alexa Prevalence and Associated Factors of Stunting among 6-59 Months Children in Pastoral Community of Korahay Zone, Somali Regional State, Ethiopia 2016 | OMICS International
ISSN: 2161-0509
Journal of Nutritional Disorders & Therapy
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Prevalence and Associated Factors of Stunting among 6-59 Months Children in Pastoral Community of Korahay Zone, Somali Regional State, Ethiopia 2016

Sisay Shine*, Frew Tadesse, Zemenu Shiferaw, Lema Mideksa and Wubarege Seifu

College of Medicine and Health Science, Public Health Department, Epidemiology and Biostatistics Unit, Jig-Jiga University, Jig-Jiga, Ethiopia

*Corresponding Author:
Sisay shine (MPH)
Lecturer of public health
College of Medicine and Health Science
Public Health Department
Epidemiology and Biostatistics Unit, Jig-Jiga University
Jig-Jiga, Ethiopia
Tel: +251-921-646475
E-mail: [email protected]

Received date: February 03, 2017; Accepted date: March 07, 2017; Published date: March 14, 2017

Citation: Shine S, Tadesse F, Shiferaw Z, Mideksa L, Seifu W (2017) Prevalence and Associated Factors of Stunting among 6-59 Months Children in Pastoral Community of Korahay Zone, Somali Regional State, Ethiopia 2016. J Nutr Disorders Ther 7:208. doi: 10.4172/2161-0509.1000208

Copyright: © 2017 Shine, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Back ground: Stunting is one of the most important public health problems in Ethiopia with an estimated 44.4% of children less than five years of age being stunted. Thus, this study aimed to assess prevalence and associated factors of stunting among 6-59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia. Objective of the study: To assess prevalence and associated factors of stunting among 6-59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016. Methods: Community based cross sectional study design was done among 770 children in pastoral community of Korahay Zone. Systematic sampling techniques were used to select households and took child-mother pair from each selected households. Data was collected using pre-tested and structured questionnaire. Odd ratios with 95% confidence interval were used to assess level of significance. Result: Prevalence of stunting among 6-59 months age children was 31.9%. Sex (AOR: 1.47, 95%CI 1.02, 2.11), age (AOR: 2.10, 95%CI 1.16, 3.80), maternal education (AOR: 3.42, 95%CI 1.58, 7.41), maternal occupation (AOR: 3.10, 95%CI 1.85, 5.19), monthly income (AOR: 1.47, 95%CI 1.03, 2.09), postnatal care visits (AOR: 1.59, 95%CI 1.07, 2.37), source of water (AOR: 3.41, 95%CI 1.96, 5.93), toilet availability (AOR: 1.71, 95%CI 1.13, 2.58), first milk feeding (AOR: 3.37, 95%CI 2.27, 5.02) and bottle feeding (AOR: 2.07, 95%CI 1.34, 3.18) were significant predictors of stunting. Conclusion and recommendations: Prevalence of stunting among 6-59 months children was high 31.9%. Lack of maternal education, not feeding first milk, unsafe water supply, unavailability of toilet facilities and bottle feeding can increase the risk of stunting. So, educating mothers on child feeding practice, sanitation and important of first milk can reduce stunting.

Keywords

Stunting; Socio-demographic; Healthcare; Environmental; Dietary; Children; Korahay; Ethiopia

Introduction

Stunting is referred to as being low-height-for-age (HAZ), less than minus two standard deviations (SD) of the new WHO Growth Standard, as it reflects a process of failure to reach linear growth potential as a result of prolonged or repeated episodes of under nutrition starting before birth [1]. It is an indicator of chronic malnutrition [1]. Globally, 34% or one in four children under-5 years old are stunted (26 per cent in 2011). An estimated 165 million (80%) of the world’s stunted children live in just 14 countries [2]. Africa and Asia continents have the highest stunting with more than 90% of the world stunted children living in these continents [3]. About 182 million (32.5%) children in developing countries and 42% of children in sub-Saharan Africa were stunted [4,5].

