Samples of 977 under-five children were considered in this research. The prevalence of stunting, underweight, and wasting in Amhara region were 46.3%, 28.4%, and 9.8%, respectively. About 23.1% of children were both stunting and underweight, 7.3% were both underweight and wasting, and only 4.5% of children had all the three conditions.
Of that 23.3 % were large and only 2.9% were multiple birth types. About 74.9% of interviewed mothers had no education and only 2.1% of them attended higher education. About42.6% of children were found between 0 to 24 months and more than half (51.3%) were males. Only 9.1% of the respondents were from urban areas and 30.2% were in the rich wealth index. Around 19.8% of children’s mothers were underweight.
Determinants of stunting
Among the factors considered in this study, Age of child in months, size of child at birth, mother highest education level, sex of household head and sources of drinking water were associated with stunting. The log odds of stunting was higher among children in the age group of 25-47 months (AOR = 1.57, 95%CI: 1.05-2.35) and 48-59 months (AOR = 1.06, 95%CI: 70.80-1.49) respectively as compared to the age group of 0– 24months. Compared to children large size at birth, the odds of stunting among children in the medium size at birth was 0.01 times lower. The odd of stunting among children in the small size at birth was 1.60 times higher compared to children large size at birth.
The risk of being stunting among children whose mothers attended primary education was 1.07 (AOR = 1.07, 95%CI: 0.76-1.50) times more compared to children whose mothers did not attend education. The risk of being stunting among children whose mothers attended secondary education was 0.70 times less compared to children whose mothers did not attend education. The risk of being stunting among children whose father household head was 0.49 times less compared to children whose mother household headed. Children from households that used unimproved drinking water was 1.47 (AOR = 1.47, 95%CI: 1.11-1.95) times more likely to be at risk of being stunting than children from households that used improved water.
Table 1 Bivariate and multivariable logistic regression of risk factors associated with stunting on childhood less than 5 years in Amhara Region, Ethiopia, EDHS 2016.
Variables
|
|
Stunting
|
COR (95% CI)
|
AOR (95% CI)
|
|
Yes
|
No
|
|
|
Age of child in months
|
|
|
|
|
0-24
|
169 (43.7%)
|
218 (56.3%)
|
1
|
1
|
25-47
|
149 (45.8%)
|
176 (54.2%)
|
1.09 (0.81, 1.47)
|
1.57 (1.05, 2.35)*
|
48-59
|
102 (51.5%)
|
96 (48.5%)
|
1.37 (0.97, 1.93)
|
1.06 (0.80, 1.49)
|
Sex of child
|
|
|
|
|
Male
|
218 (43.6%)
|
282 (56.4%)
|
1
|
1
|
Female
|
232 (48.9%)
|
242 (51.1%)
|
1.24 (0.96, 1.60)
|
1.27 (0.97, 1.67)
|
Place of residence
|
|
|
|
|
Urban
|
39 (43.8%)
|
50 (56.2%)
|
1
|
1
|
Rural
|
411 (46.4%)
|
474 (53.6%)
|
1.11 (0.72, 1.72)
|
0.53 (.26, 1.06)
|
Religion
|
|
|
|
|
Orthodox
|
380 (46.3%)
|
441 (53.7%)
|
1
|
1
|
Muslin
|
70 (46.1%)
|
82 (53.9%)
|
0.99 (0.70, 1.40)
|
1.07 (0.69, 1.66)
|
Type of birth
|
|
|
|
|
Single birth
|
438 (46.3%)
|
508 (53.7%)
|
1
|
1
