Assessment of malnutrition and anthropometric measurement among 0–59 months aged children in Amibara and Awash Fentale districts,afar national regional state of Ethiopia

Abstract

PURPOSE:

Famines and food shortages are one of the most common long time histories of Ethiopia. Hence, malnutrition has been persisted at alarming raters in the country. Moreover, it is a major cause of morbidity and mortality in Afar National Regional State of Ethiopia. Specifically, in Amibara and Awash Fentale districts. The anthropometric data were presented on height, weight, MUAC, weight/height/Age and Body Mass Index (BMI) of under-five children.

METHODS:

A cross-sectional descriptive survey was conducted from March 01, 2017 to June 15, 2018. The data was collected by using anthropometric measurement. A multi stage random sampling procedure was applied in order to recruit the required sample size. The data collections were conducted at two selected districts in Afar region by trained interviewers and health care providers. The data were analyzed by using SPSS Version 23. Bivariate analysis between dependent and independent variables was employed. Multivariate analysis was also done to control for possible confounding variable by selecting variable which show statistically significant association ( $P<$ 0.05).

RESULTS:

Out of 410 under five children’s anthropometric finding, the majorities (62.7%) of those registered under five children were male and (33.3%) were female. The majority (46.8%) of under five children were less than or equal to 50 cm by their height. Most (54.1%) of under five children were less than or equal to 12.5 cm by their MUAC. It indicated that they were diagnosed with severe malnutrition based on anthropometric measurements. Meanwhile, majority (64%) of under five children were less than 60% their weight/age. Regression analysis result indicated that all of the variables were not significant predictors of BMI for under five children ( $P>$ 0.05). Based on ANOVA result, there was significant difference between sex and other predictors ( $P=$ 0.031). This finding implies that improvement in food aid and poverty alleviation programs are very important. Based on the finding, it is important to provide high quality and quantity of food. Moreover, less access to assets and health services commonly contributed for malnutrition. Highlighting under five children’s malnutrition will help to develop and design future policies and programs in Ethiopia.

Keywords

Anthropometric children Ethiopia malnutrition morbidity mortality

1. Introduction

Malnutrition refers to both over and under nutrition [1]. On the other hand, malnutrition is a general term that includes many conditions including under nutrition, over nutrition, and micronutrient deficiency diseases like Vitamin A deficiency, iron deficiency, anemia, iodine deficiency disorders and scurvy. It is referred that usually malnutrition is a disease related although some social and mechanical factors contributes as well [2].

Evidence indicated that malnutrition leads to deficiencies, excess or imbalances in consumption of macro and/or micro nutrients. On the other hand malnutrition leads to food insecurity, or it may relate to non-food factors. The main reason of non-food factors are inadequate care practices for children in sufficient health services and unhealthy environment [3].

It is reported that under nutrition in childhood causes stunting, wasting, fetal growth restriction and micronutrient deficiencies. On the other hand it causes socio-cultural and economic crisis among the society [4, 5].

The concept of sever wasting is described as anthropometric measurement result indicates $<$ -3SD (Z score) with weight for height while nutritional Odema stated that the manifestation of Odema clearly called Kwashiorkohor [6]. It is indicated that severe acute malnutrition has affected more than 20 million under five children and it contributed to 1 million child deaths annually [7].

Severe acute malnutrition cause three times higher fatality than pneumonia, measles and diarrhea [8, 9]. On the other hand stunting is mostly occurred under five children with linier growth failure as compared with the food intakes, diseases especially communicable diseases/infectious diseases and environmental exposures [10, 11, 12].

Ethiopian malnutrition is the main deriver of illness and fatality for under-five children in 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) report, it is reported that the stunted, underweight, and wasted children are recorded as 42%, 26.7%, and 9% of respectively. In Ethiopia reduction of under nutrition in children with stunting is decreased from 58% in 2000 to 38% in 2016. The prolonged and chronic humanitarian crises, such as droughts and floods also contribute to malnutrition [13]. The composite Index of Anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete as it is measure up to previous conventional indices. On the other hand measurement of wasting or thinness is often used to assess the severity of an emergency situation, with severe wasting being highly linked with the death of child.

