The data set included 4,130 children in DHS conducted in 2005; 10, 285 children in 2011; and 9,449 children in 2016. Over the last decade, there has been a decline in the magnitude of anthropometric failures as Table 1 shows, the overall proportion of anthropometric failures among under-five children has been decreased from 53.5% (95% CI: 52.3, 55.5) in 2005 to 46.2% (95% CI: 45.5, 47.6) in 2016. When compared to conventional anthropometric indices CIAF identified more number of children who had one form of anthropometric failures, while conventional anthropometric indices underestimate the number of children with the nutritional problem (Table 2).
Table 1
Classification of children with CIAF and conventional indicators in Ethiopia (2005–2016).
Conventional categories
|
EDHS 2005
|
EDHS 2011
|
EDHS 2016
|
n = 4130
|
n = 10285
|
n = 9449
|
Wasting
|
484(10.5)
|
1052(9.7)
|
1033(10)
|
Stunting
|
2133(46.5)
|
4834(44.4)
|
3980(38.4)
|
Underweight
|
1761(38.4)
|
3122(28.7)
|
2488(24)
|
CIAF Total
|
2211(53.5)
|
5249(51)
|
4364(46.2)
|
Table 2
Distribution of children under five years according to the seven categories of CIAF classification of nutritional status, based on data obtained from three surveys (2005–2016) conducted in Ethiopia
CIAF categories
|
EDHS 2005
|
EDHS 2011
|
EDHS 2016
|
n = 4130
|
n = 10285
|
n = 9449
|
n (%)
|
n (%)
|
n (%)
|
A No failure
|
1919(46.5)
|
5036(49)
|
5085(53.74)
|
B Wasting only
|
98(2.4)
|
340(3.31)
|
398(4.21)
|
C Wasting + underweight
|
182(4.4)
|
391(3.8)
|
362(3.83)
|
D Wasting + stunting + underweight
|
167(4)
|
460(4.4)
|
357(3.77)
|
E Stunting + underweight
|
1023(24.7)
|
2083(20.2)
|
1477(15.61)
|
F Stunting only
|
585(14.2)
|
1836(17.8)
|
1606(16.9)
|
Y Underweight only
|
156(3.8)
|
139(1.4)
|
164(1.7)
|
CIAF (%)
|
2211(53.5)
|
5249(51)
|
4364(46.2)
|
Total (%)
|
100
|
100
|
100
|
Trends of anthropometric failure
Table 3 shows the trend in anthropometric failures among under-five children in Ethiopia based on the child and maternal background characteristics reports from 2005–2016 EDHS. The result indicated a long term trend in children presented with diarrhea in the last 2 weeks was associated with anthropometric failure among children in all the survey years. Among children in the sample reported having been sick in the 2 weeks preceding the survey, 50.1%, 56%, and 49.4% had an anthropometric failure in 2005, 2011, and 2016 respectively. Place of delivery was also associated with anthropometric failure in children. Results show that among children who were born at home, 57% in 2005, 54% in 2011, and 51% in 2016 had an anthropometric failure. Maternal BMI was significantly associated with anthropometric failure in children; among children who had low BMI mothers, 58.3%, 57%, and 54% in the respective survey years had one form of anthropometric failure as well. The proportion of children who had an anthropometric failure in rural areas was higher than in urban areas in all three years, at 57.4%, 54.3%, and 49.2% respectively. The proportion of children with anthropometric failure was highest among children in the poorest households and lowest among children in the richest households across all the survey years. Further, the prevalence of childhood anthropometric failures shows a variation across regions; in 2016, for example, the range was from 56.9% in the Afar region to 18.02% in the Addis Ababa region (Fig. 1).
