Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting, Data Source, and Study Design
2.2. Data Collection
2.3. Variable and Measurements
2.4. Independent Variable
2.5. Data Analysis
3. Results
3.1. Sociodemographic Characteristics of the Sample
3.2. Prevalence of Anaemia, Stunting, and Concurrent Anaemia and Stunting (CAS)
3.3. Factors Associated with Concurrent Anaemia and Stunting (CAS)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total Weighted Frequency | Percent |
---|---|---|
Individual-level factors | ||
Child factors | ||
Sex | ||
Male | 10,824 | 51.1 |
Female | 10,348 | 48.9 |
Age (months) | ||
6–11 | 2479 | 11.7 |
12–23 | 4504 | 21.3 |
24–35 | 4471 | 21.1 |
36–59 | 9719 | 45.9 |
Birth order | ||
Firstborn | 3698 | 17.5 |
2–4 | 9206 | 43.5 |
5 or higher | 8267 | 39.0 |
Birth interval | ||
<33 months | 14,566 | 68.8 |
≥33 months | 6606 | 31.2 |
Perceived size of a child at birth | ||
Larger | 6792 | 32.2 |
Average | 8574 | 40.6 |
Small | 5739 | 27.2 |
Currently breastfeeding | ||
Yes | 14,936 | 70.5 |
No | 6236 | 29.5 |
Received measles | ||
Yes | 8086 | 47.5 |
No | 8925 | 52.5 |
Full vaccination | ||
Yes | 4156 | 28.9 |
No | 12,546 | 75.1 |
Diarrhea | ||
Yes | 3065 | 14.5 |
No | 18,077 | 85.5 |
Fever | ||
Yes | 3564 | 16.9 |
No | 17,569 | 83.1 |
Children age 6–59 months given iron supplement | ||
Yes | 1336 | 6.3 |
No | 19,836 | 93.7 |
Children age 6–59 months given deworming medication | ||
Yes | 2982 | 14.1 |
No | 18,190 | 85.9 |
Parental factors | ||
Mother’s age | ||
<18 | 108 | 0.5 |
18–24 | 4524 | 21.4 |
25–34 | 11,146 | 52.6 |
≥35 | 5394 | 25.5 |
Mother’s education | ||
No education | 14,862 | 70.2 |
Primary | 5321 | 25.1 |
Secondary | 678 | 3.2 |
Higher | 311 | 1.5 |
Mother’s occupation | ||
Not working | 11,184 | 53.0 |
Non agriculture | 4659 | 22.1 |
Agriculture | 5239 | 24.8 |
ANC Visit | ||
None | 7081 | 51.4 |
1–3 | 3438 | 24.9 |
4–7 | 2929 | 21.3 |
8+ | 318 | 2.3 |
Maternal BMI (kg/m2) | ||
<18.5 | 4416 | 21.0 |
18.5 to 24.9 | 15,609 | 74.2 |
25+ | 1001 | 4.8 |
Any anaemia | ||
Yes | 5070 | 24.5 |
No | 15,601 | 75.5 |
Maternal stature | ||
Very short (<145 cm) | 466 | 2.2 |
Short (145 to <155 cm) | 7337 | 34.9 |
Normal/Tall (155 to <200 cm) | 13,237 | 62.9 |
Listening to radio | ||
Not at all | 13,182 | 62.3 |
Yes | 7983 | 37.7 |
Watching television | ||
Not at all | 16,532 | 78.1 |
Yes | 4625 | 21.9 |
Household factors | ||
Wealth index | ||
Poor | 9640 | 45.5 |
Middle | 4439 | 21.0 |
Rich | 7094 | 33.5 |
Household Size | ||
1–4 | 5001 | 23.6 |
≥5 | 16,171 | 76.4 |
Place of cooking | ||
