ADDIS ABABA UNIVERSITY

COLLEGE OF DEVELOPMENT STUDIES

CENTER FOR POPULATION STUDIES

EFFECTS OF CHILD FEEDING PRACTICES ON NUTRITIONAL

STATUS OF CHILDREN 6 - 59 MONTHS OF AGE: THE CASE OF
SOUTHERN NATIONS, NATIONALITIES AND PEOPLES’ REGION,
ETHIOPIA

BY
NETSANET LEMMA

JULY, 2019

ADDIS ABABA, ETHIOPIA

EFFECTS OF CHILD FEEDING PRACTICES ON NUTRITIONAL
STATUS OF CHILDREN 6-59 MONTHS OF AGE: THE CASE OF
SOUTHERN NATIONS, NATIONALITIES AND PEOPLES’ REGION,
ETHIOPIA

By
Netsanet Lemma

A Thesis Submitted to College of Development Studies of Addis Ababa

University in Partial Fulfilment of the Requirements for the Degree of
Masters Science in Population Studies

Advisor
Terefe Degefa (Ph.D)

July, 2019

Addis Ababa, Ethiopia

 DECLARATION

I, the undersigned, declare that this is my original work, has not been presented for degrees in
any other university and all sources of materials used for the thesis have been duly
acknowledged.

Name: Netsanet Lemma Signature___________ date __________

Advisor’s Name: Terefe Degefa (PhD) Signature ___________ date ___________

 Addis Ababa University

School of Graduate Studies

This is to certify that the thesis prepared by Netsanet Lemma Mishiko entitled:Effects of
Child Feeding Practices on the Nutritional Status of Children 6-59 Months of Age: The
Case of Southern Nations, Nationalities, and Peoples' Region, Ethiopia and submitted in
partial fulfilment of the requirements for the Degree of Master of Science in Population
(Reproductive Health) Studies complies with the regulations of the University and meets the
accepted standards with respect to originality and quality.

Signed by the Examining board Signature Date

--------------------------------- ------------------------- ----------------

External examiner

--------------------------------- ---------------------------- ----------------

Internal examiner

---------------------------------- --------------------------- --------------

Advisor

--------------------------------- ------------------ -------- --------------

Center Head of Graduate Program Coordinator

iv
ACKNOWLEDGEMNTS

First of all, I would like to thank my great Almighty God for being there with me in every
step I took. Next my immense appreciation and honest gratitude go to my advisor, Dr. Terefe
Degefa for his help, supervision, invaluable advice, useful comments and suggestions
throughout my study.

My heartfelt thanks go to my families and relatives, for their financial and moral support. My
sincere appreciation also goes to my friends and colleagues whoever explicitly or implicitly
backed my work in whatsoever way. Finally, I would like to acknowledge Mr. Tariku Dejene
Department Head of Population Studies in Addis Ababa University and Central Statistical
Agency of Ethiopia for providing me the quantitative data used in this analysis.

i
 Table of Contents
Acknowledgemnts......................................................................................................................ii

List of Tables ............................................................................................................................ iv

List of Figures ............................................................................................................................ v

List of Appendices .................................................................................................................... vi

Abbreviations and Acronyms ..................................................................................................vii

Abstract .................................................................................................................................. viii

CHAPTER ONE

INTRODUCTION ..................................................................................................................... 1
1.1. Background of the Study ............................................................................................................. 1

1.2. Statement of the Problem ............................................................................................................. 3

1.3. Objective of the Study ................................................................................................................. 5

1.3.1. General Objective ................................................................................................................. 5

1.3.2. Specific Objectives ............................................................................................................... 5

1.4. Hypotheses ................................................................................................................................... 5

1.5. Significance of the Study ............................................................................................................. 6

1.6. Limitations of the Study............................................................................................................... 6

CHAPTER TWO

REVIEW OF RELATED LITRATURE ................................................................................... 7

2.1. Introduction .................................................................................................................................. 7

2.2. Conceptual Framework ................................................................................................................ 9

2.2.1. Description of the Conceptual Framework ......................................................................... 10

2.3. Empirical Review....................................................................................................................... 11

2.3.1. Socio- economic and Demographic Determinants of Children Nutritional Status ............. 11
2.3.1.1. Child Characteristics .............................................................................................. 11
2.3.1.2. Maternal Characteristics ........................................................................................ 11

2.3.1.3. Women Education .................................................................................................. 13

2.3.1 4. Place of Residence ................................................................................................. 13

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 2.3.1.5. Household Wealth Status ....................................................................................... 13

2.3.1.6. Source of Drinking Water ...................................................................................... 14

2.3.2. Proximate Determinants .................................................................................................. 14

2.3.2.1 Breast Feeding......................................................................................................... 14

2.3.2.2. Complementary Feeding ........................................................................................ 15

2.4. Analytical Framework ............................................................................................................... 16

CHAPTER THREE

MATERIALS AND METHODS .......................................................................................... 17

3.1. Description of the Study Area .................................................................................................... 17

3.2. Source of Data............................................................................................................................ 19

3.3. Variables and their Description.................................................................................................. 20

3.3.1. Dependent Variable............................................................................................................. 21

3.3.2. Intermediate Variables ........................................................................................................ 21

3.3.3. Independent Variables......................................................................................................... 22

3.4. Data Organization and Analysis..................................................................................................20

CHAPTER FOUR
RESULT AND DISCUSSION
4.1. Socio- economic and Demographic Characteristics of the Respondent........................25
4.2. Presentation of the Study Finding .............................................................................................. 32

4.3. Discussion of the Study Findings .............................................................................................. 33

CHAPTER FIVE ..................................................................................................................... 40
SUMMARY,CONCLUSIONS AND RECOMMENDATIONS ............................................. 40
5.1. Summary....................................................................................................................................41

5.2. Conclusions ................................................................................................................................ 41

5.3. Recommendations ...................................................................................................................... 42
References ................................................................................................................................ 43

Appendices ............................................................................................................................... 49

iii
List of Tables
Table 1: Percentage distributions of women aged 15-49 and children 6-59 months by
demographic and socio-economic characteristics, SNNPR, using 2016 EDHS. ......... 25

Table 2 :The Percentage distribution for all independent and dependent variable run in the
bivariate analysis in the stunting are shown below. ..................................................... 29

Table 3: Binary logistic regression model for women age 15-49 showing adjusted OR and
crude OR effect on their last age 6-59 months. ........................................................... 32

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List of Figures
Figure 1: Conceptual FrameWork of the Study ......................................................................... 9

Figure 2: Analytical FrameWork of the Study ........................................................................ 16

Fig 3: Distribution of study samples for SNNP Region.……………………………………20

Figure 4: Stunting of last birth children 6-59 months of age in SNNPR on 2016 EDHs
data.... ............................................................................................................................... ........28

v
List of Appendices
Table A-1: Pearson Chi-Square Tests......................................................................................49
Table A-2: Binary Logistic Regression Output Table. ............................................................ 51
Table A-3: Model evaluation results...................................................................................….52

vi
Abbreviations and Acronyms
ANC Ante-natal Care
BF Breast Feeding
BMI Body Mass Index
CED Chronic Energy Deficiency
CSA Central Statistical Agency
EAs Enumeration Areas
EDHS Ethiopian Demographic and Health Survey
FMOH Federal Ministry of Health
HAZ Height for Age Z Score
HEW Health Extension Works
HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
ICF Inner City Fund
IYCF Infant and Young Child Feeding
MUCA Mid Upper Arm Circumference
NCHS/WHO National Center for Health Statistics/World Health Organization
NNP National Nutrition Programme
PA Physical Activity
P: Value Probability Value
SD Standard Deviation
SDT Self-determination Theory
SNNPR Southern Nations, Nationalities, and Peoples' Region
SPSS Statistical Package for Social Scientists
STIS Sexually Transmitted Infections
TV Television
OR Odds Ratio
UNICEF United Nations Children’s Fund
UN United Nations
WB World Bank
WHO World Health Organization

vii
 Effects of Child Feeding Practices on the Nutritional Status of Children 6-59 Months of
Age: The Case of Southern Nations, Nationalities, and Peoples' Region, Ethiopia
Abstract
Background: Malnutrition remains one of the most common causes of morbidity and
mortality among children throughout the world. It is one of the most serious public health
problems in Ethiopia. There are also different problems in different regions of the country
related to feeding practices. The aim of this study is to investigate the effects of child feeding
practices on nutritional status of Children 6-59 months of age in the case of SNNPR,
Ethiopia.

Method: This study was carried out using quantitative data to analyses.The child data from
Ethiopian Demographic and Health Survey-2016 was taken for analysis. The study considers
last birth children 6-59 months of age in SNNPR region. A binary logistic regression was
fitted to analyze the effects of child feeding practices on nutritional status of children 6-59
months of age using SPSS Version 20.

Results: This study show that Improved source of drinking water((AOR: 0.531; 95% CI:
(0.531 - 0.772)). richer wealth status ((AOR: 0.479; 95% CI: (0.262 - 0.876)) and richest
wealth status ((AOR: 0.367; 95% CI: (0.167 - 0.809)), Antenatal Care four or more visiting
(AOR:0.629; 95% CI: (0.409 – 0.972), two under five children ((AOR:1.533; 95% CI:(1.034
- 2.273)) and three or more under-five children ((AOR:3.275; 95% CI:(1.398 - 7.672)), 18-23
age in month ((AOR:6.431; 95% CI: (2.440-16.952)) and 36-47 age in month ((AOR: 13.518;
95% CI: (3.494 - 52.307)) and very small or smaller than average sized children ((AOR:
1.615 ; 95% CI: (1.037 - 2.516)) have shown statistically significant effect on stunting of last
born children 6-59 months.

Conclusion: Strategies to improve nutritional status of children, improving the nutritional

status of the mother and her income status. With respect to health extension workers
generally giving participatory nutrition education to create awareness and to develop
behavior change communication for better feeding and caring practices among the
community.To promote family planning programs in order to control number of children and
also to increase birth interval is another important component.

Key Words: Child Feeding Practice, Breast Feeding, Under Five Children, Stunting, Ethiopia

viii
 CHAPTER ONE
INTRODUCTION
1.1. Background of the Study

Malnutrition is a major public health problem worldwide. It affects all age groups and
population, especially the poor and vulnerable ones (Delisle, 2008). Malnutrition is
associated with a lot of morbidity and more than one-third of the deaths among children
under 5 years globally. A majority of those who suffer from the brunt of malnutrition are in
developing countries ( Tankoi et al., 2016).

Malnutrition in children is one of the most serious public health problems in Ethiopia and the
highest in the world (World Bank, 2004).The country has the second highest rate of
malnutrition in sub-Saharan Africa (FMOH, 2008) and with high under five mortality rate
(67/1000 live births) which is mainly due to infection and malnutrition (EDHS, 2016).

Malnutrition is a complex phenomenon that stems from various underlying determinants,

including a lack of optimal feeding practices for infants and young children (Patrice, 1997).
Nutritional status of children is influenced by three broad underlying causes: food, health and
care (UNICEF, 1998). Focusing on these underlying causes of malnutrition appears to show
and promote a better understanding of the underlying causes in order to achieve good
nutritional outcomes.