|
Multiple birth
|
12 (42.9%)
|
16 (57.1%)
|
0.87 (0.41, 1.86)
|
1.18 (0.41, 3.39)
|
Mothers` BMI
|
|
|
|
|
Over weight
|
15 (41.7%)
|
21 (58.3%)
|
1
|
1
|
Normal weight
|
351 (47.6%)
|
387 (52.4%)
|
1.01 (0.49, 2.06)
|
0.95 (0.37, 2.43)
|
Under weight
|
81 (41.8%)
|
113 (58.2%)
|
1.40 (0.30, 6.51)
|
0.78 (0.10, 6.21)
|
Size of child at birth
|
|
|
|
|
Large
|
99 (43.6%)
|
128 (56.4%)
|
1
|
1
|
Medium
|
176 (42.1%)
|
242 (57.9%)
|
0.94 (0.68, 1.30)
|
0.99 (0.70, 1.42)
|
Small
|
175 (53.2%)
|
154 (46.8%)
|
1.47 (1.05, 2.07)
|
1.60 (1.11, 2.31)*
|
Mother highest educational level
|
|
|
|
|
No education
|
343 (46.9%)
|
388 (53.1%)
|
1
|
1
|
Primary
|
87 (47.3%)
|
97 (52.7%)
|
1.02 (0.72, 1.40)
|
1.07 (0.76, 1.50)
|
Secondary
|
7 (18.4%)
|
31 (81.6%)
|
0.26 (0.11, 0.59)
|
0.30 (0.13, 0.70)*
|
Higher
|
7 (18.4%)
|
31 (81.6%)
|
1.84 (0.75, 4.49)
|
2.37 (0.87, 6.52)
|
Type of toilet facility
|
|
|
|
|
Improved
|
236 (48.0%)
|
256 (52.0%)
|
1
|
1
|
Unimproved
|
215 (44.6%)
|
267 (55.4%)
|
1.15 (0.89, 1.47)
|
1.30 (0.96, 1.77)
|
Sex of household head
|
|
|
|
|
Female
|
36 (40.4%)
|
53 (59.6%)
|
1
|
1
|
Male
|
414 (46.8%)
|
471 (53.2%)
|
1.29 (0.83, 2.02)
|
0.51 (0.28, 0.91)*
|
Household wealth index combined
|
|
|
|
|
Poor
|
210 (46.7%)
|
240 (53.3%)
|
1
|
1
|
Medium
|
109 (47.4%)
|
121 (52.6%)
|
1.03 (0.75, 1.42)
|
1.04 (0.71, 1.52)
|
Rich
|
131 (44.6%)
|
163 (55.4%)
|
0.92 (0.68, 1.23)
|
0.77 (0.52, 1.14)
|
Number of living children
|
|
|
|
|
1-2
|
160 (45.8%)
|
189 (54.2%)
|
1
|
1
|
3-4
|
80 (46.8%)
|
91 (53.2%)
|
0.99 (0.75, 1.31)
|
1.08 (0.77, 1.52)
|
>4
|
207 (46.1%)
|
242 (53.9%)
|
1.03 (0.72, 1.46)
|
1.26 (0.82, 1.94)
|
Sources of drinking water
|
|
|
|
|
Improved
|
178 (50.9%)
|
172 (49.1%)
|
1
|
1
|
Unimproved
|
273 (43.8%)
|
351 (56.2%)
|
0.75 (0.58, 0.98)
|
1.47 (1.11, 1.95)*
|
AOR: adjusted odds ratio; COR: crude odds ratio; CI: confidence interval
Determinants of under‑weight
The size of the child at birth was associated with under-weight (P < 0.05). The risk of being underweight was 0.22 times less likely among children that were aged 25–47 months than those aged 0–24 months. The risk of being underweight was 1.36 times more likely among children that were aged 48-59 months than those aged 0–24 months. The risk of being underweight for children whose mother attended primary and secondary education were 0.23 and 0.35 times lower than children whose mothers who did not attend formal education respectively.
Children from a household with rich economic status were 0.09 times less likely to be under-weighted compared to children living in a household with poor household economic status. Children from rural areas were 1.16 times more likely to be underweight compared to children from urban areas. Female children were 1.06 times more likely to be under-weighted as compared to male children. Children who were born with small size were 1.80 times more likely to be under-weighted than children born larger (AOR = 1.80; 95% CL 0.89-3.66) and children who had born with medium size were 1.56 times more likely to be under-weighted than children born larger (AOR = 1.56; 95% CL 1.05-2.33).
