Seasonality and predictors of childhood stunting and wasting in drought-prone areas in Ethiopia: A cohort study

Abstract

Background and objectives: Over centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate seasonal variations in child stunting and wasting, and identify factors associated with both forms of child malnutrition in drought-prone areas. Methods: This cohort study was conducted among a random sample of 909 children in rural southern Ethiopia. The same children were followed for one year (2017 - 2018) with quarterly repeated measurements of their outcomes: height-for-age and weight-for-height indices (Z-scores). Linear regression models were used to analyse the association between both outcomes and baseline factors (e.g., household participation in a social safety net program and water access) and some time-varying factors (e.g., household food insecurity). Results: Child wasting rates (i.e., low weight-for-heigh Z-scores) varied with seasonal household food insecurity (ᵪ2 trend = 15.9, p = 0.001), but stunting rates (i.e., low height-for-age Z-scores) did not. Household participation in a social safety net program was associated with decreased stunting (p = 0.001) and wasting (p = 0.002). In addition to its association with decreased wasting (p = 0.001), protected drinking water access enhanced the association between household participation in a social safety net program and decreased stunting (p = 0.009). Absence of a household latrine (p = 0.011), lower maternal education level (p = 0.001), larger family size (p = 0.004), and lack of non-farming income (p = 0.002) were associated with increased child stunting. Conclusions: Seasonal household food insecurity was associated with child undernutrition in rural Ethiopia. Strengthening community-based food security programs, such as the Ethiopian social safety net program, could help to reduce child undernutrition in drought-prone areas. Improving clean water access and sanitation could also decrease child undernutrition. Key terms: Z-scores; Social safety net program; Water access

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the South Ethiopia Network of Universities in Public Health project, under the Norwegian Program for Capacity Development in Higher Education and Research for Development. The funder had no role in associated conduct, writing, or decisions to publish this manuscript.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Committee at Hawassa University in Ethiopia and the Regional Committee for Medical and Research Ethics in Western Norway approved the study protocol.

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data relevant to the study are included in the article or uploaded as supplementary information.

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