In the house | 8586 | 49.7 |
In separate building | 7089 | 41.1 |
Outdoors | 1585 | 9.2 |
Type of cooking fuel | ||
Clean fuels | 349 | 1.7 |
Solid fuels | 20,441 | 98.3 |
Toilet facility | ||
Improved | 2127 | 10.2 |
Unimproved | 9368 | 44.8 |
Open defecation | 9421 | 45.0 |
Source of drinking water | ||
Improved | 9571 | 45.8 |
Unimproved | 11,338 | 54.2 |
Household flooring | ||
Improved | 1892 | 8.9 |
Unimproved | 19,274 | 91.1 |
Time to reach a water source | ||
On premises | 1489 | 7.0 |
≤30 min | 11,863 | 56.0 |
31–60 min | 4520 | 21.4 |
>60 min | 3300 | 15.6 |
Community Level Factors | ||
Residence | ||
Urban | 2279 | 10.8 |
Rural | 18,894 | 89.2 |
Region # | ||
Large centrals | 19,459 | 91.9 |
Small peripherals | 1220 | 5.8 |
Metropolis | 493 | 2.3 |
Ecological Zone | ||
Tropical zone | 3148 | 14.9 |
Subtropical zone | 14,924 | 70.5 |
Cool zone | 3100 | 14.6 |
EDHS | ||
2005 | 3898 | 18.4 |
2011 | 8943 | 42.2 |
2016 | 8332 | 39.4 |
Variables | Concurrent Anaemia and Stunting (CAS), n (%) | Crude OR | p-Value | |
---|---|---|---|---|
Yes | No | |||
Child factors | ||||
Sex | ||||
Male | 2789 (54.0) | 8035 (50.2) | 1.14 (1.07–1.22) | p < 0.001 |
Female | 2376 (46.0) | 7972 (49.8) | Ref. | |
Age (months) | ||||
6–11 | 380 (7.4) | 2098 (13.1) | Ref. | |
12–23 | 1326 (25.7) | 3178 (19.9) | 2.69 (2.34–3.09) | p < 0.001 |
24–35 | 1297 (25.1) | 3173 (19.8) | 2.95 (2.56–3.39) | p < 0.001 |
36–59 | 2163 (41.9) | 7556 (47.2) | 1.89 (1.65–2.16) | p < 0.001 |
Birth order | ||||
First born | 812 (15.7) | 2886 (18.0) | Ref. | |
2–4 | 2186 (42.3) | 7020 (43.9) | 1.18 (1.07–1.29) | 0.001 |
5 or higher | 2167 (41.9) | 6100 (38.1) | 1.40 (1.27–1.55) | p < 0.001 |
Birth interval | ||||
<33 months | 3569 (69.1) | 10,996 (68.7) | 0.98 (0.92–1.06) | 0.767 |
≥33 months | 1596 (30.9) | 5010 (31.3) | Ref. | |
Perceived size of a child at birth | ||||
Larger | 1555 (30.2) | 5.236 (32.8) | Ref. | |
Average | 1969 (38.2) | 6604 (41.4) | 1.09 (1.01–1.19) | 0.03 |
Small | 1627 (31.6) | 4112 (25.8) | 1.45 (1.33–1.58) | p < 0.001 |
Currently breastfeeding | ||||
Yes | 3809 (73.7) | 11,127 (69.5) | 1.08 (1.01–1.16) | 0.022 |
No | 1356 (26.3) | 4879 (30.5) | Ref. | |
Full vaccination | ||||
Yes | 941 (23.0) | 3215 (25.5) | Ref. | |
No | 3153 (77.0) | 9393 (74.5) | 1.21 (1.11–1.32) | p < 0.001 |
Diarrhea | ||||
Yes | 841 (16.3) | 2224 (13.9) | 1.25 (1.14–1.37) | p < 0.001 |
No | 4319 (83.7) | 13,758 (86.1) | Ref. | |
Fever | ||||
Yes | 959 (18.6) | 2605 (16.3) | 1.19 (1.09–1.29) | p < 0.001 |
No | 4196 (81.4) | 13,373 (83.7) | Ref. | |
