This result indicated that the prevalence of stunting in Afar region was 41.1%. In this study, stunting is higher than that of the studies conducted in Ethiopia which were 38.3% [13], Tigray region 39.1% [16], Dale district 25.6% [17], Takusa district 36.5% [18]; but lower than previously reported stunting (46.9%) in Tigray region [19], (46.3%) Amhara region [20], (47.6%) Oromia region [21], and (44.7%) east Gojjam Zone [22]. The prevalence of stunting in this study is also higher than the finding reported in Nairobi Peri-Urban Slum 30.2% [23], but lower than in Nigeria (47.6%) [24]. This could be because the households lack knowledge, attitude and practices (KAP) on how to feed their children and themselves [25].
This result showed that the prevalence of underweight in Afar region was 36.2%. In this study, underweight is higher than that of the studies conducted in Ethiopia which was 23.3% [13], Tigray region 23.9% [16], Dale district 19% [17], Takusa district 19.5% [18], Nairobi Peri-Urban Slum 14.9% [23], Tigray region (33%) [19], Hidabu Abote District 30.9% [21], Nigeria 25.6% [24]. While studies in the Bure Town of West Gojjam Zone [26] and east Gojjam Zone [22] reported a lower prevalence of underweight (14.30%) and 15.3%. This might be because there is a difference in barriers to under-nutrition such as cultural differences and other socio-demographic characteristics. This might be due to there is a difference in barriers to under-nutrition such as cultural differences and other socio-demographic characteristics.
This result revealed that the prevalence of wasting in Afar region was 17.7%. The prevalence of wasting in this study is higher compared to the study conducted in Ethiopia 10.1% [13], in Haramaya district 10.7% [27], in Dale Woreda 14% [17], in Pakistan 10.7% [25] and Nairobi Peri-Urban slum 4.5% [23]. This divergence might be due to the difference in socioeconomic background, variation in sample size, dietary habits and type of meals among the study population. Similar studies conducted in Hidabu Abote District in the Oromia region reported an equivalent finding (16.7%) [21]. While studies in the Bure Town of West Gojjam Zone, Amhara region [26] and east Gojjam Zone [22] reported lower prevalence of wasting (11.1%) and (10%). This could be due to there is a difference in obstacles to under-nutrition such as cultural differences and other socio-demographic characteristics.
About 26.7% of children in Afar region were both stunted and underweight, 12.7% were both underweight and wasted, 7.6% were both stunted and wasted and only 7.0% of children had all three under-nutrition conditions. The prevalence of both stunted and underweight in this study is higher than compared to the study conducted in Ethiopia 19.47% [13] and Amhara region (23.1%) [20], but much higher than the study conducted in Kilimanjaro Region, Tanzania 33% [28]. The prevalence of both underweight and wasting at this finding is higher than the study finding in Amhara region (7.3%) [20]. The variation might be due to socioeconomic background, geographical characteristics of the study area, access to health care, cultural difference in dietary habits and care practices.
Results of the multivariable binary logistic regression model revealed that age of the child, household wealth index, number of living children and anemia level were significantly associated with being stunted. The risk of being stunted was 2.32 and 2.10 times more likely among children that were aged 25-47 and 48-59 as compared to those aged 0-24 months, respectively. This finding is in agreement with the studies conducted in Ethiopia [13], in Amhara region (36) in Haramaya district [27], in Pakistan [25] and in Kilimanjaro Region, Tanzania [28], but disagreed with the study conducted in Tigray region [16]. This could be because younger children are more likely to receive more attention and feeding effort from their parents as compared to older children [2]. It could also be due to the inappropriate and late introduction of low nutritional quality supplementary food [29]. Children from the household who had rich and medium wealth index were 0.66 and 0.63 times less likely to be stunted as compared to the children household who had poor wealth index. This finding is in agreement with the studies conducted in Ethiopia [13], Tigray region [16] and Pakistan [25]. This fining is also supported by the literature that reported that the poor wealth index is strongly correlated with under-five stunting [15, 26, 30–32]. The possible explanation for this might be mothers from households having a rich or middle wealth status were more likely to provide micronutrients in reached foods and seek medical treatment for their children. Furthermore, better households have better access to food and higher cash incomes than poor households, allowing them a quality diet, better access to medical care, and more money to spend on essential non-food items such as hygiene products [33]. The number of children who lived in household members >4 was 1.68 times more likely to be stunted compared to the number of children who lived in household members 1-2. This finding is in agreement with the study conducted in Amhara region [20] and in Haramaya district [27]. This may be because a large number of children are widely regarded as a risk factor for stunting particularly for infants and young children due to food insecurity. Households with fewer children could be expected to be more capable than households with higher real income to provide their members with an adequate dietary intake [34]. Being stunted of anemic children was 1.91 times more likely to develop stunting as compared to non-anemic children. This finding is supported by the study conducted in Ethiopia [13]. This is because the anemia causes the children to reduce feed intake and leads to malnutrition. Undernourished children are more suffered from inadequate bioavailability of micronutrients such as iron, B12 and folate in their body which are important for the formation of blood cells. Therefore, those children who are undernourished cannot form adequate blood cells as much as required; consequently the this leads to the development of nutritional deficiency anemia which is common especially in developing countries [35].