Different studies conducted in Ethiopia indicated that stunting is one of the most important public health problems in the country [6-10] with different contributing factors such as sex [7,10,11], age of child [9], maternal education [6,12], father education [8], maternal occupation [12,13], household income [6,9,14], antenatal care service utilization [7,12,14], source of water [15], first milk feeding [16] and methods of feeding [13,16].

Ethiopia’s aim is to contribute to the national target of reducing stunting among children under the age of five in selected regions, by reaching 1.5 million stunted children and reduce the prevalence of stunting by up to 26% between 2015 and 2020. The initiative plans to enhance and scale-up high impact feasible Community Based Nutrition programs with the promotion of complementary feeding and dietary diversity at the household level. This will enable children at six months of age to be introduced to nutritionally adequate and safe solid foods with continued breast feeding. The interventions will be implemented and only focused on 150 districts with a total coverage of 1.5 million stunted children living in four agrarian regions [17].

It is important to extend the intervention activity to pastoral and agro pastoral regions like Somali region at which more 37.97% of the population was pastoralist and is one of the most underserved regions in terms of access to essential services and characterized by a high level of child malnutrition, food insecurity and vulnerable livelihoods [18]. According to the 2011 demographic and health survey of Ethiopia, the prevalence of stunting in the region was very high 33% [6]. Despite few local studies conducted in different parts of the region, no previous study attempts to address the magnitude and shortcoming of causes of stunting among the pastoral community of Korahay Zone. Therefore, determining magnitude and identifying risk factors of stunting in the study area is important to guide public health planners, policy makers and implementers to plan and design appropriate intervention strategies in order to enhance nutritional status of children.

Methods

Study design, period and area

Community based cross sectional quantitative study design was used to assess prevalence and associated factors of stunting among 6-59 months age children of pastoral community of Korahay Zone Somali Regional State, Ethiopia 2016.

Source and study population

The source population was all 6-59 months age children and their mothers in Korahay Zone, Somali Regional State. The study population was 6-59 months age children living in the selected three woredas of Korahay Zone, Somali Regional State.

Inclusion and exclusion criteria

Inclusion criteria: Children 6-59 months age who lived with their mothers and whose mothers were available in the selected households.

Exclusion criteria: Both children under-five years of age and whose mothers were critically ill during data collection were not selected.

Children less than 6 month’s age and greater than 59 months age were excluded from the study.

Sample size determination

Sample size was determined based on the formula used to estimate single population proportion assuming that 34.5% of under-five children from Dola Ado pastoral community study were stunted [11]. And 5% margin of error with 95% confidence level with anticipated 10% non-response rate.

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After adjusting for non-response rate of 10% and design affect of 2 the final required sample size was 770 mother-child pair.

Sampling techniques and procedures

Multi-stage sampling technique was used to select the study population. From a total of six woredas found in the Korahay zone, three woredas were selected randomly. From each selected woreda, 3 kebeles were selected through random sampling techniques. Prior to the actual data collection, census was conducted in each selected kebeles to know the eligible households. Then, households were selected by using systematic random sampling techniques and took child-mother pair from each selected household until the required sample size was fulfilled; the starting household was selected by using lottery method.

Data collection methods and instrument

Structured questionnaire adapted from UNICEF and after reviewing different literatures of similar studies and anthropometric measurements were used for the collection of quantitative data. Data on stunting (chronic malnutrition) and demographic, socio-economic, environmental healthcare and dietary factors among 6-59 months age children were collected via interview. Sixteen data collection team members, ten data collectors, three anthropometric measurement recorders and three supervisors were involved in the data collection. English version questionnaire was translated to Somali language and again translated back to English by experts who are fluent in both languages to check consistency.