In general a prolonged and chronic humanitarian crisis, such as droughts and floods also contributes to increased malnutrition [13]. In addition, it might affect cognitive development, school attendance, and socioeconomic productivity in both youth and adulthood but also in reproductive outcomes [14, 15]. For instance, the prevalence of underweight children in India is highest in the world; nearly double that of Sub-Saharan Africa [16]. The main aim of this study was to present Anthropometric data in terms of height, weight, MUAC, weight/height/Age and the derived measure of Body Mass Index BMI of under-five aged children’s.

2. Materials and methods

2.1 Study design

Cross-sectional descriptive studies of data on assessment of malnutrition by using anthropometric measurement were used. This research considers data from two cross-sectional studies. The Amibara and Awash Fentale at Afar national regional state of Ethiopia; anthropometric survey and secondary data were used from those two districts children’s sampled from Mar-ch 01, 2017 to June 15, 2018.

2.2 Study site

Amibara and Awash-Fentale districts, which are categorized in Zone three among the five zones of Afar National Regional State are located in Eastern part of the Region bordered by neighboring districts. It is 255.5 Km from Semera (capital city of the region) and 353 Km from Addis Ababa (capital city of Ethiopia). It has a total area of 1,046,41 Km ${}^{2}$ for Awash Fentale and 2,007.05 Km ${}^{2}$ for Amibara districts having nine Kebeles in both districts (five Awash Fentale and four Amibara).

Out of which five kebeles were randomly selected. Those selected Kebeles were Doho, Kebena, Awash Arba, Kurkura and Sidhafage. However, it was regarding to plain in terms of topography. The Afar Region is dominantly Midland/Woinadega agro ecological characteristics. According to Central Statistical Agency (CSA) the total population of the Amibara district was estimated to be 63,378.00 and Awash Fentale district 29,780; of the total population of Amibara district, more than 90% live in rural area and the rest 10% live in urban areas. Additionally, from total population of Awash Fentale district more than 90% live in rural areas and the remaining 10% live in urban areas. Regarding resources, there are a lot of accesses to resource in Awash Fentale. For example, Awash National Park, productive agricultural land, and access to high way transport system. Similarly, Amibara district also maize is the staple crop and pastoral and agro-pastoral system in the dominant agricultural practice.

Table 1
Percentage distribution of height by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

Height (cm)	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
$\leqslant$ 50 cm	97	23	22	5.3	3	0.7	122	29.7	51	12	18	4.4	1	0.2	70	17
51–65 cm	2	0.4	64	15.6	16	3.9	82	20	–	–	32	7.8	7	1.7	39	9.5
66–80 cm	–	–	3	0.7	31	7.5	34	8.2	–	–	7	1.7	19	4.6	26	6.3
81–95 cm	–	–	–	–	7	1.7	7	1.7	–	–	–	–	9	2.1	9	2.1
$\geqslant$ 96 cm	–	–	–	–	12	2.9	12	2.9	–	–	0 –	–	9	2.1	9	2.1
Total	99	23.4	89	21.6	69	16.9	257	62.5	51	12	57	13.9	45	10.7	153	37.5

Source: Anthropometry measurement and registration.

Table 2

Percentage distribution of body weight by sex and age of respondent in Amibara and Awash Fentale district, afar national state of Ethiopia

Body weight (kg)	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
$\leqslant$ 20	97	23	16	3.9	2	0.4	115	28	51	12	14	3.4	1	0.2	66	16
3–8	2	0.4	70	17	22	5.3	94	22.9	–	–	37	9	8	1.9	44	10.7
9–14	–	–	3	0.7	26	6.3	29	7	–	–	6	1.4	18	4.4	24	5.8
15–20	–	–	–	–	7	1.7	8	1.9	–	–	0	–	10	2.4	10	2.4
$\geqslant$ 21	–	–	–	–	11	2.6	11	2.6	–	–	0	–	9	2.1	9	2.1
Total	99	23.4	89	21.7	68	16.5	257	62.5	51	12	57	13.9	45	10.7	153	37.5

2.3 Study subject

A multi-stage random sampling procedure was applied to select the required number of sample units. According to Cochran’s sample size determining formula, the minimum sample size required for the study area was 141. Based on the general objective of the study 410 households who have children aged less than five years were selected randomly from the prepared list depending on the total number of agro-pastoral households who have children under five years of age in each Kebeles. Thus, 40, 156, 50,100 and 64 children aged less than five year were selected from Kurkura, Sidhafage, Awash-40, Doho, and Kebena respectively.

