% precision between sample and population parameter, with the addition of 10% for possible attrition, the following formula was used. n = (Z1-α/2)2 * p (1-p)/d2 =>n= (1.96)2 *0.38(1-0.38)/ (0.05)2 The optimum sample calculated 398, where α=5%=level of significance d = absolute precision=0.05 p = 0.38=population proportion n = determined children sample size Z= z -value corresponding to a 95% level of significance (Z1- α/2=1.96=reliability coefficient) Sampling Techniques and Procedures The study employed multi-stage sampling scheme using stratified, cluster sampling, simple random and systematic sampling. First, the study area was stratified, then clustered into four kebeles were randomly selected; one from urban and three from the rural kebeles considering agro ecological areas. Systematic sampling method applied to select study participants. The sample size ensures with a probability of 95% that the estimated prevalence will be within plus or minus 5% true prevalence. Using proportional allocation to the rural and urban based on population; 267(67%) samples from the rural kebeles and 131(33%) samples from the urban kebeles was selected by clustered, simple random sampling, and Systematic sampling method. Data collection methods The questionnaire was prepared based on reviewing different available literature and standard questionnaires that were already validated by EDHS (2011). It was modified to the local targeted community considering the study area culture, the norms and other contexts. Data was generated from both primary and secondary through different data collection methods (observation and questionnaires) and other health facility record reviews. Bilateral edemas of children were collected through observing by pressing with thump finger on both feet. The questionnaires translated from English to Afan Oromo, back to English by different person fluent in both languages, and have used to collect data. The quantitative data was collected using structured questionnaires and anthropometric measurements as well. Weight was measured with minimum clothing and no shoes using a Salter spring scale and beam balance in to the nearest of 0.1 Kg. Measurement of height (length) was done in a lying position with wooden board for children of age under two years (below 85 cm) and for children above two years stature was measured in a standing position in centimeters to the nearest of 0.1cm. Only children under 12.5 cm (proxy for 5 year) and over 65 cm (proxy for 6 month were questioned to ascertain age using detail season calendar. Some questions purposefully designed openly to seek the opinions of respondents for the qualitative component to triangulate responses obtained by the structured questionnaire on associate factors of child stunting among 6- 59 months age. MUAC offers the operational advantages of a simple, easily portable measurement device (the armband/ tape) and the use of a single cut-off for children 6-59 months of age (12.5cm) as a proxy for low W/H or wasting. MUAC has also been used as a screening device for pregnant women; because MUAC is generally a stable measure throughout pregnancy, it is used as a proxy of pre-pregnancy weight, and therefore an indicator of risk for low birth weight babies. One type of color-coded measuring tape, the Shakier strip, is made from locally available materials and is appropriate for illiterate/ innumerate workers; red signifies severe malnutrition, yellow is moderate malnutrition, and green signals adequate nutrition. MUAC was measured on left mid upper arm to the nearest 1mm and the result was recorded for children. Only bilateral edema was considered an indicator of sever acute malnutrition (kwashiorkor). Edema was assessed by applying medium thumb pressure on upper side of both feet for three seconds. It was diagnosed if a bilateral depression (pitting) remained after the pressure was released. Data Collectors Ten Health Extension Workers collected the data and three Health Officers took part in the supervision. Out of ten Healthy Extension Workers, four of them recruited from Healthy Extension trainees working for practical attachment. Those participants were involved on anthropometric measurement, data collection and supervising
  • 4. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 4 the enumerators. The data collection team was recruited based on familiarity with the study area, Afan Oromo language and interest to participate on the study. Recruitment done at the presence of community leaders and the head of the nearby health institutions after the study objective was briefly communicated with them. They trained for consecutive three days on the objective, contents and each contents of question. Data processing, analysis and presentation First, the data checked for completeness and consistency for data entry and cleaning. Then, it coded and entered in the computer using EPI-6 variables names. It has a program (Epi-Nut) to convert nutritional data into Z-scores of the indices; H/A, W/H and W/A taking age and sex into consideration using NCHS reference population standard of WHO, 2011. The data was analyzed SPSS version 17.0 programs and strata version eleven (11.0) for analysis; descriptive summary using frequencies, proportions, and cross-tabs used to present study results. P-value less than 0.05 considered as statistically significant. Odds ratios at 95% confidence interval were used to see the significance of the study and the strength of association between study variables. In addition, biviarate and multivariate logistic regression used to assess the association between the study variables and to control the possible confounding. Result analysis presentation by frequency, tables and ratios. Data Quality Control Five percent of the questionnaires were pretested in other place before the actual data collection. In addition, ten Health extension workers and three Healthy officers collected data. Training was given to data collectors and supervisors prior to the onset of data collection. Strictly, supervisors and principal investigator did supervision. The collected data reviewed and checked for completeness and consistency. Ethical Considerations The department of Nutrition and food science, school of graduate study, approved the study protocol and then by institutional ethical clearance review of Wollega University, Official letter of cooperation was written to Guto Gida districts administrations for permission. The nature of the study was fully explained to the study participants to obtain their oral informed consent prior to participation in the study and data was kept confidential. Informed consent was obtained from each respondent before interview. Results Socio-demographic characteristics Socio-demographic characteristics of child caregiver’s Agro-ecologically, about 0.26% of the study area was High Land, 46.74%midland and 53% was low lands, which were residents of the study population distributed in rural and urban. From March- June 2013, a total of 359 child caregivers were participated on this study from 398 proposed families. Considerably high proportions (81.17%) of the families or caregivers heads of the household were males and the rest 17.83% were females. Concerning the caregiver, about 148(43.4%) was 18-27years, the rest 27-37 years and above was 58.5%. A substantial proportion of the mothers in our sample never had any education. Accordingly, the illiteracy rate was lower among head of households of the cases 9.2% than the primary school 50.1% and secondary 30.6% and Diploma and higher 10%. With regard to their religion; 219(61%) were Protestants, 28.1% were Orthodox, 9.2% were Muslims and 1.7% were followers of other religion. Majority of the mothers (32.4%) of the cases were daily laborer, 31.5% were homemaker (with no occupation), 22.8% were farmer or merchant and the rest 48(13.4%) were. Monthly family income of less than 1000 ETB was higher in the cases 75.2% than 1000 -2000 ETB, 16.4% and those who earn greater than 2000 ETB, 8.4%, respectively. Regarding the farmlands of the respondents, about 10.3% caregivers possess no land, 45.4% have1-2 hectares, 42.3% have 3-5 hectare and 1.9% have greater than 5 hectares. In other way, about 18.9% have not livestock’s, 60.4% had less than five livestock’s and 20.6% have more than five livestock’s. A larger family size with the number of children 6-59 months noticed more frequently in the household of the cases 67.1% than those having 24-59 months were 32.9%.