Food for nutrition as “food security” at the household level, and assessed by the level of
sustainable access to safe food of sufficient quantity and quality (providing energy, protein
and micro nutrients).However, having access to quality and quantity food by itself does not
necessarily improve nutritional status since levels and types of care provided to children are
influential factors. (UNICEF, 1998).

Care is referring to a process taking place between a caregiver and the receiver, has several
components that affect nutrition levels: appropriate complementary feeding, hygiene and
health-seeking behaviors are factors that support good nutrition. Thus understanding care as a
process that translates food availability at the household level and the presence of health
service into good growth and development of the child are important to note (Engle, 1992).

1
 Health includes access to medical services as well as to clean water and hygiene and
sanitary environment. The health environment is assessed in terms of access to safe water
and sanitation, the presence of malarial breeding sites, the quality of shelter, and consequent
levels of cold, stress, and overcrowding. Access to basic health services determines which
infection and disease can be prevented or treated (UNICEF, 1998).

Understanding the effect of infant and young child feeding (IYCF) practices on improving
the nutritional status of children under two years of age, the World Health Organization
(WHO) developed a set of core indicators to assess IYCF practices (WHO, 2010).These
indicators incorporated both breast-feeding and complementary feeding linked practices.
Appropriate feeding practices, therefore, include timely initiation of feeding of solid and
semi-solid foods from age 6 months and to improve the quantity and quality of foods
children consume, while maintaining breastfeeding (UNICEF, 2011).

There is strong evidence that the promotion of appropriate complementary feeding practices
reduces the incidence of stunting and leads to better health and growth outcome (Black et al.,
2013). Therefore, as an effective intervention strategy for malnutrition, WHO and United
Nation for Child Fund (UNICEF) recommended introduction of adequate complementary
foods at 6 months with continued breastfeeding for 2 years of age or beyond (WHO, 2010).
And this will have a potential to improve the nutritional status of children in developing
countries. However, in Ethiopia, the prevalence of appropriate complementary feeding
practices among children aged 6–23 months was very low (7 %) (EDHS, 2016). Poor child
feeding practice and childhood malnutrition are highly prevalent in SNNP Region of Ethiopia
with malnutrition rates similar to national levels. Since Amhara, Benishangul gumuz, Affar,
Dire dawa and Tigray including SNNP region are above the national average. Thus, it is
different nation and nationalist with different culture and religion lives in SNNPR and it has
good diversity in SNNPR that was selected.

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1.2. Statement of the problem
Nutritional status is the result of complex interactions between food consumption and the
overall status of health and health care practices. Numerous socioeconomic and cultural
factors influence patterns of child feeding and nutritional status of women and children
(EDHS, 2016). Malnutrition remains one of the most common causes of morbidity and
mortality among children throughout the world. It has been responsible, directly or indirectly,
for 60% of the 10.9 million deaths annually among children under five. Over two-thirds of
these deaths, which are often associated with inappropriate feeding practices, occur during
the first year of life (Mancharia et al., 2004).

Malnutrition is one of the leading causes of morbidity and mortality in children under the age
of five in developing countries (UN, 2010). Ethiopia being one of these countries
malnutrition is an important public health problem; stunting, underweight and wasting were
identified as 38%, 24% and 10%, respectively in children under five (EDHS,2016).

Child under-nutrition continues to be a major public health problem in the SNNP Region of
Ethiopia with malnutrition rates similar to national levels as reflected in the rates of three
commonly used anthropometric indicators. According to the results from the 2016 Ethiopian
Demographic and Health Survey (EDHS), 39 per cent of children under 5 are stunted,6 per
cent of children under 5 are wasted and 21 per cent of children under 5 are underweight in the
SNNP Region (EDHS,2016).

The poor nutritional status of women and children has been a consistent problem in Ethiopia.
Under-nutrition is an underlying cause of 53 percent of infant and child death. Lack of dietary
diversity and micro nutrient-dense food consumption, and problematic child feeding practices
contribute to the high rates of child under nutrition (Tibilla, 2007).

Malnutrition during childhood is a result of a wide range of factors, most of which relate to
unsatisfactory food intake or severe and repeated infections, or a combination of the two. The
most frequently suggested causes of malnutrition are: poverty, low parental education, lack of
sanitation, low food intake, diarrhea and other infections, poor feeding practices, family size,
short birth intervals, maternal time availability, child rearing practices and seasonality. There
are also economic, social, and cultural causes of malnutrition, which underscore the close link
between malnutrition (Tibilla, 2007).

3
In Ethiopia child feeding practice and health facility is a common issue of the government
strategies that it includes in its health policy in the country(EDHS, 2016).There are also
different problems in different regions of the country related to feeding styles and practice
such as lack of knowledge of mothers on exclusively breast feeding, in adequate professional
attitude on advantage of early feeding, lack of sustained promotion on breast feeding,
inadequate capacity of HEWs and community promoters, harmful traditions, lack of Infant
formula code/proclamation and occupational influence(FMOH, 2010). Regarding Child
under-nutrition, parents lack proper knowledge to feed children in Ethiopia (EDHS, 2016).

Limited researches has been conducted to assess the determinants of child feeding practices
on nutritional status of children 6-59 months like (Mahari and Yonas, 2017) in Benishangul-
Gumuz region Metekele Zone gumuz mothers feeding practice (Hiwot et al., 2016) in
Southern Ethiopia on mothers in konso through relying only on small geographic area and
populations. Likewise an attempt has been made by (Mahari and Yonas, 2017) to assess the
effects of child feeding practices on nutritional status of children 6-59 months, did not
consider variables related with source of drinking water, access to media and minimum
dietary diversity which have a significant effect for children nutritional status. Poor child
feeding practice and childhood malnutrition are highly prevalent in SNNPR. Therefore, the
study aims at filling the gap of knowledge using the data that was obtained from (EDHS,
2016).

4
1.3. Objective of the study
1.3.1. General objective

The general objective of this study was to assess the effects of child feeding practices on
nutritional status of Children 6-59 months of age in the SNNPR, Ethiopia, 2016/17.

1.3.2. Specific objectives

The Specific objectives were to:

a) Investigate the demographic determinants of child feeding practice on nutritional status

of Children 6-59 months of age.
b) Examine the proximate determinants of child feeding practice on nutritional status of
Children 6-59 months of age.
c) Identify the socio-economic determinants of child feeding practice on nutritional status
of Children 6-59 months of age.

1.4. Hypotheses
The hypotheses to be tested in this study were:

 No access to media and low household wealth status may be associated with higher
risk of low nutritional status of children 6-59 months of age.

 Large family size is likely to associate with higher risk of low nutritional status of
children 6-59 months of age.

 Low breast feeding and minimum dietary diversity are likely associated with high risk
of low nutritional status of children 6-59 months of age.

 Low nutritional status of children 6-59 months of age are higher in rural than urban
areas.

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 1.5. Significance of the study
Child malnutrition is the most widely spread disorder in tropical and subtropical areas.
Malnutrition is a primary cause of poor health and death in developing countries and
continues to be a major public health problem (Sanghvi and Murray, 1997, United Nations
Children’s fund (UNICEF), 1998)). Economically Ethiopia remains one of the poorest
countries in the world and malnutrition is one of the major and most pressing health
problems; especially among children. This study analyses the EDHS 2016 data to assessing
the effects of child feeding practices on nutritional status of Children 6-59 months of age in
SNNPR. Since different nation and nationalist with different culture and religion lives in
SNNPR and it has good diversity SNNPR was selected.

Thus the finding of the study could serve as base line information for the area in activities
related to the risk of children under nutrition, to minimize the risk of food insecurity, access
to health care services, poverty, hygiene and sanitation. In general, the result of the study will
be used for policy makers, planners and other interested researchers to design appropriate
interventions in the areas related to child health and nutrition.

1.6. Limitations of the study

 The direction of the causal relationship between child feeding practice and child under
nutrition was not clear because the EDHS data was cross-sectional data.
 Even though conducting qualitative data was important in this research to validating
results, interpreting statistical results in a very meaningful way and clarifying puzzles
that may go against usual expectations by triangulating it with quantitative results,
lack of finance are the major constraint.

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 CHAPTER TWO

REVIEW OF RELATED LITRATURE

2.1. Introduction
All life processes in the body are in a strong dependence of diet, and what constitutes for its
food – since the very first days of the life. Every living organism in its live processes
continuously spends some constituent substances. Much of these substances are being
“burned” (oxidized) in the body, resulting in energy release. The energy the organism uses to
maintain a constant body temperature, also to ensure the normal functioning of the internal
organs (heart, respiratory system, circulatory system, nervous system, etc.) and particularly to
perform any physical work (Anonymous, 2012).

Theory of Nutrition

Food is the essence and the first condition of life. Not surprisingly, all the universal natural
science concepts have been including the theory of nutrition as their important and essential
part. In the history of science there were two theories of nutrition. The first occurred in
ancient times, and the second – the classical theory of a balanced diet. (Anonymous, 2012)
The ancient theory of nutrition is associated with the names of Aristotle and Galen, and is a
part of their representations of the living. According to this theory the power to all structures
of the body is due to the blood, which is continuously formed in the digestive system of
nutrients as a result of a complex process of unknown to nature, in a way similar to the
fermentation. (Anonymous, 2012)

“The classical theory of a balanced diet is closely related to common belief about the ideal
food and optimal balanced diet. This theory is based on a balanced approach for the
assessment of diet, and it still retains its value up to now. In its simplest form, this approach
focuses on the part that the body should have a supply, composed of such molecular structure
that would compensate for their expense and loss from the metabolism, work, and for growth
that also applies to the young organisms” (Anonymous, 2012).

7
The classical theory is also based on the following fundamental principles: inflow of
substances must exactly match their expenses; influx of nutrients provided by the destruction
of structures and absorption of food nutrients – nutrients needed for metabolism and
construction of structures of the body; utilization of food is carried out by the body; food
consists of several components of different physiological significance: food, ballast and toxic
substances; (Anonymous, 2012)

Self-Determination Theory and Physical Activity

Self-Determination Theory (SDT) (Ryan and Deci, 2002) is a motivational theory that has
received significant research attention and support in predicting physical activity (PA) as well
as in the development of PA interventions. SDT draws a distinction between intrinsic
motivation, which involves engaging in a behavior for its own sake (i.e., for challenge and
enjoyment), and extrinsic forms of motivation. The latter involves doing an activity because
it is instrumental to achieving a separate consequence and this can be experienced as
heteronomous (i.e., controlling) or autonomous to varying degrees. SDT proposes a
continuum for the internalization of motivation, whereby individuals become more
autonomous (or self-determined) to engage in behaviors over time as their extrinsic motives
or reasons become more internalized. Facilitation of this internalization process has been
found to nurture more autonomous motivation with an ensuing predictive influence on
adaptive outcomes such as behavioral engagement/persistence and well-being (Ryan and
Deci, 2008).