Anthropometry measurements

Height: Length measurement for children below 24 months was taken in laying down or recumbent position and standing height was taken for children 24-59 months age and the measurement was taken to the nearest 0.1 cm using Short's Height Measuring Board, with the subjects shoeless [19,20].

Age: Childrens’ age was collected from the mother and confirmed by using birth certificate or vaccination cards and also used or a "localevents calendar" [19,20].

Operational definition

Stunting: Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the WHO reference population are considered short for their age (stunted) [1].

Duration of breastfeeding: The number of months of breastfeeding

Complementary feeding: The child receives both breast milk and breast milk substitute foods. among children.

Low income: Households with monthly income below mean income of the sample 1,500 ETB.

Study variables

Stunting was an outcome variable and socio economicdemographic, environmental, health care and dietary factors were independent variables.

Socio-demographic factors: sex, age, birth order, birth interval, mother education, father education, mother occupation, father occupation, household monthly income.

Environmental factors: source of drinking water, toilet availability.

Health care factors: child weight and size, mother place of delivery, child immunization, child diarrheal status, mother antenatal care visits, and mother postnatal care visits.

Dietary factors: breast feeding, time of initiation of breast feeding, first milk feeding duration of breast feeding, age for introduction of complementary food, method of feeding.

Data processing and analysis

Data was entered by using EPI INFO 3.5.1 version computer software package for editing, cleaning, coding, and checking completeness and consistency. Finally, data was exported to SPSS window version 16 for data management and analysis. Anthropometric indices were calculated using WHO Anthro2007 software (version 2.0.4). Association and correlation of the variables were computed using OR and 95% CI. Both bivariate and multivariate logistic regression analysis were used to identify the predictors of stunting. Variables with 95% confidence interval and P value at <0.2 during the bivariate analysis were included in the multivariate logistic regression analysis to see the relative effect of confounding variables. Adjusted odd ratios with 95% confidence interval were calculated and P-value less than 0.05 were considered as statistically significant. Finally, data was displayed by tables, graphs and statements.

Data quality management

The questionnaire was prepared originally in English and translated to Somali language and back to English to keep consistency of the questioner. Pre-test of questionnaire were done before the actual data collection to estimate time needed and some modifications were made on the basis of the findings. The interviewers, anthropometric recorders and supervisors were trained on data collection and measurement techniques for three days. On daily basis, collected information was reviewed and possible errors were returned to the data collectors for correction. Data validity and reliability was maintained through close supervision of enumerators by the principal investigator.

Results

A total of 745 children aged 6-59 months participated in the study with the response rate of 96.75%. From the total respondents, 442 (59.3) were female, 208 (27.9%) found in the age group of 12-23 months, mean age of children 25 months with the SD of ± 13.59 months, 736 (98.8%) were Muslim followers in religion and 724 (97.2%) were Somali in ethnic group.

Magnitudes of stunting among 6-59 months children

From the total children of 6-59 months age in the study area 238 (31.9%) were stunted (<-2SD), out of which 144 (19.3%) were moderately stunted (-2<SD<-3) and 94 (12.6%) were severely stunted (<-3SD) (Figure 1). The prevalence was 11.3 % in children age group of 12-23 months (Figure 2).

nutritional-disorders-therapy-pastoral-community

Figure 1: Prevalence of stunting with sex among children 6-59 months in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016.

nutritional-disorders-therapy-Regional-State

Figure 2: Prevalence of stunting with age groups among children 6-59 months in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016.

Factors associated with stunting

Socio-demographic factors: from socio-demographic variables sex of child (AOR: 1.47, 95% CI 1.02, 2.11), age of child (AOR: 2.10, 95% CI 1.16, 3.80), mother’s education can read and write (AOR: 3.04, 95% CI 1.40, 6.59), can't read and write (AOR: 3.42, 95% CI 1.58, 7.41), primary school (AOR: 7.18, 95% CI 2.05, 25.13), mother occupation (AOR: 3.10, 95% CI 1.85, 5.19) and household monthly income (AOR: 1.47, 95% CI 1.03, 2.09) showed significant association with stunting (Table 1).