  • 5. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 5 Table 1. Socio-demographic of the child caretakers in Guto Gida District, March-June, 2013 Variables , N=359 Categories Frequency(n) Percentage (%) Head of household Male 295 82.17 Female 64 17.83 Mother age 18-27 years 210 58.5 28-37 years 148 41 >37 years 1 0.3 Religion Protestants 219 61 Orthodox’s 101 28.1 Muslims 33 9.2 Others 6 1.7 Educational Background Illiterate 33 9.2 Primary school 180 50.1 secondary school 110 30.6 Diploma 33 9.2 Degree and above 3 0.8 Mothers occupation House wife only 113 31.5 Merchant or Farmer 82 22.8 Employed 48 13.4 Daily laborer 116 32.4 Children age 6-23 months 241 67.1 24-59 months 118 32.9 Monthly in come <1000 ETB 270 75.2 1000-2000 ETB 73 16.4 >2000 ETB 33 8.4 Agricultural Land Have no land 37 10.3 1-2 hectare 163 45.4 3-5 hectare 152 42.3 >5 hectare 7 1.9 Socio-demographic characteristics of Children Out of 398 children sample to be included in this study from march5/2013 to June6/2013, about 359 children were included in the final analysis making response rate of 90.2%. From the total 359 actively participated children, 189(52.6%) were males and 170 (47.9%) were female. According to age, group 221(61.6%) were 6month- 23 months and 138(38.4%) were age between 24-59 months of age. Place of delivery was at home for 151(36.7%) of the children and 261(63.3%) born at health center. Regarding the prevalence’s of stunting 150 (41.78%) of children were stunted, out of them 27.5% were severally stunted at the study area. With respect to reference category, <65% serious wasting of median weight for height children ,between 6-23 months were more than 28.13% were as children between 24-59 months were 19.77%, this implies that early toddlers were highly vulnerable groups. Table 2. Socio-demographic characteristics of Children, Guto Gida District, March-June 2013 Variable, N=359 Categories Frequency(n) Percentage (%) Child age 6-23 months 221 61.6 24-59 months 138 38.4 Birth weight <2.5Kg 102 28.4 2.5Kg-3.5Kg 186 51.8 3.5-4.2Kg 61 17 >4.2Kg 10 2.8 MUAC ≤11.5cm 142 39.6 ≥12.5cm healthy child 217 60.4 Height of child to age <65.8cm 95 27.5 65.8-74.7cm 150 41.8 >74.7cm 114 31.8 De-worming No 293 81.6 Yes 66 18.4 EBF Yes 350 97.5 No 9 2.5 Child sex Male 189 52.6 Female 170 47.4 Complete vaccine No 293 81.6 Yes 66 18.4 Place of delivery Home 227 63.2 Healthy center 132 36.8
  • 6. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 6 Indicators of child malnutrition a. Height for age From all respondents, about 112 (27.2%) were less than 65.8cm at 1 year age, the rest 171 (41.5%) between 65.8cm-74.7cm at 1year and 81.9cm at 2years was normal growth,129 (31.3)were less than cut-off point or 74.7cm at 2years and stunted. With respect to median weight to height, about 150 (41.78%) were less than 65% serious wasting of median weight for height. b. Birth weight Concerning childbirth weight, about 28.4% of children weight in the study was born low birth weight (2.5Kg cut-off point). From this 33.53% females and 23.8% were males, 186 (51.8%) at 2.5kg-3.5kg, 61 (17.0%) 3.5kg- 4.2Kg and 10 (2.8%) born with more than 4.2Kg. c. Mid-Upper Arm Circumference (MUAC) Out of enrolled 398 children, 217 (19.2%) measured MUAC≥12.5cm at 6-59 months with normal, 142 (39.6%) with MUAC≤ 11.5cm and less, meaning serious malnourished. Healthy conditions of children Concerning the healthy conditions of children, about 72.4% of the children visited health facility for illness care and did not take complete vaccine and 293(81.6%) children did not practice de-worming activities at all. Concerning diarrhea and vomiting, about 57.4% children had diarrhea just two weeks before this study was started study. Breathing problem from the enrolled children in this study constitutes 197 (54.9%) and 210 (51%) of children fever with loss of appetite, 171(47.6%) had constipation. Table 3. Healthy conditions of children, Guto Gida district, March-June 2013 Variable, N=359 Categories Frequency(n) Percentage (%) Loss of appetite No 178 49.6 Yes 181 50.4 Constipation No 171 47.6 Yes 188 52.4 Breathing problem No 197 42.6 Yes 206 57.4 Diarrhea &vomit No 153 42.6 Yes 206 57.4 Dermatitis No 222 61.8 Yes 137 38.2 History of mothers related to pregnancy Approximately 210(58.5%) of mothers gave their first birth between the age of 18-27 years, while 41.2% of them were between the age of 28-37 years and only 0.3% give birth to their first child at age of greater than 37 years. Regarding the ANC, almost all mothers (99.4) were attended ANC, while 0.6% did not. Table 4. History of mothers related to pregnancy, Guto Gida district, from March-June 2013 Variable, N=359 Categories Frequency (n) Percentage (%) Mothers age at 1st delivery 18-27 years 210 58.5 28-37 years 148 41.2 >37 years 1 0.3 Family planning No 17 4.7 Yes 342 95.3 Number of children 6-23 months 221 61.6 24-59 months 138 38.4 ANC No 2 0.6 Yes, at a month 357 99.4 Consume extra food during pregnancy Cereals & crops 271 75.5 Vegetables &fruits 63 17.5 Meats& poultry 3 0.8 Dairy & its products 16 4.5 Fats & sweats 6 1.7 Housing Quality A considerable high proportion (89.7%) of families or caregivers had house with the roof constructed from tin sheet, while the remaining 37(10.3%) of the family in this study area had house made of locally available grass.
