Accepted Manuscript

Under nutrition status and associated factors among Under-Five Children, Tigray,
Northern Ethiopia
Mussie Alemayehu, MPH/RH, Fitiwi Tinsae, MSc, Kiday Haileslassie, MSc, Oumer
Seid, MSc, Gebremedhin G/egziabher, MSc, Henock Yebyo, MSc
PII:

S0899-9007(15)00081-7

DOI:

10.1016/j.nut.2015.01.013

Reference:

NUT 9473

To appear in:

Nutrition

Received Date: 15 July 2014

Revised Date:

25 November 2014

Accepted Date: 25 January 2015

Please cite this article as: Alemayehu M, Tinsae F, Haileslassie K, Seid O, G/egziabher G, Yebyo H,
Under nutrition status and associated factors among Under-Five Children, Tigray, Northern Ethiopia,
Nutrition (2015), doi: 10.1016/j.nut.2015.01.013.
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Under nutrition status and associated factors among Under-Five Children, Tigray, Northern Ethiopia

Mussie Alemayehu MPH/RHa*, Fitiwi Tinsae MScb, Kiday Haileslassie MSca, Oumer Seid
MSca , Gebremedhin G/egziabher MScb, Henock Yebyo MSca

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a Department of Public Health, Mekelle University, Mekelle, Ethiopia

b Department of Nursing, Dr. Tewolde College of Health Sciences, Mekelle, Ethiopia

*Corresponding author

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P.O.Box:1871
Mobile: +251914749082

MA: mossalex75@gmail.com
KH: hkiday@gmail.com
FT: messi.fit@gmail.com
OS: seoumer@yahoo.com
GG:gebremedhingebretsad@gmail.com

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HY:henokyebyo@yahoo.com

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Email address:

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Abstract
Objective: The aim of this was to assess the nutritional status and associated factors among
under five children in Medebay Zana District, Northern Ethiopia.
Methods: A community based cross sectional study was conducted in Medebay Zana district
from September 8-29/2013. A two stage cluster sampling technique was employed to select 605

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under five children. Descriptive, binary and multiple logistic regression analyses were performed
using SPSS version 20.0.

Result: The level of stunting was 56.6%, underweight 45.3% and wasting 34.6%. Children from

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mothers attending high school [AOR=0.75, (CI of 95% 0.09, 0.85)], providing priority food to
father [AOR= 4.32, (CI of 95% 2.10, 9.05)] and use of unprotected sources of water [AOR=
2.13, (CI of 95% 1.09, 4.14)] were predictors of stunting. In wasting, children who initiate

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breastfeeding within 1-3 hrs [AOR=4.06, (CI of 95% 1.77, 9.33)], mothers who had power to
decide use of money [AOR= 0.09, (CI of 95% 0.02, 0.51)] and children who breastfeed for 12-23
months [AOR=0.07, (CI of 95% 0.01, 0.40)] were predictors of wasting. Moreover, in
Underweight, female children [AOR=1.84, (CI 95% 1.25, 2.69)], initiation of breastfeeding after
6 hrs [AOR= 12.94, (CI of 95% 4.04, 41.49)] and children with mothers who had power to

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decide use of money [AOR=0.33, (CI of 95% 0.15, 0.74)] were predictors of underweight.
Conclusion: The under nutrition status among under five children was high. Childrens age
group, time initiation of breastfeeding, sex of the child, source of water, parents educational
status, type of food used for starting of complementary feeding and power of deciding money

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could have an influence in under nutrition of under five children.

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Key word: Under nutrition, Stunting, Underweight, Wasting, Medabay Zana, Tigray, Ethiopia

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Introduction
Under nutrition is usually the result of a combination of inadequate dietary intake and infection
[1,2,3]. In children, under nutrition is synonymous with growth failure in which the
malnutrtioned child is shorter and lighter than they should be for their age, had high risk of
developing physical and mental impairment and finally ends with death [1, 2]. Worldwide over

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10 million children aged less than five years die annually from preventable and treatable
illnesses. Almost all these deaths occur in poor countries including Ethiopia. Currently, 195
million under-five children are affected by under nutrition; 90% of them live in sub-Saharan
Africa and South Asia [4]. Nutritional status of under five children in Ethiopia is alarming:

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almost above half (53%) of the under-five mortality rates can be attributed directly or indirectly
to under nutrition [5]. The Ethiopian Demographic Health Survey (EDHS, 2011) report shows
that nearly one in two (44%) of Ethiopian under five children are being stunted, 10% wasted and

