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Journal of Nutrition & Food Sciences DOI: 10.4172/2155-9600.1000381

ciences
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ISSN: 2155-9600

Research Article Open Access

Predictors of Chronic Under Nutrition (Stunting) Among Children Aged

6-23 Months in Kemba Woreda, Southern Ethiopia: A Community Based
Cross-Sectional Study
Eskezyiaw Agedew1 and Tefera Chane2*
Department of Public Health, Arba Minch University, Southern Ethiopia
1

Department of Public Health, Wolaita Sodo University, Southern Ethiopia

2

Abstract
Background: Stunting is a public health problem in developing countries. Stunting (deficit in height/length for
age of at least -2 Z score) affects close to 195 million children under five years of age in the developing world. Chronic
under nutrition is a major cause of disability preventing children who survive from reaching their full developmental
potential.
Objective: To assess chronic under nutrition (Stunting) and associated factors among Children aged 6-23
months in Southern Ethiopia.
Methods: Community based cross-sectional study was carried out among 562 mothers who have young
child from 6-23 months in 2014/15 in Kemba Woreda by using pre tested and structured questioners. Bivariate
and multivariate analyses were conducted by SPSS version 20 and finally result was interpreted, compared and
discussed with different recently published scientific journal.
Results: The study revealed that out of 562 children, 18.7%; 95% C.I (15.6-22.1) of children were stunted, or
chronically undernourished (i.e. HAZ ≤ 2Z-score). In multiple logistic regressions, boys [AOR: 2.50; 95% CI(1.60-
4.01)],older mothers [AOR: 2.60; 95% CI (1.07-6.35)], mothers who have no formal education [AOR: 2.76; 95%
CI (1.63-4.69)], mothers who work as daily workers [AOR: 3.06; 95% CI (1.03-9.12)] and have Private work
activity(merchant, farmers) [AOR: 2.39; 95% CI (1.61-3.53)], mothers who have no post natal follow up [AOR: 1.64;
95% CI (1.05-2.55)] and maternal illness encountered after delivery [AOR: 1.56; 95% CI (1.05-2.32)] were identified
as significant independent predictors of childhood stunting.
Conclusion and Recommendation: A significant number of young child develop chronic malnutrition in this
critical periods. Stunting was significantly associated with the illiterate mothers, mothers who work as daily workers
and Private work, those has no post natal follow up and maternal illness encountered after delivery. An organized
effort should be made at all levels to solve the problems of chronic under nutrition (stunting) in children.

Keywords: Stunting; South Ethiopia; Kemba Woreda is responsible, directly or indirectly, for at least 35% of deaths in
children less than five years of age. Stunting (deficit in height/length
Abbreviations: AOR: Adjusted Odd Ratio; SAM: Sever Acute for age of at least -2 z score) affects close to 195 million children under
Malnutrition; MUAC: Mid-Upper-Arm Circumference; CI: Confidence five years of age in the developing world [7].
Interval; SD: Standard Deviation; TFU: Therapeutic Feeding Unit
Appropriate weaning and complementary feeding behaviors,
Introduction nutritional interventions, and disease control and treatment programs
are strategies to prevent stunting. However, their effectiveness also
Poor linear growth, or stunting (low length- or height-for-age), in depends on counteracting the environmental and socio-economic
young children is the result of multiple circumstances and determinants, circumstances that allow infection and sub-optimal nutrition to persist
including antenatal, intra-uterine and postnatal malnutrition, more [1,6].
commonly due to inadequate or inappropriate nutrition and the
impact of infectious disease. Childhood stunting continues to be a The period from birth to two years of age is particularly important
public health issue in many African countries [1,2]. because of the rapid growth and brain development that occurs during