  • 7. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 7 As far as the floor and wall of their house was constructed, about 324 (90.3%) were made of mad, while significant proportion (9.7%) of the house were cemented. Moreover, about 351(97.7%) of the family had separate kitchen, while the remaining 2.3% had no separate kitchen. Furthermore, approximately 97(27%) of the family owned pit ground latrine, while the remaining 262 (73%) uses toilet with the wall and floor made of cemented. Table 5. Housing quality of the study participants, Guto Gida district, March-June 2013 Variable, N=359 Categories Frequency (n) Percent(%) Owner of the house Private 291 81.1 Rent 68 18.9 Roof type Grass 37 10.3 Tin sheet 322 89.7 Wall and floors Mad 324 90.3 Cemented 35 9.7 Rooms available 1 room available 21 5.8 2 rooms available 139 38.7 3 rooms available 166 46.2 >4 room available 33 9.2 Toilet type Pit ground latrine 97 27 Cemented 257 71.6 Ceramic 5 1.4 Quality of water supply The present study also showed that, society at study area uses different types of water sources for consumption and other activities. For instance, about 81(19.7%) use river/lakes water, 23 (5.6%) consume ground water, 123 (29.9%) use well protected spring water and 162 (39.3%) use bono/line water). However, considerably highest proportion (83.8%) of the study population gets water from long. Table 6. Quality of water supply of the study participants, Guto Gida district, March-June 2013 Variable N=359 Categories Frequency(n) Percentage (%) Water source River/lake 91 22 Groundwater Well protected spring water 30 128 7.3 31.0 Bono/stand pipe 164 39.7 Sufficient water No 346 83.8 Yes 66 16.0 Time to fetch water 1-3 minutes 80 19.3 1-5 minutes 57 13.8 5-10 minutes 94 22.8 >10 minutes 181 43.8 Dietary History of children and caregivers As far as the dietary history of children and mothers were concerned, considerably high proportions (75.5%) were depends on cereals and crops based food. Moreover, about 17.5%, 4.5% were consuming vegetable and fruits, diary and its products respectively. Besides, very insignificant proportions (< 5.3percentage) had accessible to use meat and fish. Table 7. Dietary history of child and mothers, Guto Gida district, March-June 2013 Variables Categories Frequency Percentage (%) Stipple food pyramid Cereals & crops 271 75.5 Vegetables &fruits 63 17.5 Meats& poultry 3 0.8 Dairy & its products 16 4.5 Fats & sweats 6 1.7 Frequency of using meat and its derivatives Daily 12 3.3 3-4per week 7 1.9 once a month 26 7.2 Never 314 87.5 Eating fat and sweats Daily 1 0.3 3-4per week 383 91.9 once a month 6 1.7 Never 22 6.1
  • 8. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 8 Prevalence’s of Stunting As clearly indicated in table_8, about 27.5% of children were severe stunted, while high proportions (41.78%) of children were stunted. On the other hand, about 11.14% of children of age 24-59 months in the study were wasted, but children among 6-23 months age were 12.53% more wasted. Moreover, the proportions of severely underweight and underweight children in this study area were 28.7% and 39.6% respectively. Table 8. Prevalence of Stunting among 6-59 months of age, Guto Gida district,March-June 2013 Child ages Stunting Severe stunted Stunted 6-59Months 27.5% 41.78% Stunting of Children and Its Associated Factors In this study, child stunting and its associated factors among children 6-59 months age investigated in detail. However, there was significant deference seen between the prevalence has set by DHS in 2011 when compared with analysis of this particular study. The average time it would take in collection of fire wood and fetching drinking water were identified as the major factors associated with stunting in the study area. According to this study finding families with long hour travel for household consumable supplies of water and fire wood were two fold that their children became stunted in comparison with families who travel less hour. The reason may be that the long hour travel for the mother would diminishes the caring time for the child. This has also consistent with similar studies measuring the extended separation of children from their primary caregivers' detrimental factor to child survival (Mahgoub et al., 2006). The prevalence of wasting among children who did not have complete vaccine was 1.73 times higher than in those who received vaccines irrespective of the doses. Wasting in children of illiterate and primary school mothers was 50% times higher than in those children of mother who attended at least secondary and above (table 9). Children born at home were 63.3%, which was 1.9 higher than at health center. Wasting was higher in children born at home than in those born at health centers (AOR=1.7, 95%CI: 1.23-1.90). Underweight showed significantly high association (P<0.01) with children of mothers who did not take extra food during pregnancy and lactation, house holds monthly income less than 1000.00ETB and lack of house quality and insufficient water supply. In this study the biviarate analysis showed that mothers age, staple food pyramid, birth weight of child, MUAC of child, previous exclusive breast feeding, complete vaccine, and de-worming have significant association with wasting (P<0.01). whereas child age, height of a child, number of children, child sex, constipation and breathing problem have no association with wasting of child (P>0.05). After bivariate analysis those predictors which showed statistical significance were used to run multivariate analysis. In multivariate analysis lack of complete vaccine, low birth weight, and staple food pyramid have showed also association with wasting of child (P<0.01).On multivariate analysis, loss of appetite, previous breast-feeding, did not showed significant association with wasting of child. On the other hand, anthropometric data analysis also showed that, considerably high proportion (38.8%) of children were seriously malnourished (MUAC≤11.5cm). MUAC of a child have strong statistical association with wasting of children (P<0.001). In multivariate analysis those children their MUAC <11.5cm were significantly wasted when compared to the children who had MUAC ≥12.5cm (AOR: 1.76, 95%CI: 1.48-1.98). Marginal Percentage (19.2%) of children MUAC≥12.5cm for age 6-59 months normal, 38.8%marginal percentage <11.5-12.5cm was serious mal nutrition, 42% was MUAC≥12.5cm healthy child. In multiple logistic analyses, lack of complete vaccine of children was strongly associated with wasting. Those children did not take complete vaccine were 1.73 times more likely to be wasted (AOR=1.73, 95%CI: 1.20-1.97) than those who took the complete vaccine. Table 9. Bivariate and Multivariate Logistic Regression analysis of factors associated to Wasting, Guto Gida District, Oromia, Ethiopia, March-June2013