According to the multivariable logistic regression analysis, age of child, place of residence, mothers’ BMI, household wealth index and anemia level were significantly associated with underweight. The children who were 25-47 and 48-59 aged groups were 2.29 and 2.00 times more likely to develop underweight as compared to those who were 0-24 aged groups. This finding is in line with the study conducted in Ethiopia [13] but in contradiction to the study conducted in Tigray region [16] and in Pakistan [25]. It might be due to a large portion of guardians in rural areas are ignoring to meet their children's optimal food requirements like the age of the child increases [36]. The children living in rural areas were 1.98 times more likely to develop underweight as compared to the children living in urban areas. This report is supported with the studies conducted in Takusa district, Northwest Ethiopia [18], in Haramaya District, Eastern Ethiopia [27], but against in Pakistan [25] and Tigray region [16]. While ample evidence documents that urban children generally have better nutritional status than their rural children. The environment, choices, and opportunities of urbanites differ greatly from those of rural dwellers' from employment conditions to social and family networks to access to health care and other services [13]. Children who were born underweight and normal-weight mothers were 3.20 and 4.64 times more likely to be underweight compared to children born from overweight mothers. This finding is supported by the studies conducted in Ethiopia [13], in Haramaya District, Eastern Ethiopia [27], in Pakistan [25]. Compared to children from the poor household wealth index, the odds of medium and rich household wealth index were 0.87 and 0.49 times lower. This finding is supported by the studies conducted in Ethiopia [13], in Tigray region [16] and Pakistan [25]. This could be explained by the presence of an intergenerational link between maternal and child nutrition means a small mother will have small babies who in turn grow to become small mothers [37]. Maternal BMI is also an important determinant of child under-nutrition and is influenced by maternal nutrition, to improve child growth, proper nutrition is essential for the mothers during the prenatal and postnatal period. Healthier mothers have less risk of having undernourished children [15]. The anemic children were 1.96 times more likely to be underweight as compared to non-anemic children. This finding is in line with the study conducted in Ethiopia [13]. Those children who are undernourished cannot form adequate blood cells as much as required; consequently, this leads to the development of nutritional deficiency anemia which is common especially in developing countries [35].
Based on multivariable logistic regression analysis, age of the child, size of child at birth, number of living children and anemia level were significantly associated with wasting. The results of adjusted showed that the children who were 25-47 and 48-59 aged groups were 2.34 and 2.13 times more likely to develop underweight as compared to those who were 0-24 aged groups. This report is in line with the study conducted in Tigray region [16], in Haramaya District, Eastern Ethiopia [27], in Dale Woreda, southern Ethiopia [17] and Kilimanjaro Region, Tanzania [28]. The reason might be when the children get grown-up the parent care may be reduced and the children may not get sufficient and balanced meals timely. This could be because younger children are more likely to receive more attention and feeding effort from their parents as compared to older children [2]. Children who were born with small size were 2.07 times more likely to be underweight than children who were born larger. This finding is supported by the studies conducted in Amhara region [20] and in Pakistan [25]. This is might be for the reason that low birth weight is in turn associated with a range of adverse outcomes of first childhood life. The number of children who lived in household members >4 was 1.81 times more likely to be wasting compared to the number of children who lived in household members 1-2. This finding is in line with the study conducted in Dale Woreda, southern Ethiopia [17]. Households with fewer children could be expected to be more capable than households with higher real income to provide their members with an adequate dietary intake [34]. The odds of being underweight were 1.94 times higher among anemic children compared to non-anemic children. This finding is consistent with the study conducted in Ethiopia [13].