Seasonal Variation of Household Food Insecurity and Household Dietary Diversity on Wasting and Stunting among Young Children in A Drought Prone Area in South Ethiopia: A Cohort Study

Figures & data

Figure 1. Boricha district map, Sidama, Southern Ethiopia, Ethiopia, 2017.

Figure 2. Study profile of children, Boricha district, Sidama, South Ethiopia, March through December 2017.

Table 1. Baseline information about socioeconomic characteristics in Boricha district of Southern Ethiopia; March 2017

Child Variables	March 2017 (n = 935)
Child sex	Frequency	Percentage
Male	505	54.2%
Female	427	45.8%
Child age in months
6–23 months	274	29.8%
24 month and above	645	70.2%
Household Variables	March 2017 (n = 897)
Mother’s age
19 and below	2	0.2%
20–29	503	56.5%
30–39	361	40.6%
40 and above	24	2.7%
Mother’s education
Primary	402	45.1%
Secondary	42	4.7%
No formal education	448	50.2%
Mother’s occupation
Housewife & farmer	773	86.5%
Merchant/employed	98	11%
Other	23	2.6%
Father’s education
Primary	453	50.8%
Secondary and up	107	12%
No formal education	332	37.2%
Father’s occupation
Farmer	561	62.9%
Merchant/employed	237	26.6%
Other	94	10.5%
Family size
5 and below	513	60.8%
Greater than 5	331	39.2%
Wealth status
Poorest	179	20.1%
Poor	186	20.9%
Medium	169	18.9%
Rich	178	20%
Richest	180	20.2%
Religion
Protestant	727	83.1%
Catholic	88	10.1%
Muslim	60	6.9%

Table 2. Correlation matrix of continuous variables to assess an association between baseline characteristics, household food insecurity, household dietary diversity, wasting, and stunting in four different seasons

Variable	HFI 1	HFI 2	HFI 3	HFI 4	FD 1	FD 3	FD 4	WHZ1	WHZ2	WHZ3	WHZ4	HAZ 1	HAZ2	HAZ3	HAZ4
Increased Wealth	−0.43	−0.37	−0.29	−0.09	0.23	0.16	0.03	0.035	−0.017	0.08	0.001	0.06	0.04	0.04	0.12
	(0.00)	(0.00)	(0.00)	(0.004)	(0.00)	(0.00)	(0.45)	(0.31)	(0.61)	(0.03)	(0.98)	(0.09)	(0.26)	(0.22)	(0.001)
Increased Mother education	20.24	−0.28	−0.10	−0.20	0.13	0.06	0.07	0.02	0.01	0.025	−0.001	0.09	0.08	0.07	0.11
	(0.00)	(0.00)	(0.003)	(0.00)	(0.00)	(0.07)	(0.05)	(0.54)	(0.81)	(0.48)	(0.97)	(0.005)	(0.02)	(0.07)	(0.001)
Increased Family size	0.09	0.11	0.02	0.06	−0.07	−0.02	0.02	−0.06	−0.07	−0.06	−0.012	−0.04	−0.008	−0.002	−0.02 (0.56)
	(0.004)	(0.001)	(0.63)	(0.10)	(0.04)	(0.49)	(0.64)	(0.11)	(0.03)	(0.11)	(0.74)	(0.24)	(0.82)	(0.95)
Increased Maternal age	0.19	0.08	0.06	−0.11	−0.09	0.05	−0.01	−0.01	0.02	0.03	0.08	−0.03	−0.06	−0.09	−0.13
	(0.00)	(0.02)	(0.07)	(0.002)	(0.01)	(0.13)	(0.71)	(0.78)	(0.53)	(0.45)	(0.03)	(0.36)	(0.078)	(0.01)	(0.0004)
Increased Child age								0.05	0.02	−0.11	−0.18	−0.20	−0.13	−0.05	−0.02 (0.53)
								(0.19)	(0.63)	(0.002)	(0.00)	(0.00)	(0.00)	(0.18)
Child sex								0.03	0.005	0.06	0.04	0.04	0.001	0.026	0.007
								(0.36)	(0.89)	(0.10)	(0.28)	(0.21)	(0.78)	(0.46)	(0.84)
HFI1					−0.31	−0.37	−0.17	−0.13	−0.09	−0.11	−0.13	0.04	0.002	−0.04	−0.01 (0.85)
					(0.00)	(0.00)	(0.00)	(0.00)	(0.01)	(0.002)	(0.00)	(0.29)	(0.95)	(0.25)
HFI2						−0.27	−0.19	−	−0.09	−0.09	−0.11	−	−0.06	−0.07	−0.05 (0.13)
						(0.00)	(0.00)		(0.006)	(0.01)	(0.002)		(0.07)	(0.06)
HFI3						−0.42	−0.08	−	−	−0.18	−0.11	−	−	−0.02	−0.01 (0.75)
						(0.00)	(0.02)			(0.00)	(0.002)			(0.67)
HFI4							−0.28	−	−	−	−0.19	−	−	−	0.09
							(0.00)				(0.00)				(0.013)
FD1								−0.04	0.004	−0.006	−0.01	0.08	0.09	0.09	0.06 (0.08)
								(0.23)	(0.90)	(0.85)	(0.83)	(0.02)	(0.01)	(0.01)
FD3								−		0.13	0.15	−		−0.03	−0.05 (0.17)
										(0.00)	(0.00)			(0.45)
FD4								−	−	−	0.07	−	−	−	−0.005
											(0.06)				(0.90)