Socio-demographic variable       Stunting   COR (95% CI)   AOR (95%CI)
Yes (%) No (%)
Sex of child        
Male 83 (11.1) 220 (29.5) 1.43 (1.04, 1.97) 1.47 (1.02, 2.11 )*
Female 155 (20.8) 287 (38.6) 1.00 1.00
Children’s age in month        
6-11 38 (5.1) 79 (10.6) 1.00 1.00
12-23 78 (11.3) 130 (17.4) 0.80 (0.50, 1.29) 1.60 (0.67, 2.02)
24-35 46 (6.1) 139 (18.7) 1.45 (0.87, 2.42) 2.10 (1.16, 3.80)*
36-47 42 (5.3) 86 (11.5) 0.99 (0.58, 1.68) 1.65 (0.87, 3.12 )
48-59 34 (4.1) 73 (9.9) 1.03 (0.59, 1.81) 1.59 (0.81, 3.12)
Mother’s education        
Can read and write 125 (16.8) 222 (29.8) 1.37 (0.73, 2.55) 3.04 (1.40, 6.59)*
Can't read and write 76 (10.2) 219 (29.4) 2.21 (1.17, 4.18) 3.42 (1.58, 7.41)*
Primary (1-8) school 6 (0.8) 26 (3.5) 3.33 (1.15, 9.64) 7.18 (2.05, 25.13)*
Secondary (9-12) 11 (1.5) 14 (1.9) 0.98 (1.37, 2.61) 1.62 (0.54, 4.84)
Above secondary 20 (2.6) 26 (3.5) `1.00  
Father’s education        
Can read and write 129 (17.3) 292 (39.2) 1.25 (1.05, 1.85)  
Can't read and write 28 (3.8) 72 (9.7) 1.42 (1.02, 2.45)  
Primary (1-8) 11 (1.5) 15 (2.0) 0.75 (1.32, 1.75)  
Secondary (9-12) 16 (2.1) 30 (4.0) 0.84 (1.52, 2.06)  
Above secondary 54 (7.2) 98 (13.2) 1.00  
Mother’s occupation        
House Wife 189 (25.3) 325 (43.6) 1.00 1.00
Government employee 31 (4.3) 134 (18.0) 2.51 (1.64, 3.86) 3.10 (1.85, 5.19 )**
Self-employer 18 (2.3) 48 (6.5) 1.55 (0.88, 2.74) 1.31 (0.68, 2.54 )
Father’s occupation        
Farmer 100 (13.4) 210 (28.2) 1.00  
Government employee 72 (9.6) 148 (19.9) 0.98 (0.68, 1.42)  
Non-government employee 17 (2.3) 35 (4.7) 0.98 (0.52, 1.83)  
Merchant and Self-employee 49 (6.6) 144 (15.3) 1.11 (0.74, 1.67)  
Household monthly income in ETB        
Less than 1,760 103 (13.8) 273 (36.6) 1.53 (1.12, 2.09) 1.47 (1.03, 2.09)*
1,760 and more 135 (18.1) 234 (31.5) 1.00 1.00
* Significant at P < 0.05             
** Significant at P < 0.001

Table 1: Association of stunting with socio-demographic determinants among 6 to 59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016.

Healthcare and environmental factors: from health care and environmental factors such as mother attending PNC service (AOR: 1.59, 95% CI 1.07, 2.37), unprotected well as source water (AOR: 3.41, 95% CI 1.96, 5.93) and availability toilet facility (AOR: 1.71, 95% CI 1.13, 2.58) showed significant association with stunting. But birth order of child (AOR: 4.46, 95% CI 0.38, 51.49) and preceding birth interval of child (AOR: 033, 95% CI 0.03, 3.81) didn’t show significant association with stunting (Table 2).