  • 9. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 9 N=359 Categories Wasting COR (95% CI) AOR. (95% CI) P-value No Yes Child age 6-23 months 151 101 1 1 1.00 24-59 Months 86 71 1.175(0.76-1.81) 1.23(0.83-1.85) 0.463 Staple food pyramid cereals &crops 163 108 1 1 1.00 Veg. and fruits 31 32 0.666(0.49-0.92)* 1.28(1.24-6.84)* 0.012* Meats & poultry 1 2 0.771(0.144-4.13) 0.84(0.15-4.76) 0.797 Dairy &products 11 5 0.554(0.031-9.98) 0.50(0.03-9.6) 0.689 Fats and sweats 3 3 0.721(0.33-1.56) 1.59(0.23-11.0) 0.395 Mother age 18-27 years 113 97 1 1 1.00 28-37 years 95 53 0.291(0.164-0.52)* 1.14(1.09-1.86) 0.001*** >37 years 1 0 1 1 Birth weight <2.5KG 54 48 0.62(0.39-0.97)* 1.18(1.003-1.31)* 0.038* 2.5Kg-3.5Kg 117 69 0.769(0.533-1.11) 0.37(0.19-0.73)* 0.162 3.5-4.2Kg 33 28 1.034(0.28-3.76) 0.49(0.3-0.8) 0.959 >4.2Kg 5 5 1 1 1.00 MUAC >12.5cm 35 34 1 1 1.00 ≤11.5cm 83 59 1.70(1.22-1.93)* 1.76(1.48-1.98)* 0.001*** Height of child serious stunting <65.8cm at 1yrs 50 45 0.80(0.04-0.15) 1.10(0.75-1.515) 0.721 65.8-74.7cm age of 1/2-1yr 85 65 1 1 1.00 serious stunting <74.7cm at 2yrs 74 40 0.72(0.42-1.24) 1.17(0.88-1.56) 0.235 Loss appetite No 105 73 0. 67 (0.50-0. 91)* 1.249(0.65-2.38) 0.500 Yes 104 77 1 1 1.00 No children 6-23 month 134 107 1 1 1.00 24-59 month 5 3 1.066(0.64-1.79) 1.37(0.87-2.19) 0.808 De-worming No 172 121 0.69 (0.38-0.802)* 1.64 (1.25-2.47)* 0.041* Yes 37 29 1 1 1.00 EBF Yes 204 146 1 1 1.00 No 5 4 0.57(0.5-0.73)* 0.51(0.11-3.1) 0.513 Child sex Male 104 85 1 1 1.00 Female 105 65 0.99(0.63-1.54) 0.88(0.57-1.35) 0.953 Constipation No 103 68 1.12(0.595-2.38) 1.65(0.66-4.11) 0.73 Yes 106 82 1 1 1.00 Breathing problem No 117 80 1 1 1.00 Yes 92 70 0.84(0.40-2.38) 1.36(0.50-1.66) 0.635 Complete Vaccine Yes No 55 154 44 106 1 0.54(0.53-0.56)* 1 1.73(1.2-1.97)* 1.00 0.03* NB: Wasting is considered when there if < 65% of median age for height and otherwise. MUAC>12.5cm normal for1/2-5years, ≤11.5cm serious malnourished. AOR= Adjusted odds ratio, COR = Crude Odds ratio, * Significant at p<0.05, ** Significant association at p<0.01, strong association at p<0.001. OR=1 ,no statically significant, OR>1,risk factors, OR<1 protective In this study the biviarate analysis showed that both children age between 6-23 months and 24-59 months with
  • 10. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 10 MUAC of child have significant association with wasting (P<0.01). After bivariate analysis those predictors which showed statistical significance were used to run multivariate analysis. In multivariate analysis children age between 24-59 months with MUAC of child have significant association with wasting (P<0.001). On multivariate analysis, children age between 6-23 months with MUAC did not showed significant association with wasting of child. The finding of the study identified that MUAC of a child have statistical association with wasting of children (P<0.05).In multivariate analysis those children there MUAC less than 11.5cm were significantly odds of wasting compared to the children who had MUAC greater than 11.5cm (AOR: 1.76, 95%CI: 1.48-1.98). In multiple logistic analyses, lack of complete vaccine of children was significantly associated with wasting. Children who did not taken complete vaccine were 1.73 times more likely to be wasted (AOR=1.73, 95%CI: 1.20-1.97) than those have taken complete vaccine. As the tables shows most of respondents are below severe stunting and moderate. Out of 359 participated children in this study, 69(19.2%) were measure greater than 13.5cm at 6-59 months with normal, 142 (39.6%) with MUAC≤ 11.5cm , meaning serious malnourished and 173(42%) with MUAC >12.5 cm was health child. The Marginal Percentage (19.2%) of children MUAC≥12.5CM for age 1/2-5 years normal, 39.6%marginal percentage was ≤11.5cm serious mal nutrition, 41.2% was MUAC≥12.5cm healthy child. The dependent variable has only one value observed in 40 (58.8%) subpopulation as the anthropometric data nut children software calculate from the given coded data. There are wasting among children between 6-23 months and 24-59 months seen clearly from the analysis. In this study, the proportion of underweight was significantly higher among children 24-59 months age than 6-23 months age of Guto Gida children. Table 10. Final logistic regression to predict wasting by MUAC with age, in Guto Gida district,2013 Response Child age Categories No Yes COR AO R P-value 6-23 months >65%w/ht <65%w/ ht 24 26 106 63 1 0.76(0.38-0.28)* 1 1.16(0.76-1.81) 1.00 0.463 24-59 months >65% w/ ht<65%w/ ht 11 8 66 53 1 0.50(0.54-0.66)* 1 1.05(1.00-1.17)* 1.00 0.004* NB: Wasting is considered when there if < 65% of median age for height and otherwise. AOR= Adjusted odds ratio, COR = Crude Odds ratio, * Significant at p<0.05. OR=1 ,no statically significant, OR>1,risk factors, OR <protective From the total number of children at study area when referred to wasting children among 6-23 months age 221 greater than 65% median weight for height and138 were 24-59 months were with 65% median weight for heights, 150 (41.78%) below standard meaning that wasting were seen. In this study the biviarate analysis showed that mothers age, staple food pyramid, age of child, mothers ANC have significant association with wasting (P<0.01). After bivariate analysis those predictors which showed statistical significance were used to run multivariate analysis. In multivariate analysis Vegetables and fruits from staple food pyramid, Mothers age and ANC with age of child have showed also association with wasting of child (P<0.01). The finding of the study identified that ANC of a child have significant statistical association with wasting of children (P<0.002). In multiple logistic analyses, lack of ANC of mothers was strongly associated with wasting. Those children whose mothers did not take ANC were 1.17 times more likely to be wasted (AOR=1.17, 95%CI: 1.06-1.38) than those who took the ANC.