The strengths and weakness of SDT. One of the strengths of SDT is that it offers malleable
processes of behavioral change that can be targeted in different health behavior interventions
(Fortier et al., 2007). Essentially, SDT researchers can develop and implement intervention
strategies that are purported to satisfy the three basic psychological needs, thus fostering
internalization and positive behavior change, in this case, adoption and maintenance of PA.
The purpose of SDT interventions is to assist individuals’ progress on the continuum towards
more autonomous forms of motivation. Weakness of SDT with other health behaviors (e.g.,
brushing teeth, wearing a seat belt) which are less intrinsically satisfying, intrinsic motivation
can be targeted to a considerable extent in the case of PA by honing in on people’s natural
interest and enjoyment in activities such as sports, dancing, water activities, etc. (Fortier et
al., 2009, Ryan et al., 2008).

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 Child nutritional status

Immediate
determinants
Food intake Disease

Health U
Household Care for environme N
food mothers and nt and D
security children D
services E
E
R
T
L
E
Y
R
I
M
Resources for care Resources for health N
Resources for food I
G
security N
Caregiver’s Safe water supply A
-Food production cash -Knowledge and beliefs -Adequate sanitation N
-income transfers of food in- -Physical and mental status -Health care availability T
-Control over resources -Environmental safety S
kind
Autonomy Shelter

POVERTY

Political and economic structure

Basic
Sociocultural environment
determinants

Potential resources
Environment, technology,
people

Figure 1: Conceptual Framework of the Study

Sources: UNICEF et al.,(1998)

2.2. Conceptual framework

The 1990 UNICEF policy review on the strategy for improved nutrition of children and
women in developing countries states that freedom from hungers is a basic human right and
continued malnutrition is unacceptable. In view of this, nutritional framework was adopted.
To identify potential determinants of malnutrition UNICEF’s nutrition conceptual frame
work is drown. It reflects relationships among factors and their influences on children’s and
women’s nutritional status (Figure 1).

9
 2.2.1 Description of the Conceptual Framework

The most significant immediate causes of malnutrition are inadequate dietary intake and
disease is often directly affecting the individual. Moreover, they form a vicious cycle:
Inadequate dietary intake increases the likelihood of illness because of weakened immune
levels; illnesses lead to a loss of appetite and poor absorption, which in turn worsen under
nutrition. The main underlying causes of under nutrition are lack of household food security,
inadequate care for mothers and children, and poor health and environmental conditions.
Each factor is determined by the social and economic resources available to the individuals
and the household as a whole.

Poverty is a key factor affecting all underlying determinants. Caring practices include
appropriate nutrition and support for mothers during pregnancy and lactation, infant feeding
practices (breastfeeding and complementary feeding), and health-seeking behaviors and
cognitive stimulation. The caregiver’s knowledge and beliefs also are important resources
that influence what types of health services are accessed and what caring practices are
adopted. Factors affecting the health and environment conditions of the household include
access to health care from affordable, qualified providers and safe water and sanitation
services. Poor environmental safety, including lack of adequate shelter, is also a critical
determinant of under nutrition.

The basic causes of under nutrition are insufficient resources available at the country or
community level, and the political, social, and economic conditions that govern how these
resources are distributed. The basic causes also influence institutions. These include both the
formal institutions that provide public sector services, such as health and education, and the
informal institutions that determine the social and cultural norms regarding the rights of
women and vulnerable groups in the population.
Indicate the link between child feeding practices and child nutritional status. Adequate
nutrition is essential for growth and development of children, and malnutrition reflects poor
social and economic development .According to the WHO for childhood stunting, four main
factors are responsible for stunting:(1)household and family factor-maternal disease, age
short stature, poor nutritional status, short birth interval, poor care practices, inadequate water
supply and sanitation, food insecurity, low caregiver education;(2)inadequate complementary
feeding-poor-quality food, low dietary diversity and intake of food, infrequent and inadequate
feeding, insufficient frequency of feeding;(3) inadequate practice of breastfeeding-early

10
cessation of breastfeeding, nonexclusive breastfeeding; and (4) clinical and sub clinical
infection-diarrhea, malaria are directly linked to under nutrition in children (WHO, 2010).
2.3. Empirical review
2.3.1. Socio- economic and Demographic Determinants of Children Nutritional Status
2.3.1.1. Child Characteristics
Children are most vulnerable to malnutrition in developing countries because of low dietary
intakes, lack of appropriate care, and inequitable distribution of food within the household.
Malnutrition remains one of the most common causes of morbidity and mortality among
children throughout the world (Birara et al., 2014). According to study conducted in
Nigeria, Children's characteristics associated with child malnutrition included incomplete
immunization for age, recent episodes of diarrhoea and acute respiratory infection, higher
birth order and incomplete immunization of the child (Owoaje et al., 2014).

The empirical results of the study conducted in Japan revealed that the pattern of growth-
faltering in children by age was identified. Children aged 12-59 months were less-nourished
than those aged 0-11 months (Kamiya , 2011). Study done in Ethiopia shows that the pattern
of growth-faltering in children by age was identified. Children aged 13-59 months were less-
nourished than those aged 0-12 months (Anware et al., 2016). A study conducted that in
Ethiopia also shows that revealed socio economic, demographic and child health and care
practices characteristics considered, age of the child 11-23 months, sex of the child and breast
feed the child still now remained to be significantly associated with stunting (Birara et al.,
2014).

2.3.1.2. Maternal Characteristics

A woman’s nutritional status affects her capacity to successfully carry her pregnancy to term,
deliver children and care for her children. 22 percent of women in Ethiopia are
undernourished with a BMI of less than the 18.5 cut off point and only eight percent are
obese with a BMI of more than 25.0 (EDHS, 2016). These figures put Ethiopia among sub-
Saharan countries with the highest proportion of malnourished women. A study conducted
that in Nigeria revealed that Socio-economic factors significantly associated with
malnutrition were residence in a high density area, family accommodation in a single room
apartment and family weekly expenditure on food below $55 (Owoaje et al., 2014).

11
According to the study done in Japan level of education of parents, attitudes of mothers
towards domestic violence, assets of household, local health services, and the condition of
sanitation and water were considered to be important determinants of nutritional status of
children (Kamiya , 2011). In line with this the study conducted in Ethiopia also shows that
child nutritional status is strongly associated with the child’s age, gender, immunization
status and the mother’s use of antenatal care, farm size, household size, water source and
incidence of morbidity (Tadiwos and Degnet , 2013).

A study conducted in two states of Nigeria shows that mothers ANC visit, discussion on
pregnancy and childbirth with partner and delivery attended by a skilled health worker has
significance role on child malnutrition. A child whose mother had fewer than four
government antenatal care visits was more likely to be malnourished, a child whose mother
who rarely or never discussed pregnancy and childbirth with her husband and who did not
have her last delivery attended by a skilled health worker was more likely to be malnourished
(Hamel et al., 2015).

Study done in Ethiopia shows that almost 87% of the children had preceding birth interval
greater than twelve months. More than half (56.5%) of the children were living in a
household with more than five members. Children whose preceding birth interval was less
than two years were 1.43 times at higher risk of being malnourished compared to children
with preceding birth interval greater than 24 months [adjusted odds ratio (AOR) = 1.43, 95%
CI: 1.02–2.04] ( Neima et al.,2017). The study conducted in Brazil shows that chronic
malnutrition (-2 standard deviations/height for age) was found in 8.6% of children and was
associated with mother’s age and educational level, type of residence, number of rooms,
flooring, water supply, and low birth weight (< 2,500 g) in children aged ≤ 24 months
(Silveira et al., 2010). According to the study done in Ethiopia shows that regarding religion,
Protestant Christian was slightly more than half, constituting 185(58.7%) followed by
Orthodox (Hiwot et al., 2017).

Another study done in Ethiopia also revealed that children from households in Tigray, Affar
and Amhara regions were less-nourished. Level of education of parents, possession of media
infrastructure (TV and radio), assets of household, contraceptive adoption and the condition
of sanitation and water were considered to be important determinants of nutritional status of
children (Anware et al., 2016).

12
2.3.1.3. Women Education

Mother's education plays a vital role in increased receptivity to knowledge and awareness
related to nutritional requirements of their infants. According to study done by Liaqat et al.,
(2007) a positive relationship was found between the nutritional status of infants and
educational status of mothers (P< 0.001). The study revealed that the majority of infants with
evidence of malnutrition belonged to the mothers with virtually no school education. In line
with this a study done in Bangladesh also shows that the children of illiterate women were
nutritionally more vulnerable than children of their women who had secondary and higher
education (OR=1.69, 95% CI=1.33-2.15) (Giashuddin et.al, 2003). Study conducted in
Nigeria also shows that children with less educated mothers were significantly more likely to
be stunted. Households with food insecurity and less educated mothers were more likely to
have malnourished children ( Ajao et al., 2010).

2.3.1 4. Place of Residence

According to study done in Brazil type of place of residence has effect on children nutritional
status. I.e. including other determinants type of residence contributed for chronic malnutrition
(-2 standard deviations/height for age) about 8.6% of children (Silveira et al., 2010).

2.3.1.5. Household Wealth Status

Maternal and child under nutrition is highly prevalent in low-income and middle-income
countries, resulting in substantial increases in mortality and overall disease burden (Canaan et
al., 2015). According to study done in Pakistan there was strong association of malnutrition
with family size, income of the parents and child number in the family. This indicates that the
risk of malnutrition due to large family size and lower income (Khattack and Ali ,2010).
A study done in Ghana shows that, mothers of malnourished children were more likely to be
unmarried or cohabiting, have lower family incomes, HIV infection and chronic disease.
They were less likely to stay with or provide alternative care for their child. Awareness and
use of social services, health insurance and a cash transfer programme were low (Tette et al.,
2016). According to the research conducted in Kenya being poor, mother being a house wife
and number of children in the household were the key determinants for stunting (Tankoi et
al., 2016). The study conducted in Ethiopia shows that the middle wealth quintile to the
households, number of children aged 6-59 months in the household and giving honey to the

13
child in the morning were remained to be significantly and independently associated with
underweight (Birara et al., 2014).
2.3.1.6. Source of Drinking Water
Hygiene practices directly affect the cleanliness of the environment and the number of
infectious agents that children may ingest They are divided into personal and household
hygiene practices The personal hygiene practices include, hand washing, bathing and
cleaning the child while household hygiene practices include cleaning of house and child's
play area, adequate waste disposal, use of sanitary facilities and use of safe water
(UNICEF,1997, UNICEF, 1998, Lamountagne et al.,1998, Abate, 1998)

A study conducted in rural India shows that improved conditions of sanitation and hygiene
practices are associated with reduced prevalence of stunting. i.e Compared with open
defecation, household access to toilet facility was associated with a 16–39% reduced odds of
stunting among children aged 0–23 month ( Rah et al., 2015).

2.3.2. Proximate Determinants

The proximate determinants, characteristics having a direct influence on child nutritional
status , considered in this study are breastfeeding and complementary feeding.
Following are discussions that these proximate determinants exert on child nutritional status .
2.3.2.1 Breast Feeding
Breastfeeding is very common in Ethiopia with 97% of children ever breastfed. Almost three-
quarters of children are breastfed within the first hour of life. Only 8% of children who were
ever breastfed received a prelacteal feed, though this is not recommended (EDHS, 2016).
WHO recommends that children receive nothing but breast milk (exclusive breastfeeding) for
the first six months of life. Fifty-eight percent of children less than six months are exclusively
breastfed. Children age 0-35months breastfeed until a median of 23.9 months and are
exclusively breastfed for 3.1 months (EDHS, 2016). A cross-sectional study aimed to
determine the prevalence of malnutrition and identify the relationship between feeding
practices and malnutrition in children below 5 years, in 7 remote and poor counties of China
shows that the higher prevalence of stunting among Chinese children who had never been
breastfed, who had been breastfed for less than 1 year, or had been fed with semi-solid foods
of poor quality (Zhou et al., 2012).

