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

ABSTRACT

Background: 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.

KEYWORDS:

• Child malnutrition
• nutrition-specific drivers
• nutrition-sensitive drivers
• KA-HDSS
• Ethiopia

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

The authors are thankful to the study participants and data collectors of KA-HDSS. We acknowledge the funding support of the Centers for Disease Control and Prevention (CDC) through the Ethiopian Public Health Association (EPHA) and Mekelle University provided to KA-HDSS, where this data were extracted. We also sincerely appreciate Purdue University Center for Global Food Security for funding the publication cost of this research work. The first author got a PhD scholarship opportunity from DAAD through the Food Security Centre (FSC) at the University of Hohenheim and we are also pleased to acknowledge this support.

Author contributions

SFA, EJA, AMB, AAG, GE, JL, AW, and VS have substantial contributions to the conception or design of the work, the acquisition, analysis, interpretation of the data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

KA-HDSS was established with the ethical approval from Ethiopian Science and Technology Agency with an identification number of IERC-0030. Verbal consent was obtained from all the study participants. The Health Research Ethics Review Committee (HRERC) in Mekelle University also approved this study.

Paper context

Acute child undernutrition remains a persistently prevalent health problem in Tigray region, where over the course of 16 years, its burden showed no change. The prominent added value of this paper is that it has identified the nutrition-specific and sensitive determinants of young child undernutrition by examining a wide range of socio-economic, epi-demographic, agricultural, and other nutritional factors. Joint interventions by the agriculture, nutrition and health sectors are urgently needed to address young child undernutrition.

Supplementary material

Supplementary data for this article can be accessed here.

Additional information

Funding

The surveillance site, where the first author works as a research team member, has been funded by the Centers for Disease Control and Prevention (CDC-Ethiopia) through Ethiopian Public Health Association (EPHA) in accordance with the EPHA-CDC Cooperative Agreement No.5U22/PS022179_05, and Mekelle University. The first author’s PhD stipend has been covered by DAAD through the Food Security Center (FSC) at the University of Hohenheim, Germany. All the funders had no role in the design of the study, data collection and analysis, preparation of the manuscript, or decision to publish.