2.4 Ethical consideration

Ethical clearance was issued by Ethic committee of health research, School of public Health, Tehran University of Medical Sciences, Tehran, Iran. All mothers who had Childs under five children signed informed consent to join the study.

2.5 Variables

The variables in this study consisted of characteristics that include name of under five children, age, gender, MUAC, BMI, weight, height, weight/height, weight/age.

2.6 Data collection

Data were collected at two selected districts in Afar region among households by trained interviews and health care providers. Structured questioners with pre-coded and open-ended questioner were used for data collection. Growth and monitoring chart for recording the value using anthropometric measurement were used. All questionnaires were pretested and revised accordingly. The study was conducted after considering both reliability and accuracy of the instruments is tested using Cronbach’s alpha test. The validity of under nutrition measurement is examined using anthropometric tools in Amibara and Awash Fentale.

2.7 Data analysis

The data were analyzed using SPSS Version 23. A clear descriptive analysis for all variables performed in the study. Chi-square and Fishers’ exact testes were also used to identify differences between groups. Moreover, the row data were not normally distributed and transformed using the WHO standard nutritional assessment Index software and excel. The t-test was used to identify differences in means between groups. Linear regression was used to identify variables associated with BMI. Missing data were excluded from analysis. $P$ -Values $<$ 0.05 were considered significant.

Table 3
Percentage distribution of BMI by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

BMI (kg/m ${}^{2}$ )	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
$\leqslant 8$	65	15.9	62	15.1	42	10.2	169	41.2	21	5.1	27	6.6	26	6.3	74	18
8.5–11	33	8	26	6.3	13	3.2	72	17.6	25	6.1	29	7	8	1.9	62	15.1
11.5–13.5	1	0.2	1	0.2	1	0.2	3	0.7	5	1.2	1	0.2	1	0.2	7	1.7
$\geqslant$ 13.5	0	–	–	–	13	3.2	13	3.2	–	–	0	–	10	2.4	10	2.4
Total	99	23.4	89	21.7	68	16.5	257	62.5	51	12	57	13.9	45	10.7	153	37.5

3. Results

4. Height by sex and age of under five children

Table 1 shows distributive statistics for height for males and females by age group. Acceptable measures of height were obtained for 257 males and 153 females (under five children). The highest percentage of 97 (23%) of male under five children at age of 0 to 20 months were $\leqslant$ 50 cm height, and 51 (12%) were female at the same age and height.

4.1 Body weight by sex and age of respondent

Table 2 shows distributive statistics for weight for male and female by age group. Acceptable measures of weight were obtained for 257 males and 153 females (under five children). The majority 97 (23%) of them were male $\leqslant$ 20 kg body weight male are at age between 0 and 20 months while 51 (12%) were female $\leqslant$ 20 kg of body weight at age 0–20 months (Table 2).

Table 4
Percentage distributions of weight/height by sex and age of under five children at Amibara & Awash Fentale district, afar national state of Ethiopia

Weight/height	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
$\leqslant$ 60%	63	15.4	63	15.4	40	9.7	166	40.4	28	6.8	22	5.3	17	4.14	67	16.3
61–70%	35	8.5	22	5.3	14	3.4	71	17.3	18	4.4	34	8.3	16	3.9	68	16.6
71–80%	1	0.2	4	0.9	2	0.4	7	1.7	5	1.2	1	0.2	2	0.4	8	1.9
81–90%	–	–	–	–	4	0.9	4	0.9	–	–	0	–	3	0.7	3	0.7
$\geqslant$ 90%	–	–	–	–	9	2.1	9	2.1	–	–	0	–	7	1.7	7	1.7
Total	99	23.4	89	21.7	68	16.5	257	62.5	51	12	57	13.9	45	10.7	153	37.5

Table 5

Percentage distribution of MUAC (cm) by sex and age of under five children at Amibara & Awash Fentale district, afar national state of Ethiopia