14
Another study conducted in India shows that there was significant association between
underweight with the birth order of the child, birth weight of the child and time of initiation
of the breast-feeding to the child.

This study also states that there was significant association between stunting with the sex of
the child ( Gandhi et al., 2014). A study done in Bangladesh shows that it was 16% of
women still exclusively breastfed their children for less than 6 months. Of the children 38.1%
were stunted and 38% were under weight for their age. Overall, 46% of children were
suffering from diseases (Giashuddin et al., 2003). This shows that breast feeding has impact
on children nutritional status.

A study carried out in Ethiopia also shows that 80 cases and 320 controls, more than half
(52.5%) of the cases and the controls (53.8%) were males and females, respectively. Breast
Feeding (BF) was started immediately after birth in only 43.8% of the cases. Nearly 94% of
the mothers of the cases had no breast feeding information as part of Ante Natal Care (ANC)
follow up (Wubante , 2017).

2.3.2.2. Complementary Feeding

The World Health Organization (WHO) estimated that inappropriate feeding of infants and
young children was responsible for one-third of the cases of malnutrition worldwide (WHO,
2006). It has been recognized that inappropriate feeding practices include absence of
exclusive breastfeeding in children below 6 months old, premature lactation after 6 months,
and giving complementary foods too late.
A study conducted in Nigeria shows that children who did not receive timely complementary
foods had higher odds for wasting. Children who did not receive the minimum dietary
diversity had higher odds for underweight than children who received the minimum dietary
diversity. Children who did not receive the minimum feeding frequency were more likely to
be stunted than their peers who received the minimum feeding frequency (Udoh and Amodu,
2016).

15
2.4 Analytical Framework
Based on the conceptual framework and objective of the study the analytical frame work is
shown below (Figure 2).

Figure 2: Analytical frame work of the study

Source: Developed by author based on the literature

16
 CHAPTER THREE
MATERIALS AND METHODS
3.1.Description of the Study Area
Ethiopia lies in the Horn of Africa, between 3ON and 15ON latitudes and 33OE and 48OE
longitudes. The country is land locked and is bounded by Djibouti in the east, Somalia in the
east and Southeast, Kenya in the South, South Sudan in the West, Sudan in the North and
Eritrea in the north and north east. Ethiopia is estimated to have a total area of 1,127,127 Km2
with a topographic diversity encompassing high and rugged mountains, flat-topped plateau,
deep gorges with rivers, and rolling plains (CSA, 2010).
Among the African countries, Ethiopia ranks the second-most populous country of Africa
after Nigeria. Based on the 2007 Census the national population projection of Ethiopian was
94,351,001 million, with a yearly growth rate of 2.5 percent (CSA, 2013). Nearly half of
Ethiopia has a young population, with 47 percent of its population under the age of 15 years,
while only 4 percent are age 60 years or older (EDHS, 2016). Women within the reproductive
years of 15-49 constitute 20.7 percent of the total population (CSA, 2013).

Ethiopia is a large country divided into 9 regions and 2 city administrations (CSA, 2010).
Southern Nations, Nationalities, and Peoples' Region (often abbreviated as SNNPR) is one of
the nine ethnically based regional states (kililoch) of Ethiopia. It was formed from the merger
of five kililoch, called Regions 7 to 11, following the regional council elections on 21 June
1992 (Lyons and Terrence, (1996). Its capital is Awasa. The SNNPR borders Kenya to the
south (including a small part of Lake Turkana), the Ilemi Triangle (a region claimed by
Kenya and South Sudan) to the southwest, South Sudan to the west, the Ethiopian region of
Gambela to the northwest, and the Ethiopian region of Oromia to the north and east. Besides
Awasa, the region's major cities and towns include Sodo, Arba Minch, Bonga, Chencha, Dila,
Irgalem, Mizan Teferi, Wendo, Welkite, and Worabe.

17
 Fig 3: Distribution of study samples for SNNP Region

Source; Analyzed for this study only by GIS and cartographic directorate(CSA)

Based on the 2010 Census conducted by the Central Statistical Agency of Ethiopia (CSA),
the SNNPR has an estimated total population of 14,929,548 of whom 7,425,918 men and
7,503,630 women. According to 2017 population projection total population was projected to
19,170,007 of whom 9,500,004 were men and 9,670,003 women. 13,433,991 or 89.98% of
the population are estimated to be rural inhabitants, while 1,495,557 or 10.02% are urban.
According to 2017 population projection total population was projected to 19,170,007 of
whom 15,992,000 were rural and 3,178,000 urban; this makes the SNNPR Ethiopia's most
rural region. With an estimated area of 105,887.18 square kilo meters, this region has an
estimated density of 141 people per square kilo meter. For the entire region 3,110,995
households were counted, which results in an average for the Region of 4.8 persons to a
household, with urban households having on average 3.8 and rural households 4.9 people
(CSA, 2013).
The SNNPR Water Resources Bureau announced that as of the fiscal year ending in 2006,
they had increased the area of the Region that had access to drinkable water to 54% from 10-
15% 15 years ago (CSA, 2006).

18
Priority was given to certain Zones, such as Sidama, Welayta and Gurage, as well as the
Alaba special woreda and several resettlement areas (CSA, 2006).
Values for other reported common indicators of the standard of living for the SNNPR as of
2016 include the following: 18.2% of the inhabitants fall into the lowest wealth quintile; adult
literacy for men is 64.6% and for women 35.3%; and the Regional infant mortality rate is 65
infant deaths per 1,000 live births, which is greater than the nationwide average of 48; at least
half of these deaths occurred in the infants’ first month of life (EDHS, 2016).

The 2010 census reported that the predominantly spoken mother tongue languages large to
small include Sidama (19.59%) and Amharic (4.10%). Other languages spoken in the State
include Kambaata, Mello, Goffa, Gedeo and Dima; because of the relatively few number of
speakers of most of the languages in the region, the working language of the state is Amharic
(the most widely spoken language in Ethiopia and formerly the only official language) (CSA,
2010) The CSA reported that for 2004-2005 100,338 tons of coffee were produced in the
SNNPR, based on inspection records from the Ethiopian Coffee and Tea authority. This
represents 44.2% of the total production in Ethiopia. Farmers in the Region had an estimated
total 7,938,490 head of cattle (representing 20.5% of Ethiopia's total cattle), 3,270,200 sheep
(18.8%), 2,289,970 goats (17.6%), 298,720 horses (19.7%), 63,460 mules (43.1%), 278,440
asses (11.1%), 6,586,140 poultry of all species (21.3%), and 726,960 beehives (16.7%)
(CSA,2006).

3.2. Source of data

This study was carried out using quantitative data to analyses the effects of child feeding
practices on nutritional status of children 6-59 months of age in SNNPR. Data was obtained
from the 2016 EDHS. This survey is the fourth comprehensive survey designed to provide
population and health indicators at the national (urban and rural) and regional levels. The
Ethiopian Demographic and Health Survey has been collected by the Central Statistical
Agency with the prime objective of generating health and demographic information on family
planning, fertility levels and determinants, fertility preferences; infant, child, adult and
maternal mortality; maternal and child health; nutrition, malaria, women’s empowerment,
and knowledge of HIV/AIDS along other household characteristics (CSA and ICF
international, 2016).

19
The EDHS covered 9 regions and 2 city administrative councils. The 2016 EDHS sample was
selected using a stratified two-stage cluster design. EAs were the sampling units for the first
stage. The sample included 645 EAs (202 in urban areas and 443 in rural areas) selected from
the list of enumeration areas of the 2007 Population and Housing Census sample frame.The
study design, as DHS survey are known by cross sectional.

Households comprised the second stage of sampling. A complete listing of households was
carried out in each of the 645 selected EAs and representative sample of 18,008 households
was selected for the 2016 EDHS. In the interviewed households 16,583 eligible women were
identified for individual interview; complete interviews were conducted for 15,683 yielding a
response rate of 95 percent. From the total of 16,583 interviewed women in 2016 EDHS 1171
where women from SNNPR then 680 of women were considered in the analysis since they
have children 6-59 months of age in their last birth. The source of population was children
aged 6-59 months of age and their index women aged 15-49. The study population was
selected children aged 6-59 months of age and their index women aged 15-49 they have
children 6-59 months of age in their last birth excluding those who have not children 6-59
months of age in their last birth

Household questionnaire, the woman’s questionnaire, and the men’s questionnaire were used
in the EDHS. The Woman’s Questionnaire was used to collect information from all women
age 15-49. These women were asked questions regarding: maternity care, fertility history
and preference, mortality, Knowledge and use of family planning methods, awareness and
behavior regarding AIDS and other sexually transmitted infections (STIs) nutritional status of
women and young children and some aspects of their demographic and socio-economic
background. The current study therefore used data from women’s questionnaire by
considering the effects of child feeding practices on nutritional status of Children 6-59
months of age.
3.3. Variables and their description
Depending on the review of literatures that help to clarify the objective of the study variables
listed below were needs to be explained in accordance with their dependent and independent
nature in the context of the analysis made in the main study.

20
3.3.1. Dependent Variable
 Child nutritional status:
`The dependent variable is children’s malnutrition status measured in terms of
stunting. Children whose height for-age Z-score is below minus two standard
deviations (-2 SD) from the median of the reference population are considered
short for their age (stunted). Was categorized as, “1” if “Yes and “0” if “No”.

3.3.2. Intermediate Variables

Early initiation of breastfeeding: Initiation of breastfeeding within 1 hour of birth. It
was categorized as, “1” if “Yes and “0” if “No”.

Exclusive breastfeeding under 6 months: It is recommended that children be exclusively

breastfed during the first 6 months of their life; this means that they should be given
nothing but breast milk .Was categorized as, “1” if “Yes and “0” if “No”.

Initiation of complementary feeding (solid, semi-solid or soft foods): After the first 6
months, breast milk is no longer adequate to meet the nutritional needs of the infant, and
complementary foods should be added to the child’s diet. It has been recommended that
meat, poultry, fish, or eggs should be part of the daily diet, and eaten as often as possible
(WHO 2010),was categorized as, “1” if “Yes” and “0” if “No”.

Minimum dietary diversity: It is recommended that children 6 to 23 months receive

foods from at least 4 food groups daily.The four food groups should come from a list of
seven food groups: grains, roots, and tubers; legumes and nuts; dairy products (milk
yogurt, cheese); flesh foods (meat, fish, poultry, and liver/organ meat); eggs; vitamin A-
rich fruits and vegetables; and other fruits and vegetables. Was categorized as, “1” if “Yes
and “0” if “No”.

Minimum meal frequency: Breastfed children are considered to be consuming standard

minimum meal frequency if they receive solid, semi-solid, or soft foods at least twice a
day for infants age 6-8 months and at least three times a day for children age 9-23 months.
Non-breastfed children age 6-23 months are considered to be fed with a minimum meal
frequency if they receive solid, semi-solid, or soft foods at least four times a day. Was
categorized as, “1” if “Yes and “0” if “No”.

