RESEARCH ARTICLE

Prevalence of stunting and its associated

factors among children 6-59 months of age in
Libo-Kemekem district, Northwest Ethiopia; A
community based cross sectional study
Selamawit Bekele Geberselassie1, Solomon Mekonnen Abebe2, Yayehirad
Alemu Melsew3, Shadrack Mulinge Mutuku4, Molla Mesele Wassie2*

a1111111111 1 Program Development Division, World Vision Ethiopia, Addis Abeba, Ethiopia, 2 Department of Human
Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar,
a1111111111
Ethiopia, 3 Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and
a1111111111 Health Sciences, University of Gondar, Gondar, Ethiopia, 4 Adelaide Medical School, Faculty of Health and
a1111111111 Medical Sciences, University of Adelaide, Adelaide, Australia
a1111111111
* molmesele@gmail.com

OPEN ACCESS
Abstract
Citation: Geberselassie SB, Abebe SM, Melsew YA,
Mutuku SM, Wassie MM (2018) Prevalence of
Background
stunting and its associated factors among children
6-59 months of age in Libo-Kemekem district, Children in developing countries are highly vulnerable to impaired physical growth because
Northwest Ethiopia; A community based cross of poor dietary intake, lack of appropriate care, and repeated infections. This study aimed at
sectional study. PLoS ONE 13(5): e0195361.
assessing the prevalence of stunting and associated factors among children 6–59 months
https://doi.org/10.1371/journal.pone.0195361
of age in Libo-kemekem district, northwest Ethiopia.
Editor: Michelle Louise Gatton, Quensland
University of Technology, AUSTRALIA

Received: February 24, 2017

Methods
Accepted: March 21, 2018
A community based cross sectional study was conducted in Libo-Kemekem from October
15 to December 15, 2015. The multistage sampling technique was employed to select 1,320
Published: May 3, 2018
children aged 6-59months. Data were collected by trained community health extension
Copyright: © 2018 Geberselassie et al. This is an workers under regular supervision. Data were entered into EPI-Info version 3.5.1, and
open access article distributed under the terms of
the Creative Commons Attribution License, which
height for age was converted to Z-score with ENA-SMART software. Data were then
permits unrestricted use, distribution, and exported to SPSS version 20 for descriptive and binary logistic regression analysees. The
reproduction in any medium, provided the original significance of associations was determined at p<0.05.
author and source are credited.

Data Availability Statement: All data underlying

Results
the study are within the paper and its Supporting
Information files. Out of 1287 children included in the analysis, 49.4% (95% CI: 46.7%–52.3%) were found to
Funding: The thesis is supported by University of be stunted. In the multivariate analysis, increased child age [AOR = 6.31, 95%CI: (3.65,
Gondar. 10.91)], family size of six and above [AOR = 1.77, 95%CI: (1.35, 2.32)] were positively asso-
Competing interests: The authors have declared ciated with stunting, while, fathers with secondary school education [AOR = 0.50, 95%CI:
that no competing interests exist. (0.30, 0.81)], farmers as household heads [AOR = 0.56, 95%CI: (0.38, 0.84)] and self-
Abbreviations: AOR, Adjusted Odds Ratio; ARI, employed parents as household head [AOR = 0.45, 95% CI: (0.28, 0.72)] were found to be
Acute respiratory infection; CBN, Community preventive factors.

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 High prevalence of stunting in children

Based Nutrition; CI, Confidence Interval; CSA, Conclusion

Central Statistics Agency; COR, Crude Odds Ratio;
ENA, Emergency Nutrition Assessment; EDHS, The prevalence of stunting was high in the study area. We found that stunting was signifi-
Ethiopian Demographic Health Data; SD, Standard cantly correlated with child age, occupational status of household head, family size, and
deviation; SMART, Standardize Monitoring and fathers’ education. Therefore, intervention focusing on supporting housewives, family plan-
assessment of Relief and Transition; SPSS,
Statistical Package for Social Science; WHO, World
ning, and education on child feeding and nutrition should be implemented.
Health Organization.