Healthcare and environmental variable         Stunting   COR (95% CI)  
AOR (95%CI)
Yes (%)   No (%)
No. of ANC visits of mother        
None 30 (4.0) 77 (10.3) 0.96 (0.40, 2.31)  
1 39 (5.2) 80 (10.7) 0.77 (0.33, 1.81)  
2-3 160 (21.5) 326 (43.9) 0.76 (0.35, 1.68)  
4 and more 9 (1.2) 24 (3.2) 1.00  
PNC visits of Mother        
Yes
No
104 (13.1)
134 (18.8)
144 (19.3)
363 (48.8)
1.00
1.96 (1.42, 2.70)
1.00
1.59 (1.07, 2.37)* 
Mother’s age at Pregnancy        
Less than 20 years 85 (11.4) 160 (21.5) 0.98 (0.56, 1.72)  
20 to 35 years 129 (17.3) 301 (40.4) 1.23 (0.71, 2.08)  
More than 35 years 24 (3.2) 46 (6.2) 1.00  
Mother’s place of delivery          
Public facility 79 (10.6) 151 (20.3) 1.00  
Private facility 4 (0.5) 12 (1.6) 1.57 (0.49, 5.03)  
At home 155 (20.8) 344 (46.2) 1.16 (0.83, 1.62)  
Birth order of child        
1 87 (11.7)      123 (16.6) 1.00 1.00
2-3 111 (14.9) 275 (36.9) 1.75 (1.23, 2.49) 4.46 (0.38, 51.49)
4 and above 40 (5.3) 109 (14.6) 1.93 (1.22, 3.04) 5.49 (0.47, 64.22)
Preceding birth interval        
Less than 24 months 151 (20.3) 378 (50.7) 1.68 (1.21, 2.35) 0.33 (0.03, 3.81)
More than 24 months  87 (11.6) 129 (17.4) 1.00 1.00
Took any form of vaccination        
Yes 153 (20.5)     348 (46.7) 1.00  
No   85 (11.4) 159 (21.4) 0.82 (0.59, 1.14)  
Diarrheal status of children        
Yes  48 (6.4) 96 (12.9) 0.93 (0.63, 1.36)  
No 190 (25.5) 411 (55.2) 1.00  
Sources of drinking water          
Private tap 71 (9.5)      84 (11.3) 1.00 1.00
Public tap 83 (11.1) 177 (23.8) 1.80 (1.20, 2.72) 1.35 (0.84, 2.17)
Protected well 26 (3.5) 62 (8.3) 2.02 (1.16, 3.53) 1.76 (0.92, 3.37)
Unprotected well 58 (7.8) 184 (24.7) 2.68 (1.74, 4.13) 3.41 (1.96, 5.93)**
Toilet facility availability        
Yes 176 (23.6)     307 (41.2) 1.00 1.00
No 62 (8.3) 200 (26.9) 1.85 (1.32, 2.60) 1.71 (1.13, 2.58)*
* Significant at P < 0.05             
** Significant at P < 0.001

Table 2: Association of stunting with healthcare and environmental factors among 6 to 59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016.

Dietary factors: dietary factors such as child fed first milk (AOR: 3.37, 95% CI 2.27, 5.02) and bottle feeding (AOR: 2.07, 95% CI 1.34, 3.18) showed significant association with stunting. But time for initiation of breast feeding (AOR: 1.25, 95% CI 0.86, 1.82) and age of children at which complementary food started before six months (AOR: 095, 95% CI 0.63, 1.45) and after six months (AOR: 1.19, 95% CI 0.63, 2.23) didn’t show significant association with stunting (Table 3).