Table 2 Bivariate and multivariable logistic regression of risk factors associated with under-weight on childhood less than 5 years in Amhara Region, Ethiopia, EDHS 2016
Variables
|
|
Underweight
|
COR (95% CI)
|
AOR (95% CI)
|
|
Yes
|
No
|
|
|
Age of child in months
|
|
|
|
|
0-24
|
104 (26.9%)
|
283 (73.1%)
|
1
|
1
|
25-47
|
86 (26.5%)
|
239 (73.5%)
|
0.98 (0.70, 1.37)
|
0.78 (0.53, 1.16)
|
48-59
|
63 (31.8%)
|
135 (68.2%)
|
1.27 (0.87, 1.85)
|
1.36 (0.89, 2.09)
|
Sex of child
|
|
|
|
|
Male
|
134 (26.8%)
|
366 (73.2%)
|
1
|
1
|
Female
|
142 (30.0%)
|
332 (70.0%)
|
1.17 (0.88, 1.54)
|
1.06 (0.76, 1.49)
|
Place of residence
|
|
|
|
|
Urban
|
15 (16.9%)
|
74 (83.1%)
|
1
|
1
|
Rural
|
261 (29.5%)
|
624 (70.5%)
|
2.06 (1.16, 3.66)
|
1.16 (0.50, 2.69)
|
Religion
|
|
|
|
|
Orthodox
|
228 (27.8%)
|
593 (72.2%)
|
1
|
1
|
Muslin
|
48 (31.6%)
|
104 (68.4%)
|
1.20 (0.83, 1.75)
|
1.60 (1.01, 2.54)
|
Type of birth
|
|
|
|
|
Single birth
|
268 (28.3%)
|
678 (71.7%)
|
1
|
1
|
Multiple birth
|
8 (28.6%)
|
20 (71.4%)
|
1.01 (0.44, 2.32)
|
1.32 (0.43, 4.03)
|
Mothers` BMI
|
|
|
|
|
Over weight
|
8 (22.2%)
|
28 (77.8%)
|
1
|
1
|
Normal weight
|
209 (28.3%)
|
529 (71.7%)
|
1.46 (0.63, 3.39)
|
2.28 (0.63, 8.27)
|
Under weight
|
57 (29.4%)
|
137 (70.6%)
|
1.17 (0.20, 6.94)
|
0.88 (0.07, 11.51)
|
Size of child at birth
|
|
|
|
|
Large
|
61 (26.9%)
|
166 (73.1%)
|
1
|
1
|
Medium
|
101 (24.2%)
|
317 (75.8%)
|
0.87 (0.60, 1.25)
|
1.56 (1.05, 2.33)*
|
Small
|
114 (34.7%)
|
215 (65.3%)
|
1.44 (0.99, 2.09)
|
1.80 (0.89, 3.66)
|
Mother highest educational level
|
|
|
|
|
No education
|
217 (29.7%)
|
514 (70.3%)
|
1
|
1
|
Primary
|
47 (25.5%)
|
137 (74.5%)
|
0.82 (0.56, 1.17)
|
0.89 (0.58, 1.38)
|
Secondary
|
5 (13.2%)
|
33 (86.8%)
|
0.36 (0.14, 0.93)
|
0.25 (0.05, 1.14)
|
Higher
|
7 (33.3%)
|
14 (66.7%)
|
1.18 (0.47, 2.96)
|
1.92 (0.50, 7.34)
|
Type of toilet facility
|
|
|
|
|
Improved
|
130 (26.4%)
|
362 (73.6%)
|
1
|
1
|
Unimproved
|
146 (30.3%)
|
336 (69.7%)
|
0.83 (0.62, 1.09)
|
0.80 (0.57, 1.12)
|
Sex of household head
|
|
|
|
|
Female
|
25 (28.1%)
|
64 (71.9%)
|
1
|
1
|
Male
|
251 (28.4%)
|
634 (71.6%)
|
0.99 (0.61, 1.60)
|
0.53 (0.27, 1.05)
|
Household wealth index combined
|
|
|
|
|
Poor
|
133 (29.6%)
|
317 (70.4%)
|
1
|
1
|
Medium
|
67 (29.1%)
|
163 (70.9%)
|
0.98 (0.69, 1.39)
|
1.07 (0.71, 1.61)
|
Rich
|
76 (25.9%)
|
218 (74.1%)
|
0.83 (0.60, 1.16)
|
0.91 (0.59, 1.40)
|
Number of living children
|
|
|
|
|
1-2
|
85 (24.4%)
|
264 (75.6%)
|
1
|
1
|
3-4
|
54 (31.6%)
|
117 (68.4%)
|
0.75 (0.55, 1.03)
|
0.86 (0.59, 1.26)
|
>4
|
135 (30.1%)
|
314 (69.9%)
|
0.1.07 (0.73, 3.90)
|
1.25 (0.79, 1.97)
|
Sources of drinking water
|
|
|
|
|
Improved
|
113 (32.3%)
|
237 (67.7%)
|
1
|
1
|
Unimproved
|
163 (26.1%)
|
461 (73.9%)
|
1.35 (1.01, 1.80)
|
1.20 (0.85, 1.69)
|
AOR: adjusted odds ratio; COR: crude odds ratio; CI: confidence interval
Determinants of wasting
Results of the multivariable binary logistic regression model showed that the type of toilet facility and sex of household head were significantly associated with wasting. Children living in a household with improved toilet type were 0.48 less likely to be wasting compared to children living in a household with unimproved toilet type. Children from a male household head were 1.99 times higher compared to children from a female household head. Children of the rich household were 0.32 times less likely to be wasting compared to children living in a household with poor household economic status.