MUAC (cm)	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
Severe malnutrition ( $<$ 12.5)	56	13.7	65	45.9	35	8.5	156	38	20	4.9	35	8.5	21	5.1	66	16
Moderate malnutrition (12.5–13.5)	42	10.2	20	4.9	18	4.4	80	19.5	26	6.3	32	7.8	13	3.2	71	17.3
Mild malnutrition (13.6–14.9)	1	0.2	4	0.9	3	0.7	8	1.9	5	1.2	–	–	1	0.2	6	1.4
Obese ( $\geqslant$ 15 cm)	0	–	–	–	13	3.2	13	3.2	0	–	–	–	10	2.4	10	2.4
Total	99	23.4	89	21.7	68	16.5	257	62.5	51	12	57	13.9	45	10.7	153	37.5

Table 6

Percentage distribution of weight/age by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

Weight/Age (%)	Male (age)								Female (age)
	0–20 month		21–40 month		41–59 month		Total		0–20 month		21–40 month		41–59 month		Total
	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%	$n$	%
$\leqslant$ 60%	70	17	71	17.3	37	9	178	43.4	21	5.1	36	8.8	28	6.8	67	16.3
61–70%	28	6.8	15	3.6	14	3.4	57	13.9	15	3.6	20	4.9	7	1.7	52	12.7
71–80%	1	0.2	3	0.7	6	1.4	10	2.4	5	1.2	1	0.2	1	0.2	7	1.7
81–90%	–	–	–		3	0.7	3	0.7	–	–	–	–	3	0.7	3	0.7
$\geqslant$ 90%	–	–		–	9	2.1	9	2.1	–	–	–	–	6	1.4	6	1.4
Total	99	23.4	89	21.7	68	16.5	257	62.5	51	12	57	13.9	45	10.7	153	37.5

4.2 BMI by sex and age of under five children

Table 3 shows descriptive statistics for weight for BMI in kg/m ${}^{2}$ for both sexes by age group. Acceptable measures of weight were obtained for all under five children’s. Majority 65 (15.9%) of them were male with $\leqslant$ 8 kg/m ${}^{2}$ of BMI at age between 0 and 20 months, while 29 (7%) of them were female with 8.5–11 kg/m ${}^{2}$ BMI with age between 21 and 40 months (Table 3).

4.3 Weight/Height by sex and age of under five children

Table 4 shows descriptive statistics for weight/heig-ht/for male and female both sex and age for under five group children Majority 63 (15.4%) of them were $\leqslant$ 60% weight/height male are at age between 0–20 and 21–40 respectively. It is indicated that there was common problem for both age groups, while 34 (8.3%) were female between 61–70% weight/height at age of 21–40 months (Table 4).

4.4 MUAC (cm) by sex and age of under five children

Table 5 Shows descriptive statistics for MUAC for male and female both age and sex group. Acceptable measures of MUAC were obtained for 257 male and 153 females (under five children). The majority 65 (45.9%) of them were male $<$ 12.5 cm by MUAC $<$ while 35 (8.5%) and 32 (7.8%) were females $\leqslant$ 2.5 cm and between 12.5–13.5 cm of their MUAC at the age between 21 and 40 months.

4.5 Weight/age by sex and age of under five children

Table 6 shows distributive statistics for weight/age (%) for both genders by age groups. Acceptable measures of weight/age were obtained for 410 under five children. The highest percentage 71 (17.3%) of them were male participants with $\leqslant$ 60% of body weight/age at interval of age between 21 and 40 month, while 36 (8.8%) were female with $\leqslant$ 60% of their body weight/age between 21 and 40 month old.

4.6 Body weight, weight/height, MUAC, BMI and weight/age by sex

The total of 410 under five children assessed their nutritional status by using anthropometric measurement in the scope of the study was attending actively to identify the seriousness of the issues due to drought in selected two districts in Afar national regional state of Ethiopia. The majority 115 (28%) of under five children whose body weight $\leqslant$ 20 kg was male followed by 94 (22.9%) between 3–8 kg. However, 66 (16%) of them whose body weight $\leqslant$ 20 kg was female, and 44 (10.7%) were 3–8 kg. It indicated that 181 (44%) of under five children of both sexes were $\leqslant$ 20 kg body weight meanwhile, 138 (33.6%) were between 3 and 8 kg of body weight. This result also shown that the number of male under five children whose body weight $\leqslant$ 20 kg was found out meaningfully higher than the females with the same weight.