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29% underweight. According to the estimates, one in every 17 Ethiopian children dies before the
first birthday, and one in every 11 children dies before the fifth birthday [6].
Furthermore, having poor nutritional status of children becomes a common characteristics of
Ethiopian children, even though; the health sector has increased its efforts to enhance good
nutritional practices through health education, treatment of extremely malnourished children, and

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provision of micronutrients to the most vulnerable group of the population [6]. However, dealing
about nutritional status of children is crucial since the nutritional status of children today reflects
a healthy and productive generation in the future. And in the long-run it leads to an increase in
the strength of the labor force and thereby it contributes positively to the economic growth. Thus,

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a good nutrition is essential for healthy, thriving individuals, families and a nation [7]. Therefore,
the objective of this study was to assess the under nutrition status and associated factors among

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under five children in Medabay Zana district.

Methods
Setting and study design

A community based cross-sectional study was conducted in the Medebay Zana District from
September 8-29/2013. The total population of the area is 130,623, with 17,934 children 6-59
months and it owns 2 health centers and 20 health posts [8]. Tigraway is the dominant ethnic
group in Medebay Zana. All children aged 6-59 months were considered as source population.
To determine the sample size, a single population proportion formula with the proportion of
stunting in Tigray region, 51.4% [6], a confidence level of 95%, and a 5% degree of precision,

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were used. A non-response rate of 10% was also added up. From this, the final sample size
calculated was 634. Two stage cluster sampling technique with design effect of 1.5 was used. On
the first stage, 4 kebeles were selected out of the total 18. Systematic random sampling was used
to select the study subjects. There total sample size was proportionally allocated to the selected
kebeles based on the available number of under five children. Based on the sample fraction,
children were selected at equal interval using systematic random sampling. Those who didnt

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fulfill the inclusion criteria were excluded and the next children fulfilling the criteria were
included. However, mothers of children who refused to participate were excluded from the study
without replacement.

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Data collection instrument and quality issue

Structured and pre-tested questionnaire, guided by the interviewer was used to collect the
information. The questionnaire was adapted from different literatures and considering the local

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situation of the study subjects [6 - 8]. It was first prepared in English and then translated to
Tigrigna and then translated back to English for consistency by two different language expert
individuals. Information collected included socio-demographic characteristics, child health and
caring practices, anthropometric measurement information and household information. Six
health extension workers who speak local languages were employed in the data collection
process. Two clinical nurses were selected as a supervisor. Training was given to the data

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collector and supervisor for two consecutive days on the objectives of the study, the contents of
the questionnaire, anthropometric measurement and particularly on issues related to the
confidentiality of the responses and the rights of respondents. One week prior to the data
collection a pre-test was conducted in another Woreda (Wukro Maray) on 5% of the sample size.

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Weight measuring scales were checked for accuracy and calibrated by using known weights
before we measuring the children. Standard techniques were used while measuring the weight

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and height of the children. For instance, length is measured in recumbent position in children < 2
years old to the nearest 1mm and for children > 2 years and adults in standing position to the
nearest 0.1 cm. An assistance of two people is needed in taking the measurement. Weight
measurement is performed to the nearest 10g and 0.1 Kg for children less than and greater than 2
years, respectively.
Data analysis
Data collected were cleaned, edited, coded, entered and analyzed by using SPSS for windows
version 20.0 (SPSS Inc. version 20.Chicago, Illinois). Weight, height and age data were used to
calculate Weight-for-Age, Height-for-Age and Weight-for-Height z-scores based on the WHO

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Anthro reference and categorize accordingly. Wasting refers to low weight-for-height < -2 SD of
the median value of the national center for health statistics (NCHS/WHO) international weight
for height reference. Severely wasted is defined <-3 SD. Stunting is defined as low height-forage at < -2 SD of median value of the NCHS/WHO international growth reference. Severely
stunted is defined as < -3 SD. Underweight is an index of weight for age represents body weight
relative to age. Underweight is defined as low weight for age at < -2 SD of the median value of

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the NCHS/WHO international reference. Severely underweight is defined as < -3 SD.

Descriptive and multiple logistic regression was used to estimate the respective indicators, and
effects of factors on the malnutrition (stunting, wasting and under weight) of the under five
children. Co linearity among independent factors was checked using VIF. The sample effect size

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was estimated using OR and the parameters were estimated using 95% confidence interval of the
OR. For all the analyses, P-value less than 0.05 was considered statistically significant.