21
3.3.3. Independent Variables
 Child characteristics

Age: Refers to the age of the children at the time of the survey. It was categories in to seven
and coded as 6-8,9-11,12-17,18-23, 24-35, 36-47 and 48-49.
Sex: Categorized as male and female
Size of child at birth: It was categorized as average or larger than average and very small or
smaller than average.
Birth interval: Categories as first birth, <24months, 24-36months,37-48months and
above 49 months.
 Maternal characteristics :
Age:-Refers to the age of the women at the time of the survey. It was categories in to five and
coded as 15-24, 25-34, 35-39 and 40-49.
Body Mass Index (BMI): height < 45cm, body mass index (BMI) < 18.5 cm (thinness),
weight < 45kg and mid upper arm circumference (MUAC) < 22.5cm WHO (2003) classified
the BMI for the assessment of nutritional status as follows: under-weight (CED) < 18.5,
normal 18.5-24.9, overweight 25-29.9 and obese 30 and above.
Number of children aged <=5: It was categories in to three and coded as 1child, 2 child
and 3 and above.

ANC visits: It was categorized as 0, 1- 3 and 4+ .

Family size: It was categorized as,<5 and >=5

Family income: Depending on women’s household income status, it was classified as

poorest, poorer, middle, richer and richest.

Place of residence: Categorized as Urban and Rural.

Maternal education: Categorized as; No education and educated.

Maternal occupation: Refers to working status of women at the time of the survey.
Categorized as not working and working.
Source of drinking water: Coded as improved source of water and unimproved source of
water.

22
Exposure to mass media: Information obtained with regard to watching television, listening
to radio and reading newspaper was considered to measure exposure to media in the analysis.
It was classified into three categories: Frequently used if a woman has an almost every day
access to either of these media, sometimes if a women has infrequent access and No access if
a woman has no access to any of these media.

Religion: Refers to the religious affiliation of a woman at the time of the survey. It was
classified into; Christians, Muslim and others.

3.4. Data Organization and Analysis

The secondary data which was taken from child data of EDHS-2016 was used for analysis.
The data was cleaned; organized and analyzed using statistical packages SPSS v.20. The
study considers children 6-59 months of age in SNNPR region. The three major
anthropometric indicators to assess children’s malnutrition are: Weight-for-age
(Underweight) is a composite index of height-for-age and weight for-height. It takes into
account chronic malnutrition. A child can be underweight for his/her age because he or she is
stunted, wasted, or both. Weight-for-age is an overall indicator of a population’s nutritional
health. Children with height- for- age where by height of a child is below minus two Z-score
of the expected height of a reference child (NCHS/WHO, 2010) of the same age. Children
who are below minus three standard deviations (-3 SD) are considered severely stunted. This
study therefore uses children whose height-for-age Z-score is below minus two standard
deviations (-2 SD) (stunting) to assess children nutritional status.

To investigate the proximate, demographic and socio-economic determinants of child feeding

practice on nutritional status of children 6-59 months of age were binary logistic regression
model was fitted. Univariate (simple descriptive statistics of all variables) and bivariate
association of the dependent variable with each of the independent variable were performed.
Statistical significance at P<0.1, P<0.05 and P<0.01 was performed based on the chi-square
statistics for the bivariate analysis Since, it is used to show the extent to which each of the
independent variable is influence with children’s malnutrition.The chi-square test is intended
to test how likely it is that an observed distribution is due to chance. The individual test of
parameters is useful to determine if an individual variable provides additional information in
the presence of all other variables. It was used to show the association of one to one or
dependent to one independent variable.

23
In descriptive statistics percentage and frequency values was employed to analyze the
demographic and socio-economic characteristics of the children. Bivariate analysis was
undertaken independently for demographic and socio-economic variables against the
outcome variables.

Logistic regression model used to estimate the relationship between two or more variables. It
indicates the significant relationships between dependent variable and independent variables
and also the strength of impact of multiple independent variables on a dependent variable. To
avoid over fitting and under fitting, we should include all significant variables. A good
approach to ensure this practice is to use a step-wise method to estimate the logistic
regression.

Logistic regression model at multivariate analysis was used to estimate the strength of
associations between the dependent and independent variables. In multivariate analysis all the
demographic and socioeconomic, variables was looked together in relation to nutritional
status of children 6-59 months of age. The purpose of multivariate analysis is to determine
the extent to which all the variables have an influence on nutritional status of children 6-59
months of age dependent on each other’s presence. Since the interest is in identifying
children at risk of malnutrition, the dependent variables was coded as 1 if the children were
stunted (−2 SD) and coded as 0 if not.
The logistic regression model was used in this study to show the association of malnutrition
with k independent (x1, x2, xk), demographic and socio - economic variables is therefore
given by:
Logit P(x) = a + ∑ βi xi; i = 1, 2... k
i=1
Where, βi’s are regression coefficients , a = constant and Exp (βi) = Odds ratio
The Exp(B) or Odds ratio is determined from the logistic regression which shows the
increasing or decreasing chance of nutritional status of 6-59 months of children for each
predictor variables controlling the effects of others. An odds ratio gives an estimate of the
magnitude of association between the dependent variable (stunting) and predicator variable.
In this analysis an odds ratio of 1.0 indicates no difference, a ratio below 1 indicates a
negative association and a ratio above 1.0 indicates a positive association between the
independent variable and the dependent variable (stunting). P-values (P < 0.1, P <0.05, P
<0.01, P< 0.001) were considered to be significant.

24
 CHAPTER FOUR
RESULT AND DISCUSSION
4.1. Socio- economic and Demographic Characteristics of the Respondent
Number and percentage of women age (15-49) and children 6-59 months by different socio-
economic and demographic characteristics that included in the study 2016 EDHS can be seen
in Table 1 below.
Table 1 Percentage distributions of women aged 15-49 and children 6-59 months by
demographic and socio-economic characteristics, SNNPR, using 2016/2017 EDHS.

Women and child Women and child

Characteristics N % Characteristics N %
Place of residence Source of drinking water
Urban 61 9.0 Unimproved 388 57.1
Rural 619 91.0 Improved 292 42.9
Total 680 100 Total 680 100
Age of Women BMI*
15-24 125 18.4 Underweight 98 14.5
25-34 367 54.0 Normal 529 78.3
35-39 115 16.9 Overweight 40 5.9
40-49 73 10.7 Obese 9 1.3
Total 680 100 Total 680 100
Education Family size
No education 397 58.4 <5 315 46.3
Educated 283 41.6 >=5 365 53.7
Total 680 100 Total 680 100
Religion of women Access to media
Christian 561 82.5 Not at all 478 70.3
Muslim 98 14.4 Some times 91 13.4
Others 21 3.1 Frequently 111 16.3
Total 680 100 Total 680 100
Women work Ante natal care
Not working 267 39.3 None 205 30.1
Working 413 60.7 1-3 visit 207 30.4
Total 680 100 Above 4 visit 268 39.4
Household wealth status Total 680 100
Poorest 116 17.1 Number of children below age 5
Poorer 157 23.1
Middle 174 25.6 One child 355 52.2
Richer 144 21,2 Two children 285 41.9
Richest 89 13.1 3 and above children 40 5.9
Total 680 100 Total 680 100
Complementary feeding Sex of child

25
 No 390 57.4 Male 347 51.0
Yes 290 42.6 Female 333 49.0
Total 680 100 Total 680 100

**Min dietary diversity **Early breast feeding

No 591 86.9 No 168 24.5
Yes 89 13.1 Yes 512 75.3
Total 680 100 Total 680 100
Meal frequency **Exclusive breast feeding
No 567 83.4 Not exclusively breast fed 85 12.5
Yes
113 16.6 Exclusively breast fed 595 87.5
Total 680 100 Total 680 100
Age in month Birth interval
6-8 62 9.1 First birth 113 16.6
9-11 54 7.9 <24 months 123 18.1
12-17 117 17.2 24-36 months 170 25.0
18-23 88 12.9 37-48 months 125 18.4
24-35 177 26.0 49and above months 149 21.9
36-47 111 16.3 Total 680 100
48-59 71 10.4 Size of child at birth

Total 680 100 Average /larger than average 549 81.3

Very small/smaller than
average 126 18.7

Total 680 100

Note * Body mass index do not add up to the total as there are missing observation. **Correlations of exclusive breast
feeding =-0.0314 shows smaller downhill (negative) linear pattern, **Early breast feeding =-0.0373 shows a smaller
downhill (negative) linear relationship and **Min dietary diversity =-0.0537 shows a smaller downhill (negative) linear
relationship.

Source: Computed from the survey data.

As can be seen from Table 1 above the sampled women were predominantly rural residents.
Nearly 91% of those women were residing in rural areas at the time of the survey. The
proportion of women in the young age cohort are (18.4%), 25-34 were (54%), 35-39 were
(16.9%) and 10.7% of them were 40-49 age group. 58.4% of the sampled women aged 15-49
who have children 6-59 months of age in their last birth were illiterate, whereas educated
women was 41.6%. Above two third (82.5%) of these women are Christians, other religion
followers were 3.9% and 14.4% of them were Muslim. Among sampled women 39.26% of
them were not working at the time of the survey whereas 60.74% of them were engaged in
different works. The percentage distributions of women in poorest income status were
17.06%, while 23.09%, 25.59%, 21.18% and 13.09% of them were in poorer, middle, richer

26
and richest income status respectively. 57.06% of the sampled women aged 15-49 who have
children 6-59 months of age in their last birth used unimproved sources of drinking water
whereas 42.94% of them were used improved sources of drinking water.

Women who were not taken any of antenatal care visit in their last birth were 30.15% while,
women who take only 1-3 antenatal visiting were 30.44% and women who take 4 and above
antenatal visit were 39.41%. Proportion of women aged 15-49 who have children 6-59
months of age in their last birth with large family size (>=5) were 53.68% while 44.32% of
them were lived in small household members. On the other hand, above two third of the
sampled women had no access to mass media (70.29%) whereas the percentage of women
with sometimes access to media where 13.38 while percentage of women with frequent
access to media was 16.32.
About 14.5 percent of sampled women aged 15-49 who have children 6-59 months of age in
their last birth were under-weight, 78.25% of them has normal body mass index while women
with overweight and obese were 5.92% and 1.33% respectively. Women who have only 1
under-five age child were 52.21%, women who have two under-five age children were
41.91% and women who have more than under-five children during the survey were 5.88%.
From the last births of sampled women 51.03% and 48.97% of children were male and
female respectively.

From the last births of children of the sampled women 57.35% were not taken
complementary feeding in their 6-59 months of age the rest of them (42.65%) taken
complementary feeding. On the other hand 24.71% of the children were not taken early
initiation of breast feeding but 75.29% of them were taken early initiation of breast feeding.
Among children 6-59 months of age who were born to SNNPR women in 15-49 age group,
87.5% were exclusively breast fed while 12.5% of them were not exclusively breast fed.
From the last births of sampled women 81.3 and 18.7of children were average or larger than
average and very small or smaller than average respectively.