One 166 (40.4%) of under five children whose weight/height $\leqslant$ 60% were male and 67 (16.3) were female. Regarding to weight/height, 71 (7.3%) were male with 61–70% of weight/height and 68 (16.6%) were female with 61–70% of weight/height. The number of male under five children with weight/height $\leqslant$ 60% was found out meaningfully higher than the females with the same weight/height value. The majority of 233 (56.7%) of under five children both sexes were $\leqslant$ 60% in their body weight/height followed by 139 (33.9%) between 61 and 70% of weight/height.

Based on another types of anthropometric measurement findings, 156 (38%) of male under five children were $\leqslant$ 12.5 cm in MUAC, 169 (41.2%) $\leqslant$ 8 BMI and 178 (43.4%) $\leqslant$ 60% weight/age, while 71 (17.3%) of female under five children were between 12.5 and 13.5 cm in MUAC, 74 (18%) in $\leqslant$ 8 BMI and 67 (16.3%) $\leqslant$ 60% of their body weight/age (Table 7).

Table 7
Percentage distribution of body weight, weight/height, MUAC, BMI and weight/age by sex in Amibara and awash-fentale districts

Variables	Categories	Male		Female
		$N$	%	$N$	%
Body weight (kg)	$\leqslant$ 20	115	28	66	16
	3–8	94	22.9	44	10.7
	9–14	29	7	24	5.8
	15–20	8	1.9	10	2.4
	$\geqslant$ 21	11	2.6	9	2.1
	Total	257	62.5	153	37.5
Weight/height (%)	$\leqslant$ 60%	166	40.4	67	16.3
	61–70%	71	17.3	68	16.6
	71–80%	7	1.7	8	1.9
	81–90%	4	0.9	3	0.7
	$\geqslant$ 90%	9	2.1	7	1.7
	Total	257	62.5	153	37.5
MUAC (cm)	$\leqslant$ 12.5 cm	156	38	66	16
	12.5–13.5 cm	80	19.5	71	17.3
	13.6–14.9	8	1.9	6	1.4
	$\geqslant$ 15 cm	13	3.2	10	2.4
	Total	257	62.5	153	37.5
BMI (kg/m ${}^{2}$ )	$\leqslant$ 8	169	41.2	74	18
	8.5–11	72	17.6	62	15.1
	11.5–13.5	3	0.7	7	1.7
	$\geqslant$ 14	13	3.2	10	2.4
	Total	257	62.5	153	37.5
Weight/age (%)	$\leqslant$ 60%	178	43.4	67	16.3
	61–70%	57	13.9	52	12.7
	71–80%	10	2.4	7	1.7
	81–90%	3	0.7	3	0.7
	$\geqslant$ 90%	9	2.1	6	1.4
	Total	257	62.5	153	37.5

4.7 Regression analysis results

In Table 8, the result of best-fitting multiple regression models for six independent variables are presented. All of the variables were not significant predictors of BMI for under five children ( $P>$ 0.05) (Table 8). However, the over al finding based on ANOVA, there was significant difference between sex and other predicators ( $p=$ 0.031) (Table 9).

Table 8
Results of liner ordinary least squares regression analysis for selected explanatory variables of under five children BMI Amibara and Awash Fentale district, afar national state of Ethiopia

Variables	Unstandardized		Standard	$t$	$p$ -value	95% confidence		Correlation			Collinearly statistics
	coefficients		coefficient			interval for B
	B	Std. error	B			Lower bored	Upper bored	Zero order	Partial	Part	Tolerance	VIF
(Constant)	1.214	0.060		20.111	0.000	1.095	1.332
Height (Ht)	$-$ 0.087	0.084	$-$ 0.199	$-$ 1.040	0.299	$-$ 0.252	0.078	0.068	$-$ 0.052	$-$ 0.051	0.065	15.335
Weight (Wt)	0.097	0.084	0.217	1.152	0.250	$-$ 0.068	0.262	0.079	0.057	0.056	0.067	14.834
Weight/height	0.073	0.064	0.142	1.145	0.253	$-$ 0.052	0.198	0.141	0.057	0.56	0.157	6.382
MUAC (cm)	0.041	0.075	0.068	0.544	0.587	$-$ 0.107	0.189	0.129	0.027	0.027	0.154	6.495
BMI (kg/m ${}^{{2}}$ )	0.088	0.070	1.247	1.247	0.213	$-$ 0.050	0.226	0.147	0.062	0.061	0.176	5.694
Weight (wt)/age	$-$ 0.117	0.061	$-$ 0.223	$-$ 1.897	0.058	$-$ 0.237	0.004	0.090	$-$ 0.094	$-$ 0.093	0.173	5.764