  • 11. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 11 Table 11. Final logistic regression to predict wasting by age category, Guto Gida , March-June 2013 Child age Categories Wasting No Yes COR AOR P-value 6-23 months Mother age 18-27 years 80 62 1 1 1.00 28-37 years 52 27 0.291(0.164-0.52)* 1.69 (1.14-1.86)* 0.001* 24-59 months Mother age 18-27 years 33 35 1 1.00 28-37 years 43 26 0.051(.42-1.00) 0.55(0.42- 1.05) 0.129 6-23 months food items Cereals& crops 115 70 1 1 1.00 Veg.& fruits 10 15 0.666(0.49-0.92)* 1.28(1.24-6.84)* 0.012* Meats & poultry 1 2 0.771(0.144-4.13) 0.84(0.15-4.76) 0.797 Dairy & prod. 4 2 0.554(0.031-9.98) 0.50(0.03-9.6) 0.689 Fats &sweats 2 0 0.721(0.33-1.56) 1.59(0.23-11.0) 0.395 24-59 months Food items Cereals& crops 48 38 1 1 1.00 Veg.& fruits 21 17 0.228(0.67-0.92)* 0.67(0.15-4.76) 0.066 Dairy & prod. Fats &sweats 2 7 3 0 0.00(0.144-0.41) 0.003( -.58 -.02)* 0.42(0.03-9.6) 0.059* 0.59(0.23-11.0) 0.999 No 1 0.385(0.16 -0.54)* 1.13(1.06-1.81)* 0.012* 6-23 months ANC Just at month 132 89 1 1 1.00 24-59 months ANC No 1 0 0.39(0.16 -0.524)* 1.17(1.06-1.38)* 0.002* Just at a month 76 61 1 1.00 N.B: Wasting is considered when there if < 65% of median age for height and otherwise. AOR= Adjusted odds ratio, COR = Crude Odds ratio, * Significant at p<0.05 In this study the biviarate analysis showed that age of child has significant association with wasting (P<0.01). After bivariate analysis those predictors which showed statistical significance were used to run multivariate analysis. In multivariate analysis, and 24-59 has showed association with wasting of child (P<0.01). On multivariate analysis, age of child 6-23 did not showed significant association with wasting of child. The finding of the study identified that age of child with 6-59 months have significant statistical association with wasting of children (P<0.05). In multiple logistic analyses, age of children with 24-59 months has strongly associated with wasting. Those children between 24-59 months of age were 1.05 times more likely to be wasted than 6-23 months age (AOR=1.05, 95%CI: - 1.00-1.17) (table-12). The result of finding concerning the standard deviations is less than-2SD international median stunting. With respect to age group children between 6-23 months were -1.3 to 1.8SD and 24-59 months age were measure between -2.2 to 1.7SD (table_12). This implies that, acute malnutrition (Wasting) below minus two standard deviations from the median weight for height of the standard reference population, (UNICEF, 2011). Table 12. Final logistic regression Model to predict stunting of children by age category in Guto Gida District, from March to June 2013 Stunting Yes No Yes Child age 6-23 months Count 72 90 59 Std. 1.8 -0.2 -1.3 24-59 Months Count 23 60 55 Std. -2.2 0.3 1.7 N.B: Yes= (serious stunting <65.8cm at 6-59 months), No= (65.8-74.7cm at age of 6-59 months), Yes (serious stunting <74.7cm at 2years&above) respectively.
  • 12. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 12 Most of the indicators related to the children themselves were significantly associated to the severity of malnutrition. Children between 24-59 months age were characterized by severe acute mal nutrition meaning that standard deviation (SD) less than two. For instance, female children are less likely to be either malnourished or severely malnourished than male children are. Stunting in children with low birth weight were 1.18 times higher (41.78% prevalence) (AOR=1.18, 9%CI: 1.003-1.31) than those children with average birth size. Finally, this study result presented that children with multiple diarrheas and vomiting significantly suffer from malnutrition, which suggests that children in larger families in the study area face increased competition for scarce nutritional resources. Furthermore, the mothers’ characteristics, especially educational attainment particularly on child and maternal nutrition, are important for reducing malnutrition. When a mother has some primary-level education, the severity of the child’s undernourishment was significantly reduced. It should also be noted that the size of the education variables increases with higher maternal educational attainment. A mother’s attainment of a secondary or higher level education significantly reduces the severity of her child’s malnutrition compared to the severity of malnutrition for a child whose mother either attained some secondary-level education or graduated from primary school than illiterate family. Discussion The study reveals that stunting is a problem in Guto Gida District, where by it affects children among 6-59 months age as measured .Inadequate intakes of energy and essential nutrients may compromise growth & development to an extent, which may have lasting consequences. Stunting gets worse as the children grow older. The energy and nutrient density of the complementary foods are low as the foods were prepared from a limited number of local staple cereals without the addition of sugar, fat/oil or animal products. However, in most relatively wealthy community where a wide variety of foods are available, growth and development usually occurs quite satisfactorily without detailed dietary advice. An important consideration is that eating habits determined in childhood may be important determinants of chronic disease in later life. Prevalence’s of Stunting In the study area, child stunting was one of the most bottlenecks of public healthy to alleviate poverty. This indicates that the prevalence’s of stunting and its associate factors among children 6-59 months age in Guto Gida District, Oromia Regional state, Ethiopia shares the magnitude of national stunting. Prevalence of child stunting is the percentage of children among 6-59 months whose height for age (stunting) is more than two standard deviations below the median for the international reference population ages 6-59 months. For children up to two years old height is measured by recumbent length. For older children height is measured by stature while standing (WHO, 2006). Low-birth weight babies are newborns weighing less than 2,500 grams, with the measurement taken within the first hours of life, before significant postnatal weight loss has occurred. Wasting prevalence is the proportion of children under five whose weight for height is more than two standard deviations below the median for the international reference population ages 6-59 months (WHO, 2006). Ethiopia has a high prevalence of acute and chronic malnutrition, with almost half of Ethiopian children chronically malnourished and one-in-ten children wasted and two out of five were underweight. About 47% of children under-five were stunted, 11% were wasted and 38%were underweight (DHS, 2011). Child malnutrition increases with the age of the child, and the peak age is between 6 and 24 months of age. The stunting z-scores are the outcomes of the ratio of height over age minus the median of the reference population and the standard deviation of the reference population Stunting two standard deviations and below - 3SD is severe stunting. (Bhalotra and Rawlings, 2010). The result of finding concerning the standard deviations is less than plus or minus 2SD international median stunting. With respect to age group children between 6-23 months were -1.3-1.8SD and 24-59 months age were measure between -2.2-1.7SD. There was very high prevalence of wasting, diarrhea and vomiting, under standard measures of MUAC and low birth weight in the