Determinants of stunting reduction in Ethiopia 2000 – 2011

Abstract

The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0-59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height-for-age z-scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6 months, 6-23 months, and 24-59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children < 6 months of age, only mother's height was both a significant predictor of HAZ and showed a progressive, albeit non-significant, increase from 2000 to 2011. In children 6-23 months of age, only mother's use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24-59 months of age a consistent and progressive change is seen in child's diarrhea, fever, mother's education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child's age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5 years of age include markers of child health, mother's nutritional status, mother's educational level, and environmental hygiene.

Assessment of the WHO Stunting Framework using Ethiopia as a case study

“…In contrast, Jones et al () observed a significantly lower HAZ in children exclusively breastfed from 0 to 6 months of age. In our analysis of pooled DHS data from 2000, 2005 and 2011 (Woodruff et al ), exclusive breastfeeding was not associated with HAZ. Regarding early cessation of breastfeeding, WHO recommends that children be breastfed up to 2 years of age or beyond (World Health Organization et al ).…”

“…Low maternal education has been associated with higher levels of stunting in children 6–23 months of age in southern Ethiopia (Agedew & Chane ) and among children 0–59 months in an analysis of Ethiopia's DHS data from 2000 and 2005 (Alemayehu & Huang ). Our pooled analysis of Ethiopia's 2000, 2005, and 2011 DHS data did not find any association between maternal education and HAZ in children 0–23 months of age, but maternal education was significantly associated with child growth in children 24–59 months, and improvements in maternal education since 2000 were associated with reductions in stunting for this age group (Woodruff et al ). Results were mixed for parental literacy's influence on linear growth.…”

“…Using data from Ethiopia's 2000 DHS, Silva () found no associations between household water source and growth; only the water quality was significantly associated with underweight at the community level. Yimer () and Woodruff et al () also failed to find an association between household water source and stunting. Haidar et al () observed a positive association between the distance from a household to its water source and the prevalence of stunting.…”

“…Using Ethiopia's 2005 DHS, Ali et al () and Jones et al () found associations between stunting and dietary diversity and minimum acceptable diet, respectively. A separate study using pooled data from Ethiopia's DHS in 2000, 2005 and 2011 identified only milk consumption as significantly associated with HAZ in children 6–23 and 24–59 months of age (Woodruff et al ). Feeding frequency is correlated with energy intake from complementary foods in two cross‐sectional studies in rural Ethiopia, where feeding fewer than three times a day was associated with increased risk for stunting (Umeta et al ; Teshome et al ).…”

Child Malnutrition and Associated Factors among Drought Affected Pastoralists in the Somali Region, Eastern Ethiopia

“…Along with poor prior health and immunization status, decreased access to basic needs such as food, water, shelter, and sanitation, we found the study community under high risk of contracting various infectious diseases and subsequent death. Furthermore, infectious diseases can also exacerbate malnutrition [18]. This destructive needs to be broken with appropriate food and nutritional support for the drought affected households, treatment of malnourished children as well as preventing and rapidly treating disease conditions.…”