Date Published: June 10, 2019
Publisher: Public Library of Science
Author(s): Kidanemaryam Berhe, Omer Seid, Yemane Gebremariam, Almaz Berhe, Natnael Etsay, Iratxe Puebla.
In 2014, 159 million under 5 year-old children were stunted (suffered chronic undernutrition) worldwide. Identifying risk factors for stunting among 6 to 24 month-age children in Mekelle City is important for evidence-based interventions.
Case-Control study design was undertaken in 330 children, from January to February 2016. World Health Organization (WHO) anthropometric software and statistical package for social sciences version 20 were used for analysis. Logistic regression analysis was applied.
The following were identified as risk factors for stunting: mother’s lack of formal education (adjusted odds ratio (AOR = 6.4)), mother height less than 150cm (AOR = 4.2), mother with a body mass index less than 18.5 kg/m2 (AOR = 3.8), childbirth weight less than 2.5kg (AOR = 5.3), household with two and above under-five children (AOR = 2.9), a WHO diet diversity score < 4 (AOR = 3.2) and repeated diarrheal episodes (AOR = 5.3). The factors associated with stunting among children aged 6 to 24 months are no formal education in mother, mother height less than 150cm, low BMI of the mother, low birth weight, low WHO DDS, number of under 5 children in the household and repeated diarrheal episodes. Nutritional interventions should give emphasis to maternal education, maternal nutrition, childbirth weight, family size, diet diversity, and diarrheal diseases.
Stunting is a measure of chronic undernutrition and it is measured by length or height for age standard deviation score (z-score) . In 2014,159 million under 5-year-old children were stunted worldwide. More than half of all stunted under-five children lived in Asia (57%) and more than one third lived in Africa (37%). Africa was the only region where the number of stunting among under five-year-old children increased over the past decade. By 2020 stunting prevalence in Africa is estimated to reach 40% with 70.2 million children affected . The consequences of stunting in children are broad and include high morbidity and mortality, display of less exploratory behavior, higher anxiety, depression, poor health, adult short stature, chronic diseases later in life, poor intelligent quotient (IQ) level, poor cognitive function, and poor school achievements [3, 4].
The study was conducted after approval from the college of health sciences research review committee, Mekelle University. An official letter was taken from the school of public health to Tigray Regional Health Bureau and health facilities. Permission from Tigray Regional Health Bureau, Mekelle sub city health offices and health facilities were obtained. Informed consent was taken and all data were handled confidentially. The right of the participants to withdraw at any time was respected. There was no procedure that could put the participant on risk and these all were explained before interviewing using the local language (Tigrigna). Mothers or caregivers were counseled on child and maternal nutrition, sanitation, and hygiene practices.
In this study maternal formal education was found to be associated with child stunting. The proportion of mothers with no formal education was higher in cases group (stunted children) compared to the controls group (AOR = 6.4; 95% confidence interval (CI): 2.02, 24.6). A similar finding was observed in studies conducted in Ethiopia, Northeastern Brazil, Myanmar, Indonesia, Bangladesh (Dhaka City), Palestine, Libya, Medebay Zana woreda, shire indasilassie (Tigray Region), Urmia (Northwest of Iran) [8,10,11,12, 16,17,18,19, 20,21,22] in which mother educational status was found to be associated with child stunting. Giving attention to children, good care practices, utilization of accessible health care services are influenced by maternal educational level which in turn affects stunting and other health-related issues. Maternal education influences the preparation, procurement, and selection of nutritious foods for themselves and their children. Moreover, maternal education increases women’s knowledge and attitude to act on new information related to nutrition and health .
The factors associated with stunting among children aged 6 to 24 months are no formal education in mother, mother height less than 150cm, low BMI of the mother, low birth weight, low WHO DDS, number of under 5 children in the household and repeated diarrheal episodes. Nutritional interventions should give emphasis to maternal education, maternal nutrition, childbirth weight, family size, diet diversity, and diarrheal diseases.