Nutrition-specific and sensitive drivers of poor child nutrition in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Northern Ethiopia: implications for public health nutrition in resource-poor settings

Semaw Ferede Abera,Eva Johanna Kantelhardt,Afewrok Mulugeta Bezabih,Alemseged Aregay Gebru,Gebisa Ejeta,Judith Lauvai,Andreas Wienke,Veronika Scherbaum

doi:10.1080/16549716.2018.1556572

Abstract

ABSTRACTBackground: Child undernutrition is a prevalent health problem and poses various short and long-term consequences.Objective: This study seeks to investigate the burden of child undernutrition and its drivers in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, northern Ethiopia.Methods: In 2015, cross-sectional data were collected from 1,525 children aged 6–23 months. Maternal and child nutritional status was assessed using the mid upper arm circumference. Child’s dietary diversity score was calculated using 24-hours dietary recall method. Log-binomial regression and partial proportional odds model were fitted to examine the drivers of poor child nutrition and child dietary diversity (CDD), respectively.Results: The burden of undernutrition and inadequate CDD was 13.7% (95% CI: 12.1–15.5%) and 81.3% (95%CI: 79.2–83.1%), respectively. Maternal undernutrition (adjusted prevalence ratio, adjPR = 1.47; 95%CI: 1.14–1.89), low CDD (adjPR = 1.90; 95%CI: 1.22–2.97), and morbidity (adjPR = 1.83; 95%CI: 1.15–2.92) were the nutrition-specific drivers of child undernutrition. The nutrition-sensitive drivers were poverty (compared to the poorest, adjPR poor = 0.65 [95%CI:0.45–0.93], adjPR medium = 0.64 [95%CI: 0.44–0.93], adjPR wealthy = 0.46 [95%CI: 0.30–0.70], and adjPR wealthiest = 0.53 [95%CI: 0.34–0.82]), larger family size (adjPR = 1.10; 95%CI: 1.02–1.18), household head’s employment insecurity (adjPR = 2.10; 95%CI: 1.43–3.09), and residing in highlands (adjPR = 1.93; 95%CI: 1.36–2.75). The data show that higher CDD was positively associated with wealth (OR wealthy = 3.06 [95%CI: 1.88–4.99], OR wealthiest = 2.57 [95%CI: 1.53–4.31]), but it was inversely associated with lack of diverse food crops production in highlands (OR = 0.23; 95%CI: 0.10–0.57]).Conclusions: Our findings suggest that the burden of poor child nutrition is very high in the study area. Multi-sectoral collaboration and cross-disciplinary interventions between agriculture, nutrition and health sectors are recommended to address child undernutrition in resource poor and food insecure rural communities of similar settings.

Highlights

Child undernutrition is a prevalent health problem and poses various short and long-term consequences
The distribution of MUACZ score of the study children was left shifted as compared with the Z-scores of World Health Organization (WHO) standard (Figure B1)
We found that various determinants were significantly associated with child undernutrition including: maternal undernutrition, inadequate child dietary diversity, daily laborer occupation of household head, and occurrence of morbidity among a family member (Table 2)

Summary

Introduction

Child undernutrition is a prevalent health problem and poses various short and long-term consequences. Child undernutrition is the leading cause of child morbidity and mortality globally [1,2] It is still a persistently prevalent health problem in Ethiopia [3,4,5,6,7,8] even though its burden shows a declining trend [9]. According to the Ethiopian Demographic and Health Survey (EDHS) 2000 and 2016 child wasting, an indicator of acute food deficit, showed only a 2% decline at national level, and persisted at 11.1% in Tigray regional state [9,10]. Multiple factors and their complex interactions result in child undernutrition. Maternal nutritional insult, larger family size with short birth interval, the absence of diverse agricultural food crop production, living in highlands and childhood morbidity, were reported to be associated with child undernutrition [11,14,15,22,23,24,25,26,27,28,29,30]

Methods

Results

Conclusion