study area alarming to increased risk of death to children. It signifies acute malnutrition problem due to illness and/or recent food shortage. As consequence high chronic malnutrition also signifies children's failure to grow; influence both physical and mental capacity of the affected children and reduce productivity power in the future. Still trend of stunting significantly high when compared to the magnitude of wasting 11% and underweight 38% (9% severe and 29%were moderate) which were predicted by EDHS in 2011.Similarly the prevalence of wasting and underweight in Guto Gida District from March-June 2013 were 11.14% and 39.69% respectively. Because the area were survey taken community had members of newly lunched who were migrated (mobility problem) from Hararge Zone. Estimated family monthly income per day was 11.11ETB (Ethiopian birr), which was below poverty line (1.25USA dollar), was 75.2%. The quality of water was also one of the bottlenecks of child mal nutrition at study area. The likelihood of being stunted were increased across age category of 6-23 months through age category of 24- 59 months (AOR=1.05, 95%CI:1.00-1.17), while there was slight increment at the age category of 24-59 months by 1.05 times in reference to the age category of 6-23 months. In general both the descriptive and multivariable logistic regression analysis revealed that child stunting were increased by the increase of child
  • 13. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 13 age though the increases not learner with its pattern. This finding has also supported by (Wagsaff , 2003; and Van de Poel, 2007). This might be due to start of complementary food, which may affect the child in exposing for risk of external contaminates. Similarly as the age increase, the replacement of breast-feeding with solid food will progressively increase. On the other hand, the quality and the frequency of feeding were being matched with the type and frequency of feeding of the adults in family. This increases the likelihood of consuming contaminated foods and removes the protection provided by breast milk and children start playing at outdoor the unsanitary environment, which exposes them to infections. The study revealed that children whose birth weight were perceived as below average were 1.18 times more likely exposed for risk of stunting than children whose birth weight were perceived as average and above. This finding was in line with many other findings reported that the negative relationship of birth weight to stunting (Rayhan and Khan, 2006, ORC and CSA, 2006, Willey et al., 2009). This indicates the importance of adequate nutrition in utero through proper feeding of mothers (Victora et al., 2008). Therefore, the unmeasured factors of maternal nutritional status could be one of the reasons for the child to be born as low birth weighted and consequently exposed for stunting. Analysis of prevalence of severe malnutrition conditions by child age group point out that severe stunting is higher in children aged 24-59 months, which indicates that the children are already in the state of being stunted because of cumulative effect of the risk factors. Associated Factors of Child Stunting In this study, the birth weight of the child was included as one of the possible explanatory variables for the malnutrition. Even though it is best to get the exact measurement of the childbirth weight, it was difficult such important data because of the great majority of delivery was at home. Therefore, this variable was estimated as per the perceived mother's weight of their child at birth. Based on this data the study revealed that children whose birth weight were perceived as below average were 1.9 times more likely exposed for risk of stunting than children whose birth weight were perceived as average and above. This finding was in line with many other findings reported that the negative relationship of birth weight to stunting (Rayhan and Khan, 2006, ORC and CSA, 2006, Willey et al., 2009). This indicates the importance of adequate nutrition in utero through proper feeding of mothers (Victora et al., 2008). Therefore, the unmeasured factors of maternal nutritional status could be one of the reasons for the child to be born as low birth weighted and consequently exposed for stunting. The findings of this study revealed that the livestock size owned by family were negatively associated with stunting of the children in the study area. The reason for this might be that the availability of especially milk cow benefits the child in diversifying its food variety. This were also widely accepted that livestock serves as a major component of food security system in farming community (FAO, 2004a). The finding of this study showed that the association between the food usually given to children and stunting were significant. Children, who were regularly given with variety of food like cow milk, fruits and vegetables were 17.5% less likely stunted than children who regularly provided with single type of food like porridge of cereals or food that prepared for adult family members. Feeding mixed food type to less than five ages of children was used as a proxy to diet quality and was found to be negatively and significantly related with stunting. A significant proportion of children who were feed with porridge from cereals and a food that served for adult, as a weaning food, were found to have been stunted possibly because of the low nutrient content. The findings of previous empirical studies were consistent with the current findings (de Onis et al., 2001, Engebretsen et al., 2008). Similar to association of the type of food this study revealed that the negative association between frequency of meal served for the child and stunting. The risk of being stunted for children who received food for three and more times per day was 21% less likely than children who obtain food for less than three times per day. It is obvious that children need frequent but small amount per meal than adults to get the required nutrient amount per day. Therefore the less frequent meal serving family due to lack of resource, lack of child caring time or lack of awareness would increase the likely hood of their child stunted. This finding was also consistent with (de Onis et al., 2001). Children from a family whose landholding size were less than 0.5 hectare were four fold times more likely stunted as compared with children whose family had more than or equals to 0.5 hectare of agricultural land. This finding was not consistent with the pervious study (Melkie, 2006). The possible explanation for this finding could be variation in size of land means a variation in level of income, which in turn implied variation in quantity and quality of available resources for the family. This could also create a significant variation in the nutritional status of the children who were the prime vulnerable for the problem. This study finding revealed that stunting had strong negative association with annual income of the family. The descriptive analysis of this study showed that the population who were involved in producing cash crop was as high as 84.8% this also diminishes the allocated land size for crop production( for their staple food). As a result they were prone to purchase of different cereals and other food items in a nearby market. Therefore, increased annual income would at least guarantee to purchase their food demand given the current uncertain market price.