HFI1 = Household food insecurity score in season 1, FD1 = Food diversity score in season1, WHZ1 = weight-for-height Z scores in season 1, HAZ 1 = Height-for-age Z score in season 1; Numbers next to acronyms indicated for seasons. For example, 1 = season 1, 2 = season 2, 3 = season3 and 4 = season 4

Figure 3. Seasonal variation trend line of food insecurity, wasting, and stunting among children under age five years, Boricha, South Ethiopia, 2017.

Table 3. The overall seasonal pattern of household food consumption, Boricha, Southern Ethiopia, 2017

Season	Lowest (≤ 3) food groups	Above 4 food groups	X^2	P-value	Odds ratio	95% confidence limit
March	285 (32.2%)	599 (67.8%)	Ref	Ref	Ref	Ref
September	185 (21.5%)	675 (78.5)	25	< 0.001	0.58	0.46–0.71
December	48 (5.8%)	785 (94.2%)	191	< 0.001	0.13	0.09–0.18

Figure 4. Frequency of utilizing twelve food groups in the past 24 hours, Boricha, South Ethiopia, 2017. Bar with 95% confidence level.

Table 4. Seasonal patterns in household dietary diversity (HDDS) items, Boricha, Southern Ethiopia, 2017

S.No	Items	March, 2017	September, 2017	December, 2017	X^2	P-value
1	Cereals	697 (78.2%)	808 (94.3%)	825 (99.0%)	236	P < .001
2	Root or tubers	583 (65.6%)	560 (65.1%)	562 (67.6%)	1	P > .05
3	Vegetables	244 (27.4%)	687 (79.9%)	759 (91.3%)	895	P < .001
4	Fruits	100 (11.4%)	141 (16.5%)	67 (8.1%)	29	P < .001
5	Meat or poultry	9 (1.0%)	33 (3.8%)	3 (0.4%)	34	P < .001
6	Eggs	15 (1.7%)	32 (3.73)	3 (0.36%)	26	P < .001
7	Fish	11 (1.2%)	13 (1.5%)	13 (1.6%)	0.4	P > .05
8	Pulses or legumes	374 (42.1%)	369 (43.0%)	631 (76.0%)	254	P < .001
9	Milk and milk product	250 (28.3%)	258 (30.1%)	140 (17.0%)	45	P < .001
10	Oil or fats	607 (68.1%)	599 (70.2)	667 (80.8%)	40	P < .001
11	Sugar or honey	23 (2.6%)	45 (5.3%)	13 (1.6%)	20	P < .001
12	Condiments, coffee	840 (94.2%)	837 (98.0%)	816 (98.3%)	30	P < .001

Figure 5. Seasonal variation of wasting among children under age five in Boricha, South Ethiopia, 2017. Bar with 95% confidence level.