R $=$ 0.183; R-square $=$ 0.034; Adjusted R square $=$ 0.019; Durbin Watson $=$ 0.773; Standard error of the estimate $=$ 0.480.

Table 9

ANOVA of BMI for under five children in Amibara and Awash Fentale district, afar national state of Ethiopia

Results	Some of squares	df	Mean square	F-test	$P$ -value
Regression	3.224	6	0.537
Residual	92.681	403	0.230	2.336	0.031
Total	95.905	409

Dependent variable: sex. Predications: (constant), weight (Wt)/ age, weight (Wt), BMI (kg/m ${}^{2}$ ), weight/height, MUAC (cm), height.

Table 10

Mean and standard deviation of height, weight, MUAC, BMI, and weight/age among under five children at Amibara and Awash Fentale districts in afar national regional state of Ethiopia

Variables	Category	Mean	Standard deviation (SD)	$n$ (%)	Variance	F-test	$P$ -value
Height	$\leqslant$ 50 cm	1.36	0.483	192 (46.8%)	0.233	1.264	0.284
	51–65 cm	1.32	0.469	121 (29.5%)	0.220
	66–80 cm	1.43	0.500	60 (14.6%)	0.250
	81–95 cm	1.56	0.512	16 (3.9%)	0.263
	$\geqslant$ 96 cm	1.43	0.507	21 (5.1%)	0.257
	Total	1.37	0.484	410 (100%)	0.234
Weight	$\leqslant$ 2 kg	1.36	0.483	181 (44.1%)	0.233	1.580	0.179
	3–8 kg	1.32	0.468	138 (33.7%)	0.219
	9–14 kg	1.45	0.503	53 (12.9%)	0.253
	15–20 kg	1.56	0.511	18 (4.4%)	0.261
	$\geqslant$ 21 kg	1.45	0.510	20 (4.9%)	0.261
	Total	1.37	0.484	410 (100%)	0.234
MUAC	$<$ 12.5 cm	1.30	0.458	222 (54.1%)	0.210	4.115	0.007
	12.5–13.5 cm	1.47	0.501	151 (36.8%)	0.251
	13.6–14.9 cm	1.43	0.514	14 (3.4%)	0.264
	$\geqslant$ 15 cm	1.43	0.507	23 (5.6%)	0.257
	Total	1.37	0.484	410 (100%)	0.234
BMI	$\leqslant$ 8 kg/m ${}^{2}$	1.30	0.461	243 (59.3%)	0.213	4.072	0.003
	8.5–11 kg/m ${}^{2}$	1.46	0.500	134 (32.7%)	0.250
	11.5–13.5 kg/m ${}^{2}$	1.70	0.483	10 (2.4%)	0.233
	$\geqslant$ 14	1.41	0.503	23 (5.6%)	0.253
	Total	1.37	0.484	410 (100%)	0.234
Weight/age	$\leqslant$ 60%	1.32	0.469	263 (64.1%)	0.220	2.119	0.078
	61–70%	1.48	0.502	109 (26.6%)	0.251
	71–80%	1.41	0.507	17 (4.1%)	0.257
	81–90%	1.50	0.548	6 (1.5%)	0.300
	$\geqslant$ 90%	1.40	0.507	15 (3.7%)	0.257
	Total	1.37	0.484	410 (100%)	0.234

Table 11

Mean and standard deviation

Variables	Mean	SD	Variance
Height	1.91	1.107	1.227
Weight	1.92	1.087	1.182
Weight/height	1.62	0.939	0.882
MUAC	1.60	0.803	0.645
BMI	1.55	0.806	0.649
Weight/age	1.54	0.928	0.860

5. Discussion

In this study the result shown that two-fifths (41.0%) of the households who had participated in this study responded that really the household head and their children have to eat less in a meal than they wanted because there was no enough food. A study conducted in North India by [17] found that an adequate food intake, in terms of quantity and quality is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world’s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is the home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned [18].

