The nutritional status of children is affected by different interwoven factors which may vary from location to location, and inter-households. This study was aimed at assessing the prevalence of stunting and its predictors among children aged 6–59 months living in households enrolled in productive safety net program and those non-enrolled in the program in Meta District of east Harerge zone of eastern Ethiopia. Accordingly, the prevalence of stunting was 47.7% among children aged 6–59 months from PSNP beneficiaries and 35.5% for children who belong to NPSNP beneficiaries’ households respectively. Stunting was significantly associated with lack of maternal education, women’s inability to make decision, non-attendance of fourth antenatal care visit, practicing of hand washing during the critical periods, child’s illness, lack of excusive breastfeeding, eating less diversified foods, and child ‘s age (being 24–59 months). However, being a beneficiary of PSNP did not show an association with stunting which needs to be more investigated using large scale study.
In this study, the prevalence of stunting among children aged 6–59 months in PSNP beneficiary and NPSNP beneficiary households was 47.7% and 33.5% respectively. This finding indicates a significant difference among the comparison groups. Similar finding was reported from Saesie Tsaeda Emba district, Tigray region, northern Ethiopia which implies that stunting is more common among food insecure households in Ethiopia. The prevalence of stunting observed in Saesie Tsaeda Emba district of productive safety net program beneficiary and non-productive safety net program households were 52.1% and 46.1% respectively [19].
Another national based study reported that the prevalence of stunting was higher among PSNP users (47%) compared with NPSNP users (41.8%) respectively [3]. This difference might be attributed to low food accessibility during months of food gaps among children from PSNP and NPSNP households. Food insecurity may be the result of low rainfall, highly sloppy and degraded farm land, and low productivity of the farm land to support the population’s food yield [20].It is important that the existing PSNP needs to be upgraded to the level which satisfies the balanced food needs the of poor segment of the area’s population.
The risk of stunting increases as the child’s age increases. In this study, childen aged 24–59 months were 6. 9 times more likely to be stunted compared to children aged 6–23 months. This result was in line with the national figure [3] and study done in Belesa District [4], where children aged 24–35 months were more likely to be stunted when compared to earlier age group. This might be due to lack of continued child feeding practice with diversified diet and may be related to poor breast-feeding practice before the age of 23 months.
Stunting was also significantly associated with uneducated mothers/ care takers. The odds of stunting were nearly 4 times higher among chidren born to mothers who have no formal education compared to their counter parts. Similar finding was reported from South Wollo community, northern part of Ethiopia [21], Fadis District community, Hararghe Zone eastern Ethiopia [20] and study from Saesie Tsaeda-Emba District community, Tigray of north Ethiopia [19], and from Tanzania [22]. This might be attributed to the fact that child caring is mainly responsibility of the mother /care giver in Ethiopian context which is added to lack of knowledge of implementing appropriate to age child feeing practices and understanding of the adverse effects of undernutrition on children in the later life.
The odds of stunting were reduced by 62 %, among children from households who practice hand washing during the critical periods. This finding was consistent with study finding from northern part of the country [19]. This might be due to the efficiency of hand washing practice which can reduce pathogens that cause disease and thereby reduce stunting. It also implies in addition to other factors related chronic malnutrition an attempt needs to be made in scaling-up such cost effective intervention in reducing the magnitude of chronic malnutrition.
Children who had recovered from illness in the last 2 weeks of data collection periods were nearly 9 times more likely to be stunted than children who did not illness. This finding was comparable with community-based study done in, northwest Ethiopia [4]) and Latin America Amazon, Western Brazilian [23]. This might be due to increase in body’s calorie requirement during illness and destruction of tissue as the result of the microorganisms among stunted children
Stunting was nearly 6 times more common among chidren of mothers who have not exclusively breastfed their children in the previous six months compared with their counter parts. This finding is agreement with community based study from Somali region of eastern Ethiopia [24], Saesie Tsaeda Emba district of north Ethiopia [19] and in rural Colombia [25]. This might be explained in such a way that breast milk has substantial amount of anti-infective substances that can safeguard children from the occurrence of infection thereby break malnutrition - infection viscious cycle
In this study, there was also a significant association between minimal dietary diversity and undernutrition. The odds of stunting was nearly 7 times higher among children who used to eat less diversified foods compared with their counter parts This result was comparable with findings of studies done in Saesie Tsaeda Emba district of northern Ethiopia [19], Somali region of eastern Ethiopia [24] and Colombia [25]. This result implies that diversified foods are very important for child growth and development during the age of 6–59 months in availing all micronutrients and macro nutrients for the body requirements
Children who born to mothers who were not able to make decision on the household issues were nearly 5 times more likely to have an increased odd of stunting compared with children born to empowered women to decide on households matters This finding was consistent with Maharashtra’s study of Indians [6]. This might imply that when women are empowered to decide on household’s matters the likelihood of caring for their children increases since they have access to household resources enhancing food accessibility for the household members.
Lack of proper antenatal care follow-up was also found to be associated the development of stunting. The odds of stunting were 7 times higher among children being delivered from mothers who did not attend their fourth ANC four follow-up when compared with their counterparts. Similar finding was reported from Yemen [7]. This might be due to the issues related to child nutrition often addressed during pregnancy upon consecutive ANC visit to alert pregnant women as how to feed their children after delivery in an attempt to prevent the onset of child undernutrition.
This study could have the following limitations. Firstly, some of the mother s /caregivers might have under or over reported their children’s age, t which could resulted in inappropriate estimation of the respective nutritional indices. However, age was estimated carefully based on mother’s /caregiver/s unforgettable events such as public and religious holidays of the year using local calendar for those who did not have scientific background. Secondly, recall bias could be introduced upon collecting data on some past background variables such as 24 hours recall questions in which case an interactive 24 recall method was used to minimize such a bias. Thirdly, an anthropometric measurement error could potentially affect the results of this study due to both random and systematic error. Nevertheless, all important efforts such as calibration of measuring equipment, standardization procedure before deploying data enumerators to the field, and refreshment training for data enumerators were made to minimize the errors.