Understanding child malnutrition in Ethiopia : determinants of child caring practices, multiple anthropometric failures and seasonality of growth

Persistently high prevalence malnutrition rates have been a major challenge for Ethiopia over the last several years. Although the Ethiopian government recognizes the high prevalence of malnutrition and made progress to reducing malnutrition, food and nutrition insecurity remain a national concern. The Ethiopian government is committed to reduce nutrition and developed a national plan in this regard. Research plays an important role in the understanding of determinants of nutrition issues. Research finding can particularly guide policy makers towards efforts to address malnutrition and scale-up effective actions. The PhD project was conducted to address and fill gaps in knowledge on the causes of nutrition in Ethiopia. Addressing the existing gaps contributes to the formulation of policy and nutrition program planning of the country and the development of integrated multisectoral nutrition interventions. The main aim of PhD project was to improve understanding of child malnutrition in Ethiopia through a comprehensive analysis of child caring practices, seasons and nutrition, and their determinants. We used data generated from the 2-year longitudinal agriculture–nutrition panel surveys to address concordance of poor child feeding and preventive behavior and its predictors. Six hundred twenty-three children under the age of five years and their respective caregivers were included in the analyses. Concordance of poor child feeding and preventive behavior was observed in 45.1% of the children. Concordance of poor child feeding and preventive behavior was significantly associated with age of the caretaker of ≥ 40 years (p<0.05), low household dietary diversity (p<0.001), medium household dietary diversity (p<0.05), severe household food insecurity (p<0.05) and child age (p<0.001). These findings provide useful entry points for comprehensive interventions to address child feeding and caring in the area. Three rounds of a longitudinal agriculture–nutrition panel surveys were conducted to assess determinants and morbidities of multiple anthropometric deficits. We estimated undernutrition using conventional indices and a composite index of anthropometrical failures. Five hundred seventy-nine, 674, and 674 children under-age of five of round one, two and three respectively were included in the analysis. A composite index of anthropological failure, estimated 45.1%, 42.4% and 46.4% undernourished at round one, two and three respectively. The conventional indices estimated 24.4%, 24.2% and 30.4% underweight at round one, two and three respectively. Mixed-effects logistic regression model showed that being female (p 0.05). This finding indicates that conventional indices underestimated undernutrition and children with multiple anthropometric failures are at high risk of developing childhood morbidities and should benefit from nutrition intervention to reduce child morbidities. Data obtained from four rounds of a longitudinal agriculture–nutrition panel surveys were used to assess seasonality and determinants of child growth velocity and growth deficit. Five hundred seventy-nine, 674, 674 and 680 children under the age of five years and their respective caregivers of round one, two, three and four respectively were included in the analyses. Higher length and weight velocity were observed in pre-harvest season compared with post-harvest season (length velocity=6. 4 cm/year and weight velocit =0. 6 kg/year). The mean height of children increased an additional 3.3 cm (p<0.001) per year in the pre-harvest season compared with the post-harvest season. Similarly, the mean weight of children increased 1.0 kg (p<0.001) per year more in the pre-harvest season compared with the post - harvest season. Children who had a low dietary diversity (p<0.001) and were born during the lean season in both seasons had a higher linear growth deficit (p<0.05). Being member of a highly food insecure household was negatively associated with higher weight gain (p<0.05). Having experienced no illness during the previous two weeks was positively associated with linear growth and weight gain (p<0.05). This finding indicates that household income generating options should be designed to solve seasonality of child growth velocity and deficits. In general, the majority of children suffered from a poor child caring practice, multiple anthropometric failures, morbidities, and linear growth deficits. Children with multiple anthropometric failures experienced from frequent morbidity episodes. Season was a major influencing factor for child linear growth and weight gain. Therefore, evidence-based nutrition education and promotion and social and behavior change communication strategies with clear goals, objective, and task should be designed to reduce malnutrition.