Table 3
Bivariate analysis showing the proportion of children age 6–59 months who had anthropometric failures by child and maternal background characteristics, EDHS 2005, 2011, 2016
Variables
|
2005 EDHS
|
2011 EDHS
|
2016 EDHS
|
Pooled data
|
p-value/
percent
|
n
|
p-value/
percent
|
n
|
p-value/
percent
|
n
|
p-value/
percent
|
n
|
Sex of child
|
0.175
|
|
0.000
|
|
0.000
|
|
|
Male
|
54.99
|
1,075
|
52.79
|
2,539
|
47.9
|
2137
|
51.9
|
5751
|
Female
|
52.81
|
997
|
48.87
|
2,269
|
44.0
|
1890
|
48.5
|
5156
|
Age of child
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
0-5m
|
16.51
|
54
|
26.67
|
264
|
27.6
|
252
|
23.6
|
570
|
6-11m
|
41.86
|
162
|
34.28
|
327
|
31.5
|
300
|
35.9
|
789
|
12-23m
|
62.77
|
472
|
52.87
|
931
|
47.4
|
842
|
54.3
|
2245
|
24-35m
|
59.33
|
445
|
60.67
|
1,120
|
55.2
|
937
|
58.4
|
2502
|
36 and above
|
57.71
|
939
|
55.51
|
2,166
|
49.6
|
1696
|
54.3
|
4801
|
Had cough in last two weeks
|
0.033
|
|
0.100
|
|
0.088
|
|
|
|
Yes
|
50.08
|
1,753
|
52.53
|
1,018
|
48.0
|
696
|
50.2
|
3467
|
No
|
54.68
|
319 |
|
50.43
|
3,790
|
45.6
|
3331
|
50.2
|
7440
|
Had fever in last two weeks
|
0.727
|
|
0.000
|
|
0.008
|
|
|
|
Yes
|
53.32
|
377 |
|
54.62
|
1,028
|
49.4
|
620
|
52.4
|
2025
|
No
|
54.05
|
1,695
|
49.93
|
3,780
|
45.4
|
3047
|
49.8
|
8522
|
Had diarrhea recently
|
0.033
|
|
0.000
|
|
0.021
|
|
|
|
Yes
|
50.08
|
319
|
55.74
|
820
|
49.4
|
497
|
51.7
|
1636
|
No
|
54.68
|
1,753
|
49.96
|
3,988
|
45.6
|
3530
|
50.1
|
9271
|
Birth weight
|
0.037
|
|
0.002
|
|
0.000
|
|
|
|
Low < 2500
|
40.00
|
12
|
36.27
|
37
|
46.0
|
93
|
40.8
|
142
|
Normal > = 2500
|
22.59
|
54
|
22.60
|
174
|
30.4
|
480
|
25.2
|
708
|
Age of mother at first birth
|
0.117
|
|
0.000
|
|
0.000
|
|
|
|
< 20
|
54.95
|
1,549
|
52.19
|
3,560
|
47.8
|
3018
|
51.6
|
8127
|
20–34
|
51.18
|
520
|
47.38
|
1,232
|
41.4
|
1004
|
46.7
|
2756
|
35–49
|
50.00
|
2
|
62.50
|
10
|
25.0
|
5
|
45.8
|
17
|
Breastfeeding Initiation
|
0.080
|
|
0.031
|
|
0.155
|
|
|
|
Within an hour
|
53.92
|
957
|
48.46
|
1,720
|
43.8
|
1890
|
48.7
|
4567
|
After an hour
|
47.75
|
191
|
50.27
|
835
|
46.8
|
552
|
48.3
|
1578
|
After one day
|
52.00
|
182
|
52.73
|
657
|
195
|
42.9
|
49.2
|
1034
|
Place of delivery
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
Health facilities
|
28.80
|
106
|
31.39
|
382
|
35.8
|
995
|
31.9
|
1483
|
At home
|
56.60
|
1,937
|
53.67
|
4,362
|
50.8
|
2981
|
53.7
|
9280
|
Other places
|
57.14
|
28
|
62.37
|
58
|
49.5
|
51
|
56.3
|
137
|
Birth order
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
1st
|
48.53
|
627
|
46.43
|
1,579
|
42.3
|
1367
|
45.8
|
3573
|
3–4
|
55.90
|
597
|
53.00
|
1,380
|
45.3
|
1089
|
51.4
|
3066
|
5 and more
|
57.27
|
847 |
|
53.70
|
1,843
|
50.4
|
1571
|
53.8
|
4261
|
Residence
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
urban
|
32.58
|
172
|
32.94
|
499
|
31.8
|
512
|
36.0
|
1183
|
Rural
|
57.35
|
1,899
|
54.32
|
4,303
|
49.2
|
3515
|
53.6
|
9717
|
Household size
|
0.003
|
|
0.013
|
|
0.000
|
|
|
|
1–4
|
50.56
|
448
|
48.87
|
1,123
|
42.5
|
1008