Children age 6–59 months given iron supplement | ||||
Yes | 309 (6.0) | 1026 (6.4) | Ref. | |
No | 4856 (94.0) | 14,980 (93.6) | 1.03 (0.91–1.18) | 0.623 |
Children age 6–59 months given deworming medication | ||||
Yes | 652 (12.6) | 2330 (14.6) | Ref. | |
No | 4513 (87.4) | 13,677 (85.4) | 1.18 (1.07–1.31) | 0.001 |
Parental factors | ||||
Mother’s age | ||||
<18 | 33 (0.6) | 75 (0.5) | 0.90 (0.56–1.44) | 0.665 |
18–24 | 1110 (21.5) | 3413 (21.3) | 0.96 (0.87–1.06) | 0.490 |
25–34 | 2727 (52.8) | 8419 (52.6) | 0.99 (0.92–1.08) | 0.981 |
≥35 | 1295 (25.1) | 4099 (25.6) | Ref. | |
Mother’s education | ||||
No education | 3881 (75.1) | 10,980 (68.6) | 6.06 (3.95–9.29) | p < 0.001 |
Primary | 1159 (22.4) | 4.162 (26.0) | 4.35 (2.83–6.69) | p < 0.001 |
Secondary | 102 (2.0) | 576 (3.6) | 2.65 (1.67–4.22) | p < 0.001 |
Higher | 23 (0.5) | 287 (1.8) | Ref. | |
Mother’s occupation | ||||
Not working | 2828 (54.9) | 8355 (52.4) | 1.29 (1.18–1.41) | p < 0.001 |
Agriculture | 1312 (25.5) | 3927 (24.6) | 1.24 (1.11–1.39) | p < 0.001 |
Non agriculture | 1004 (19.5) | 3656 (22.9) | Ref. | |
ANC visit | ||||
None | 1949 (57.1) | 5132 (49.6) | 2.11 (1.63–2.72) | p < 0.001 |
1–3 | 817 (23.9) | 2621 (25.3) | 1.71 (1.32–2.22) | p < 0.001 |
4–7 | 591 (17.3) | 2337 (22.6) | 1.18 (0.91–1.54) | 0.219 |
8+ | 54 (1.6) | 264 (2.5) | Ref. | |
Maternal BMI (kg/m2) | ||||
<18.5 | 1215 (23.7) | 3202 (20.1) | Ref. | |
18.5 to 24.9 | 3761 (73.4) | 11,848 (74.5) | 0.80 (0.74–0.87) | p < 0.001 |
25+ | 149 (2.9) | 852 (5.4) | 0.43 (0.36–0.51) | p < 0.001 |
Any anaemia | ||||
Yes | 1550 (30.4) | 3520 (22.6) | 1.42 (1.32–1.53) | p < 0.001 |
No | 3543 (69.6) | 12,058 (77.4) | Ref. | |
Maternal stature | ||||
Very short (<145 cm) | 157 (3.1) | 309 (1.9) | 1.77 (1.41–2.22) | p < 0.001 |
Short (145 to <155 cm) | 2059 (40.2) | 5278 (33.2) | 1.39 (1.29–1.49) | p < 0.001 |
Normal/Tall (155 to <200 cm) | 2909 (56.7) | 10,328 (64.9) | Ref. | |
Listening to radio | ||||
Not at all | 3332 (64.6) | 9849 (61.5) | 1.25 (1.17–1.35) | p < 0.001 |
Yes | 1828 (35.4) | 6155 (38.5) | Ref. | |
Watching television | ||||
Not at all | 4197 (81.3) | 12,335 (77.1) | 1.71 (1.56–1.87) | p < 0.001 |
Yes | 968 (18.7) | 3657 (22.9) | Ref. | |
Household factors | ||||
Wealth index | ||||
Poor | 2732 (52.9) | 6908 (43.2) | 1.90 (1.75–2.06) | p < 0.001 |
Middle | 1048 (20.3) | 3391 (21.2) | 1.39 (1.25–1.55) | p < 0.001 |
Rich | 1386 (26.8) | 5707 (35.6) | Ref. | |
Household size | ||||
1–4 | 1114 (21.6) | 3888 (24.3) | 0.83 (0.77–0.90) | p < 0.001 |
≥5 | 4052 (78.4) | 12,119 (75.7) | Ref. | |
Place of cooking | ||||