27
The majorities 83.38% of children 6-59 months of age have not taken minimum dietary
diversity and only 16.62% have taken minimum dietary diversity. The proportion of children
in 6-8, 9-11, 12-17, 18-23, 24-35, 36-47 and 48-59 months age group were 9.12%, 7.94%,
17.21%, 12.94%, 26.03%, 16.32% and 10.44% respectively.

Bivariate results of stunting

Stunting of last birth children 6-59 months of age in SNNPR on 2016 EDHs data. 61.2 % of
children 6-59 months of age in their last birth were not stunted. On the other hand 38.8 % of
children 6-59 months of age in their last birth were stunted (Figure 4).

Stunting

38.8, 39%
not stunting
stunting

61.2, 61%

Figure 4: Stunting of last birth children 6-59 months of age in SNNPR on 2016 EDHs data.
Source: Processed from EDHS data, 2016.

28
 Table 2 The Percentage distribution for all independent and dependent variable run in the
bivariate analysis in the stunting are shown below.
Pearson Pearson
Chi- Chi-
Stunting Square Sig Stunting Square Sig
covariates No Yes Covariates No Yes

n(%) n(%) n (%) n (%)

Meal Early breast 59.5% 40.5% 0.257 0.612
frequency No 58.6% 41.4% 9.882 0.002* feeding No
61.7% 38.3%
Yes 74.3% 25.7% Yes
60.7% 39.3% Exclusive 60.5% 39.5% 0.906 0.341
Not breast
Women work working 0.047 0.82 feeding No
61.5% 38.5% 65.9% 34.1%
Working Yes
Household Poorest 52.6% 47.4% Age in
wealth status 11.211 0.024* month 6-8 88.7% 11.3% 36.171 0.000*
58.0% 42.0%
Poorer 9-11 77.8% 22.2%
59.2% 40.8%
Middle 12-17 64.1% 35.9%
Richer 67.4% 32.6% 18-23 55.7% 44.3%
Richest 71.9% 28.1% 24-35 52.5% 47.55
Religion Christian 63.1% 36.9% 0.082 0.165 36-47 53.2% 46.8%
Muslim 52.0% 48.0% 48-59 60.6% 39.4%
Others 52.4% 47.6% 63.1% 36.9% 1.118 0.290
Sex of child Male
<5 63.2% 36.8% 0.986 0.617 Female 59.2% 40.8%
Family size
Complemen 56.4% 43.6% 8.747
>=5 59.5% 40.5% tary feeding No
Women Uneducatio 56.9% 43.1% 67.6% 32.4%
education n 7.253 0.007* Yes
67.1% 32.9% Minimum
dietary
Educated diversity No 60.2% 39.8% 1.678 0.195
Access to
media Not at all 59.8% 40.2% 4.852 0.088 Yes 67.4% 32.6%
Birth Firth 63.7% 36.3% 11.040 0.026*
Sometimes 57.1% 42.9% interval birth
<24 52.8% 47.2%
Frequently 70.3% 29.7% months
Number of 63.7% 36.3% 55.3% 44.7%
children below 24-36
age 5 One child 3.307 0.191 months
Two 59.6% 40.4% 37-48 68.0% 32.0%
children months
50.0% 50.0% 49 and 67.1% 32.9%
3 and above above
children months
Body mass Underweigh Age of
index t 56.1% 43.9% 1.853 0.603 Women 15-24 64.8% 35.2% 1.790 0.617
Normal 61.4% 36.8% 25-34 61.6% 38.4%
Overweight 67.5% 32.5% 35-39 56.5% 43.5%
Obese 66.7% 33.3% 40-49 60.3% 39.7%
54.1% 45.9%
Ante natal None 8.973 0.011*

29
care

59.9% 40.1% Source of Unimpr 58.8% 41.2% 2.216 0.137

drinking oved
1-3 vist water source
67.5% 32.5% Improv 64.4% 35.6%
ed
4 and above source
Average Type of 68.9% 31.1% 1.662 0.197
Size of child at /larger than place of
birth average 63.9% 36.1% 8.390 0.004* residence Urban
Very 50.0% 50.0% 60.4% 39.6%
small/small
er than
average Rural

Significant level were *** P<0.001, ** P<0.01 and *P< 0.05

Source: Processed from EDHS data, 2016.

Association between child nutritional status (stunting) and demographic and socioeconomic
indicators are presented in table 2. In this study among several variables age of child in
month, complementary feeding, wealth index, meal frequency, number of antenatal care
visits, size of child at birth and education of mother have significantly associated with
stunting of last born 6-59 months children.

There was a significant association (p < 0.05) between ages in months of children and the
stunting of last born children 6-59 months of age. The proportion of children who were
stunted in the age group 9-11, 12-17, 18-23, 24-35, 36-47 and 48-59 are 22.2%, 35.9%,
44.3%, 47.5%, 46.8% and 39.4% respectively when compared to children in 6-8 months of
age group. The proportion of children who were not stunted in 9-11, 12-17, 18-23, 24-35, 36-
47 and 48-59 age groups were 77.8%, 64.1%, 55.7%, 52.5%, 53.2% and 60.6%, respectively
when compared with children in 6-8 months of age group (88.7%).

There was a significant association between (p<0.05) between complementary feeding and
the stunting of last born age 6-59 months age children. Stunting was observed to be prevalent
(43.6%) among children who did not take complementary feeding compared to those who
were taken (32.4%).

Household wealth status also has significantly (p<0.05) associated with stunting of last born
6-59 months age children. Children who were stunted in poorer, middle, richer and richest
wealth quintile group were 58.0%, 59.2%, 67.4% and 71.9% compared with children in the
poorest wealth quintile group (52.6%).

30
Similarly, meal frequency was also has significantly associated (p<0.05) with stunting of last
born 6-59 months age children. Stunting was less prevalent in children who were nourished
as in the recommended meal frequency (25.7%) compared with those children were not
nourish (41.4%) as recommended.

On the other hand women’s antenatal care visits has significantly associated (p<0.05) with
stunting of last born 6-59 months age children. The percentage distribution of stunting among
children where there mother had attended one to three and four or more antenatal care visits
were 40.1% and 32.5% compared with children where there mother did not attend any
antenatal care visits (45.9%).

Education of women has significantly associated (p<0.05) with stunting of last born 6-59
months children. Stunting is more prevalent in children where their mothers were not
educated (43.1%) compared with those children where their mothers had educated (32.9%).

Size of child at first birth has significantly associated (p<0.05) with stunting of last born 6-59
months children. Stunting is more prevalent for very small or smaller than average sized
children (50%) compared with those of an averaged or larger than average sized children
(36.1%).

31
 4.2. Presentation of the Study Finding
The individual test of parameters is useful to determine if an individual variable provides
additional information in the presence of all other variables. Nonetheless, the binary logistic
regression test is helpful to ascertain if there is a regression relation between the dependent
and all independent variables (Table 3).
Table 3 Binary logistic regression model for women age 15-49 showing adjusted OR and
crude OR on their last age 6-59 months.
Adjusted OR
Crude OR Adjusted OR Crude OR
variables OR SE. OR SE. Variables OR SE. OR SE.
Place of residence Source of drinking water
1
Urban (ref) 1 1 Unimproved (ref) 1
1.213 0.44 0.691 0.288 0.531** 0.101 1.269 0.16
Rural Improved
Education BMI
1 Overweight (ref) 1
No education (ref) 1 1
0.917 0.181 1.546** 0.162 Underweight 1.412 0.584 0.963 0.784
Educated
Number of children Normal 1.165 0.412 1.564 0.736
below age 5
1 Obese 3.597 3.055 1.255 0.713
One child (ref) 1
1.533* 0.308 0.571 0.335
Two children Exclusive breast feeding
3.275** 1.422 0.676 0.338 Not Exclusively breast 1
3 and above children fed(ref) 1
0.698 0.1969 1.261 0.244
Women occupation Exclusively breast fed
1
Not working (ref) 1 Access to media
1.161 0.212 1.035 0.161 Frequently (ref) 1
Working 1
Household wealth Not at all 1.094 0.309 0.564* 0.297
status
Poorest (ref) 1 Sometimes 1.702 0.602 0.895 0.231
1
Poorer 0.680 0.191 2.308** 0.3 Complementary feeding

Middle 0.695 0.196 1.857* 0.286 No (ref) 1

1
Richer 0.479* 0.147 1.765* 0.282 Yes 1.340 0.683 1.611** 0.162

Richest 0.367* 0.148 1.24 0.295

Min dietary diversity
No (ref) 1
Ante natal care visiting 1
1 Yes 1.024 0.330 1.366 0.241
None (ref) 1

32
 0.781 0.178 1.762** 0.191 Size of child at birth
1-3 vist
Average / larger than
0.6* 0.13 1.393 0.193 average (ref) 1
4 and above 1
Very small/smaller than
average 1.614* 0.365 0.564** 0.199
Family size
>=5 (ref) 1
1
<5 1.165 0.222 1.17 0.158
Meal frequency
No (ref) 1
Age in month 1
1 Yes 0.750 0.215 2.05** 0.232
6-8 (ref) 1
2.299 1.222 0.195** 0.469
9-11 Sex of child
4.099* 1.940 0.439* 0.408 1
12-17 Female (ref) 1
6.431* 3.180 0.86 0.31 0.8638 0.15991 1.181 0.158
18-23 Male
9.247** 6.248 1.222 0.324
24-35 Early breast feeding
13.518* 9.332 1.387 0.286 1
36-47 No (ref) 1
8.266* 5.829 1.354 0.308 0.791 0.176 1.096 0.182
48-59 Yes

Note BMI: body mass index; (ref): Reference category; SE: Standard error; OR: Odds ratio; AOR: Adjusted odds ratio,
COR: crude odds ratio, Significant level were *** P<0.001, ** P<0.01 and *P< 0.05

Both the adjusted and unadjusted logistic regression analysis presented in the above table
assesses the association between child nutritional status (stunting) and different demographic
and socioeconomic indicators for last born 6-59 months age children.

The unadjusted logistic regression model (without controlling the effect of other factors)
education of mother, source of drinking water, media exposure, wealth index, number of
under-five children, age group of child, antenatal care visits, complementary feeding, meal
frequency and size of child at birth had significantly associated with stunting of last born 6-
59 age children. However, the adjusted logistic regression analysis result shows among the
variables considered in the model source of drinking water, wealth index, number of under-
five children, age group of child, antenatal care visits and size of child at birth had
significantly associated with stunting of last born 6-59 months age children.

33
Source of drinking water
Both the adjusted and unadjusted logistic regression analysis shows that source of drinking
water had a significant effect on stunting of last born 6-59 months age children. The adjusted
logistic regression model result showed that children who lived in households using an
improved drinking water source are 46.9% less likely to be stunted compared with those
children lived in households having unimproved water source ((AOR: 0.531; 95% CI: (0.531
- 0.772)).