|
47.3
|
2579
|
5–9
|
55.69
|
1,493
|
51.93
|
3,317
|
47.2
|
2752
|
51.6
|
1562
|
10 and more
|
47.79
|
130
|
48.20
|
362
|
48.5
|
267
|
48.1
|
759
|
Mothers BMI
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
Thin
|
58.27
|
511
|
56.99
|
1,410
|
53.7
|
1103
|
56.3
|
3024
|
Normal
|
53.87
|
1,490
|
50.38
|
3,206
|
45.9
|
2664
|
50.1
|
7360
|
Overweight
|
35.71
|
70
|
31.05
|
186
|
26.3
|
215
|
31.0
|
471
|
Mother educational level
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
No education
|
58.15
|
1,705
|
54.76
|
3,598
|
50.83
|
232
|
54.6
|
5535
|
Primary
|
47.36
|
296
|
45.67
|
1,097
|
42.43
|
2,834
|
45.0
|
1409
|
Secondary and above
|
24.82
|
70
|
23.06
|
107
|
25.33
|
961
|
24.4
|
379
|
Wealth index
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
Poorest
|
60.51
|
599
|
57.70
|
1,679
|
53.6
|
1682
|
57.3
|
3960
|
Poorer
|
59.83
|
429
|
56.89
|
995
|
51.8
|
794
|
56.2
|
2218
|
Middle
|
56.91
|
391
|
52.35
|
814
|
46.6
|
588
|
52.0
|
1793
|
Richer
|
53.19
|
358
|
49.58
|
772
|
40.4
|
446
|
47.7
|
1576
|
Richest
|
38.08
|
294 |
|
32.53
|
542
|
30.0
|
517
|
33.5
|
1353
|
Current marital status
|
0.424
|
|
0.095
|
|
0.895
|
|
|
|
Currently not in union
|
56.43
|
136
|
54.08
|
345
|
46.3
|
224
|
52.3
|
705
|
Currently in union
|
53.78
|
1,935
|
50.65
|
457
|
45.9
|
3803
|
50.1
|
6195
|
Preceding birth interval
|
0.001
|
|
0.000
|
|
0.000
|
|
|
|
≤ 24 months
|
60.88
|
445
|
56.02
|
1,014
|
51.4
|
892
|
56.1
|
2351
|
> 24 months
|
54.05
|
1,320
|
50.72
|
2,956
|
45.5
|
2407
|
50.01
|
6683
|
ANC visit
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
Yes
|
44.04
|
377
|
42.31
|
1,226
|
41.4
|
1690
|
42.6
|
3293
|
No
|
57.09
|
962
|
55.61
|
1,993
|
50.1
|
1010
|
54.3
|
3965
|
Source of drinking water
|
0.283
|
|
0.000
|
|
0.000
|
|
|
|
unimproved source
|
49.14
|
114
|
54.83
|
2,555
|
49.9
|
1710
|
51.3
|
4379
|
Improved source
|
52.84
|
1,154
|
47.04
|
2,232
|
43.5
|
2314
|
47.8
|
5700
|
No of children under five years in the household
|
0.225
|
|
0.012
|
|
0.000
|
|
|
|
1
|
51.02
|
425
|
51.05
|
1,556
|
42.7
|
1313
|
48.3
|
3321
|
2
|
54.38
|
633
|
51.94
|
2,314
|
49.4
|
1929
|
51.9
|
4876
|
3
|
50.60
|
211
|
47.84
|
876 |
|
43.9
|
755
|
47.4
|
1842
|
Husband/partner’s education
|
0.000
|
|
0.000
|
|
0.000
|
|
|
|
No education
|
58.43
|
821
|
56.45
|
2,749
|
52.02
|
2,069
|
56.6
|
5639
|
Primary
|
52.55
|
309
|
48.74
|
1,702
|
43.48
|
1,197
|
48.3
|
3208
|
Secondary and above
|
31.34
|
139
|
31.78
|
321
|
34.17
|
505
|
32.4
|
965
|
The spatial trend of childhood anthropometric failure in Ethiopia
The spatial autocorrelation analysis revealed the presence of statistically significant clusters at a 0.01, level of significance in each survey (Table 4). The spatial analysis indicates there were regional variations, with Tigray, Amhara, Afar, and Benishangul- Gumuz regions having a higher proportion of anthropometric failures, while the lowest proportion of anthropometric failures was observed in Addis Ababa and Gambella Regions consistently over time (Figs. 2, 3 and 4).