In the house | 2324 (56.3) | 6262 (47.7) | Ref. | |
In separate building | 1438 (34.9) | 5651 (43.0) | 0.72 (0.66–0.79) | p < 0.001 |
Outdoors | 362 (8.8) | 1223 (9.3) | 0.79 (0.71–0.89) | p < 0.001 |
Type of cooking fuel | ||||
Clean fuels | 41 (0.8) | 308 (2.0) | Ref. | |
Solid fuels | 5019 (99.2) | 15,421 (98.0) | 3.69 (2.72–5.01) | p < 0.001 |
Toilet facility | ||||
Improved | 352 (6.9) | 1774 (11.2) | Ref. | |
Unimproved | 2147 (42.1) | 7221 (45.7) | 1.57 (1.39–1.77) | p < 0.001 |
Open defecation | 2599 (51.0) | 6822 (43.1) | 2.18 (1.94–2.44) | p < 0.001 |
Source of drinking water | ||||
Improved | 2228 (43.7) | 7343 (46.4) | Ref. | |
Unimproved | 2870 (56.3) | 8468 (53.6) | 1.24 (1.15–1.33) | p < 0.001 |
Household flooring | ||||
Improved | 251 (4.9) | 1641 (10.3) | Ref. | |
Unimproved | 4915 (95.1) | 14,359 (89.7) | 2.28 (2.02–2.57) | p < 0.001 |
Time to reach a water source | ||||
On premises | 199 (3.9) | 1289 (8.1) | Ref. | |
≤30 min | 2889 (55.9) | 8973 (56.1) | 1.94 (1.70–2.23) | p < 0.001 |
31–60 min | 1197 (23.2) | 3322 (20.7) | 2.26 (1.95–2.63) | p < 0.001 |
>60 min | 879 (17.0) | 2421 (15.1) | 2.46 (2.12–2.85) | p < 0.001 |
Community Level Factors | ||||
Residence | ||||
Urban | 333 (6.4) | 1946 (12.2) | Ref. | |
Rural | 4833 (93.6) | 14,060 (87.8) | 2.22 (1.98–2.48) | p < 0.001 |
Region | ||||
Large centrals | 4763 (92.2) | 14,696 (91.8) | 1.22 (1.09–1.37) | 0.001 |
Small peripherals | 335 (6.5) | 885 (5.5) | 1.49 (1.32–1.69) | p < 0.001 |
Metropolis | 67 (1.3) | 426 (2.7) | Ref. | |
Ecological zone | ||||
Tropical zone | 741 (14.3) | 2406 (15.0) | 0.92 (0.80–1.04) | 0.199 |
Subtropical zone | 3532 (68.4) | 11,392 (71.2) | 0.71 (0.62–0.81) | p < 0.001 |
Cool zone | 892 (17.3) | 2208 (13.8) | Ref. | |
EDHS | ||||
2005 | 1038 (20.1) | 2859 (17.9) | 1.01 (0.91–1.10) | 0.954 |
2011 | 2004 (38.8) | 6939 (43.3) | 0.92 (0.85–0.99) | 0.029 |
2016 | 2124 (41.1) | 6208 (38.8) | Ref. |
Variables | Null Model | Model I a | Model II b | Model III c | Model IV d |
---|---|---|---|---|---|
AOR (95%CI) | AOR (95%CI) | AOR (95%CI) | AOR (95%CI) | ||
Individual-Level Factors | |||||
Child factors | |||||
Sex | |||||
Male | 0.80 (0.73–0.88) ** | 0.81 (0.73–0.91) ** | |||
Female | Ref. | Ref. | |||
Age (months) | |||||
6–11 | Ref. | Ref. | |||
12–23 | 2.83 (2.43–3.28) ** | 3.07 (2.58–3.66) ** | |||
24–35 | 3.55 (3.01–4.18) ** | 4.13 (3.40–5.01) ** | |||
36–59 | 2.17 (1.78–2.64) ** | 2.51 (1.97–3.20) ** | |||
Birth order | |||||
First born | Ref. | Ref. | |||
2–4 | 1.08 (0.94–1.24) | 1.01 (0.85–1.17) | |||