Stunting in early life is associated with adverse functional

consequences and growth failure during infancy and early childhood *Corresponding author: Tefera Chane, Lecturer in Department of Public
is often irreversible, leading to short stature during adolescence Health, Wolaita Sodo University, Southern Ethiopia, Tel: +251 28794089; E-mail:
and adulthood. Stunting is associated with an elevated risk of child [email protected]

mortality, increased susceptibility to infection and poor cognitive and Received March 27, 2015; Accepted May 26, 2015; Published May 29, 2015
psychomotor development. The long-term consequences of stunting Citation: Agedew E, Chane T (2015) Predictors of Chronic Under Nutrition
include deficits in school achievement, reduced work capacity and (Stunting) Among Children Aged 6-23 Months in Kemba Woreda, Southern
adverse pregnancy outcomes. Worldwide, stunting affects nearly one- Ethiopia: A Community Based Cross-Sectional Study. J Nutr Food Sci 5: 381.
doi:10.4172/2155-9600.1000381
third of children under 5 years of age, with the prevalence being higher
in low-resource countries in sub-Saharan Africa and South Asia [3-5]. Copyright: © 2015 Agedew E, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
Stunting is a multi-factorial phenomenon with a high prevalence in unrestricted use, distribution, and reproduction in any medium, provided the
developing countries [6]. Globally, it is estimated that under nutrition original author and source are credited.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 5 • Issue 4 • 1000381
Citation: Agedew E, Chane T (2015) Predictors of Chronic Under Nutrition (Stunting) Among Children Aged 6-23 Months in Kemba Woreda, Southern
Ethiopia: A Community Based Cross-Sectional Study. J Nutr Food Sci 5: 381. doi:10.4172/2155-9600.1000381

Page 2 of 5

this time. The period is often marked by growth faltering, micronutrient to population size allocation methods by using community based
deficiencies and common childhood illnesses [8]. demographic and health related information registration prepared by
health extension workers as the sampling frame. Rapid censuses were
Infant-feeding practices constitute a major component of child
conducted first to identify the target household. Finally infant-mother
caring practices apart from socio-cultural, economic and demographic
pairs were selected from each Kebele by using simple random sampling
factors. Somehow, these practices constitute one of the most neglected
methods after giving code for each household which has young child
determinants of young child malnutrition in spite of their important
from six months to 24 months.
role in growth pattern of children [9].
Data exists in Ethiopia that show the problem of malnutrition Data collection methods, measurement and quality control
beginning early in life, primarily during the first 12 months when Data was collected from Mothers/care givers who have one child in
growth faltering takes hold due to sub-optimal infant feeding practices. age 6 months-2 years from each household by direct interviewing. Pre-
Stunted infants grow to be stunted children and stunted adults [10]. At tested structured questionnaire adapted from different literature was
national level, 44% of children under age five are stunted and 21%of used to collect socio-demographic and others variables. The questioners
children are severely stunted [11]. In order to effectively accomplish were arranged and grouped according to the issue addressed. First the
the goals of accelerated Stunting reduction, identifying the potential questioners was prepared in English and translated to Amharic and
determinants of chronic under nutrition is a vital step to reduce the pre tested on 5% of mothers before actual data collection outside the
burden of stunting. Therefore, the aim of this study was to have detailed selected kebeles; correction and modification was done based on the
and concrete data that fill these gaps and would add a value that directs
gap identified during interview. Six Grade 12 completed students were
policy makers to draw appropriate intervention measures to improve
recruited as data collectors and supervised by 3 Nurse. Three day training
and flourish the health of future generation.