In this study the finding indicated that the anthropometrics measurement is one of the most common and relevant classification of under nourished or not therefore more than half (54.1%) of under five children were affected by severe malnutrition (MUAC $\leqslant$ 12.5 cm); similarly, 2/5 (36.8%) of them affected by moderate malnutrition cases. According to the FAO [19], 1–5 million Nicaraguans, 29% of the population, are under-nourished, the highest percentage in the region and the second highest in Latin America after Haiti, 2.9 million people 25% of the population, are under nourished in Guatemala, is also has the highest level of chronic malnutrition in children the whole of Latin American (49.3%) [20].

Our study shows that there is a high prevalence of under-nutrition (weight/age $\leqslant$ 60%). Another published evidence shown that weight – for age was $<$ $-$ 2sd in 23.0% of the children and $<$ $-$ 3sd in 10.3% thirty-seven children (1.4%) were severely malnourished and admitted for day care [21].

This study shows that most (44.1%) of under-five children’s were under weight ( $\leqslant$ 2 kg in their body weight). A cross sectional survey was conducted in Khartoum state by [15] which aimed to understand the relationship between feeding practices and prevalence of stunting, wasting, and underweight among 6–59 months aged children. Similarly, the finding shown that the prevalence of acute malnutrition (wasting), underweight, chronic malnutrition (stunting) were represented that 19%, 35% and 51% respectively [22]. Our study finding shows that three-fifth (59.3%) of children whose age $<$ 5 years old.

In this study the result shown that the majority (59.3%) of children whose age $<$ 5 year were under expected BMI value ( $\leqslant$ 8 kg/m ${}^{2}$ ). Thus, this result indicates that those children have severe malnutrition. Similarly, a study was conducted in urban West Africa Senegal by [23] found that 4.9% of children were stunted, 18.4% were thin 5.6% had sever thinness (BMI-for_age $<-3$ z-scores). Only one chilled had a BMI-for-age $>$ 2 z-scores. Height for age and retinal were significance lower in participants $\geqslant$ 10 year and $<$ 10 year respectively. In general, under nutrition, especially thinness was common [23]. Another study was conducted by [17] found that 33.4% and 24.6% of children were underweight and wasted respectively. Prevalence of acute malnutrition was higher in males as compared to females. Meanwhile, underweight was associated with child age, consuming extra food during pregnancy and maternal BMI less than 18.5 kg/m ${}^{2}$ . The finding also assessed the children age and receiving pre-lactate food. It indicated that there is independent association with wasting. Moreover, the prevalence of malnutrition among children aged 6–59 months was high, indicating that the nutrition situation in study area is very critical issue. Therefore, especial attention should be given on intervention of malnutrition [24]. Evidence indicated that socioeconomic and demographic variables have a significant influence on the odds of malnutrition in children in Konso, Southern Ethiopia [25].

This study revealed that the lower height for male and female in 0–20 month’s group compared with more than 21 months age group may reflect either true loss of height with age as a result of spinal compression, or a shorter adult stature as a result of differences in growth during child hood. Hence, the higher height $\leqslant$ 50% cm for male (23%) at age 0–20 months compared with height $\leqslant$ 50 cm for with the same age groups. In line with a study was conducted in Kenya [25, 26] that gender inequality in food intake nutritional status of children under 5 years old in rural eastern Kenya. This study finding indicated that the prevalence of malnutrition among children in rural eastern Kenya is sizable. In contrast, girls were more stunted, underweight and wasted than boys at all age categories devote consistent lower food intake. A study was conducted in Korea by [5] found that the prevalence of food insecurity was 4.4%. Specifically, the prevalence of food insecurity in female (4.9%) was greater than male (3.9%) [27].

This finding indicated that male aged 0–20 months were significantly lower $\leqslant$ 2 kg, than male 21–40 months 3–8 kg. Female aged 0–20 months were significantly lower $\leqslant$ 2 kg, than female aged 21–40 months, 3–8 kg. The data show that male were significant more likely than female to be underweight that is having a BMI of $\leqslant$ 8, 15.9% of male 5.1% of female.