Background
Stunting is defined as a height that is more than two standard deviations below the World
Health Organization (WHO) child growth standard median [1, 2]. Stunting is considered as a
severe public health problem in the community when its prevalence in children is greater than
40% [3]. It is a largely irreversible outcome of inadequate nutrition and repeated bouts of
infection during the first 1000 days of the child’s life [1, 4]. It has long term effects on individu-
als and societies, including diminished cognitive and physical development, reduced produc-
tive capacity, and poor health, and increased risk of degenerative diseases such as diabetes [[4,
5]. Furthermore, stunted children experienced rapid weight gain after 2 years have an
increased risk of becoming overweight or obese later in life [4, 5].
Globally 161 million children under five were stunted in 2013 [6]. In 2015, Africa has the
highest prevalence of stunting at 37.6%, followed by Asia at 22.9% [7] According to the Ethio-
pian mini Demographic and Health Survey (EDHS) report 2014, stunting among children
under five years of age is at 40%. In the Amhara National Regional State of Ethiopia stunting,
wasting, and underweight is reported to be 40%, 10% and 33%, respectively [8].
Stunting can be caused by various factors such as parental, socio-demographic, and eco-
nomic status, as well as cultural practices and environmental and other health related variables
[9]. For instance, poverty, low parental education, lack of sanitation, low food intake, poor
feeding practices, inadequate breastfeeding, repeated infections, family size and birth interval
are regarded as key determinants of stunting [9–11]. Another study reported that family socio-
economic status was the most important factor associated with stunting [12]. Similarly, other
studies are in agreement that stunting is influenced by child age [13], age of the mother, child
sex, family size, wealth index [13], maternal/paternal education, marital status of mother, and
number of livestock of the family [10, 14–19]. Moreover, availability and utilization of health
services and the care provided to the child were found to be other determinants of stunting
[20].
The Ethiopian government recognizes stunting as a major public health problem and obsta-
cle to its economic goals. Since stunting is greatly dependent on the local geo-cultural factors
such as tradition and community livelihood, investigating its prevalence and causative factors
within this context is important to prioritize development interventions to mitigate the prob-
lem. Therefore, the aim of this study was to determine the magnitude of stunting and identify
its determinants among children aged less than five years in Libo-kemkem district, northwest
Ethiopia.

Methods
Study design and setting
A community based cross sectional study was conducted in Libo-Kemkem district from Octo-
ber 15 to December 15, 2015, to determine the level of stunting among children 6–59 months

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 High prevalence of stunting in children

of age. The district has an area of 1,560 km2 and is located at 11˚57’46.6’-12˚25’32.6N latitude
and 37˚34’48.9–38˚3’30.9” E longitude. It comprises 34 villages of which 5 are urban. The dis-
trict is located on black cotton clay soil and flat plain with relatively high temperature and high
rainfall, with a mean of 1173mm rain per annum. Agricultural activities are restricted to a sin-
gle rain season (from June to September). Maize, barley and millet are the main food crops,
while rice, vetch, and chickpeas are the main cash crops. The total population of the district in
2010 was 198,951 of which 100,951 were males and 97,423 females. The district has a popula-
tion density of 1948 per square km [21].

Ethics approval
Ethical clearance was obtained from the Ethical Review Committee of the Institute of Public
Health, College of Medicine and Health Sciences, the University of Gondar. Letters of permis-
sion were also obtained from the North Gondar Zonal Health Office and the Libo-kemekem
District Administration. Informed consent obtained from each parent/care giver after the pur-
pose of the study was explained. Confidentiality was ensured by using code numbers rather
than names.

Study population and sampling

The study population included children aged 6–59 months in the 12 randomly selected villages
of the district, three urban and nine rural villages. Children who were seriously ill during the
whole data collection season and children with spinal curvature (Kiphosis, scoliosis and kiphos-
coliosis) were excluded. Out of 34 villages in the district, 12 were selected randomly. The total
sample size (n = 1320) was distributed to each village proportionally based on the number of
households in the village, using probability proportionate to size method. The number of house-
holds in each village was obtained from the respective health posts. Sampling interval (K) was
calculated for each village, and the first household in each village was identified using a random
number from k number of households. Then, systematic random sampling technique was used
to select study participants from selected households for measurements. For households which
had more than one eligible children, lottery method was used to select one child for the study.
Mothers or care givers were interviewed on socio-demographic, economic, child health related
characteristics and environmental conditions with a pre-tested structured questionnaire. Child
morbidity status was asked in the previous 6 months as diagnosed by a health professional.

