Science Journal of Public Health

2020; 8(4): 123-129

http://www.sciencepublishinggroup.com/j/sjph
doi: 10.11648/j.sjph.20200804.15
ISSN: 2328-7942 (Print); ISSN: 2328-7950 (Online)

Prevalence of Acute Malnutrition and Associated Factors

Among Under-Five Children in Gursum District, Somali
Region, Ethiopia
Mohamed Arab Abdilahi*, Abdikani Mawlid Nur, Abdireshid Dahir Jibril
Department of Public Health, Jigjiga University, Jigjiga, Ethiopia

Email address:
*
Corresponding author

To cite this article:

Mohamed Arab Abdilahi, Abdikani Mawlid Nur, Abdireshid Dahir Jibril. Prevalence of Acute Malnutrition and Associated Factors Among
Under-Five Children in Gursum District, Somali Region, Ethiopia. Science Journal of Public Health. Vol. 8, No. 4, 2020, pp. 123-129.
doi: 10.11648/j.sjph.20200804.15

Received: July 23, 2020; Accepted: August 12, 2020; Published: August 25, 2020

Abstract: Background: Acute malnutrition is one type of under-nutrition that is devastating life and as reflected a
nutritionally deficient state of recent onset related to sudden food deprivation or mal-absorption utilization of nutrients which
results significant weight loss. In Ethiopia, child under-nutrition is one of the most serious public health problem and the
highest in the world. Therefore, this study designed to assess the prevalence of acute malnutrition and its associated factors in
children aged 6-59 months in Gursum district in Somali region in Ethiopia. Method: A community-based cross-sectional study
was conducted on 541 children aged 6–59 months from Feb. 14–25, 2019. A multistage sampling method was used to select
the study participants. Interviewer administered questionnaire was used and EPI-DATA statistical software were entered the
data and SPSS version20 were used for analysis. The Z-scores for weight-for-height (WHZ) were calculated using the World
Health Organization anthro2010. Binary logistic regression was used to identify the factors associated with acute malnutrition.
The statistical significance Variable was declared at P-Value less than0.05. Multi-co-linearity effect was checked. The study
found the prevalence of wasting was 21.2% (17.54, 24.726). Educational status of the mother (AOR=1.87, 95% CL: 1.065,
3.286), diarrhoea two weeks before interview (AOR=2.469, 95% CI: 1.487, 4.100), family size (AOR=1.72, 95% CL: 1.058,
2.797), colostrum feeding (AOR: 2.26; 95%CI: 1.404, 3.646), bottle feeding (AOR: 3.297; 95% CI (1.944, 5.591) were
significantly associated with acute malnutrition in Gursum district. Conclusion: The prevalence of acute malnutrition in the
study area was high. Health extension workers and stakeholders should give concern on promotion of proper nutrition in the
community.
Keywords: Acute Malnutrition, Under-five Children, Wasting, Jigjiga, Ethiopia

1. Introduction
Under-nutrition has persistently remained one of the major Globally under-nutrition is the major single underlying cause
public health problems/threats in globally particularly for of death in children worldwide [4]. This is responsible
developing countries [1, 2]. Acute malnutrition is one type of approximately 3.1 million deaths in under five children every
under-nutrition that is devastating life and as reflected a year which is almost equivalent half [45%] of all deaths [5].
nutritionally deficient state of recent onset related to sudden Moreover, child's under-nutrition is a strong predictor for low
food deprivation or mal-absorption utilization of nutrients school performance, poor mental development as well as
which results significant weight loss. According to United greater behavioral problems [6]. Children of acute
Nations International Children’s Emergency Fund malnutrition have high probability of death to the counter
UNICEF]/World Bank estimates, in 2016, nearly 52 million part from common childhood illness such as diarrhea,
from this 17 million were severely was acute malnutrition [3]. pneumonia, and malaria [7]. In Ethiopia, child under-
 Science Journal of Public Health 2020; 8(4): 123-129 124