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The study protocol was approved by the ethical committee of Mekelle University, College of
health science research and community service committee. Written consent was obtained from
the study respondents (care givers). The right of the respondent to withdraw from the interview
or not to participate at all was assured.
Result

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Socio-demographic and economic characteristics

A total of 605 under five children were included in the study with a response rate of 95.4%.
Majority of the children were males 297(49.4%) and had a mean of age 32.14 (17.29) months.
The participant was from a family who had an average of 5.44 (2. 19) and 1.68 (0. 62) family

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size and under-five children, respectively. The majority of the mothers 421 (70%) were illiterate,
house wife 562 (93.3%), orthodox followers 597 (99.3%) and married 569 (94.7%). Fathers were

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the head of household 509 (84.7%) and had the power to use the money 481 (80%). Five
hundred twenty (86.6%) earn a monthly income less than 26.1$ [Table1].
Nutritional Status of children
Out of the total children, 56.6% were found stunting, underweight 45.3% and wasting, 34.6%.
Moreover, severe malnutrition was found among the child stunting (22%), underweight (23.3%)
and wasting (12%).

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Factors associated with Stunting
Multiple logistic regressions showed that, attending ANC service during pregnancy, obtaining
counseling on EBF, having an animal, head of HH, and monthly income were not significantly
associated with stunting malnutrition. However, children from mothers attending high school
were less likely stunted as compared with children, their mother illiterate [AOR= 0.75, (CI of
95% 1.10, 12.85)]. Providing priority food to the father in the child's household was 4 times

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more likely stunted as compared with a family who had equal food distribution among family
member [AOR=4.32, (CI of 95% 2.10, 9.05)]. Fathers educational level was negatively
associated with having stunting children; primary school, high school and college were less
likely stunted [AOR= .041, (CI of 95% 0.23, 0.71)], [AOR= 0.30 (CI of 95% 0.10, 0.90)] and

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[AOR=0.14, (CI of 95% 0.03, 0.68)] respectively as compared illiterate fathers. Using
unprotected sources of water in the household of children were 2 times more likely stunted as
compared with those who got protected water [AOR= 2.13, (CI of 95% 1.09, 4.14)]. Stunting

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was more likely among children in the age group of 12-23 month and 24-35 months [AOR=2.
06, (CI of 95% 1.09, 3.95)] and [AOR= 4.01, (CI of 95% 1.87, 8.57)] as compared to age group
of 6-11 months. On the other hand, female childrens were less likely stunted [AOR= 0.47, (CI
of 95% 0.31, 0.72)] as compared to male children. Initiation of breastfeeding after 6 hrs d after
birth was 4 times more likely stunted as compared to initiation of breastfeeding within 1hr

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[AOR=4.34,(CI 95% 1.41, 13.34)]. Children in the family size of 10-13 person in a single
household were 12 times more likely stunted [AOR= 12.43, (CI of 95% 2.70, 57.26)] as
compared to household who had a family size of 2-5 [Table 2].

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Factors associated with Under Weight

Multiple logistic regression showed that the sex of the child, time of BF initiation after birth,
childs age group, having toilet household, power to use money in the household and type of

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food given at time of weaning were significantly associated with underweight. The analysis
showed that female children were 2 times more likely to be underweight as compared to male
children [AOR=1.84, (CI of 95% 1.25, 2.69)]. Initiation of breastfeeding after 6hrs after birth
were 13 times more likely underweight as compared with children who feed, breastfeeding
within 1hr [AOR= 12.94, (CI of 95% 4.04, 41.49)]. Children of household who didnt have toilet
was more likely underweighted as compared with toilet owner [AOR= 1.51, (CI of 95% 1.02,
2.23)]. Children in the age group of 12-23 months were 3 times more likely underweight as
compared to 6-11 months age group [AOR=2.58, (CI of 95% 1.37, 4.85)]. Children started
weaning with cereal gruel [AOR= 0.28, (CI of 95% 0.12, 0.61)] and porridge [AOR=0.36, (CI of

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95% 0.16, 0.81)] was less likely underweight as compared with children weaning with milk.
Children with mothers who had the power to decide the use of money was less likely
underweight [AOR= 0.33, (CI of 95% 0.15, 0.74)] as compared to fathers who had the power to
decide [Table 3].
Factors Associated With Wasting