Table 5. Multivariate risk factor of wasting under the age of 5 years in nine Kebele, Boricha, Southern Ethiopia, 2017

Variables		Cases among participants				Crude OR (95% CI)		Adjusted OR (95%CI)
		Yes (N)	%	No (N)	%	OR	95% CI	OR	95% CI
Wealth quintile	Poorest	38	5.6	646	94.4	1.42	0.64−3.12	1.01	0.45−2.26
	Poor	42	5.9	676	94.2	1.21	0.83−1.77	1.11	0.78−1.58
	Medium	44	6.9	591	93.1	1.32	0.97−1.80	1.23	0.95−1.60
	Rich	30	4.4	653	95.6	0.83	0.49−1.41	0.75	0.44−1.27
	Richest	34	5.0	641	94.9	1	Ref	1	Ref
Food security	Secure	19	3.2	573	96.8	0.50	0.31−0.80**	0.56	0.37−0.83**
	Mild	10	3.8	255	96.2	0.60	0.27−1.31	0.78	0.36−1.67
	Moderate	27	5.0	511	94.9	0.66	0.46−0.96*	0.82	0.48−1.39
	Severe	134	6.6	1,890	93.4	1	Ref	1	Ref
Season	Wasting in March 2017	70	7.9	810	92.1	1	Ref	1	Ref
	Wasting in June 2017	49	5.5	842	94.5	0.64	0.36−1.14	0.64	0.37−1.09
	Wasting in September 2017	26	3.2	795	96.8	0.34	0.18−0.62***	0.42	0.24−0.72**
	Wasting in December 2017	46	5.4	800	94.6	0.63	0.32−1.24	0.73	0.39−1.37
Mother’s age		186	5.5	3,199	94.5	0.99	0.95−1.03	0.99	0.95−1.03
Mother’s occupation	Housewife and farmer	164	5.6	2,770	94.4	0.76	0.34−1.71	0.77	0.29−2.04
	Employed/merchant	17	4.4	373	95.6	0.50	0.15−1.65	0.48	0.11−2.08
	Others	7	8.6	74	91.4	1	Ref	1	Ref
Mother’s educational status	Primary	87	5.8	1,420	94.2	1.08	0.79−1.48	1.39	0.97−1.99
	Secondary and above	7	4.5	149	95.5	0.67	0.25−1.82	0.89	0.23−3.39
	No formal education	95	5.5	1,638	94.5	1	Ref	1	Ref
Father’s educational status	Primary	86	5.0	1,628	95.0	0.69	0.48−0.97*	0.68	0.48−0.95*
	Secondary and above	21	5.2	387	94.9	0.69	0.39−1.18	0.68	0.29−1.59
	No formal education	82	6.5	1,190	93.6	1	Ref	1	Ref
Father’s occupation	Farmer	110	5.1	2,028	94.9	0.74	0.45−1.20	0.68	0.41−1.14
	Merchant	51	5.6	857	94.4	0.73	0.37−1.42	0.76	0.38−1.51
	Others	26	7.4	325	92.6	1	Ref	1	Ref
Child sex	Male	113	6.0	1,758	94.0	1.18	0.93−1.50	1.16	0.92−1.46
	Female	78	5.0	1,489	95.0	1	Ref	1	Ref
Morbidity	No	156	5.2	2,859	94.8	0.52	0.28−0.96**	0.79	0.40−1.54
	Yes	35	8.3	388	91.7	1	Ref	1	Ref

*p <.05, **p <.01, and ***p <.001

Figure 6. Seasonal variation in stunting among children under age five, Boricha, South Ethiopia, 2017. Bar with 95% confidence level.