The risk of being wasting was 1.08 and 1.52 times higher among children of 25–47 and 48–59 months than those 0–24 months, respectively. The odds of being wasting of children from rural areas were 1.18 times higher compared to children from urban areas. The odds of being wasting were 0.04 times lower among female children than male children. The odds of being wasting was 1.17 times higher among children who lived in household members of >4 children who had lived in household members of 1–2 (AOR = 1.17, 95% CI 0.59-2.33).
Table 3 Bivariate and multivariable logistic regression of risk factors associated with wasting on childhood less than 5 years in Amhara Region, Ethiopia, EDHS 2016
Variables
|
|
Wasting
|
COR (95% CI)
|
AOR (95% CI)
|
|
Yes
|
No
|
|
|
Age of child in months
|
|
|
|
|
0-24
|
33 (8.5%)
|
354 (91.5%)
|
1
|
1
|
25-47
|
30 (9.2%)
|
295 (90.8%)
|
1.09 (0.65, 1.83)
|
1.08 (0.64, 1.82)
|
48-59
|
25 (12.6%)
|
173 (87.4%)
|
1.55 (0.89, 2.69)
|
1.52 (0.87, 2.64)
|
Sex of child
|
|
|
|
|
Male
|
50 (10.0%)
|
450 (90.0%)
|
1
|
1
|
Female
|
46 (9.7%)
|
428 (90.3%)
|
0.97 (0.63, 1.48)
|
0.96 (0.58, 1.58)
|
Place of residence
|
|
|
|
|
Urban
|
7 (7.9%)
|
82 (92.1%)
|
1
|
1
|
Rural
|
89 (10.1%)
|
796 (89.9%)
|
1.31 (0.59, 2.92)
|
1.18 (0.36, 3.88)
|
Religion
|
|
|
|
|
Orthodox
|
79 (9.6%)
|
742 (90.4%)
|
1
|
1
|
Muslin
|
17 (11.2%)
|
135 (88.8%)
|
1.18 (0.68, 2.06)
|
1.22 (0.62, 2.37)
|
Type of birth
|
|
|
|
|
Single birth
|
94 (9.9%)
|
852 (90.1%)
|
1
|
1
|
Multiple birth
|
2 (7.1%)
|
26 (92.9%)
|
0.68 (0.16, 2.98)
|
0.53 (0.06, 4.32)
|
Mothers` BMI
|
|
|
|
|
Over weight
|
5 (13.9%)
|
31 (86.1%)
|
1
|
1
|
Normal weight
|
71 (9.6%)
|
667 (90.4%)
|
0.67 (0.23, 1.94)
|
2.50 (0.32, 19.44)
|
Under weight
|
19 (9.8%)
|
175 (90.2%)
|
0.89 (0.09, 8.82)
|
2.73 (0.34, 22.08)
|
Size of child at birth
|
|
|
|
|
Large
|
22 (9.7%)
|
205 (90.3%)
|
1
|
1
|
Medium
|
46 (11.0%)
|
372 (89.0%)
|
1.15 (0.67, 1.97)
|
1.36 (0.71, 2.61)
|
Small
|
28 (8.5%)
|
301 (91.5%)
|
0.87 (0.48, 1.56)
|
0.87 (0.42, 1.77)
|
Mother highest educational level
|
|
|
|
|
No education
|
72 (9.8%)
|
659 (90.2%)
|
1
|
1
|
Primary
|
18 (9.8%)
|
166 (90.2%)
|
0.99 (0.58, 1.71)
|
1.32 (0.71, 2.46)
|
Secondary
|
4 (10.5%)
|
34 (89.5%)
|
1.08 (0.37, 3.12)
|
1.63 (0.39, 6.73)
|
Higher
|
2 (9.5%)
|
19 (90.5%)
|
0.96 (0.22, 4.22)
|