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Multiple logistic regressions showed that, time of initiation BF after birth, the power to use
money in the household and duration of breastfeeding were significantly associated with wasting
of children. The analysis showed that child who initiate breastfeeding within1-3hrs and after 6
hrs of the child after birth were more likely wasted [AOR=4.06, (CI of 95% 1.77, 9.33)] and

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[AOR= 13.97, (CI of 95% 4.20, 46.41)] respectively as compared with children who initiate feed
breast milk within 1hr. The finding also showed that a household with mothers who had the

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power to decide to use money was less likely wasted [AOR= 0.09, (CI of 95% 0.02, 0.51)] as a
father. Children who breastfeed for 12-23 months were less likely wasted [AOR= 0.07, (CI of
95% 0.01, 0.40)] as compared with the duration of breastfeeding 6-11 months [Table 4].
Discussion

The prevalence for stunting, underweight and wasting in this study was 56.6%, 45.3% and
34.6%, respectively. Regarding information about severe under nutrition revealed that stunting

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was found in 22% of children, underweight (23.3%) and wasting (12%). The result of multi
variable logistic regressions indicates that, time of initiation BF after birth, power to use money
in household and duration of breastfeeding were significantly associated with wasting of

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children. Moreover, children from mothers attending high school, giving priority food to father
in the household, fathers educational level, source of water, sex of child, time of initiation of
breast feeding and age group of children were significantly associated with stunting. Finally, sex

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of the child, time of BF initiation after birth, childs age group, having toilet and power to use
money in the household, and type of food given at time of weaning were significantly associated
with underweight.

The poor nutritional status of children has been a serious problem in Ethiopia for many years [6].
Moreover, the latest reports of EDHS 2011, in Tigray regions revealed that, stunting (51%) and
sever stunting (22.4%) [6]. However, there is a still higher proportion of malnutrition stunting
(56.6%) and severe stunting (22%) in this study. This implies that the government should work
more on minimizing the chronic malnutrition problem through inter-sectoral collaboration so as
have a productive generation. Moreover, the health sector should increased its efforts to enhance

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good nutritional practices through health education, treatment of extremely malnourished
children, and provision of micronutrients to the most vulnerable group of the population, that is,
mothers and children. In addition, the Health Extension Program (HEP) has included nutrition as
part of their health package
This study revealed that the prevalence of underweight was 45.3%.And this was consistent with

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a study done West Gojam Zone Amhara region, reported that 49.2% [9].However, it was higher
as compared with a report of EDHS,2011(29%) and studies done in Gumbrit of Amhara region
(28.5%), and 38.3% four rural communities zones of Tigray region(38.3%) [6,10,11]. And this
is consistent with a study done m This difference may be due to the attribution of season

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variation in which the data of this study was collected in September-October when most rural
areas of the Ethiopian farmers have shortage of food during this season.

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The proportion of wasting in different studies ranges from 10-14.8% [6, 11, 12]. However, the
findings of this study reveled that high proportion of wasting (34.6%) and sever wasting
(23.3%).The possible reason for this huge difference might be due to season variation in which
the data collection of this study was from September October, when most rural areas have
shortage of food during this season. And in the EDHS 2011 report indicates that rural children
are more likely to be underweight (30 %) than urban children (16 %) [6].This implies that

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government should bring an alternative mechanism like expansion irrigation service for the
farmers to increase their food consumption and to reach food security.
A studies done in Gumbrit, West Gojjam and Pakistan [10, 12, 13] shown that male children

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were at higher risk of stunting than female children. Similarly this study revealed that female
children were less likely stunted [AOR=0.74, (C of I95% 0.31, 0.72)] as compare to males.

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These sex-related differences require further study. One report from Ghana suggested that boys
were more influenced by environmental stress [14]. This is also supported by the report of
EDHS, 2011 indicated that male children are slightly more likely to be stunted than female
children (46 % and 43%, respectively [6].
The mothers level of education generally has an inverse relationship with stunting levels. And a
report from EDHS, 2011 indicates that children of mothers with more than secondary education
are the least likely to be stunted (19%), while children whose mothers who did not have
education are most likely to be stunted (47%) [6]. This is also supported by our result showed
that children from mothers who attend high school educational level of mother [AOR=0.75, (CI

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of 95% 0.09, 0.85)] were less likely to be stunted and as compared with illiterate. However our
finding is contradict with as study done in Gumbrit, Amhara region [10].This might be due to the
fact that educational status has a direct impact on practicing of prevention aspect of disease as
well as lower fertility and more child-centered caring practices. So this implies that the
government should empowered women in education, employment and political areas.