Table 4
Spatial autocorrelation analysis of anthropometric failure from EDHS (2005, 2011 and 2016).
Survey
|
Pick Clustering distance in meters
|
Observed Moran’s I
|
Expected Moran’s I
|
Z-Score
|
P-value
|
EDHS, 2005
|
133994.0909
|
0.494
|
-0.001919
|
14.49
|
< 0.01
|
EDHS, 2011
|
95786.7875
|
0.9102
|
-0.001754
|
28.79
|
< 0.01
|
EDHS, 2016
|
121812.8929
|
0.4474
|
-0.00094
|
14.63
|
< 0.01
|
In the 2005 EDHS, all zones in Addis Ababa, Harari, and Dire Dawa were significantly clustered with a low prevalence of anthropometric failures (negative Z-score and Gipvalue < 0.05). Three zones in Oromia region (Jimma, Horo Guduru and West arsi) and three zones in Somali region (Liben,Afder and fafan) and four zones in SNNP region (Yem, Woliyta, Dawro and Sidama and West arsi) nine zones in Amhara region (Awi/agew, Oromia, North Shewa, North Gonder, South Gondar, West Gojjam, East Gojjam, North wollo, and South wollo ), and Southern zone in Tigray region were significantly clustered with a high prevalence of anthropometric failures (Positive Z-score and Gipvalue < 0.05). The rest of the zones were not significantly clustered with either low or high prevalence of anthropometric failures (Fig. 2).
Figure 3 shows the spatial variation of anthropometric failures at zonal level in 2011 EDHS. The spatial analysis shows that a statistically significant high proportion of anthropometric failure was found in northern parts of the country (Amhara, Benishangul-Gumuz, Tigray and Affar regions), whereas statistically significant low spots of anthropometric failure were found in the western (Gambella), central oromia, Addis Ababa and eastern parts of the country.
In the 2016 EDHS, hot spot (high risk) areas for childhood anthropometric failures includes six zones in Tigray region (North-Western, Western, Southern, Eastern, Central, and East). North Gondar, South Gondar, West Gojam ,East Gojam, awi/agew, North and South wollo of Amhara region. All zone of Afar region, Metekel, and Asosa of Benshangul Gumuz region and Liben and Afder of Somali region (Fig. 4).
Spatial scan statistics
In the 2005 EDHS, the spatial scan statistics identified a total of 6 significant clusters of anthropometric failures. Of these, one was most likely (primary cluster), the spatial window was located in Amhara and southern part Tigray regions centered at (11.529743 N, 38.342559 E) with 162.07 -km radius, a Relative Risk (RR) of 1.40 and Log-Likelihood (LLR) of 40.6, at p-value < 0.01 which was detected as the most likely cluster with Maximum Likelihood. It showed that children within the spatial window had 1.4 times more likely a higher risk of anthropometric failures than the children outside areas of the spatial window. Whereas the secondary clusters were located in SNNP, the southern part of Oromia, and the southern part of the Somali region (Fig. 5).
In EDHS 2011, the spatial scan statistics identified a total of 3 significant clusters of anthropometric failures. Of these, one was most likely (primary cluster), the spatial window was located Amhara, Tigray, and afar regions centered at (11.646140 N, 39.234715 E) with 264.4-km radius, a Relative Risk (RR) of 1.3 and Log-Likelihood (LLR) of 75.8, at p-value < 0.01 which was detected as the most likely cluster with Maximum Likelihood. It showed that children within the spatial window had a 1.3 times higher likelihood of anthropometric failure as compared to children outside the spatial window. Whereas the secondary clusters were located in the Benishangul region. Which was centered at (9.981136 N, 35.224095 E) with a 55.24-km radius and LLR of 12.2 at p-value 0.003. It showed that children within the spatial window had 1.37 times higher risk of anthropometric failures than children outside the window (Fig. 6).