  • 14. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 14 The finding of this study were also consistent with other previous findings which showed the negative relationship between family income and stunting (Mahgoub et al., 2006, Melkie Edris, 2007) The finding of this study indicates the positive association between stunting and having larger family size. This finding was in contrary to what (Measta et al., 2008) findings of the negative association between malnutrition and larger family size which indicated the larger size as an opportunity for the mother in getting substitute care givers for her child. But the possible reason for the current finding of positive association were, as the number of family member increase, the available resource for the family obtained from the small land holding will diminishes. Similarly, it would be possible to relate that increased size of the family in Ethiopia implies the increased dependency ratio, which further burden for the typical households (CSA, 2008). The result of this study revealed that the livestock size owned by family were negatively associated with stunting of the children in the study area. The reason for this might be that the availability of especially milk cow benefits the child in diversifying its food variety. This were also widely accepted that livestock serves as a major component of food security system in farming community (FAO, 2012). The finding of this study showed that the association between the staple food pyramid usually given to children and stunting were significant. Children, who regularly provided with single type of food like cereals and crops that prepared for adult family members were stunted. Consuming mixed food type to 6-59 months of children was used as a proxy to diet quality and was found to be negatively and significantly related with stunting. A significant proportion of children who were feed with cereals and crops that served for adult, as a weaning food, were found to have been stunted possibly because of the low nutrient content. The findings of previous empirical studies were consistent with the current findings (de Onis et al., 2001, Engebretsen et al., 2008). Similar to association of the type of food this study revealed that the negative association between frequency of meal served for the child and stunting. The risk of being stunted for children who had not received meats and it derivative per a month or never was 87.5% higher than children who obtained meat. It is obvious that children need frequent but small amount per meal than adults to get the required nutrient amount per day. Therefore, the less frequent meal serving family due to lack of resource, lack of child caring time or lack of awareness would increase the likely hood of their child stunted. This finding was also consistent with (Engebretsen et al., 2008, Onis, 2001). Children from a family whose landholding size were less than 0.5 hectare were four fold times more likely stunted as compared with children whose family had more than or equals to 1-2 hectare of agricultural land. This finding was not consistent with the pervious study (Melkie, 2006). The possible explanation for this finding could be variation in size of land means a variation in level of income, which in turn implied variation in quantity and quality of available resources for the family. This could also create a significant variation in the nutritional status of the children who were the prime vulnerable for the problem. This study finding revealed that stunting had strong negative association with annual income of the family. The descriptive analysis of this study showed that the population who were involved in producing raw food materials was as high, but not in mechanized way. As a result, they were prone to purchase of different cereals and other food items in a nearby market. Therefore, increased annual income would at least guarantee to purchase their food demand given the current uncertain market price. The finding of this study was also consistent with other previous findings, which showed the negative relationship between family income and stunting (Mahgoub et al., 2006, Melkie Edris, 2007). Some community members said that, recently there was a failure of crop products to provide adequate foods and affected income of the households to purchase food items. Common staple food of the area is also cereals and crops that cannot provide nutritious food particularly for children as compared to food pyramid. In addition, there is inadequate child caring practices mainly on child nutrition. Both biviarate and multivariate logistic analysis indicated that low birth weight, lack of balanced diet as of food pyramid and housing quality, water quality are some associate factors of stunting, underweight and wasting. In addition, in binary logistic analysis, maternal lack of education and socio-economic status were found significant predictors of stunting. In multiple logistic analyses, for example age of children with 24-59 months has strongly associated with wasting. Those children between 24-59 months of age were 1.05 times more likely to be wasted (AOR=1.05, 95%CI: 1.00-1.17) than those who took the complete vaccine. This report also indicated that biological factors; child’s age and mother’s character sticks and social economic factors; dietary history; water quality, household wealth and mother’s education, are important associated factors of a child’s nutritional status. Moreover, the analysis of prevalence of serious malnutrition conditions by child age group point out that severe wasting are higher in children among 6-59 months, which indicates that the children are already in the state of being wasting and stunting because of cumulative effect of the risk factors. This study was supported by on prevalence of undernourishment and the impact of some socioeconomic- demographical, health and nutrition care characteristics on the nutritional status of under two years old children of rural Bangladesh in 2012.
  • 15. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 15 Interventions aimed at reducing child malnutrition in populations like the one reported in this paper should attempt to include all children among 6-59 months in the community to elucidate clearly the impacts of associate factors of undernourishment. Investments in child health and in particular child nutrition have a potentially high pay-off for the long-run development of the individual and of the society. It is important to understand if and to what extent nutritionist development can contribute to improvements of children’s nutritional status. In particular, it is unclear whether overall child nutrition reaches those who are in need. Due to sum-script and proximity of the Nekemte town, Guto Gida is on cross road to different regional states, zones, districts, and its tremendous agricultural resources, has a good opportunity to be a center of Agro-tourism and potentials for agro-diversity. The area has potential of commercial coffee production and conducive climate for other investment. Whatever the ecology of area is comfortable for agriculture for food security even for the MDG, the society still not reacts on food insecurity. In general, there is a need to intersectional collaboration to address the basic, immediate and intermediate causes of child malnutrition in Guto Gida Districts. Annual income of family, lack of education on child nutrition, childcare practice, lack of adequate water and quality house, not taking ANC and complete vaccine were negative association with stunting in the study area. The inter relationship of one factors to the other can contribute for child stunting in one or the other ways. Conclusions Depending on facts of the study, it can be concluded that; child stunting or chronic mal nutrition problem is highly observed in Guto Gida District. There was significant relation seen between Socio-economic status, House and Water quality, Children Healthy condition, Child and caregivers characteristics, Maternal Care, dietary history of child and mother, household food intake, and public healthy practice and dependent one. Both biviarate and multivariate logistic analysis indicated that low birth weight, lack of balanced diet as of food pyramid and housing quality, water quality are some associate factors of stunting, underweight and wasting. It may help the policy planners to develop strategies to combat different forms of malnutrition by targeting the vulnerable groups. Thus, it needs intersectional collaboration to address the basic, underlining and immediate causes of child under nutrition. Regarding the socio-economic variables in multivariable analysis, annual income has great significance negative association with all three indicators (stunting, underweighting and wasting) of malnutrition in the study area. Finally, it can be concluded professional that most households in the study area were illiterate, had low income, consumed cereals and crops, had not get quality water, had low nutritional information, majority of children did not taken Rota viral vaccine(de-worming activities). Therefore, it is a time to tickle child stunting, which is a silent killer of the community. Recommendations Based on the finding of the results the following recommended as a researcher: Managing Malnutrition through community mobilization to improve access to safe and adequate water supply, child nutrition, adopting American food pyramid, housekeeping, and mothers care practices were advisable. Collaboration of women and children affaires offices with rural technology expansion institute, agricultural and forestry offices need to avail technologies that suite the rural society in minimizing the amount of fuel to be consumed per each food preparation. The quality and quantity of food intake, generally accepted as being crucially important in the rehabilitation of the malnourished children (For example blended glucose-protein food, Lakadama or blended honey with red teff bread and medical species), since some of them were newly launched at the study area. It is crucial for the Healthy Institutions to coordinate different sectors and community leaders to influence the caregivers and the head of household in giving due attention for proper using of food pyramids and childcare practices, done by Healthy extension workers de-worming activities two wise a year and encouraging taking complete vaccine. Intervention initiatives should focus on improving agricultural mechanization, household food security; aware entrepreneurship, Kaizen and nutrition education. References Abebe Gebremariam, 2004. Family health lecture note for health extension trainees in Ethiopia, Jimma University. Alderman, H., S.M. Appleton, L.J. Haddad et al., 2003. ”Reducing Child Malnutrition: How Far Does Income Growth Take Us? World Bank Economic Review Vol 17. Alemu Mekonnen, Nicola Jones and Bekele Tefera.,2012. Tackling Child Malnutrition in Ethiopia:Do the Sustainable Development Poverty Reduction Programme’s underlying policy assumptions reflect local realities? Young Lives Save the Children UK.