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A study conducted in Ethiopia showed that household who drinks water from unprotected source
was associated with more stunted as compared with their counterparts [15]. The same is true in
this study in which children from household who drinks water from unprotected source were
more likely to be stunted [AOR=2.13, (CI of 95% 1.09, 4.14)] as compared with those family

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who got their water from protected source.

Children from families that used cereal-based complementary foods had statistically higher

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WAZ scores than those who did not [11]. The same was true in this result cereal gruel
complementary food used child was less likely underweight [AOR=0.28, (CI of 95% 0.12, 0.61)]
as compare cows milk user.

A study done in India showed that the prevalence of protein energy malnutrition (PEM) was
associated with family size; one (21.56 %), two (30.55%), three (36.28%) and four and above
(45.11%) [16]. This is also supported by our finding in which household who had a family size

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of 10-13 person per household were more likely to be stunted [AOR=12.43, CI of95% 2.70,
57.26)] as compared to 2-5 person in a household. This might be due to lack of food resources
(imbalance need and supply) of food in the household. This implies that the government should

mothers.

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work more on family planning by providing good method mix and appropriate counseling for the

Age of the children has different effect on the nutritional status (stunting and underweight) of the

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children. The prevalence of stunting increases as the age of a child increase [6, 17]. Moreover,
our study also supports this finding in which children with the age group of 12-23 and 24-35
months were more likely to be stunted as compared with children in the youngest age group of 611 months. This implies the government should create awareness of the community in which
malnutrition can occur at any age and in all aspect of the household. However, as the age of the
children increased there appeared a kind of decreasing trend in the level of underweight [6, 10,
18]. This may be explained by the fact that foods for weaning are typically introduced to children
in the older age group, thus increasing their exposure to infections and susceptibility to illness.
This tendency, coupled with inappropriate or inadequate feeding practices, may contribute to

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faltering nutritional status among children in these age groups. Different study revealed that there
is a relationship of age and underweight. The same result was obtained in this study; underweight
reach peak level during 12-23 months more likely underweight [AOR=2.58, (CI of 95% 1.37,
4.85)] as compared 6-11 months age children.
Early initiation of breast feeding within one hour is currently recommended for children to

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promote their nutritional status. The first liquid (colostrum) provides natural immunity to the
infant and .it also has an input in reduction of hypoglycemia and hypothermia which in turn have
a devastating effect on the health status of the infant [6]. Initiation of breastfeeding within one
hour after birth was associated with less stunted and underweight [17,18]. The same is true in

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this finding, initiation of breastfeeding after 6 hrs was more likely to be stunted [AOR=4.34, (CI
of 95% 1.41, 13.34)] and underweight [AOR=12.94, CI of95% 4.04, 41.49)] as compared with
initiated breast feeding within one hour after child birth.. This might be early initiation of

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breastfeeding is important for the child. This implies the health care providers should counsel
mother on early initiation of breast feeding.

Sex of the child has also different effect on the nutritional status of the children. Being male are
at high risk of developing stunting [10, 12, 13] and underweight [6, 14, 18]. Similarly this study

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revealed that female children were less likely stunted [AOR=0.74, (CI of 95% 0.31, 0.72)] as
compare to males. These sex-related differences require further study. One report from Ghana
suggested that boys were more influenced by environmental stress [14]. This is also supported by
the report of EDHS, 2011 indicated that male children are slightly more likely to be stunted than

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female children (46 % and 43%, respectively [6]. However, our finding is inconsistent in case of
underweight; Female children were significantly less underweight than male]. But in this study

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female children were more likely underweight [AOR=1.84, (CI of 95% 1.25, 2.69)] as compare
male children.

The study faces the following limitations: Since the study employ cross-sectional study it is
difficult to establish cause effect relationship. Respondent might have not told us real
information about their socio economic status, because of high dependency on the need to get
support. Some measurements may not be accurate due to subjective responses and recall biases.
Not including mothers nutritional factors in this study, because nutritional status of mother can
be influence child nutritional status.

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Conclusion
The under nutrition status among under five children was high. Time of initiation BF after birth,
power to use money in the household and duration of breast feeding could influence wasting of
children. Moreover, children born from mothers attending high school, Giving priority food to
father in the children household, fathers educational level, source of water, sex of child, time of

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initiation of breast feeding and age group of children could influence stunting of the children.
Finally, sex of the child, time of BF initiation after birth, childs age group, presence of toilet at
the household, power to use money in the household and type of food given at time of weaning

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could influence underweight of the children.