5 or higher | 1.18 (1.03–1.37) * | 1.09 (0.90–1.32) | |||
Perceived size of a child at birth | |||||
Larger | Ref. | Ref. | |||
Average | 1.12 (1.01–1.26) * | 1.09 (0.95–1.25) | |||
Small | 1.47 (1.30–1.66) ** | 1.47 (1.28–1.69) ** | |||
Currently breastfeeding | |||||
Yes | 1.13 (1.01–1.27) * | 1.11 (0.97–1.27) | |||
No | Ref. | Ref. | |||
Full vaccination | |||||
Yes | Ref. | Ref. | |||
No | 1.08 (0.97–1.21) | 1.02 (0.89–1.16) | |||
Diarrhea | |||||
Yes | 1.11 (0.98–1.25) | 1.09 (0.94–1.25) | |||
No | Ref. | Ref. | |||
Fever | |||||
Yes | 1.07 (0.95–1.19) | 1.11 (0.97–1.27) | |||
No | Ref. | Ref. | |||
Children age 6–59 months given deworming medication | |||||
Yes | Ref. | Ref. | |||
No | 1.13 (0.98–1.30) | 1.11 (0.95–1.28) | |||
Parental factors | |||||
Mother’s education | |||||
No education | 4.13 (2.25–7.57) ** | 3.66 (1.85–7.22) ** | |||
Primary | 3.64 (1.99–6.65) ** | 3.48 (1.77–6.84) ** | |||
Secondary | 2.95 (1.56–5.56) * | 3.13 (1.54–6.37) * | |||
Higher | Ref. | Ref. | |||
Mother’s occupation | |||||
Not working | 1.15 (1.01–1.29) * | 1.03 (0.90–1.19) | |||
Agriculture | 1.11 (0.96–1.28) | 0.98 (0.83–1.16) | |||
Non agriculture | Ref. | Ref. | |||
ANC visit | |||||
None | 1.14 (0.83–1.55) | 0.86 (0.60–1.24) | |||
1–3 | 1.05 (0.77–1.44) | 0.81 (0.56–1.17) | |||
4–7 | 0.84 (0.62–1.14) | 0.71 (0.49–1.01) | |||
8+ | Ref. | Ref. | |||
Maternal BMI (kg/m2) | |||||
<18.5 | Ref. | Ref. | |||
18.5 to 24.9 | 0.81 (0.73–0.89) ** | 0.82 (0.73–0.92) * | |||
25+ | 0.53 (0.41–0.69) ** | 0.60 (0.45–0.81) * | |||
Any anaemia | |||||
Yes | 1.30 (1.17–1.44) ** | 1.25 (1.11–1.41) ** | |||
No | Ref. | Ref. | |||
Maternal stature | |||||
Very short (<145 cm) | 1.93 (1.41–2.62) ** | 2.04 (1.44–2.91) ** | |||
Short (145 to <155 cm) | 1.43 (1.29–1.57) ** | 1.48 (1.32–1.65) ** | |||
Normal/Tall (155 to <200 cm) | Ref. | Ref. | |||
Listening to radio | |||||
Not at all | 0.96 (0.86–1.07) | 0.88 (0.78–1.01) | |||
Yes | Ref. | Ref. | |||
Watching television | |||||
Not at all | 1.33 (1.16–1.52) ** | 1.07 (0.91–1.25) | |||
Yes | Ref. | Ref. | |||
Household factors | |||||
Wealth index | |||||
Poor | 1.38 (1.22–1.57) ** | 1.15 (0.95–1.37) | |||
Middle | 1.09 (0.95–1.25) | 0.98 (0.81–1.18) | |||
Rich | Ref. | Ref. | |||
Household size | |||||
1–4 | 0.88 (0.81–0.97) * | 0.88 (0.77–1.02) | |||
≥5 | Ref. | Ref. | |||
Place of cooking | |||||
In the house | Ref. | Ref. | |||
In separate building | 0.84 (0.77–0.93) ** | 0.90 (0.79–1.03) | |||
Outdoors | 0.83 (0.74–0.94) * | 0.82 (0.69–0.97) * | |||
Type of cooking fuel | |||||
Clean fuels | Ref. | Ref. | |||