Data collection and analysis

Data were collected by trained community health extension workers from October 15 to
December 15, 2016. Mothers or care givers were interviewed and anthropometry measure-
ment (height and weight) was taken on children.
Height of infants aged six months to 23 months was measured in a recumbent position to
the nearest 0.1 cm, using a board with an upright wooden base and movable headpieces. Chil-
dren aged 24 to 59 months were measured in a standing up position to the nearest of 0.1 cm.
Additionally, child weight was measured by an electronic digital weight scale for children who
were comfortable to be measured alone, and also for children who were uncomfortable to be
measured alone, we used the combined mother and child weight and the mother’s individual
weight to calculate the child’s weight [3].Respondent economic status was accounted for
through the occupational variables. The Categories of morbidity status were based on the types
of diseases that the child encountered in the previous six months. For instance, if the child had
one type of disease it will be categorized as one disease. Distance of water source from

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 High prevalence of stunting in children

household was categorized as near if it takes less than 30 minutes while far if it takes 30 min-
utes on foot.
The collected data underwent cleaning and entered using the EPI-INFO 3.5.1 software.
Data on sex, age, height, and weight was transferred with participants’ identification number
to ENA for SMART software to convert nutritional data into Z scores of the indices HAZ
using the WHO standard. The anthropometry measurement of height for age (HAZ) was cal-
culated through ENA SMART software, and children less than -2 SD were classified as stunted.
Those children with HFA indices between -2 and -3 SD were classideid as moderate stunting
while < -3 SD were classified as severe stunting. Data was also exported to SPSS version 20 for
further analysis and identification of factors associated with stunting by the binary logistic
regression model. Variables with a p-value less than 0.2 in the bivariate analysis were included
in the multivariate logistic regression model. The strength of association was determined by
the Adjusted Odds Ratio (AOR) at a 95% confidence interval, and p-value <0.05 was used to
show the association between independent variables and the presence of stunting. Variables
having p-value, of < 0.05 were considered as statistically significant.

Results
Demographic and socio-economic characteristics
In this study a total of 1287 children aged 6-59months were included, with a response rate of
97.5%. The majority 1149 (86.9%) of the mothers were married, and 788 (61.2%) were within
the age group of 26–35 years. With regard to parents educational status, 61.2% of the mothers
and 47.6% of the father were illiterate. Out of the total households included, 649 (53.9%) family
heads were farmers. (Table 1)
The children varied in terms of sex and age in that 665 (51.7%) were females, while 367
(28.5%) and 356 (27.7%) were 13–25, and 25–36 months old, respectively. Regarding child
morbidity status, most of the children 948 (73.7%) had infectious diseases such as diarrhea
caused by infectious agents for in the previous six months. (Table 2)

Environmental health condition

The majority (71.3%) of the households used public tap water for drinking. Almost all, 1170
(90%), of the households had access to a nearby water source, whereas 117 (9.1%) are required
to travel more than 30 minutes on foot to fetch water.
With regard to the availability of toilet, 745 (57.9%) households had toilettes; traditional pit
latrines were most commonly used, whilst 529(41.1%) households used open field defecation.
(Table 3)

Prevalence of stunting
The overall prevalence of stunting in the study population was 49.4% [95% CI: 46.7–52.3]. The
prevalence of stunting was 52.3% among female children and 47.7% among males. The preva-
lence of moderate and severe stunting was 37.5% and 13.1%, respectively. Stunting was most
prevalent in the 49–59 months age group at 65.5%, while the 6–12 months age group had the
least. (Fig 1)

Factor associated with stunting

Child age, family size, fathers educational status, occupational status of household head, child
morbidity status, and marital status of parents were entered into the multivariate binary logis-
tic regression model. The output of the multivariate binary logistic regression showed that,