Acknowledgement
It gives us a great reputation and opportunity to thank University of Mekelle for financial support

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and our earnest thanks to study participants, data collector and supervisors who spent their

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valuable time responding to the questionnaire accordingly.

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Table 1: Socio-demographic and socioeconomic characteristics of study population, Medebay

Percent

297
304

49.4
50.6

100
136
80
84
201

16.6
22.6
13.3
14.0
33.4

597
4

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356
225
20

99.3
0.7

M
AN
U

180
197
212
12

RI
PT

Number

30.0
32.8
35.3
2.0
59.2
37.4
3.3
2.7
94.7
2.0
0.7

562
40

93.3
6.7

421
72
32
52
24

70.0
12.0
5.3
8.7
4.0

369
108
20
56
48

61.4
18.0
3.3
9.3
8.0

AC
C

16
569
12
4

EP

Variables
Sex of children
Male
Female
Age of children
6-11 months
12-23 months
24-35 months
36-47 months
48-59 months
Religion
Orthodox
Muslim
Mothers age
15-24 years
25-34 years
35-44 years
> 44 years
Family size
2-5 person
6-9 person
10-13 person
Mothers marital status
Single
Married
Divorced
Widowed
Mothers occupation
House wife
Governmental employee
Maternal education
Illiterate
Primary school
Junior high school
High school
College and above
Paternal education
Illiterate
Primary school
Junior high school
High school
College and above
Head of household

SC

Zana District, 2013

ACCEPTED MANUSCRIPT
509
92

84.7
15.3

481
120

80.0
20.0

520
81

86.6%
13.4%

AC
C

EP

TE
D

M
AN
U

SC

RI
PT

Father
Mother
Power to use money
Father
Mother
Monthly income of household
< 26.1$
>26.1$

ACCEPTED MANUSCRIPT
Table 2: Factors associated with stunting of under nutrition on selected variables, Medebay Zana
Wereda, 2013.
Multivariate
AOR (95%CI)

248 (72.9%)
36 (10.6%)
20(5.9%)
28 (8.2%)
8(2.4%)

173(66.3%)
36(13.8%)
12(4.6%)
24(9.2%)
16(6.1%)

1.00
0.70(0.42,1.15)
1.16(0.55, 2.44)
0.81(0.46, 1.45)
0.35(0.15, 0.83)*

1.00
0.61(0.31,1.23)
2.525(0.91, 6.99)
0.75(0.09,0.85)*
0.90(0.18, 4.51)

248(72.9%)
92 (27.1%)

221(84.1%)
40(15.3%)

1.00
2.05(1.36, 3.09)*

1.00
1.51(0.85, 2.68)

134(39.4%)
206(60.6%)

SC

139(53.3%)
122(46.7%)

1.00
1.752(1.26,2.43)*

1.00
1.55(0.96, 2.51)

60(23%)
44(17%)
157(60%)

1.00
3.41(1.94,5.99)*
2.723(1.69, 4.38)*

1.00
4.32(2.1,9.04)***
5.86(.09,11.08)

137(52.5%)
60(23%)
8(10.8%)
28(10.7%)
28(10.7%)

1.00
0.47(0.31, 0.73)*
0.89(0.35, 2.22)
0.59(0.34, 1.04)
0.42(0.23, 0.78)*

1.00
0.41(0.23, 0.71)**
1.02(0.34, 3.05)
0.29(0.10, 0.88)*
0.14(0.03, 0.68)*

208(61.2%)
132(38.8%)

117(44.8%)
144(55.2%)

1.00
0.52(0.37, 0.72)*

1.00
0.53(0.33, 1.85)

280(82.4%)
60(17.6%)

237(90.8%)
24(9.2%)

1.00
2.12(1.28, 3.50)*

1.00
2.13(1.09, 4.14)*

300(88.2%)
40(11.8%)

209(80.%)
52(20%)

1.00
0.54(0.34, 0.84)*

1.00
0.61(0.33, 1.13)

180(52.9%)
160(47.1%)

117(44.8%)
144(55.2)

1.00
0.72(0.52, 0.99)*

1.00
0.47(0.31, 0.72)***

104(30.6%)
80(23.5%)

81(31%)
72(27.6)

1.00
0.87(0.56,1.33)

1.00
1.674(0.955,2.932)

32(9.4%)
80(23.5%)
228(67.1%)
232(68.2%)
48(14.1%)
12(3.5%)
28(8.2%)
20(5.9%)