Women Education
Women education had significant effect on stunting of their last born 6-59 age children in the
unadjusted model. Children with their educated mothers are 33.8% less likely to be stunted
compared with no education mother children ((COR: .662; 95% CI: (0.477 - 0.917)). But in
the adjusted model education of mother have no significant effect on stunting of last born 6-
59 months age children.
Household wealth status
Household wealth status of women had significant association with stunting of last born
children 6-59 months of age both in adjusted and unadjusted model. Women in richer wealth
quantile is significantly associated ((AOR: 0.479; 95% CI: (0.262 - 0.876)) with stunting of
last born children 6-59 months of age when compared to women in poorest wealth status and
also women in richest wealth status have a statistical significant effect ((AOR: 0.367; 95%
CI: (0.167 - 0.809)) on stunting of last born children 6-59 months of age when compared to
women in poorest wealth status on the adjusted model. The odds of stunting of last born
children 6-59 months among mothers in richer wealth status were 52.1% less likely to be
stunting of last born children 6-59 months of age than mothers in poorest wealth quintiles.
Similarly odds of women in richest wealth status were 63.3% less likely to be stunting of last
born children 6-59 months of age compared to women in poorest wealth status on the
adjusted logistic regression model.

Antenatal care
Women who take only three or less antenatal care visits on their last birth had not statistically
significant effect on stunting of children 6-59 months of age when compared to women who
were not taken any of antenatal care visits in their last birth. But women who take four and
above antenatal care visit had a significant effect (AOR:0.629; 95% CI: (0.409 – 0.972) on
stunting of children 6-59 months of age when compared to women who were not taken any of

34
antenatal care visit in their last birth both in the adjusted and unadjusted model . Women who
take four or more antenatal care visits were 37.1% less likely that their last 6-59 months age
children to be stunted compared to women who were not taken any of antenatal care visits.

Access to media
Access to media had a significant association with the stunting of last born children 6-59
months of age only in unadjusted model. But this association vanished when the demographic
and socioeconomic factors are controlled. Women who had no access to mass media
(COR:1.611; 95% CI: (1.013 – 2.563) have statistically significantly associated with stunting
of last born children 6-59 months of age when compared to women with frequent access to
media on unadjusted model. The odds of women with no access to mass media were 1.611
times more likely that their last born children of age 6-59 months to be stunted compared to
women with frequent access to media (See TableA-2, Appendix).
Number of under-five children
Women who have only two and three or more under-five children during the survey period
had a significant effect on stunting of the last born children 6-59 months of age when
compared to women who have only one child both in the adjusted and unadjusted logistic
regression model. Women who have only two under five children during the survey period
were about 1.533 times more likely for stunting of their last born children 6-59 months of age
compared to women who have only one child ((AOR:1.533; 95% CI:(1.034 - 2.273)).
Similarly, women who have three or more under five children during the survey period were
about 3.275 times more likely for stunting of their last born children 6-59 months of age
compared to women who have only one child ((AOR:3.275; 95% CI:(1.398 - 7.672)).
Complementary feeding
Complementary feeding had a statistically significant effect on stunting of last born 6-59
months age children only in unadjusted logistic regression model ((COR: 0.623; 95% CI:
(0.450-0.863)). Children who had taken complementary feedings were 37.7% less likely to be
stunted compare with those children who had not taken any complementary feedings.

35
Meal frequency
Meal frequency had a significant effect on stunting of last born 6-59 months age children
only in the unadjusted logistic regression model((COR: 0.538; 95% CI: (0.337 - 0.858)).
Children who were nourished in the recommended meal frequency were 46.2% less likely to
be stunted compared with those children who were not nourished in the recommended (7+)
meal frequency.
Age in month
Age in month of children had a significant effect on the child malnutrition both in the
adjusted and unadjusted logistic regression models. Children in 12-17 age group with
(AOR:4.099; 95% CI: (1.621-10.367)), 18-23 age group with(AOR:6.431; 95% CI: (2.440-
16.952)), 24-35 age group with (AOR:9.247; 95% CI: (2.459-34.765)), in age group 36-47
with (AOR: 13.518; 95% CI: (3.494 - 52.307)), and in 48-59 age group with (AOR: 8.266;
95% CI: (2.075 - 32.930)), had showed a significant effect on child malnutrition i.e. stunting
of children when compared to children within 6-8 months age group while only children in 9-
11 age group have showed a non-significant effect on child malnutrition (stunting) when
compared with children in 6-8 months age group in the adjusted logistic regression model.

The odds of stunting of last born 6-59 months children belonging to the age group 12-17, 18-
23, 24-35, 36-47 and 48-59 months were 4.099, 6.431, 9.247, 13.518, 8.266 times more likely
the odds of stunting of children belongs to 6-8 months of age group, respectively for the
adjusted model (See TableA-2, Appendix).
Size of child at birth

Size of child at birth had significantly associated with stunting of last born 6-59 months age
children both in the adjusted and unadjusted logistic regression model. Children having a
very small or smaller than average sizes during their births were 1.615 times more likely to
be stunted compared with those children having and average or larger than average sizes
((AOR: 1.615 ; 95% CI: (1.037 - 2.516)).

Even though variables discussed above have significant effect on stunting of the last born
children 6-59 months of age there are some variables like place of residence, women
occupation, family size, minimum dietary diversity, early breastfeeding, exclusive
breastfeeding, sex of the child, body mass index that does not show statistical significant
effect both in the adjusted and unadjusted model.

36
5.2. Discussion of the Study Finding
In this study it is found that drinking water source, wealth status, access to media, number of
under-five aged children in the household, age of child in months, size of child at first birth,
complementary feeding, meal frequency, ANC and education of mother had significantly
affect stunting of the last born children 6-59 months of age. On the other hand, mothers work
status, early breastfeeding, exclusive breastfeeding, minimum dietary diversity, family size
and BMI had no influence on stunting of the last born children 6-59 months of age.

The findings of this study both in the adjusted and unadjusted odds ratio showed that drinking
water source had significantly associated with stunting of last born 6-59 months aged
children. Children lived in households that had improved drinking water source are 46.9%
less likely to be stunted compared with those children who had lived in households having
unimproved drinking water source. This is because hygiene practices directly affect the
cleanliness of the environment and the number of infectious agents that children may ingest.
This result is consistent with a study conducted by Rah et al., (2015) in rural India that
showed improved conditions of sanitation and hygiene practices are associated with reduced
prevalence of stunting.

The results of this study also shows that household wealth status of women had significant
association with stunting of last born children 6-59 months of age in both models. Number of
under-five children in the household also significantly contributes for stunting of the last born
6-59 months aged children. The study conducted by Khattack and Ali, (2010), Tette et
al.,(2016) and Tankoi et al.,(2016) also shows that there was strong association of
malnutrition with income of the parents and child number in the family. This indicates that
the risk of malnutrition due to large family size and lower income. Being poor, mother being
a house wife and number of children in the household were the key determinants for stunting.
They were less likely to stay with or provide alternative care for their child. Awareness and
use of social services, health insurance and a cash transfer program were low.

Another result of this study reveals that age in month of children had a significant impact on
child malnutrition. Children in 12-17, 18-23, 24-35, 36-47 and 48-59 age groups have
showed a significant effect on child malnutrition i.e. stunting when compared to children in
6-8 age group. Study done by Kamiya, (2011), shows that including the various
socioeconomic, demographic and child health and care practices characteristics considered,

37
age of the child 11-23 months (AOR= 2.30; 95% CI: 1.28-4.12), remained to be significantly
associated with stunting and some studies done in Ethiopia like, Birara et al., (2014) and
Anware et al., (2016) shows that the pattern of growth-faltering in children by age was
identified, Children aged 12-59 months were less-nourished than those aged 0-11 months.

The unadjusted odds ratio women who had no access to mass media had statistically
significant association with stunting of last born children 6-59 months of age when compared
to women with frequent access to media. In line with this study done in Ethiopia also
revealed that children from households in Tigray, Affar and Amhara regions were less-
nourished. Possession of media infrastructure (TV and radio) considered to be important
determinant of nutritional status of children (Anware et al., 2016) since mass media can be
influential component in providing information, attitudes and knowledge about child feeding
and caring practice. However, this study indicated that when the effect of other indicators are
controlled media exposure had no significant effect on stunting of last born 6-59 months aged
children.

Similarly, in unadjusted odds ratio complementary feeding and meal frequency had showed
significant impact on stunting of last born 6-59 months aged children. Children who were
provided with complementary feedings had 38% less likely to be stunted compared with
those children without complementary feedings. In the same way children who were
nourished as in the recommended meal frequency had 51.2% less likely to be stunted
compared with those children who did not nourish in the recommended eating frequency. In
line with this result, a study conducted by Udoh and Amodu, (2016) in Nigeria shows that
children who did not receive timely complementary foods had higher odds for wasting.
Children who did not receive the minimum dietary diversity had higher odds for underweight
than children who received the minimum dietary diversity. Children who did not receive the
minimum feeding frequency were more likely to be stunted than their peers who received the
minimum feeding frequency.

Mother’s educational status also showed a significant impact on the stunting of 6-59 months
aged children in the unadjusted odds ratio. The crude odds ratio indicated that educated
mother children had 35.3% less likely to be stunted compared with those of none educated
mother children. Consistent with this result, a study done by Liaqat et al., (2007) was found
a positive relationship between the nutritional status of infants and educational status of

38
mothers. The study revealed that the majority of infants with evidence of malnutrition
belonged to a mothers with virtually no school education. In line with this similar study done
by Giashuddin et.al, in 2003 in Bangladesh also shows that children of illiterate women were
nutritionally more vulnerable than children of their women who had secondary and higher
education Another study conducted by Ajao et al., in 2010 in Nigeria also shows that children
with less educated mothers were significantly more likely to be stunted. Households with
food insecurity and less educated mothers were more likely to have malnourished children.

Another remarkable finding of this study is ANC have inversely related on stunting of
children 6-59 months of age in both adjusted and unadjusted odds ratios. Women who take
four or more antenatal care visits had a statistically significant effect on stunting of children
6-59 months of age when compared to women who were not taken any of antenatal care visits
in their last birth. The study reveals that women who were taken four or more antenatal care
visits had 37.1% less likely that their last born 6-59 months age children to be stunted
compared with those children where their mother were not take any antenatal care visits.

Finally, this study reveals that size of child at birth had significantly associated with stunting
of last born 6-59 months aged children in both the adjusted and unadjusted logistic regression
models. The study found that very small or smaller than average size children had 1.615
times more likely to be stunted compared with an average and larger than average sized
children.

39
 CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1. SUMMARY
Ethiopia is one of the sub-Saharan African countries characterized with declining but still
has high population growth. Ethiopia is the most populous landlocked country in the
continent of Africa and the second-most populous country of Africa after Nigeria.
Malnutrition in children is one of the most serious public health problems in Ethiopia and the
highest in the world. The country has the second highest rate of malnutrition in sub-Saharan
Africa and with high under five mortality rate (67/1000 live births) which is mainly due to
infection and malnutrition. The objective of this study was to assess the effects of child
feeding practices on nutritional status of Children 6-59 months of age in the SNNP Region.
The variable considered as dependent variable in this study was children nutritional status
(stunting) of last born 6-59 months age children. The total number of observations considered
in this study was 724 but due to missing values and applicability to household level indicators
we finally used 680 observations in the descriptive and logistic regression analysis. All model
analysis used weighting procedures as obtained in the EDHS manual.