Solid fuels | 2.21 (1.48–3.31) ** | 1.29 (0.78–2.15) | |||
Toilet facility | |||||
Improved | Ref. | Ref. | |||
Unimproved | 1.16 (1.01–1.34) * | 1.20 (0.98–1.47) | |||
Open defecation | 1.41 (1.21–1.63) ** | 1.57 (1.27–1.92) ** | |||
Source of drinking water | |||||
Improved | Ref. | Ref. | |||
Unimproved | 0.95 (0.86–1.05) | 0.88 (0.77–1.01) | |||
Household flooring | |||||
Improved | Ref. | Ref. | |||
Unimproved | 1.28 (1.08–1.51) * | 1.13 (0.89–1.44) | |||
Time to reach a water source | |||||
On premises | Ref. | Ref. | |||
≤30 min | 1.08 (0.91–1.29) | 0.90 (0.69–1.16) | |||
31–60 min | 1.22 (1.02–1.47) * | 1.02 (0.78–1.34) | |||
>60 min | 1.26 (1.04–1.53) * | 1.05 (0.79–1.38) | |||
Community Level Factors | |||||
Residence | |||||
Urban | Ref. | Ref. | |||
Rural | 2.34 (2.07–2.65) ** | 1.41 (1.10–1.82) * | |||
Region | |||||
Large centrals | 0.83 (0.73–0.95) * | 0.79 (0.63–0.98) * | |||
Small peripherals | 1.01 (0.88–1.16) | 0.89 (0.71–1.12) | |||
Metropolis | Ref. | Ref. | |||
Ecological zone | |||||
Tropical zone | 0.82 (0.71–0.97) * | 0.92 (0.71–1.19) | |||
Subtropical zone | 0.70 (0.62–0.80) ** | 0.81 (0.65–1.01) | |||
Cool zone | Ref. | Ref. | |||
EDHS | |||||
2005 | 0.99 (0.90–1.10) | 0.98 (0.90–1.11) | |||
2011 | 0.93 (0.86–1.01) | 0.82 (0.72–0.93) * | |||
2016 | Ref. | Ref. | |||
Random effect | |||||
Variance (SE) | 0.1632 (0.0001) | 0.1177 (0.0014) | 0.1992 (0.0001) | 0.1426 (0.0006) | 0.1851 (0.0018) |
ICC (%) | 4.72 | 3.45 | 5.71 | 4.15 | 5.32 |
MOR | 1.59 | 1.49 | 1.68 | 1.55 | 1.65 |
PCV (%) | Ref. | 27.87 | 22.05 | 12.62 | 13.41 |
Model comparison | |||||
LL | −10,915.60 | −5699.8017 | −8563.7301 | −10,772.627 | −4430.9835 |
Deviance | 21,831.20 | 11,399.6 | 17,127.46 | 21,545.254 | 8861.96 |
AIC | 21,835.2 | 11,459.6 | 17,157.46 | 21,563.25 | 8959.967 |
BIC | 21,850.98 | 11,677.97 | 17,272.55 | 21,634.25 | 9305.986 |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Sahiledengle, B.; Mwanri, L.; Petrucka, P.; Agho, K.E. Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study. Int. J. Environ. Res. Public Health 2023, 20, 6251. https://doi.org/10.3390/ijerph20136251
Sahiledengle B, Mwanri L, Petrucka P, Agho KE. Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2023; 20(13):6251. https://doi.org/10.3390/ijerph20136251
Chicago/Turabian StyleSahiledengle, Biniyam, Lillian Mwanri, Pammla Petrucka, and Kingsley Emwinyore Agho. 2023. "Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study" International Journal of Environmental Research and Public Health 20, no. 13: 6251. https://doi.org/10.3390/ijerph20136251