A combined model of child malnutrition and morbidity in Ethiopia using structural equation models

Abstract

Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68–0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88–0.99), 48 months and above (AOR = 0.71, 95% CI 0.65–0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78–0.91), high-income households (AOR = 0.66, 95% CI 0.61–0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75–0.85) and higher education level (AOR = 0.57, 95% CI 0.41–0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77–0.99), fourth and higher (AOR = 0.88, 95% CI 0.79–0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64–0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80–0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94–0.097), from middle income (AOR = 0.97, 95% CI 0.96–0.99), high-income households (AOR = 0.94, 95% CI 0.93–0.96), birth spacing 24–47 months (AOR = 0.99, 95% CI 0.98–1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94–0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices.