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Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects
Biniyam Sahiledengle1, Kingsley E Agho2,3,4, Pammla Petrucka5
1Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
Insights
Concurrent wasting and stunting (WaSt) affects nearly 1 in 20 Ethiopian children, with higher risks for older children, those with illness, and those perceived smaller at birth. Interventions are crucial to mitigate poor health outcomes.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Concurrent wasting and stunting (WaSt) represents a severe form of child malnutrition, characterized by the simultaneous presence of low weight-for-height and low height-for-age.
- This dual burden of malnutrition poses significant risks for child mortality, morbidity, and long-term developmental impairments.
- Understanding the prevalence and determinants of WaSt is critical for developing effective public health interventions in vulnerable populations.
Purpose of the Study:
- To determine the prevalence of concurrent wasting and stunting (WaSt) in Ethiopian children aged 0-59 months.
- To identify key associated factors and determinants contributing to WaSt in the Ethiopian context.
- To inform targeted interventions aimed at reducing the burden of WaSt and its associated adverse outcomes.
Main Methods:
- Analysis of a large dataset (n=33,650) from four waves of the Ethiopian Demographic and Health Survey (EDHS).
- Utilized a mixed-effects logistic regression model to identify factors associated with WaSt.
- Examined child age, birth size perception, illness history (diarrhea, fever), vaccination status, maternal BMI, household wealth, and geographic setting (urban/rural).
Main Results:
- The overall prevalence of WaSt was 4.7%, with higher rates in rural (4.9%) versus urban (2.5%) settings.
- Factors significantly associated with increased odds of WaSt included older age groups (12-23 and 24-59 months), perceived small birth size, and recent episodes of diarrhea or fever.
- Factors associated with reduced odds of WaSt included being female, receiving measles vaccination, normal maternal BMI, higher household wealth, and living in a rural setting.
Conclusions:
- Concurrent wasting and stunting is a significant public health concern in Ethiopia, affecting approximately 1 in 20 children.
- Prompt identification and intervention are necessary, particularly for older children, those with a history of illness, and those perceived small at birth.
- Public health strategies should address nutritional status, healthcare access, maternal health, and socioeconomic factors to combat WaSt effectively.
Abstract:
Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.
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