TE
D

AC
C

RI
PT

Bivariate
COR(95% CI)

EP

Mothers education
Illiterate
Primary school
Junior high school
High school
College & above
ANC service received
during pregnancy
Yes
No
Education on exclusive
breastfeeding
Yes
No
Food distribution in
household
Equal in all
Priority to father
Priority to child
Educational of father
Illiterate
Primary school
Junior high school
High school
College & above
Animal owner in
household
Yes
No
Sources of drink water
Pipe water/protected
Well water/not protected
Head of HH
Father
Mother
Sex
Male
Female
Time of BF after birth
Before 1 hr
1-3hrs

Stunted
Yes (%)
No (%)

M
AN
U

Variable

ACCEPTED MANUSCRIPT

M
AN
U

SC

RI
PT

4-6hrs
124(36.5%) 100(38.3)
0.97(0.65,1.43)
1.560(0.854,2.851)
After 6hrs
32(9.4%)
8(3.1%)
3.12(1.36, 7.13)**
4.34(1.41,13.34)*
Child age
6-11 months
48(14.1%)
52(19.9%)
1.00
1.00
12-23 months
80(23.5%)
56(21.5%)
1.55(0.92, 2.60)
2.06(1.08, 3.95)*
24-35 months
56(16.5%)
24(9.2%)
2.53(1.36, 4.69)**
4.01(1.87, 8.57)***
36-47 months
52(15.3%)
32(12.3%)
1.76(0.98, 3.18)
1.998(0.939, 4.251)
48-60 months
104(30.6%) 97(37.2%)
1.16(0.72, 1.88)
1.111(0.616, 2.002)
Household family size
2-5 person
208(61.2%) 148(56.7%) 1.00
1.00
6-9 person
116(34.1%) 109(41.8%) 2.85(0.93,8.69)
0.701(0.434, 1.133)
10-13 person
16(4.7%)
4(1.5%)
3.78(1.22, 11.59)** 12.43(2.70, 57.26)**
Household monthly
income
< 26.1 birr
300(88.2%) 221(84.7%) 1.00
1.00
26.1-76.3$
24(7.1%)
16(6.1%)
1.11(0.57, 2.13)
1.91(0.70,5.16)
>76.3 $
16(4.7%)
24(9.2%)
0.49(0.26, 0.95)*
2.03(0.55,7.49)
N.B *(P<0.05), ** (P<0.01) & *** (P<0.001), 1.00= reference category, 1$=19.64 ETB

AC
C

EP

TE
D

ACCEPTED MANUSCRIPT
Table 3: Factors associated with underweight under nutrition on selected variables Medebay
Zana District, 2013.
Under weight
Yes(%)
No(%)

Bivariate
COR(95% CI)

1.00
0.88(0.36, 2.73)

AC
C

EP

TE
D

M
AN
U

SC

RI
PT

Variable
Mothers occupation
House wives
264(97.1%) 297(90.3%) 1.00
Governmental worker
8(2.9%)
32(9.7%)
0.28(0.13,0.62)*
Time of breastfeeding
initiation after birth
Before 1hr
72(26.5%) 113(34.3%) 1.00
1-3hrs
68(25.0%) 84(25.5%)
1.27(0.82, 1.96)
4-6hrs
96(35.3%) 128(38.9%) 1.18(0.79, 1.75)
After 6hrs
36(13.2%) 4(1.2%)
14.13(4.82,41.36)*
ANC service received
yes
196(72.1%) 273(83%)
1.00
No
76(27.9%) 56(15%)
1.89(1.28, 2.79)*
Head of household
father
244(89.7%) 265(80.5%) 1.00
Mother
28(10.3%) 64(19.5%)
0.48(0.30, 0.77)*
Power to use money in
household
Father
240(88.2%) 241(73.3%) 1.00
Mother
32(11.8%) 88(26.7%)
0.37(0.24, 0.57)**
Toilet owner in household
Yes
152(55.9%) 213(64.7%) 1.00
No
120(44.1%) 116(35.3%) 1.45(1.043, 2.015)*
Food aid received
Yes
104(38.2%) 97(29.5%)
1.00
No
168(61.8%) 232(70.5%) 0.68(0.48, 0.95)*
Sex
Male
116(42.6%) 181(55%)
1.00
Female
156(57.4%) 148(45%)
1.65(1.19, 2.27)*
Child age(months)
6-11
40(14.7%) 60(18.2%)
1.00
12-23
76(27.9%) 60(18.2%)
1.90(1.13, 3.21)*
24-35
36(13.2%) 44(13.4%)
1.23(0.68, 2.23)
36-47
44(16.2%) 40(12.2%)
1.65(0.92, 2.97)
48-59
76(27.9%) 125(38%)
0.91(0.56, 1.49)
Commonly type of
complementary food
Cows milk
24(9.2%)
20(6.2%)
1.00
Cereal gruel
44(16.9%) 84(26.2%)
0.44(0.22, 0.88)*
Injera /bread
132(50.8%) 109(34%)
1.01(0.53, 1.92)
Porridge
60(23.1%) 108(33.6%) 0.46(0.24, 0.91)*
N.B *(P<0.05), **(P<0.01) & ***(P<0.00 , 1.00= reference category

