Prevalence of undernutrition and associated factors among children aged 6-59 months in rural model households in the Central Zone of Sidama regional state, Ethiopia: a community-based cross-sectional study using robust Poisson regression analysis.

objectiveUndernutrition remains a public health challenge in Ethiopia, despite several nutrition programmes. Therefore, the aim of this study was to assess the prevalence of undernutrition and its associated factors among children aged 6-59 months in rural model households in the Central Zone of the Sidama regional state.

designThis study employed a community-based cross-sectional design between 4 July and 4 August 2024.

settingThe study was conducted in selected woredas of the Central Zone of the Sidama regional state.

participantsA multi-stage sampling technique was used to select 627 children aged 6-59 months in the model households. Model households, defined as those that attended at least 75% of the 96-hour training sessions and successfully implemented 75% of the Health Extension Program (HEP) packages, were awarded certificates. PRIMARY OUTCOME: The primary outcomes of this study were undernutrition, specifically stunting, underweight and wasting. SECONDARY OUTCOME: The secondary outcome focused on factors associated with stunting, underweight and wasting. Bivariable and multivariable robust Poisson regression analyses were used to identify the associations between outcome and risk factors. The strength and significance of associations were assessed using adjusted prevalence ratios (APRs) with 95% CIs and p<0.05.

resultsAlthough multilevel analysis was performed to account for woreda and kebele clustering, no significant effects were found. Simple robust Poisson regression findings are therefore presented. Stunting prevalence was 37.6%, underweight 13.9% and wasting 9.4%. Being male is linked to a higher prevalence of stunting (APR 1.37, 95% CI 1.11 to 1.69), underweight (APR 1.72, 95% CI 1.12 to 2.65) and wasting (APR 1.73, 95% CI 1.003 to 2.98). Conversely, spoon-feeding (APR 0.61, 95% CI 0.39 to 0.95), mothers as housewives (APR 0.56, 95% CI 0.42 to 0.76) versus farmers and maternal household decision-making (APR 0.29, 95% CI 0.12 to 0.70) were associated with lower prevalence of stunting. Additionally, larger households (≥5 members) were also associated with higher prevalence of underweight (APR 1.61, 95% CI 1.04 to 2.52) and wasting (APR 1.88, 95% CI 1.09 to 3.24).

conclusionsOur findings indicate a higher prevalence of stunting, accompanied by moderate rates of wasting, among children residing in rural model households in the Sidama region. Notably, practices such as spoon-feeding and maternal involvement in decision-making were associated with a lower prevalence of stunting. Conversely, larger family size was linked with a higher prevalence of underweight and wasting among children. To address these challenges, it is essential to promote hygienic feeding practices via the HEP, empower women in their communities, advocate for family planning to manage family size and strengthen community-based nutrition programmes. These measures could help combat undernutrition in rural areas.