In this study result indicated that male were significantly more likely than female to be wasted, that is having a weight for height of $\leqslant$ 60%, 15,4% of male and 6.8% of female. Another study was conducted in Nigeria by [27, 28], friend that the weight and height were measured using standard methods.

This finding reveled that male were significantly more likely than female to be severely malnourished, that is having a MAUC $\leqslant$ 12.5 cm, 13.7% of male and 49% of female. However, female more likely than male to be moderate malnutrition at age between 21 and 40 months old, that is having a MAUC of 12.5–13.5 cm, 7.8% for female and 4.9% for male. A study conducted with children with Moderate Acute Malnutrition (MAM) feeding programs in Ethiopia states that, 32.5% remained with MAM, 9.3% experienced at list one episode of SAM(MUAC $<$ 11 cm and/or bilateral pitting Oedema), and 0.9% died. Only 54.2% of the children recovered with no episode of thus, children with the lowest MUAC at involvement had a significantly higher risk of remaining with MAM and a lower chance of recovering [29].

Our study findings shows that male under- five children whose age 21–40 months old were significantly more likely than female with the same ages to be sever underweight, that is having a weight/age of $\leqslant$ 60%, 17.3 for male and 8.8% for female. A study was conducted by Armstrong and colleges [29] found that the prevalence of weight from and 1.2 to 13% obesity has been increased however the finding also shows that moderate stunting decrease over the 10 years considered in South Africa this was compared with previous data in the counting. The research suggested that there were lower levels of mild stunting among overweight children compared with non-overweight children.

6. Conclusion

In this study thinness and stunting is clearly shown among the participants. The prevalence of malnutrition among children’s in this study area was very high. Thus, the prevalence of malnutrition among this children’s is associated with the maternal education, wealth status, and birth interval among the households. On the other hand the prevalence of malnutrition in the under five children in both districts is extremely high. Thus, this research indicated that childhood vaccination, family planning and poverty alleviation would be a good intervention. Therefore, as a concluding remarks this study concludes that there is high prevalence of malnutrition (stunting, thinness and underweight).

Footnotes

Acknowledgments

The authors thank all the study participants, District health office, agricultural office and all other sectors of Amibara and Awash Fentale, Afar national regional State of Ethiopia for their cooperation of the work.

Conflict of interest

The authors report no conflicts of interest in this valuable work.

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Assessment of malnutrition and anthropometric measurement among 0–59 months aged children in Amibara and Awash Fentale districts,afar national regional state of Ethiopia

Abstract

PURPOSE:

METHODS:

RESULTS:

Keywords

1. Introduction

2. Materials and methods

2.1 Study design

2.2 Study site

Table 1 Percentage distribution of height by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

2.4 Ethical consideration

2.5 Variables

2.6 Data collection

2.7 Data analysis

Table 3 Percentage distribution of BMI by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

4. Height by sex and age of under five children

4.1 Body weight by sex and age of respondent

Table 4 Percentage distributions of weight/height by sex and age of under five children at Amibara & Awash Fentale district, afar national state of Ethiopia

4.3 Weight/Height by sex and age of under five children

4.4 MUAC (cm) by sex and age of under five children

4.5 Weight/age by sex and age of under five children

4.6 Body weight, weight/height, MUAC, BMI and weight/age by sex

Table 7 Percentage distribution of body weight, weight/height, MUAC, BMI and weight/age by sex in Amibara and awash-fentale districts

Table 8 Results of liner ordinary least squares regression analysis for selected explanatory variables of under five children BMI Amibara and Awash Fentale district, afar national state of Ethiopia

6. Conclusion

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Percentage distribution of height by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

Table 3
Percentage distribution of BMI by sex and age of under five children at Amibara and Awash Fentale district, afar national state of Ethiopia

Table 4
Percentage distributions of weight/height by sex and age of under five children at Amibara & Awash Fentale district, afar national state of Ethiopia

Table 7
Percentage distribution of body weight, weight/height, MUAC, BMI and weight/age by sex in Amibara and awash-fentale districts

Table 8
Results of liner ordinary least squares regression analysis for selected explanatory variables of under five children BMI Amibara and Awash Fentale district, afar national state of Ethiopia