Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis
Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a p...
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| description | Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa.
A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value 8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated w |
| doi_str_mv | 10.1371/journal.pone.0248637 |
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A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors.
The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36-48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25-34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting.
The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0248637</identifier><identifier>PMID: 33765094</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abbreviations ; Biology and Life Sciences ; Birth order ; Children ; Children & youth ; Chronic illnesses ; Cognitive ability ; Confidence intervals ; Correlation coefficient ; Correlation coefficients ; Education ; Epidemiology ; Families & family life ; Health risks ; Health surveys ; Households ; Human nutrition ; Likelihood ratio ; Malnutrition ; Medical schools ; Medicine ; Medicine and Health Sciences ; Mortality ; Multiple births ; NGOs ; Nongovernmental organizations ; Nutrition ; People and Places ; Prenatal care ; Public health ; Regression analysis ; Rural populations ; Statistical models ; Undernutrition</subject><ispartof>PloS one, 2021-03, Vol.16 (3), p.e0248637-e0248637</ispartof><rights>2021 Tesema et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Tesema et al 2021 Tesema et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-bb2cc827ed11860ac35923b78a3212b41d1d59b3e507ac1050466cdacec186e13</citedby><cites>FETCH-LOGICAL-c526t-bb2cc827ed11860ac35923b78a3212b41d1d59b3e507ac1050466cdacec186e13</cites><orcidid>0000-0003-3878-7956 ; 0000-0001-6812-1659</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993805/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993805/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33765094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Scott, Jane Anne</contributor><creatorcontrib>Tesema, Getayeneh Antehunegn</creatorcontrib><creatorcontrib>Yeshaw, Yigizie</creatorcontrib><creatorcontrib>Worku, Misganaw Gebrie</creatorcontrib><creatorcontrib>Tessema, Zemenu Tadesse</creatorcontrib><creatorcontrib>Teshale, Achamyeleh Birhanu</creatorcontrib><title>Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa.
A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors.
The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36-48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25-34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting.
The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.</description><subject>Abbreviations</subject><subject>Biology and Life Sciences</subject><subject>Birth order</subject><subject>Children</subject><subject>Children & youth</subject><subject>Chronic illnesses</subject><subject>Cognitive ability</subject><subject>Confidence intervals</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>Education</subject><subject>Epidemiology</subject><subject>Families & family life</subject><subject>Health risks</subject><subject>Health surveys</subject><subject>Households</subject><subject>Human nutrition</subject><subject>Likelihood ratio</subject><subject>Malnutrition</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Multiple births</subject><subject>NGOs</subject><subject>Nongovernmental organizations</subject><subject>Nutrition</subject><subject>People and Places</subject><subject>Prenatal care</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Rural populations</subject><subject>Statistical 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prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis</title><author>Tesema, Getayeneh Antehunegn ; Yeshaw, Yigizie ; Worku, Misganaw Gebrie ; Tessema, Zemenu Tadesse ; Teshale, Achamyeleh Birhanu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-bb2cc827ed11860ac35923b78a3212b41d1d59b3e507ac1050466cdacec186e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abbreviations</topic><topic>Biology and Life Sciences</topic><topic>Birth order</topic><topic>Children</topic><topic>Children & youth</topic><topic>Chronic illnesses</topic><topic>Cognitive ability</topic><topic>Confidence intervals</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>Education</topic><topic>Epidemiology</topic><topic>Families & family life</topic><topic>Health risks</topic><topic>Health surveys</topic><topic>Households</topic><topic>Human nutrition</topic><topic>Likelihood ratio</topic><topic>Malnutrition</topic><topic>Medical schools</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Mortality</topic><topic>Multiple births</topic><topic>NGOs</topic><topic>Nongovernmental organizations</topic><topic>Nutrition</topic><topic>People and Places</topic><topic>Prenatal care</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Rural populations</topic><topic>Statistical models</topic><topic>Undernutrition</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tesema, Getayeneh Antehunegn</creatorcontrib><creatorcontrib>Yeshaw, Yigizie</creatorcontrib><creatorcontrib>Worku, Misganaw Gebrie</creatorcontrib><creatorcontrib>Tessema, Zemenu Tadesse</creatorcontrib><creatorcontrib>Teshale, Achamyeleh 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One</addtitle><date>2021-03-25</date><risdate>2021</risdate><volume>16</volume><issue>3</issue><spage>e0248637</spage><epage>e0248637</epage><pages>e0248637-e0248637</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa.
A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors.
The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36-48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25-34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting.
The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33765094</pmid><doi>10.1371/journal.pone.0248637</doi><orcidid>https://orcid.org/0000-0003-3878-7956</orcidid><orcidid>https://orcid.org/0000-0001-6812-1659</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-03, Vol.16 (3), p.e0248637-e0248637 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abbreviations Biology and Life Sciences Birth order Children Children & youth Chronic illnesses Cognitive ability Confidence intervals Correlation coefficient Correlation coefficients Education Epidemiology Families & family life Health risks Health surveys Households Human nutrition Likelihood ratio Malnutrition Medical schools Medicine Medicine and Health Sciences Mortality Multiple births NGOs Nongovernmental organizations Nutrition People and Places Prenatal care Public health Regression analysis Rural populations Statistical models Undernutrition |
| title | Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis |
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