In the 2016 EDHS, a total of 8 clusters were identified and four of them were significant clusters with p-value < 0.05. A total of 1236 locations/spots with a total sampled population of 2226 were found as primary cluster areas were identified using sat scan analysis with a p-value < 0.001. The primary cluster spatial window was located mainly in Amhara, Tigray, and afar regions centered at (11.626646 N, 39.666951 E) with 280.04 km radius, a Relative Risk (RR) of 1.3 and Log-Likelihood (LLR) of 58.48, at p-value < 0.001which was detected as the most likely cluster with Maximum Likelihood. It showed that children within the spatial window had a 1.31 times higher likelihood of anthropometric failures as compared to children outside the spatial window. Whereas the secondary clusters were located in Benishangul and the southern part of Somali regions (Fig. 7).
Spatial Interpolation
The kriging interpolation analysis mapped the estimated distributions of anthropometric failures interpolating the available data to the areas where data were not taken. From EDHS 2005 sampled data, the geostatistical analysis predicts that the highest prevalence of childhood anthropometric failures was detected in the Amhara and southern part of Tigray regions whereas, predicted relatively low anthropometric failures located in the Addis Ababa and central part of Oromia (Fig. 8 ). In 2011, Kriging interpolation revealed that the highest predicted prevalence of anthropometric failure was found in Amhara, Tigray, Afar, and Benishangul Gumuz regions. In contrast, predicted low anthropometric failure was detected in Addis Abeaba, the central part of Oromia, Harari, and Dire Dawa (Fig. 9). Based on EDHS 2016, Kriging interpolation predict that the highest prevalence of anthropometric failure was detected in the Amhara, the southern and central part of Tigray, and afar regions whereas, predicted relatively low anthropometric failures located in the Addis Ababa, central Oromia, and Gambella (Fig. 10).
Multilevel Analysis
Bi-variable multilevel logistic regression analysis was done to identify variables for multivariable multilevel logistic analysis and Variables with a p-value less than 0.2 were considered for multivariable analysis. In multivariable multilevel mixed-effect logistic regression analysis individual-level factors such as the age of the child, maternal BMI status, birth weight, initiation of breastfeeding, number of under-five children in the house, maternal and paternal educational level were a significant predictor of childhood anthropometric failure.
Children age between 6–11 months were 2.34 times (AOR = 2.34, 95%CI = 1.22–3.26), between 12–23 months 3.66 times (AOR = 3.66, 95% CI = 2.22–4.26), between 24–35 months 5.20 times (AOR = 5.20, 95%CI = 4.42–6.21), and above 36 months 4.12 times (AOR = 4.12, 95%CI = 3.11–5.22) more likely to develop anthropometric failures when compared with children age between 0–5 months. Children who had high birth weight were 25% (AOR = 1.25, 95% CI: 1.16–1.49) less likely to had anthropometric failure as compared with their counterparts. The odds of anthropometric failure for initiation of breastfeeding after an hour and after one day were 1.62 times (AOR = 1.62, 95%CI = 1.22–2.28) and, 1.51 times (AOR = 1.51, 95%CI = 1.06–2.11) higher as compared with breastfeeding initiation within an hour respectively. The odds of anthropometric failure of children born from mothers who had low BMI was 1.35 times higher than that of children born from normal BMI mothers. Children with mothers who completed primary and secondary education level were 18% (AOR = 0.82, 95% CI: 0.66–0.96) and, 23% (AOR = 0.77, 95% CI: 0.62–0.95), less likely to had anthropometric failures respectively as compared to those children whose mothers had no formal education. Similarly, children with fathers who completed secondary and above educational level were 25% lower (AOR = 1.51, 95% CI: 1.07–2.12) to had anthropometric failure as compared with those children whose fathers had no formal education (Table 5).