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 High prevalence of stunting in children

Table 1. Demograpic and socio-economic characteristics of parents in Libo-kemekem district, northwest Ethiopia.
Characteristics Category Frequency Percent (%)
Age of the mother 18–25 278 21.6
26–35 788 61.2
36 and above 221 17.2

Marital status Single 43 3.3
Married 1149 86.9
Divorced, Widow and separated 125 9.7
Husband education Cannot read & write 612 47.6
Primary education 432 33.6
Secondary education 111 8.6
Tertiary education 132 10.3
Maternal education Cannot read & write 788 61.2
Primary education 309 24.0
Secondary education 104 8.1
Tertiary education 86 6.7
Occupational status of head of the HHs House wife 237 18.4
Farmer 694 53.9
Merchant 115 8.9
Government employee 66 5.1
Self-employee 175 13.6

n is not 1,287.

https://doi.org/10.1371/journal.pone.0195361.t001

child age, family size, fathers educational, and occupational status were significantly associated
with stunting. (Table 4)
Age of a child was directly correlated with stunting. Accordingly, compared to children
aged 6-12months, children of age13-24 months were 2.07 times more likely to be stunted
[AOR = 2.07, 95% CI: (1.34, 3.18)]. Similarly, children aged 25–36 months had 3.86 times
more odds of being stunted than children aged 6-12months [AOR = 3.86, 95%CI: (2.50, 5.97)].
Thus older children had a stronger association with stunting. Children aged 37–48 months
were 4.73 times [AOR = 4.73, 95%CI: (3.00, 10.91)] more stunted while children aged 49–59
months were 6.31 times more likely to be stunted compared to children aged 6-12months
[AOR = 6.31, 95%CI: (3.65, 10.91)].

Table 2. Children health and characteristics at Libo-kemekem district, northwest Ethiopia.

Characteristics Category Frequency percent
Sex of child Male 622 48.3
Female 665 51.7
Age of child 0–12 159 12.4
13–24 367 28.5
25–36 356 27.7
37–48 284 22.1
49–59 121 9.4

Morbidity status Only 1 disease 138 10.7
Only 2 diseases 948 73.7
3 and above diseases 201 15.6

The categories of morbidity status were based on the types of diseases that the child encountered in the previous six months.

https://doi.org/10.1371/journal.pone.0195361.t002

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 High prevalence of stunting in children

Table 3. Environmental health conditions of households in Libo-kemekem district, northwest Ethiopia.

Characteristics Category Frequency Percent
Availability of toilet Yes 745 57.9
No 529 41.1
Source of water River 156 12.1
Spring 62 4.8
Public tab 917 71.3
Others 74 5.7
Distance of water source Near 1170 90.9
Far 117 9.1

n is not 1287.

https://doi.org/10.1371/journal.pone.0195361.t003

Family size had also shown a positive significant association with stunting. Children in a
family of at least six members were 1.77 times at higher odds of stunting than children in a
family of five and less [AOR = 1.77, 95%CI: (1.35, 2.32)].
Reduction in the odds of stunting was observed among children who lived with their fathers
and whose parents were farmers and self-employed. Children whose fathers completed sec-
ondary school education had shown 50% reduced odds of being stunted compared to children
with illiterate fathers [AOR = 0.50, 95%CI: (0.30, 0.81)]. Similarly, farmers and self-employed
household heads reduced the odds of their children compared to housewife heads. As a result
children of farmer household heads had 44% lower odds of being stunted [AOR = 0.56, 95%
CI: (0.38, 0.84)] than children of housewives. Similarly, children from self-employed house-
hold heads had 55% lower odds of stunting than housewives [AOR = 0.45, 95% CI: (0.28,
0.72)].