was given on the aim of the research, content of the questionnaire, and
Methods and Materials how to conduct interview for data collectors and supervisor to increase
their performance in field activities. The Collected data were checked
Study setting and source population every day by supervisors and principal investigator for its completeness
This community based cross-sectional study was carried out from and consistency.
December 7-27/2014 on 562 mothers who has young child from 6 Anthropometric measurements such as weight and height were
months to 2 years age in Kemba Woreda located in Southern parts of measured using standard technique and calibrated equipment. The
Ethiopia. The Southern Nations Nationalities and People’s Regional weight of each child was taken by using digital scale wearing light cloth,
State (SNNPRS) consists of 13 zones and 104 woreda. The region checking the calibration using 2 kg rod during each instant of weight
has an estimated 15,042,531 (20.4% of the national estimate) people. measuring and the measurement was approximated to the nearest 10 g.
Close to 90% of the population are estimated to be rural inhabitants, Children were not in fasting condition and each subject was weighted
while 1,545,710 or 10.3% are urban. Kemba woreda is one of the twice and the average weight was taken. Length was measured in
administrative woreda in Gamo Gofa Zone, South Ethiopia 100 km recumbent position using sliding board by two data collectors and
away from Zonal town Arba Minch. From the total population around taken to the nearest 1 mm [2,13,14]. The data collectors were trained
44,000 are women in reproductive age group. The Health institution efficiently on how to take the anthropometric measurements.
distribution in the woreda is 39 health posts and 9 health centers
providing health services including maternal and child health care. Data analysis and management
Inclusion and exclusion criteria Data was coded and entered in to Epi-Info version 3.5.1 and
exported to SPSS Version 20 for analysis. Exploratory data analysis
Mothers/care givers who have young children from 6 months to was done to check missing values, potential outliers and the normality
23 months old who live in the selected Keble for at least 6 months were distribution for those continuous variables. The presence of multi-
included in the study and those who had mental illnesses interfering collinearity also was checked and effort was made to incorporate
the interview were not considered in study. different models to cross check. Anthropometric index (HAZ) was
Sample size determination and sampling methods analyzed by using WHO Anthro software version 3.2.2 and categorized
as stunted if HAZ ≤ 2 Z score and as normal if HAZ ≥2 Z score; stunting
The sample size was determined by using single population is defined as HAZ ≤ 2 SD [13]. Extreme outlier of ≤ 6 Z score of HFA
proportion formula by the following assumption for prevalence of was omitted from the analysis. Descriptive frequencies were calculated
stunting (chronic malnutrition) as 44% in SNNPR, Southern Ethiopia to describe the study population in relation to relevant variables.
[12], desired precision (d) as 5% and 95% as confidence interval. Bivariate logistic regression analysis was calculated to assess the crude
2 association between dependent and independent variables. Finally
z 
 á  p(1-p) variables which shows association in bivariate logistic regression
z
N=   2 analysis and have P-value less than 0.25 (not to miss some of important
d variables that are not significant in the bivariate analysis) were entered
The final sample size was calculated by taking 1.5 as design effect in to Multivariate logistic regression model, to identify significant
which is 567. independent predictors of stunting and to control the possible effect of
confounding. Variables with P-value less than 0.05 were identified as
Sampling methods significant predictors of stunting.
Interviewed mothers were selected from eight kebeles which
Ethical consideration
selected by using lottery method from all kebeles. Then the number of
study participant was allocated for each Keble based on proportional Ethical clearance was obtained from Research ethics committee