2.96 (0.46, 19.07)
|
Type of toilet facility
|
|
|
|
|
Improved
|
39 (7.9%)
|
453 (92.1%)
|
1
|
1
|
Unimproved
|
57 (11.8%)
|
425 (88.2%)
|
0.64 (0.42, 0.99)
|
0.52 (0.31, 0.87)*
|
Sex of household head
|
|
|
|
|
Female
|
14 (15.7%)
|
75 (84.3%)
|
1
|
1
|
Male
|
82 (9.3%)
|
803 (90.7%)
|
1.83 (0.99, 3.39)
|
1.99 (1.06, 3.73)*
|
Household wealth index combined
|
|
|
|
|
Poor
|
46 (10.2%)
|
404 (89.8%)
|
1
|
1
|
Medium
|
29 (12.6%)
|
201 (87.4%)
|
1.27 (0.77, 2.08)
|
1.12 (0.66, 1.90)
|
Rich
|
21 (7.1%)
|
273 (92.9%)
|
0.68 (0.39, 1.16)
|
0.68 (0.38, 1.19)
|
Number of living children
|
|
|
|
|
1-2
|
30 (8.6%)
|
319 (91.4%)
|
1
|
1
|
3-4
|
17 (9.9%)
|
154 (90.1%)
|
0.77 (0.48, 1.24)
|
1.04 (0.59, 1.82)
|
>4
|
49 (10.9%)
|
400 (89.1%)
|
0.90 (0.53, 1.61)
|
1.17 (0.59, 2.33)
|
Sources of drinking water
|
|
|
|
|
Improved
|
36 (10.3%)
|
314 (89.7%)
|
1
|
1
|
Unimproved
|
59 (9.5%)
|
565 (90.5%)
|
1.10 (0.71, 1.70)
|
0.96 (0.57, 1.61)
|
AOR: adjusted odds ratio; COR: crude odds ratio; CI: confidence interval
Associations between children’s anemia and malnutrition
This study showed that among stunting, underweight, and wasting children, 41.5%, 45.8%, and 35.0% were anemic respectively. Moreover, the percentages of stunting, underweighting and wasting were lower among anemic children as compared to no-anemic children. Stunting children were 1.31 times more likely to be anemic compared to those of not stunting (AOR= 1.31; 95% CI 0.94, 1.82). Underweight children were 0.36 times less likely to be anemic compared to those of not underweight (AOR= 0.64; 95% CI 0.44, 0.93). Wasting children were 1.80 times more likely to be anemic compared to those of not wasting (AOR= 1.80, 95% CI 1.07, 3.04).
Table 4 Malnutrition associated with anemia among under-five children in Amhara Region, Ethiopia, EDHS 2016
Variables
|
Categories
|
Anemic
|
Non-anemic
|
P-value
|
AOR (95% CI)
|
Stunting
|
Stunting
|
146 (41.5%)
|
206 (58.5%)
|
0.10
|
1.31 (0.94, 1.82)
|
|
Non stunting
|
186 (43.5%)
|
242 (56.5%)
|
|
1
|
Underweight
|
Underweight
|
104 (45.8%)
|
123 (54.2%)
|
0.02
|
0.64 (0.44, 0.93)
|
|
Non underweight
|
228 (41.2%)
|
325 (58.8%)
|
|
1
|
Wasting
|
Wasting
|
28 (35.0%)
|
52 (65.0%)
|
0.03
|
1.80 (1.07, 3.04)
|
|
Non wasting
|
304 (43.4%)
|
396 (56.6%)
|
|
1
|
AOR: adjusted odds ratio; CI: confidence interval