Discussion
This study has explored the prevalence of stunting and its associated factors among children
aged 6–59 months at Libo-kemekem district, North West Ethiopia. The prevalence of stunting
was 49.4%, of this 47.3% in males and 50.3% in females. This finding was the highest compared

Fig 1. Prevalence of stunting by age (in months) among children aged 6–59 months at Libo-kemekem district,
northwest Ethiopia.
https://doi.org/10.1371/journal.pone.0195361.g001

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 High prevalence of stunting in children

Table 4. Binary logistic regression analysis output for factors associated with stunting among children age 6-59months, in Libo-kemekem district, northwest
Ethiopia.
Variables Stunting Crude OR (95% CI) Adjusted OR (95% CI)
Yes No
Morbidity
Only Diarrhea 64 73 1 1
Diarrhea & ARI 439 496 1.010(0.705,1,446) 0.84(0.57,1.25)
Diarrhea,ARI & other diseases 125 75 1,901(1.223,2.955) 1.46(0.90,2.36)
Age of child
6–12 months 42 116 1 1
13–24 months 143 219 1.803 (1.196,2,720) 2.07(1.34,3.18)
25–36 months 195 159 3.387(2,247,5,106) 3.86(2.50,5.97)
37–48 months 170 109 4.308(2,810,6,603) 4.73(3.00,10.91)
49–59 months 78 41 5.254(3.132,8,813) 6.31(3.65,10.91)
Number of family size
Less than and equal to 5 346 450 1 1
6 and above 282 194 1.891(1.502,2.380) 1.77(1.35,2.32)
Marital status
Single 25 18 1 1
Married 541 564 0.691(0.373,1.280) 0.62(0.32,1.23)
Divorced, separated and widowed 62 62 0.720(0.357,1.451) 0.94(0.43,2.03)
Father’s educational status
Cannot read and write 336 266 1 1
Primary education (1–8) 200 227 0.698(0.544,0.895) 0.75(0.57,1.00)
Secondary education (9–12) 38 73 0.412(0.270,0.630) 0.50(0.30,0.81)
College and above 54 78 0.548(0.374,0.803) 0.63(0.36,1.11)
Occupational status of household head
House wife 125 110 1 1
Farmer 348 334 0.917(0.681,1.234) 0.56(0.38,0.84)
Merchant 55 60 0.807(0.516,1.265) 0.67(0.41,1.10)
Government employed 25 41 0.537(0.307,0.939) 0.68(0.34,1.37)
Self-employed 99 75 0.667(0.449,0,989) 0.45(0.28,0.72)

Statistically significant at p-value less than 0.05

https://doi.org/10.1371/journal.pone.0195361.t004

to the regional, national and WHO cut off point of 40% set for stunting [8, 22]. The current
magnitude was also higher compared to that of Kenyan study which was 39% [23] and other
study conducted in eastern Ethiopia which showed prevalence of 34.4% [24, 25]. Similarly, it
was higher than those of studies conducted in southwest Ethiopia, which was 35.4% [26]. A
studies in Libo-kemkem and Fogera districts of northwest Ethiopia, and Haramaya district of
eastern Ethiopia reported a higher prevalence of 42.7% [27] and 45.8% [28] stunting among
school age children, respectively.
Our findings might vary in part from previous ones due to differences in geographic char-
acteristics of the study area [23–25], study period, age difference of the study participants [27]
(i.e. 0–59 and 6–59 months) and other socio-economic characteristics of the participants.
Higher prevalence of infectious diseases like malaria and Visceral leishmaniosis and micronu-
trient deficiencies in Libo-kemkem district with inadequate health care may contribute higher
occurrences of child stunting in our study subjects [29, 30]. However, the magnitude of stunt-
ing in the study area is much higher compared to the national recommendations and efforts to

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 High prevalence of stunting in children