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 5 • Issue 4 • 1000381
Citation: Agedew E, Chane T (2015) Predictors of Chronic Under Nutrition (Stunting) Among Children Aged 6-23 Months in Kemba Woreda, Southern
Ethiopia: A Community Based Cross-Sectional Study. J Nutr Food Sci 5: 381. doi:10.4172/2155-9600.1000381

Page 3 of 5

(REC) of Addis continental institute of Public Health. Permission Frequency

letter was obtained from Kemba Woreda Health office. Verbal Variables Percent (%)
(n=562)
informed consent from each study participant was obtained after clear Age of child    
explanation about the purpose of the study. All the study participants 6-8 months 125 22.2
were reassured that only anonymous data were taken. They were given 9-12 months 172 30.6
the chance to ask anything about the study and made free to refuse or 13-17 months 119 21.2
stop the interview at any moment they want if that was their choice.
18-23 months 146 26
Results Sex of child    
Male 273 48.6
Socio-demographic characteristics of the mothers and young Female 289 51.4
child Residence of mother    
Rural 205 36.5
A total of 562 women having young child aged 6 months to 23
Urban 357 63.5
months were interviewed in the study from 567 sampled mothers
Age of mother    
with 99.11% response rate. The overall mean age of young child 13.82
15-19 97 17.3
months ± 5.85 (SD), 53% were in age range from 6 months to 1 years
20-24 165 29.4
and 273 (48.6%) were male and 289 (51.4%) were female with sex ratio
25-29 256 45.6
of 0.94. Almost half of the mothers, 271 (48.2%) were in age range 25-
>=30 44 7.7
29 years. About one third of respondents (30.8%) were have no formal
Religion statues    
educational and 46% of them were farmers and daily workers in there
Orthodox 197 35.1
occupational statues. About two third of the respondent mothers 348
Protestant 348 61.9
(61.9%) were protestant followers and rest were orthodox and Muslims
Muslim 17 3
(Table 1).
Education    
Prevalence of chronic under nutrition (Stunting) No education 173 30.8
Primary Education 202 35.9
From 562 interviewed mothers-child pair 18.7%; 95% C.I (15.6-
Secondary & above 187 33.3
22.1) of children had chronic under-nutrition (i.e. HAZ ≤ 2Z-score) of
Occupational statues    
which 25.8%; 95% C.I (20.8-31.4) were boys and 12.5%; C.I (8.5-16.0)
Daily laborer 20 3.6
were girls. The level of moderate stunting was 10.4%; C.I (7.9-12.9);
Private (merchant,
among all boys, 14.4%; 95% C.I (10.2-18.6) boys and among all girls, farmers)
259 46.1
6.8%; 95%; C.I (3.9-9.7) girls had moderate chronic under-nutrition. Government worker 27 4.8
The prevalence of severe stunting (HAZ ≤ 3 Z-score) was 8.4%; 95% C.I Housewife 256 45.6
(6.1-10.7). In the overall scenario, boys were more affected than girls. Ethnicity    
There were higher numbers of stunted boys than stunted girls (Figure Gamo &Gofa 491 87.4
1). Wolaita 58 10.3
Factors associated with chronic under nutrition (Stunting) Amhara 11 2
Others 2 0.4
After conducting Multivariate logistic regression analysis boys
Table 1: Socio-demographic characteristics of mothers, who had infant aged from
[AOR: 2.50; 95% CI (1.60-4.01)], age of mothers those in age group ≥ 6-23 months, who live in Kemba Woreda, 2014/15.

Kameba woreda (39 kebeles)

SRS

Kemba 01 Lae Gata fudele Mero Shamla Dembedolo

301 247 323 213 178 225

PPs

114 94 123 82 68 86

567

Figure 1: Schematic presentation of sampling procedure in Kemba Woreda, Southrn Ethiopia, 2014/15.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 5 • Issue 4 • 1000381
Citation: Agedew E, Chane T (2015) Predictors of Chronic Under Nutrition (Stunting) Among Children Aged 6-23 Months in Kemba Woreda, Southern
Ethiopia: A Community Based Cross-Sectional Study. J Nutr Food Sci 5: 381. doi:10.4172/2155-9600.1000381

Page 4 of 5

30 years AOR (2.60; 95% CI (1.07-6.35), education level those who have even lower than the regional stunting levels of Ethiopian demographic
no formal education AOR 2.76 (1.63-4.69), occupational of mothers and health surveillance report [11], Eastern Kenya (33.3%) [15]. This
those who work as daily workers AOR 3.06 (1.03-9.12) and private finding was consistent with finding from Johannesburg (18%) [16]. In
work activity (merchant, farmers) AOR 2.39 (1.61-3.53), mothers who contrast to the above findings, the magnitude of stunting in the our
have no post natal follow up for their child in Health service AOR (1.64 study area was higher than report from Latin America and Caribbean
(1.05-2.55), and maternal illness encountered after delivery AOR 1.56 countries (11%) [17]. The reason why the finding in our setting is
(1.05-2.32) were significantly associated with chronic under nutrition. lower than the others may be due the narrowing of age of children in
However, variables such as place of residence, place of delivery and the study make the magnitude of stunting is declined as compared to
ANC follow up did not show statistical association with chronic under studies having wide target children(<5 years of age. The reason is goes
nutrition (Table 2). in line with findings from Eastern Kenya that shows stunting is more
prevalent in children >2 years [15].
Discussion
In this study, child sex, maternal age, maternal educational level
The result of this study showed that the prevalence of stunting and occupational status, post natal follow up and were statistically
(HAZ ≤ 2SD) was 18.7%) 95% C.I (15.6-22.1). Boys were more likely to significant with chronic under nutrition. Having no formal education
be stunted than girls (25.8% vs. 12.5%). The prevalence of stunting in of mothers and older mothers (>31 years) were negatively associated
this setting was much lower than as compared findings from different with the nutritional status of children. Similarly the findings are
parts of Ethiopia (Bule Hora (47.6%), Jimma arjo (41.4%) [14] and supported with findings from Johannesburg, Tanzania and Kenya

