High burden of undernutrition among primary school-aged children and its determinant factors in Ethiopia; a systematic review and meta-analysis

Abstract

Background Undernutrition remains a major public health concern affecting both children and adolescents in Ethiopia. However, little attention has been given to the undernutrition of primary school-aged children, with their exclusion within national surveys. Therefore, this systematic review and meta-analysis was conducted to determine pooled estimate and determinant factors of undernutrition among primary school-aged children (6 to 15 years of age) in Ethiopia. Method We systematically retrieved available articles on the prevalence of undernutrition in primary school-aged children in Ethiopia by using a number of computerized databases, including PubMed, Scopus, Cochrane Library, Google Scholar, and Science Direct between September 1 and November 25, 2019. Two authors independently extracted relevant data using a standardized data extraction form. Heterogeneity among included studies was assessed with the Cochrane Q test statistics and Higgins I2 tests. The pooled estimates and determinant factors of school-aged undernutrition were assessed with random-effects model using Stata/se Version 14. Result We have retrieved 30 eligible articles with pooled sample size of 16,642 primary school- aged children to determine the prevalence of undernutrition in Ethiopia. Hence, the pooled prevalence of stunting, underweight, and wasting were found to be 21.3% (95% CI: 17.0, 25.5), 18.2% (95% CI: 14.4, 22.0) and 17.7% (95% CI, 13.5, 21.8) respectively. Heterogeneity was assessed by doing subgroup analysis for study province/region. Thus, the highest prevalence of stunting was 27.6% (95% CI, 20.7, 34.5) and underweight 22.7% (95% CI, 19.2, 26.3) in Amhara Region while, in the instance of wasting, it was 19.3%(95% CI: 5.1, 33.4) in Southern Nations, Nationalities and People’s Region. Maternal educational status (OR = 1.91, 95% CI: 1.33, 2.73), age of school-aged child (OR = 0.56, 95% CI: 0.44, 0.72) and sex of school-aged child (OR = 0.73, 95% CI: 0.62, 0.85) were found to be significantly associated with stunting. Maternal educational status (OR = 0.6, 95% CI: 0.36, 0.9) and age of school-aged child (OR = 2.74, 95% CI: 1.81, 4.14) were associated with thinness/wasting. Parasitic infection (OR = 2.02, 95% CI: 1.10, 3.73) were associated with underweight of school age children. Conclusion The prevalence of stunting and underweight among primary school-aged children are moderately high while acute undernutrition (wasting) is more critical than under-five national average as reported in the 2016 Ethiopian Demography and Health Survey. Therefore, this finding warrants the need to design a school-aged children nutrition survey and expand school feeding programs to improve the nutritional status of primary school-aged children in the country. In addition, emphasis should be given to female school-aged children in the early school years, creating awareness for those mothers who lack formal education, and preventing and treating/deworming parasitic infection. Moreover, researchers must conduct research in province/regions which have not yet studied school aged children’s nutritional status to date.

Prevalence and factors associated with stunting and thinness among school age children in rural primary schools, East Dembia District, Northwest Ethiopia

“…Hence, to the best of our knowledge, under-nutrition affects children living in rural areas disproportionately as compared to their urban counterparts [ 18 ]. In addition, little attention is given to school-aged children in comparison to under-five children [ 19 ], which hides the prevalence and significant factors of under-nutrition. Therefore, the aim of this study was to assess the prevalence of stunting and thinness and associated factors among school-age children in rural primary schools in the East Dembia District, Northwest Ethiopia.…”

Use of modified composite index of anthropometric failure and MUAC-for-age to assess prevalence of malnutrition among school-age children and adolescents involved in the school feeding program in Addis Ababa, Ethiopia

“…A pooled estimate of prevalence in Ethiopia showed that 21.3, 18.2, and 17.7% of school-age children and adolescents were stunted, underweight or thin, respectively [ 17 ], and the pooled prevalence of stunting in Addis Ababa was 22% [ 17 ]. These figures were similar to those obtained by conventional methods in our study.…”

“…Several studies from Addis Ababa showed that the nutritional status of school-age children was far from desirable [ 15 – 17 ]. As student academic performance and school attendance are believed to be influenced by nutrition, it was appropriate to assess the nutritional status of schoolchildren at the initiation of the school feeding program to evaluate its benefits.…”

Impact of malnutrition on the academic performance of school children in Ethiopia: A systematic review and meta-analysis

“…7 In Ethiopia, the prevalence of wasting, underweight, and stunting among primary school children were 17.7%, 18.2%, and 21.3%, respectively. 8 Malnutrition has substantial effects on the neurological development and behavioral capacity of children. 9 Thus, malnourished children may never reach their full scholastic potential.…”