alleviate the problem. For example, the prevalence is consistent with the 2005 national report
[31]; however, there have been improvements over that time as reported in 2014 [8].
Also this study showed that the prevalence of stunting increases with the age of the child.
This association was supported by other studies in north and northwest Ethiopia [27, 32]. This
might be due to the nutritional status of the mother since stunting has a chronic and cyclic
nature, poor dietary practice, weaning, lower and inappropriate breast and complementary
feeding practices. The other possible explanation for increased risk of stunting in older chil-
dren may be due to unhygienic preparation of complementary foods which exposes children
to recurrent infections. Limited access to safe drinking water in the study area also exposes
these children to varied types of infections and diarrheal diseases which further increase the
risk of chronic malnutrition.
Our results shows that, education is the key resource that enabled women and men to pro-
vide appropriate childcare with regard to health, child feeding and child education. Comple-
tion of secondary education of the father was observed to ameliorate the prevalence of
stunting among the study participants. These associations were not observed in those com-
pleted primary education and may be due to the fact that life science courses are not integrated
with nutrition education and communication. Similar associations were seen in studies con-
ducted in Bangladesh and the Philippines [33, 34]. This is because in the study area fathers
who are educated better than their wife’s as, household heads have control over family expen-
ditures. Thus, they have a leading role in providing quality health care and optimal feeding for
their children. Therefore, if the father is educated, he is more knowledgeable in childcare as
well as optimal child feeding recommendations and can advise the mother on children’s nutri-
tional requirements.
On the other hand, this study identified that as family size increases, so to do the odds of
being stunted. Children from families with six and more members had a higher odds of being
stunted compared to children from five or less family members. This finding is supported by
another study conducted in southeast Ethiopia which stated that children whose mothers gave
birth to more than four children were more likely to be stunted compared to children from
mothers who gave birth to one child[14]. This could be due to the fact that, families with more
children are more stretched economically and cannot feed themselves well and face difficulty
in providing the daily nutrition requirements for proper child physical development. This
means, as the size of a family increases there is a scarcity of resources for household consump-
tion, especially food, and healthcare which ultimately leads to stunted growth. Furthermore,
parents with more children generally lack adequate time to pay proper attention to the need of
each child.
The occupational status of the household head also has a significant role in a child’s stunt-
ing. Households headed by farmers and self-employed parents reduced the odds of stunting
among their children compared to households led by housewives. This is because the income
earned by a single parent (a mothers) is always often less than what couples can procure.
The study has the following limitations. We cannot declare a temporal relationship between
stunting and other independent variables due to the cross sectional design of the study. Stan-
dard procedures were used for the measurement of height/length but measurement errors are
inevitable especially within assessors. Moreover, there may be a recall bias in reporting age of
children in a rural villages.

Conclusion
Our findings demonstrate a higher prevalence of stunting in Libo-kemkem district and thus
represents an important public health concern. This study also revealed that a child’s age,

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 High prevalence of stunting in children

occupational status of the household head, family size, and fathers’ education were signifi-
cantly associated factors for stunting. Therefore, a strong nutrition specific and sensitive inter-
vention should be implemented in the study area with a special focus on supporting
housewives, promoting family planning, and education on child feeding and nutrition.

Supporting information
S1 Dataset. Metadata.
(DTA)

Acknowledgments
We would like to thank the Institute of Public Health, the University of Gondar, Libo-keme-
kem District Health Office for their support. We are also grateful to the study participants.

Author Contributions
Conceptualization: Selamawit Bekele Geberselassie, Solomon Mekonnen Abebe, Molla
Mesele Wassie.
Data curation: Selamawit Bekele Geberselassie.
Formal analysis: Selamawit Bekele Geberselassie, Solomon Mekonnen Abebe.
Investigation: Selamawit Bekele Geberselassie, Molla Mesele Wassie.
Methodology: Selamawit Bekele Geberselassie, Solomon Mekonnen Abebe, Yayehirad Alemu
Melsew, Molla Mesele Wassie.
Project administration: Selamawit Bekele Geberselassie, Molla Mesele Wassie.
Resources: Molla Mesele Wassie.
Software: Yayehirad Alemu Melsew, Molla Mesele Wassie.
Supervision: Solomon Mekonnen Abebe, Molla Mesele Wassie.
Validation: Solomon Mekonnen Abebe, Shadrack Mulinge Mutuku.
Writing – original draft: Molla Mesele Wassie.
Writing – review & editing: Solomon Mekonnen Abebe, Yayehirad Alemu Melsew, Shadrack
Mulinge Mutuku, Molla Mesele Wassie.