Chronic Nutritional statues  

Explanatory Variable Crude OR (95% CI) Adjusted OR (95% CI) P-value
Normal (%) Stunted (%)
Residence
Rural 159 (77.6) 46 (22.4) 1.50 (1.04-3.33) 1.34 (0.82-2.19) 0.24
Urban 298 (83.5) 59 (16.5) 1 1  
Sex of child
Male 204 (74.2) 69 (25.8) 2.43 (1.56-3.80) 2.50 (1.60-4.01) 0.001
Female 253 (87.5) 36 (12.5) 1    
Age of mother
<=19 74 (76.3) 23 (23.7) 1 1  
20-24 144 (87.3) 21 (12.7) 1.03 (0.60-1.74) 1.15 (0.647-2.08) 0.62
25-30 203 (79.3) 53 (20.7) 1.20 (0.74-1.95) 0.97 (0.54-1.75) 0.924
>=31 36 (81.8) 8 (18.2) 1.96 (0.94-4.09) *2.60 (1.07-6.35) 0.035
Maternal Education level
No formal Education 102 (75.6) 33 (24.4) 3.08 (1.98-4.79 *2.76 (1.63-4.69) 0.001
Primary education 199 (80.9 ) 47 (19.1) 1.72 (1.15-2.57) 1.42 (0.89-2.25)  
Secondary & above 156 (86.2) 25 (13.8) 1 1  
Occupational statues
3.55 (1.40-9.09) 0.41 (0.28-
Daily laborer 16 (72.7) 6 (17.3) *3.06 (1.03-9.12) 0.045
0.59)
Private (merchant, farmers,) 216 (80.9 ) 51 (19.1) 0.34 (0.12-0.96) *2.39 (1.61-3.53) 0.001
Government worker 30 (88.2) 4 (11.8) 1 0.44 (0.16-1.18) 0.103
Housewife 195 (81.6) 44 (18.4)   1  
Media Exposure
Yes 251 (83.7) 49 (16.3) 1    
No 206 (78.6) 56 (21.4) 1.91 (1.35-2.69) 0.86 (0.53-1.39) 0.54
Place of delivery
Home 153 (78.9 ) 41 (21.1) 1.25 (0.87-1.78) 1.41 (0.89-2.24) 1 0.14
Health facility 304 (82.6) 64 (17.4) 1 1  
ANC follow up
Yes 404 (81.3) 93 (18.7) 1 1  
No 53 (81.5) 12 (18.5) 1.66 (0.95-2.89) 0.82 (0.44-1.57) 0.55
PNC follow up
Yes 132 (84.1 ) 25 (15.9) 1 1  
No 325 (80.2) 80 (19.8) 1.80 (1.48-3.2) **1.64 (1.05-2.55) 0.029
maternal illness
Yes 19 (79.2) 5 (20.8) 1.40 (0.99-1.96) **1.56 (1.05-2.32) 0.027
No 437 (81.4) 100 (18.6) 1 1  
**Significant factors

Table 2: Factors associated with stunting among mothers who have 6-23 months of young child in Kemba Woreda in 2014/15.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 5 • Issue 4 • 1000381
Citation: Agedew E, Chane T (2015) Predictors of Chronic Under Nutrition (Stunting) Among Children Aged 6-23 Months in Kemba Woreda, Southern
Ethiopia: A Community Based Cross-Sectional Study. J Nutr Food Sci 5: 381. doi:10.4172/2155-9600.1000381

Page 5 of 5

Authors’ Contribution
% of Children Height-for-Age z-scores (boys/girls) EA: Initiated the research, wrote the research proposal, conducted the
45 WHO standards research, did data entry and analysis and wrote the manuscript.
boys (264) TC: Contributed in the designing of methodology and write up of proposal.
40
girls (293)
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35
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We would like to thank Arba Minch University for funding of our research work.
Our deepest gratitude goes to data collectors, kebeles leaders and Kemba woreda
Health center manager for his cooperation starting from the beginning till the end
of data collection time.

Conflict of Interest
The authors declare that they have no computing interest

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 5 • Issue 4 • 1000381