Dietary variable Stunting COR (95% CI) AOR (95%CI)
Yes (%) No (%)
Time for initiation of BF
Within 1 hour 110 (14.8) 182 (24.4) 1.00 1.00
Within 24 hours 128 (17.1) 325 (43.7) 1.54 (1.12, 2.10) 1.25 (0.86, 1.82)
Child fed first milk
Yes 186 (17.2) 299 (40.1) 1.00 1.00
No 52 (14.7) 208 (27.9) 3.40 (2.39, 4.88) 3.37 (2.27, 5.02 )**
Duration of breast feeding
Less than 12 months 128 (20.0) 274 (36.8) 1.24 (0.91, 1.69) 1.17 (0.82, 1.68)
More than 12 months 110 (11.9) 233 (31.3) 1.00 1.00
Complementary food Started
At 6 month 71 (9.5)    123 (16.5) 1.00 1.00
Before 6 month
After 6 month
142 (19.1)
25 (3.3)
   316 (42.4)
68 (9.2)
1.30 (0 .92, 1.83)
1.57 (0.91, 2.71)
0.95 (0.63, 1.45)
1.19 (0.63, 2.23)
Cup for feeding
Yes 199 (26.7) 411 (55.2)  0.84 (0.55, 1.12)
No 39 (5.2) 96 (12.9) 1.00
Spoon for feeding
Yes 10 (1.3) 16 (2.2) 0.74 (0.33, 1.61)
No 228 (30.6) 491 (65.9) 1.00
Hand for feeding
Yes 37 (5.0) 73 (9.8) 0.91 (0.60, 1.40)
No 201 (26.9) 434 (58.3) 1.00
Bottle for feeding
Yes    112 (15.0)     282 (37.9) 0.71 (0.52, 0.97) 2.07 (1.34, 3.18)**
No  126 (16.9)     225 (30.2) 1.00 1.00
* Significant at P < 0.05             
** Significant at P < 0.001

Table 3: Association of stunting with dietary factors among 6 to 59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016.

Discussion

In this study, the prevalence of stunting was 31.9%. This is congruent with previous study reports in China [21], was 27%, Indonesia [22], was 29%, Uganda [20], was 33.3%, Somalia [23], was 31% and in different part of Ethiopia [6,9-12]. However, the findings of this study was higher than the report in Brazil [24], was 15.5%, Iran [25], was 9.53% and pastoral community of Tanzania [26], was 14%. These variations might be due to the area was one of the most underserved area in terms of access to health services and characterized by high level of food insecurity, vulnerable livelihood and recurrent episodes of drought. However, prevalence of stunting in this study was lower than the report in Delhi [27], was 42.2%, India [28], was 49.6%, Nigeria [29], was 38.7%, Kenya [30], was 45.9%, and different part of Ethiopia [7,14,16]. These might be due to deference in cultural diet of pastoral community which is typically protein rich food like milk and meat.

This study revealed that boys (AOR: 1.47, 95% CI 1.02, 2.11) were more likely to be stunted compared with girls. This was consistent with the reports in Iran [25], Indonesia [22], Somalia [23], Democratic Republic of Congo [31], Sub-Sahara Africa countries [32] and Ethiopia [6,7,10,16]. In contrast study conducted in India [33] showed that girls were more stunted than boys. This variation might be due to unmeasured factors on care-giving behaviours by the sex preference of mothers. However, Studies conduct in China [21], Cambodia [34], and in Ethiopia [15] suggested that there was no difference in prevalence of stunting by sex of the children this might be due to the variation of study population.

In this study, child at age category of 24-35 (AOR: 2.10, 95% CI 1.16, 3.80) were more likely stunted compared with 6-11months. It was consistent with a previous study done in Ethiopia [9]. This could be because; it was the critical age for children to shift from breast milk feed to other food.

This study indicated that maternal educational status was inversely associated with stunting. This was consistent with the report in Nepal [35], India [28], Iran [25], Nigeria [36], Tanzania [26], Kenya [37], Somalia [23], and Ethiopia [6,12]. Maternal education increase knowledge about their children’s health and nutrition, which can have impact on prevention of stunting.