References
1. World Health Organization. Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-
length, weight-for-height and body mass index-for-age: Methods and development. Geneva WHO,
2006.
2. World Health Organization: Child growth standards Anthro and macro: WHO; 2011.
3. World Health Organization. Physical status: The use and interpretation of anthropometry: report of a
WHO expert committee Geneva WHO; 1995.
4. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutri-
tion 1—Maternal and child undernutrition: global and regional exposures and health consequences.
Lancet. 2008; 371(9608):243–60. doi: 10.1016/S0140-6736(07)61690-0. WOS:000252471900028.
PMID: 18207566
5. Dewey K, Begum K. Long-term consequences of stunting in early life. Maternal & child nutrition. 2011; 7
(s3):5–18.
6. de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016; 12 Suppl 1:12–
26. https://doi.org/10.1111/mcn.12231 PMID: 27187907; PubMed Central PMCID: PMC5084763.

PLOS ONE | https://doi.org/10.1371/journal.pone.0195361 May 3, 2018 9 / 11

 High prevalence of stunting in children

7. de Onis M, Blossner M, Borghi E. Prevalence and trends of stunting among pre-school children, 1990–
2020. Public Health Nutr. 2012; 15(1):142–8. https://doi.org/10.1017/S1368980011001315 PMID:
21752311.
8. CSA. Ethiopia Mini Demographic and Health Survey 2014. Central Statistical Agency Addis Ababa,
Ethiopia. 2014.
9. UNICEF. Focus on nutrition: The state of the world’s children Oxford and Nework: UNICEF, 1998.
10. Mengistu K, Alemu K, Destaw B. Prevalence of Malnutrition and Associated Factors Among Children
Aged 6–59 Months at Hidabu Abote District, North Shewa, Oromia Regional State. Nutritional Disorders
& Therapy 2013.
11. Gelano T, Birhan N, Mekonnen M. Prevalence of under nutrition and its associated factors among
under five children in Gondar city, Northwest Ethiopia. Journal Of Harmonized Research in Medical &
Health Sci 2015; 2(4):163–74.
12. Ruwali D. Nutritional Status of Children Under Five Years of Age and Factors Associated in Padampur
VDC, Chitwan. Health Prospect. 2011; 10(14–8).
13. Derso T, Tariku A, Biks GA, Wassie MM. Stunting, wasting and associated factors among children
aged 6–24 months in Dabat health and demographic surveillance system site: A community based
cross-sectional study in Ethiopia. BMC Pediatr. 2017; 17(1):96. https://doi.org/10.1186/s12887-017-
0848-2 PMID: 28376746; PubMed Central PMCID: PMC5379504.
14. Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors
among children aged between six to fifty nine months in Bule Hora district, South Ethiopia. BMC Public
Health. 2015; 15:41. https://doi.org/10.1186/s12889-015-1370-9 PMID: 25636688; PubMed Central
PMCID: PMC4314803.
15. Megabiaw B, Rahman A. Prevalence and Determinants of Chronic Malnutrition Among Under-5 Chil-
dren in Ethiopia. International Journal of Child Health and Nutrition. 2013; 2(3):230–6.
16. Rajalakshmi J, Endazenaw G. Assesment of Nutritional Status among Under-Five Children in Bishoftu-
town, Oromiya Region, Ethiopia. International Journal of Nursing Didactics. 2015;; 15(11):10–2.
17. Yalew B. Prevalence of Malnutrition and Associated Factors among Children Age 6–59 Months at Lali-
bela Town Administration, North WolloZone, Anrs, Northern Ethiopia. J Nutr Disorders Ther 2014;
4:132.
18. Ali W, Ayub A, Hussain H. Prevalance and associated risk factors of under nutrition among children
aged 6 to 59 months in Iinternally displaced persons of JalazoiI camp, district Nowshera, Khyber Pakh-
tunkhwa. JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD. 2015; 27(3):556–9. https://www.
ncbi.nlm.nih.gov/pubmed/26721006. PMID: 26721006
19. Kadima YE. Factors influencing malnutrition among children under age of five age in Kweneng West
District of Botswana: University of South Africa; 2012.
20. WHO. Global nutrition report 2015; actions and accountability to advance nutrition & sustainable devel-
opmen. 2015.
21. CSA. Population and Housing Census Report at National Level. Addis Ababa, Ethiopia. 2010. www.
csa.gov.et/newcsaweb/images/documents/pdf_files/regional/report.pdf.
22. World Health Organization. Global Nutrition Targets 2025 Stunting Policy Brief (WHO/NMH/NHD/14.3).
Geneva: WHO, 2014.
23. Mutua N, Onyango D, Wakoli A, Mueni H. Factors associated with increase in undernutrition among
children aged 6–59 months in kamoriongo village, nandi county, kenya. International Journal of Aca-
demic Research and Reflection 2015; 3(2).
24. Demissie S, Worku A. Magnitude and factors associated with malnutrition in children 6–59 months of
age in pastoral community of Dollo Ado district, Somali region, Ethiopia. Science Journal of Public
Health 2013; 1(4):175–83.
25. Sisay Z. Magnitude and factors associated with malnutrition of children under five years of age in rural
Kebeles of Haramaya, Ethiopia. Harar Bull Health Sci Extracts. 2012; 4.
26. Ayalew E. The prevalence of stunting and associated factors among children age 6–59 months at
Mizan-Aman Town, Bench Maji zone, SNNPR region, Ethiopia. Addis Abeba University 2015.
27. Herrador Z, Sordo L, Gadisa E, Moreno J, Nieto J, Benito A, et al. Cross-sectional study of malnutrition
and associated factors among school aged children in rural and urban settings of Fogera and Libo Kem-
kem districts, Ethiopia. PLoS One. 2014; 9(9):e105880. https://doi.org/10.1371/journal.pone.0105880
PMID: 25265481; PubMed Central PMCID: PMC4179248.
28. Yisak H, Gobena T, Mesfin F. Prevalence and risk factors for under nutrition among children under five
at Haramaya district, Eastern Ethiopia. BMC Pediatr. 2015; 15:212. https://doi.org/10.1186/s12887-
015-0535-0 PMID: 26675579; PubMed Central PMCID: PMC4682239.