The children’s malnutrition status measured in terms of stunting was categorized as, “1” if
“Yes and “0” if “No”. Logistic regression model was utilized to assess the effect of
independent variables on the dependent variable. Based on the 2016 EDHS data, both the
descriptive and analytical results were processed. The descriptive results were used to help
describe the distribution of all socio-economic and demographic characteristics against each
independent variable. The independent variables are all categorical, which includes variables
like place of residence, drinking water source, wealth status, BMI, ANC, access to media, age
in month, minimum dietary diversity, exclusive breast feeding, women education, women
occupation, family size, number of under-five children, complementary feeding, meal
frequency, sex of the child, size of child at birth and early breast feeding. Controlling for the
effects of others, according to the result obtained from logistic regression model, it is found
that source of drinking water, wealth status, age in month of child, number of under-five
children in the household, ANC and size of child at birth has significantly related with
stunting of the last born children 6-59 months of age.

40
5.2. Conclusions
This study investigated the effects of child feeding practices on nutritional Status of last birth
children 6-59 months of age based on the 2016 EDHS data in the case of SNNPR, Ethiopia.
In this study among all independent variables considered in the study (the adjusted model)
some household, mother and child’s characteristics were significantly affected the dependent
variable. From these characteristics, drinking water source, wealth status, number of under-
five children in the household, ANC, age in month and size of child at birth Significantly
affecting the stunting of last born 6-59 months age children. Even though variables discussed
above have significant effect on stunting of the last born children 6-59 months of age there
are some variables like place of residence, women occupation, family size, minimum meal
diversity, sex of the child, BMI, exclusive breastfeeding and early breastfeeding that doesn’t
show any statistical significant effect both on adjusted and unadjusted binary logistic
regression model. Strategies to improve nutritional status of children should also include
improving the nutritional status of the mother and her income status. To promote family
planning programs in order to control number of children and also to increase birth interval is
another important component.

41
5.3. Recommendations
 Efforts need be made on regional mass media agencies in order to give priority on child
feeding practice and general child and mothers nutritional status to penetrate in to the
culture values and norms of the society that expose children to malnutrition.
 Regional health bureaus have to work on extension workers in order to better guide
community to use family planning for birth interval, ANC visiting and giving much
attention on child feeding practice.
 Makes them more likely to be employed outside their home environment is important in
order to reduce child malnutrition since mothers in low economic status were less likely
to stay with or provide alternative care for their child.
 Since there is strong bond between mothers and children there need to promote women’s
health and nutrition as a strategy that will benefit child nutritional status.

42
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Appendix
Table A-1: Pearson Chi-Square Test

Table 1
stunting Pearson Chi-Square
not stunting stunting Tests
Response
Variables Category Count Row N % Count Row N % stunting
Women age group 40-49 44 60.3% 29 39.7% Chi-square 1.790
15-24 81 64.8% 44 35.2% df 3
25-34 226 61.6% 141 38.4% Sig. .617
35-39 65 56.5% 50 43.5%
family size >=5 217 59.5% 148 40.5% Chi-square .986
<5 199 63.2% 116 36.8% df 1
Sig. .321
Mother's media Frequently 78 70.3% 33 29.7% Chi-square 4.852
exposure Not at all 286 59.8% 192 40.2% df 2
Sometimes 52 57.1% 39 42.9% Sig. .088
Previously 5 35.7% 9 64.3%
married
Minimum diet No 356 60.2% 235 39.8% Chi-square 1.678
diversity yes 60 67.4% 29 32.6% df 1
Sig. .195
Mother's body mass overweight 27 67.5% 13 32.5% Chi-square 1.853
index underweight 55 56.1% 43 43.9% df 3
normal 325 61.4% 204 38.6% Sig. .603
obese 6 66.7% 3 33.3%
Age of child in month 6-8 55 88.7% 7 11.3% Chi-square 36.171
9-11 42 77.8% 12 22.2% df 6
12-17 75 64.1% 42 35.9% Sig. .000*
18-23 49 55.7% 39 44.3%
24-35 93 52.5% 84 47.5%
36-47 59 53.2% 52 46.8%
48-59 43 60.6% 28 39.4%
Sex of child female 197 59.2% 136 40.8% Chi-square 1.118
male 219 63.1% 128 36.9% df 1
Sig. .290
Early breast feeding no 100 59.5% 68 40.5% Chi-square .257
yes 316 61.7% 196 38.3% df 1
Sig. .612
Exclusive breast no 360 60.5% 235 39.5% Chi-square .906
feeding yes 56 65.9% 29 34.1% df 1
Sig. .341
Birth interval first birth 72 63.7% 41 36.3% Chi-square 11.040
< 24 months 65 52.8% 58 47.2% df 4
24-36 months 94 55.3% 76 44.7% Sig. .026*
37 - 48 85 68.0% 40 32.0%
47and above 100 67.1% 49 32.9%
months

49
 Response stunting Pearson Chi-Square
Variables
Category Tests
not stunting stunting
count Row N% count Row N% stunting
Complementary foods no 220 56.4% 170 43.6% Chi-square 8.747
yes 196 67.6% 94 32.4% df 1
Sig. .003*
Wealth index Poorest 61 52.6% 55 47.4% Chi-square 11.211
(combined) Poorer 91 58.0% 66 42.0% df 4
Middle 103 59.2% 71 40.8% Sig. .024*
Richer 97 67.4% 47 32.6%
Richest 64 71.9% 25 28.1%
Improved 45 70.3% 19 29.7% df 1
Facility
Sig. .115
Meal frequency no 332 58.6% 235 41.4% Chi-square 9.882
yes 84 74.3% 29 25.7% df 1
Sig. .002*
Source of drinking Unimproved 228 58.8% 160 41.2% Chi-square 2.216
water source
Improved source 188 64.4% 104 35.6% df 1
Sig. .137
Mother's work status not working 162 60.7% 105 39.3% Chi-square .047
working 254 61.5% 159 38.5% df 1
Sig. .829
Number of children one 226 63.7% 129 36.3% Chi-square 3.307
below age 5 two 170 59.6% 115 40.4% df 2
three or more 20 50.0% 20 50.0% Sig. .191
Number of antenatal none 111 54.1% 94 45.9% Chi-square 8.973
care visit one to three 124 59.9% 83 40.1% df 2
visit
four and above 181 67.5% 87 32.5% Sig. .011*
Place of residence urban 42 68.9% 19 31.1% Chi-square 1.662
rural 374 60.4% 245 39.6% df 1
Sig. .197
Size of Child at Birth Average / larger 351 63.9% 198 36.1% Chi-square 8.390
than average
Very 63 50.0% 63 50.0% df 1
small/smaller
than average
Sig. .004*
education of mother No education 226 56.9% 171 43.1% Chi-square 7.253
Primary or 190 67.1% 93 32.9% df 1
above
Sig. .007*

50
Table A-2: Binary logistic regression output table.

Variables in the equation

95%
C.I.for
Variables B S.E. Wald df Sig. Exp(B) EXP(B)

Lower Upper

women_age 1.08 3 0.782

women_age(1) -0.03 0.42 0.005 1 0.942 0.97 0.426 2.21

women_age(2) 0.017 0.308 0.003 1 0.956 1.017 0.556 1.859

women_age(3) 0.262 0.332 0.622 1 0.43 1.3 0.678 2.493

Religion 2.423 2 0.298

Religion(1) -0.373 0.259 2.072 1 0.15 0.689 0.415 1.144

Religion(2) -0.036 0.561 0.004 1 0.949 0.965 0.321 2.899

familysize(1) 0.093 0.209 0.199 1 0.656 1.098 0.728 1.655

media 3.504 2 0.173

media(1) 0.13 0.289 0.202 1 0.653 1.139 0.646 2.007

media(2) 0.581 0.35 2.753 1 0.097 1.788 0.9 3.552

mindietdiverstiy(1) 0.017 0.321 0.003 1 0.958 1.017 0.542 1.908

bodymass_index 1.427 3 0.699

bodymass_index(1) 0.278 0.443 0.393 1 0.531 1.32 0.554 3.144

bodymass_index(2) 0.093 0.39 0.056 1 0.812 1.097 0.511 2.355

bodymass_index(3) 0.832 0.882 0.89 1 0.346 2.298 0.408 12.944

Age_month 24.106 6 0

Age_month(1) 0.798 0.544 2.156 1 0.142 2.222 0.766 6.449

Age_month(2) 1.555 0.476 10.663 1 0.001 4.733 1.862 12.032

Age_month(3) 1.871 0.495 14.306 1 0 6.495 2.463 17.126

Age_month(4) 2.27 0.624 13.216 1 0 9.682 2.847 32.924

Age_month(5) 2.534 0.648 15.297 1 0 12.605 3.54 44.879

Age_month(6) 2.118 0.676 9.825 1 0.002 8.315 2.211 31.262

51
Child_sex(1) -0.088 0.18 0.239 1 0.625 0.916 0.644 1.302

earlybreastfeeding(1) -0.173 0.217 0.635 1 0.426 0.841 0.549 1.288

exclusive(1) -0.401 0.289 1.92 1 0.166 0.67 0.38 1.181

Birthinterval 2.334 4 0.675

Birthinterval(1) -0.255 0.379 0.452 1 0.501 0.775 0.369 1.628

Birthinterval(2) -0.05 0.351 0.021 1 0.886 0.951 0.478 1.891

Birthinterval(3) -0.418 0.368 1.292 1 0.256 0.658 0.32 1.354

Birthinterval(4) -0.146 0.346 0.178 1 0.673 0.864 0.438 1.704

comp(1) 0.34 0.515 0.434 1 0.51 1.404 0.512 3.855

wealth_index 6.033 4 0.197

wealth_index(1) -0.245 0.279 0.773 1 0.379 0.782 0.453 1.352

wealth_index(2) -0.317 0.278 1.306 1 0.253 0.728 0.422 1.255

wealth_index(3) -0.591 0.295 4.001 1 0.045 0.554 0.31 0.988

wealth_index(4) -0.814 0.394 4.27 1 0.039 0.443 0.205 0.959

MFR(1) -0.361 0.301 1.438 1 0.23 0.697 0.387 1.257

drinking_water(1) -0.486 0.189 6.599 1 0.01 0.615 0.425 0.891

mothers_work(1) 0.133 0.182 0.532 1 0.466 1.142 0.799 1.633

Under5children 7.303 2 0.026

Under5children(1) 0.435 0.244 3.169 1 0.075 1.544 0.957 2.492

Under5children(2) 1.163 0.443 6.885 1 0.009 3.2 1.342 7.631

ANC 4.653 2 0.098

ANC(1) -0.201 0.224 0.81 1 0.368 0.818 0.528 1.267

ANC(2) -0.469 0.219 4.586 1 0.032 0.626 0.407 0.961

place_residence(1) 0.136 0.375 0.132 1 0.717 1.146 0.549 2.389

size_childBIRTH(1) 0.498 0.223 4.984 1 0.026 1.646 1.063 2.548

education(1) -0.092 0.205 0.2 1 0.655 0.912 0.611 1.364

Constant -1.804 0.975 3.423 1 0.064 0.165

52
Table A-3: Model evaluation results
Logistic model for stunt1,goodness-of-fit test

(Table collapsed on quantiles of estimated probabilities

number of observation 671

number of groups 10

Hosmer-lemeshow chi2(8) 9.83

prob>chi2 0.2775

53