  • 16. Food Science and Quality Management www.iiste.org ISSN 2224-6088 (Paper) ISSN 2225-0557 (Online) Vol.29, 2014 16 Benson T., 2005. Improving nutrition as a development priority: Addressing under nutrition within national policy processes in sub-Saharan Africa. Washington, DC, USA: International Food Policy Research Institute. Bhutta ZA. et al.,2008. What works Interventions for maternal and child under nutrition and survival. The Lancet, 371(9610):417-440. Black R. et al.,2008. Maternal and child under nutrition: global and regional exposures and health consequences. Central Statistical Agency,2004. Welfare Monitoring Survey 2004. Addis Ababa: Central Statistical Agency. Central Statistical Agency,2005. Ethiopia Demographic and Health Survey. Addis Ababa: Central Statistical Agency. Central Statistical Agency,2011. Ethiopian Welfare Monitoring Survey, 2011. Summary Report. Addis Ababa: Central Statistical Agency. Central Statistical Agency,2012. Ethiopia Demographic and Health Survey. Addis Ababa: Central Statistical Agency. Central Statistics Agency,2007. Population projection (2012) according to the Ethiopia Census. Chiwara, R.M,2011. National Nutrition Programme/MDG-F Joint Programme. Christiansen L. & Alderman, H., 2001.Child malnutrition in Ethiopia; Can maternal knowledge augment the role of income? ; Africa region working paper series. Cogill B., 2003. Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, D.C. Crowther J, 1999. Oxford Advanced Learner’s Dictionary of Current English. Fifth edition. Oxford: Oxford University Press. David, L.P. and Edward, A.F,2003. Changes in child survival are strongly associated. Davis, B et al., 2012. ‘Evaluating the impact of cash transfer programmes in sub-Saharan Africa: an introduction to the special issue’, Journal of Development Effectiveness, 4:1, 1-8. Domellof, Magnus.,2011. Iron requirements in infancy. Annals of nutrition & metabolism. 2011 Jan;59(1):59-63. EDHS, 2011. Central Statistical Agency Addis Ababa, Ethiopia ICF International Calverton, Maryland, USA March 2012. EDHS, 2011. Demographic and Health Survey, Preliminary Report. Ethiopia;. Available ICF Macro Calverton, Maryland, U.S.A. Edris M.,2007. Assessment of nutritional status of preschool children of Gumbrit, North West Ethiopia. Emergency Nutrition Network (ENN)., 2011.Government Experiences of scale-up of Community Based Management of acute Malnutrition (CMAM),HOH, Ethiopia. Engebretsen I, Tylleskar T, Wamani H, Karamagi C, Tumwine J, 2008. Determinants of infant growth in Eastern Uganda: a community-based cross-sectional study. BMC Public Health. 8(1):418. FAO, WFP and IFAD, 2012. The State of Food Insecurity in the World 2012. Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition. Rome, FAO. Getahun Z,2001. A: Review of the status of malnutrition and trends in Ethiopia. Ethiopian Journal of Health Development, 15(2):55-74. Haddad, L., E. Kennedy, and J. Sullivan.,1994. Choice of indicators for food security and nutrition monitoring. Food Policy 19 (3): 329-343. Hoddinott J, Maluccio JA, Behrman JR, Flores R, Marmoreal R.,2008. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet; 371: 411–16. Horton, S., H. Alderman and J. A. Rivera. ,2008. “Hunger and Malnutrition” Copenhagen Consensus 2008 Challenge Paper. Ibrahim Kasirye,2010. What are the successful strategies for reducing malnutrition among young children in East Africa? Human Development Research Paper, UNDP, 2010/15. Kenneth Harttgen, Stephan Klasen, and Sebastian Vollmer,2012. Economic Growth and Child Undernutrition in Africa Medhin G, Hanlon C, Dewey M, Alemu A, Tesfaye F, Worku B,Tomlinson M and Prince M., 2010. Six and twelve months in Butajira, Ethiopia: The P-MaMiE Birth Cohort. BMC Public Health, 10:27. Mekonnen A, Jones N, Tefera B.,2005. Tackling child malnutrition in Ethiopia: do the sustainable development poverty reduction programme's underlying policy assumptions reflect local realities? In Working paper no 9. London: Young Lives, Save the Children UK. Mekonnen, Y and Mekonnen, A., 2002. Utilization of Maternal Health Care Services in Ethiopia, MeasureDHS, ORC Macro. Melkie Edris, 2004. Nutrition Lecture note for health extension trainees in Ethiopia, Gondar University. Mercedes, 2004. Estimates of Global Prevalence of Childhood Underweight in 1990 and 2015. Ocha,2011. “United Nations Office for the Coordination of Humanitarian Affairs, ‘Humanitarian Bulletin: Weekly humanitarian highlights in Ethiopia”, Geneva and New York ,Addis Ababa, July 2011, p. 13.
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