PLOS ONE | https://doi.org/10.1371/journal.pone.0195361 May 3, 2018 10 / 11

 High prevalence of stunting in children

29. Herrador Z, Sordo L, Gadisa E, Buno A, Gomez-Rioja R, Iturzaeta JM, et al. Micronutrient deficiencies
and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and
Fogera districts, Amhara Regional State. PLoS One. 2014; 9(12):e112858. https://doi.org/10.1371/
journal.pone.0112858 PMID: 25546056; PubMed Central PMCID: PMC4278675.
30. Lopez-Perea N, Sordo L, Gadisa E, Cruz I, Hailu T, Moreno J, et al. Knowledge, attitudes and practices
related to visceral leishmaniasis in rural communities of Amhara State: a longitudinal study in northwest
Ethiopia. PLoS Negl Trop Dis. 2014; 8(4):e2799. https://doi.org/10.1371/journal.pntd.0002799 PMID:
24743328; PubMed Central PMCID: PMC3990515.
31. CSA. Ethiopia Demographic and Health Survey Calverton, Maryland, USA Central Statistical Agency,
Addis Ababa, Ethiopia 2005.
32. Afework M, Fitsum H, Gideon K. Factors Contributing to Child Malnutrition in Tigray, Northern Ethiopia.
2005; 1(7).
33. Jamro B, Junejo A, Lal S, Bouk G, Jamro S. Risk factors for severe acute malnutrition in children under
the age of five year in Sukkur. Pakistan Journal of Medical Research. 2012; 51(4):111.
34. Islam MM, Alam M, Tariquzaman M, Kabir MA, Pervin R, Begum M, et al. Predictors of the number of
under-five malnourished children in Bangladesh: application of the generalized poisson regression
model. BMC Public Health. 2013; 13(11):11. https://doi.org/10.1186/1471-2458-13-11 PMID:
23297699; PubMed Central PMCID: PMC3599578.

PLOS ONE | https://doi.org/10.1371/journal.pone.0195361 May 3, 2018 11 / 11