Table 5
Factors associated with childhood anthropometric failures in Ethiopia by multilevel logistic regression analysis, EDHS 2016
Variables
|
Model 2
AOR(95% CI)
|
Model 3
AOR(95% CI)
|
Model 4
AOR(95% CI)
|
Individual level factors
|
|
|
|
Child’s age(months )
|
|
|
|
0-5m
|
1.00
|
---
|
1.00
|
6-11m
|
2.52(3.22–5.11)
|
---
|
2.34[1.22–3.26]
|
12-23m
|
4.47(5.00-7.44)
|
---
|
3.66[2.22–4.26]
|
24-35m
|
4.22(5.00-7.25)
|
---
|
5.20[4.42–6.21]
|
Above 36 m
|
3.55(2.33–6.10)
|
---
|
4.12[3.11–5.22]
|
Birth weight
|
|
|
|
Low < 2500
|
1.00
|
---
|
1.00
|
High > = 2500
|
1.40(1.05–1.89)
|
---
|
1.25[1.16–1.49]
|
Initiation of breast feeding
|
|
|
|
Within an hour
|
1.00
|
---
|
1.32[1.16–1.54]
|
After an hour
|
1.42(1.12–1.56)
|
---
|
1.62[1.22–2.28]
|
After one day
|
1.33(1.1.88)
|
---
|
1.51[1.06–2.11]
|
No of children under-five in the house hold
|
|
|
|
1
|
1.00
|
---
|
1.00
|
2
|
0.74(0.66–1.4)
|
---
|
0.89[0.69–1.03]
|
3
|
0.85(0.73–1.01)
|
---
|
0.96[0.79–1.12]
|
Maternal BMI
|
|
|
0.92[0.51–1.23]
|
Normal
|
1.00
|
---
|
1.00
|
Thin
|
1.22[1.01–2.2]
|
---
|
1.35[1.01–1.95]
|
Overweight
|
1.77[1.42–3.2]
|
---
|
0.79[0.52–0.95]
|
Maternal educational level
|
|
|
|
No education
|
1.00
|
---
|
1.00
|
Primary
|
0.87[0.75–1.03]
|
---
|
0.82[0.66–0.96]
|
Secondary and above
|
0.66[0.36–1.03]
|
---
|
0.77[0.62–0.95]
|
Paternal educational level
|
|
|
|
No education
|
1.00
|
---
|
1.00
|
Primary
|
0.92[0.88–1.22]
|
---
|
0.96[0.82–1.12]
|
Secondary and above
|
0.74[0.59–0.95]
|
---
|
0.75[0.46–0.89]
|
Community level factors
|
|
|
|
Residence
|
|
|
|
Urban
|
---
|
1.00
|
1.00
|
Rural
|
---
|
1.42[1.02–1.88]
|
1.38[1.07–2.21]
|
Region
|
|
|
|
Dire Dawa
|
---
|
1.00
|
1.00
|
Tigray
|
---
|
5.35[4.65–8.01]
|
3.02[2.00-4.23]
|
Afar
|
---
|
1.45[1.05–2.01]
|
2.10[1.30–3.46]
|
Amhara
|
---
|
3.20[2.2–4.33]
|
4.65[3.22–5.35]
|
Oromiya
|
---
|
2.01[1.82–3.25]
|
2.01[1.52–3.15]
|
somali
|
---
|
3.05[2.11–5.02]
|
2.88[1.88–4.66]
|
Benishangul gumz
|
---
|
1.92[1.28–2.89]
|
1.96[1.42–2.84]
|
SNNP
|
---
|
1.23[1.00-1.67]
|
1.22[1.22–2.55]
|
Gambella
|
---
|
0.77[0.56–0.98]
|
0.67[0.37–0.95]
|
Harari
|
---
|
0.86[0.52–1.21]
|
0.71[0.46–1.20]
|
Addis Abeba
|
---
|
0.81[0.52-1.0.98]
|
0.57[0.37–0.89]
|
Community-level predictors for anthropometric failure.
In the multivariable multilevel logistic regression model place of residence and region of residence were significantly associated with childhood anthropometric failure.
Children from rural households had 38% higher odds (AOR = 1.38, 95% CI: 1.07–2.21) of anthropometric failure compared to children from urban households. The odds of childhood anthropometric failure in Tigray (AOR = 3.02; 95% CI: 2.00–4.23), Afar (AOR 2.10; 95% CI 1.30–3.46), Amhara (AOR 4.65; 95% CI 3.22–5.35) and Oromiya (AOR = 2.01; 95% CI: 1.52–3.15) were higher compared to Dire Dawa respectively. Similarly, the odds of anthropometric failure in Somali was 2.88 times (AOR = 2.88, 95% CI: 1.88–4.66), Benishangul gumz 1.96 times (AOR = 1.96, 95% CI: 1.42–2.84), and SNNP 1.22 times (AOR = 1.22, 95% CI: 1.02–2.55), more likely as compared to Dire Dawa. However, the odds of childhood anthropometric failure at Gambella and Addis Abeba regions were lower by 33% and 43% as compared to Dire Dawa (Table 5).