Children from government employee’s mothers (AOR: 3.10, 95% CI 1.85, 5.19) were more likely to develop stunting than house wife mothers. It was consistent with the study done in Nepal [35] and Ethiopia [6,12]. This might be due to housewife mothers could get more time to care their children.

This study indicated that children living in households that have low monthly income (AOR: 1.47, 95% CI 1.03, 2.09) were more likely to develop stunting than children living in high monthly income. It was consistent with the study done Nepal [35], India [28], Iran [25], Indonesia [22], and Ethiopia [6,9,12,14]. This could be due to the fact that, low income levels of households limits the kinds and the amounts of food available for consumption and will not have access to health care and get quality food.

In the study area, postnatal visits (AOR: 1.59, 95% CI 1.07, 2.37) showed significant association with stunting. But a study done in Northeastern Ethiopia [10] showed that postnatal visits didn’t show significant association with stunting. This variation might be due to the difference in population on the acceptability of health service provided in the area.

In this study using unprotected well (AOR: 3.41, 95% CI 1.96, 5.93) as source of water supply showed significant association with stunting. This was consistent with the report in Guatemala [38], Nigeria [36], and Ethiopia [15]. In contrary, studies in Iran [25], Cambodia [34], and Ethiopia [12] revealed that availability of safe drinking water had no associated with stunting. This variation might be due to the difference in sampling techniques and study population.

Availability of toilet facilities (AOR: 1.71, 95% CI 1.13, 2.58) showed association with risk of stunting in the study. It was consistent with the study done in Nigeria [36] and Ethiopia [12]. Toilet availability leads the community to have better sanitation that lowers the risk of infection among the children.

Children who were not fed first milk (AOR: 3.37, 95% CI 2.27, 5.02) had higher occurrence of stunting than who fed first milk. It was consistent with the study done in India [28], Nepal [35], and Ethiopia [16]. First milk can protect children from different diseases such as diarrhea and pneumonia.

Feeding children by using bottle increase the risk of stunting in the study area. It was consistent with the studies done in Ethiopia [13,16]. In contrary, another study done in Ethiopia [9] showed that bottle feeding had no association with stunting. Bottle feeding can increase repeated infection of children by diarrhea due to bottle is easily contaminated.

In this study, we have limitations that should be noted. Use of crosssectional study may not create true causal relationship between stunting and its risk factors. Qualitative data were not included to explore some associated factors and to triangulate the finding of the quantitative study through qualitative data.

Conclusion and Recommendation

Prevalence of stunting among under-five children in the study area is still high 31.9%. Sex of child, age of child, maternal education, maternal occupation, household monthly income, postnatal care visit by mothers, source of drinking water, toilet availability, children feeding first milk and bottle feeding were risk factors of stunting. So, educating mothers on child feeding practice, sanitation and important of first milk can reduce stunting.

Declarations

Ethical approval and consent to participate

This study was carried out after getting ethical clearance from Jig- Jiga University research ethics review committee. Data collection was carried out after receiving ethical clearance letter from the regional health bureau and administration office. Informed verbal consent was obtained from each study participant prior to data collection.

Acknowledgements

We would like to thank Regional Health Bureau and Zonal Health Office heads for their collaboration during conducting this research. Our gratitude also goes to our data collectors and study participants for their willingness to participate in the study. At last but not least, we would like to forward my special thank and sincere appreciations to our friends who gave advice and comment throughout the whole research project activities.

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Agri & Aquaculture Journals

Dr. Krish

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1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

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1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

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Chemistry Journals

Gabriel Shaw

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Clinical Journals

Datta A

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Engineering Journals

James Franklin

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Food & Nutrition Journals

Katie Wilson

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General Science

Andrea Jason

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1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

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1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

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1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

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Nursing & Health Care Journals

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Medical Journals

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Neuroscience & Psychology Journals

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Pharmaceutical Sciences Journals

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Social & Political Science Journals

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