Multivariate
AOR (95% CI)

1.00
1.68(0.99, 2.85)
1.14(0.69, 1.89)
12.94(4.04,41.49)***

1.00
1.16(0.71,1.90)
1.00
1.55(0.71, 3.35)

1.00
0.33(0.15, 0.74)**
1.00
1.506(1.016, 2.233)*
1.00
0.724(0.476, 1.103)
1.00
1.84(1.25, 2.69)**
1.00
2.58(1.37, 4.85)*
1.17(0.57, 2.42)
1.75(0.87, 3.51)
0.73(0.41, 1.32)

1.00
0.28(0.12, 0.61)**
0.75(0.35, 1.61)
0.36(0.16, 0.81)*

ACCEPTED MANUSCRIPT
Table 4 Factors associated with wasting of under nutrition of selected variables, Medebay Zana
district, 2013.
Multivariate
AOR (95% CI)

48(23.1%)
64(30.8%)
64(30.8%)
32(15.4%)

137(34.9%)
88(22.4%)
160(40.7%)
8(2.0%)

1.00
2.08(1.31, 3.29)*
1.14(.74, 1.78)
11.42(4.9,26.5)*

1.00
4.06(1.77, 9.33)**
0.92(0.41, 2.07)
13.97(4.20, 46.41)***

152(73.1%)
56(26.9%)

317(80.7%)
76(19.3%)

1.00
1.54(1.04, 2.28)*

1.00
2.25(0.99, 5.08)

188(90.4%)
20(9.6%)

321(81.7%)
72(18.3%)

184(88.5%)
24(11.5%)

SC

1.00
0.48(0.28,0.80)*

1.00
1.93(0.45, 8.31)

297(75.6%)
96(24.4%)

1.00
0.40(0.25, 0.66)*

1.00
0.09(0.02, 0.51)**

257(65.4%)
136(34.6%)

1.00
1.75(1.24, 2.46)*

1.00
1.51(0.81, 2.79)

341(86.8%)
52(13.2%)

1.00
0.55(0.30, 0.98)*

1.00
0.477(0.104, 2.18)

224(57.0%)
161(41.0%)
8(2.0%)

1.00
0.68(0.47, 0.97)*
2.55(1.01,6.39)*

1.00
0.57(0.30, 1.05)
1.31(0.07, 25.63)

8(3.8%)
200(96.2%)

53(13.5%)
340(86.5%)

1.00
3.90(1.82,8.37)*

1.00
1.93(0.49,7.67)

8(61.5%)
16(19.5%)
64(32.0%)
12(30.0%)

5(2.1%)
66(28.1%)
136(57.9%)
28(11.9%)

1.00
3.73(1.01,13.78)*
0.57(0.24,1.35)*
1.10(0.53,2.30)

1.00
0.07(0.01,0.40)**
0.31(0.07,1.50)
0.25(0.04,1.36)

108(51.9%)
100(48.1%)
192(92.3%)
16(7.7%)

TE
D

AC
C

RI
PT

Bivariate
COR(95% CI)

132(63.5%)
64(30.8%)
12(5.8%)

EP

Time of B/F initiation after

birth
Before 1 hr
1-3hrs
4-6 hrs
After 6hrs
ANC service received
Yes
No
Head of household
Father
Mother
Power of decide to use
money in household
Father
Mother
Toilet owner in household
Yes
No
EBF 1st 6 months
Yes
No
Household family size
2-5 person
6-9 person
10-13 person
Fever within 2wks
Yes
No
Total time of Breastfeeding
6-11months
12-23months
24-35months
36-47months

Wasting
Yes (%)
No (%)

M
AN
U

Variable

N.B *(P<0.05), ** (P<0.01) & *** (P<0.001)

1.00= reference category