Table 6. Multivariate risk factor for stunting among children younger than 5 years in nine kebele in Boricha, Southern Ethiopia, 2017

Variables		Cases among participants				Crude OR (95% CI)		Adjusted OR (95% CI)
		Yes (N)	%	No (N)	%	OR	95% CI	OR	95% CI
Wealth quintile	Poorest	331	50.2	329	49.9	4.99	1.80−13.82**	4.01	1.33−12.08*
	Poor	293	42.5	396	57.5	3.01	1.21−7.44*	2.47	0.96−6.35
	Middle	258	40.9	373	59.1	1.75	0.65−4.69	1.81	0.62−5.25
	Rich	290	42.8	387	57.2	1.39	0.89−2.19	1.65	1.11−2.46*
	Richest	224	35.3	411	64.7	1	Ref	1	Ref
Food security	Secure	229	40.2	341	59.8	1.92	0.99−3.74	1.28	0.72−2.26
	Mild	140	55.6	112	44.4	2.94	1.18−7.31*	1.35	0.78−2.35
	Moderate	218	41.8	303	58.2	1.56	1.02−2.39*	1.01	0.71−1.45
	Severe	816	41.6	1,134	58.2	1	Ref	1	Ref
Season	Stunting in March 2017	303	35.7	545	64.3	0.24	0.08−0.71*	0.23	0.08−0.68**
	Stunting in June 2017	330	38.7	522	61.3	0.31	0.12−0.82*	0.44	0.16−1.21
	Stunting in September 2017	379	47.7	415	52.3	0.98	0.20−3.31	0.98	0.27−3.54
	Stunting in December 2017	396	48.4	422	51.6	1	Ref	1	Ref
Mother’s education	Primary	581	39.1	906	60.9	0.47	0.27−0.84**	0.43	0.19−0.96*
	Secondary and above	39	26.2	110	73.8	0.18	0.09−0.35***	0.36	0.16−0.83*
	No formal education	780	47.1	876	52.9	1	Ref	1	Ref
Mother’s occupation	Farmer and housewife	1,233	43.5	1,600	56.5	0.36	0.18−0.69**	0.09	0.02−0.34***
	Employed/merchant	136	35.1	252	64.9	0.14	0.05−0.43***	0.05	0.01−0.25***
	Others	38	47.5	42	52.5	1	Ref	1	Ref
Mother’s age		1,385	42.2	1,899	57.8	1.03	0.99−1.07	0.97	0.92−1.02
Child sex	Male	791	44.1	1,004	55.9	1.45	0.85−2.49	1.52	0.77−2.98
	Female	617	40.1	900	59.3	1	Ref	1	Ref
Child age	6–23 months	351	40.7	511	59.3	0.80	0.41−1.57	1.43	0.57−3.57
	>=24 months	1,057	43.1	1,393	56.9	1	Ref	1	Ref
Father’s educational status	Primary	692	41.5	975	58.5	0.72	0.41−1.23	1.08	0.63−1.84
	Secondary and above	120	30.2	277	69.8	0.24	0.12−0.47***	0.41	0.14−1.17
	No formal education	581	47.4	645	52.6	1	Ref	1	Ref
Father’s occupational status	Farmer	923	44.9	1,133	55.1	0.71	0.29−1.69	0.55	0.22−1.39
	Merchant	318	35.6	576	64.4	0.32	0.15−0.69**	0.22	0.08−0.61**
	Others	159	46.4	184	53.6	1	Ref	1	Ref
Exclusive breastfeeding practice	Only breast milk	1,259	41.24	1,794	58.8	0.09	0.01−0.86*	0.05	0.002−1.18
	Breast and other food items	129	67.5	62	32.5	1	Ref	1	Ref
Household dietary diversity score		1,067	43.7	1,377	56.3	1.16	1.07−1.26***	1.07	0.97−1.18

*p <.05, **p <.01, and ***p <.001