nutrition is one of the most serious public health problem and deformities that hinder height measurements at the time of
the highest in the world [8, 9]. data collection were excluded from the study.
Community based cross sectional study done among
Nepal under five children showed that from the total 2.3. Sample Size and Technique
participants 7.0% were wasted [10]. Multi-analysis study The sample size was calculated by using single population
conducted in Nigeria also showed that the prevalence of proportion formula: n=Z [α/2]2*p [1-p]/d2 by taking the
acute malnutrition was 18% [11]. The prevalence of acute prevalence of wasted children of Similar study conducted in
malnutrition in Ethiopia is among the worst in the world Shinile district in Somali region (20%) of wasted children
and it remains greatest public health treat. Ethiopian [18]. A multi-stage random sampling technique was used to
Demographic and Health Survey [EDHS] 2016 reported select the target population. The estimate of the sample in
that 10% of children were wasted at country level. Somali this study was desired to be precise at a confidence level of
and Afar region registered the highest prevalence acute 95% and a margin of error of 5%. Accordingly, 541 children
malnutrition [wasting] of 23 and 18%, respectively [12]. A paired with their mothers were selected by considering a 10%
Study done In Hawassa, South Nation and Nationalities of non-respondent rate. The total sample size was distributed
Ethiopia showed that wasting was 28.20% [13]. In Bule among 6 kebeles in the study area according to the number of
Hora district of Oromia region wasting was 13.40% [14]. households in each kebeles. Systematic sampling was used to
The worst figure that showed the prevalence of wasting identify the study households from each Kebele. In cases
[42.3%] was found in Somali region [15]. Although where household has more than one eligible child to the
Ethiopia has come a long way in reducing poverty and food study in the selected households, a lottery method was used
insecurity, the prevalent of poverty and food insecurity still to pick one of them. Moreover, in cases where the selected
present [16]. In Ethiopian’s Somali Region, high prevalence household was closed or the eligible person was absent two
of acute malnutrition, food security crisis, Livestock losses attempts were made to find the respondents.
and excess mortality among under-five children were
reported from the last years [17]. This indicates that acute 2.4. Data Collection Procedures
malnutrition is common problem in Somali region.
However, the prevalence of acute malnutrition and Data were collected using structured questionnaire and
associated factors in children aged 6-59 months has not anthropometric measurement. Eleven data collectors who
been well documented in the study area. Therefore, this were able to communicate in Somali were recruited from
study designed to assess the prevalence of acute health centers and health posts in the district. Training was
malnutrition and its associated factors in children aged 6-59 provided for data collectors and supervisor for two days.
months in Gursum district in Somali region in Ethiopia. Anthropometric data: The anthropometric data were collected
Knowing the extent of the problem and identifying the risk using the procedure stipulated by the WHO (2006) for taking
factors related with nutritional status of under-five children anthropometric measurements. Before taking anthropometric
in the study area will enable to guide public health planners data for children; the age of the child was taken from growth
and policy makers in determining priorities, in designing monitoring and immunization card. For those who missed the
appropriate and effective nutritional intervention programs card, A local event was used to establish the birth period and
to address the problem and its associated consequences age was recorded relying on the date given by the mothers or
caretakers.
Dietary diversity score (DDS) was collected as a simple
2. Materials and Methods count of 7 food groups consumed by the child in the
2.1. Study Area, Design and Period 24hours prior to the data collection to calculate minimum
dietary diversity by using WHO guidance. DDS was
Community-based cross-sectional survey was conducted in calculated by giving a score of (1) for those who
Gursum district from February14-25, 2019. The district consumed > 4 food items and a score of (0) for those who
located at a distance of 598km from the capital city of consume < 4 food item over the past 24 hours (19).
Ethiopia. Length/height and weight of each child was measured
using standardized and calibrated equipment. Weight was
2.2. Source of Population and Study Population measured with the minimum child wearing clothing (t-
All the children 6 to 59 months of age and their mothers shirt only) with no shoes using UNICEF Electronic Scale
/caregivers (mother – child pair) who were living in Gursum to the nearest of 0.1 kg. The UNICEF mother/child
district. Whereas the study population consisted of a sample electronic scale requires the mother and child to be
of All randomly selected children 6 to 59 months of age and weighed at the same time. The mother was weighed with
their mothers /caregivers (mother – child pair) who were in the child and then weighed without the child. The
the selected kebeles in Gursum district Study participants difference between the two measures is the child’s weight.
who were living to the study area for 6 months and more The height of infants aged 6–23 months was measured in a
were included, children whom others were unable to recumbent position. Height of children 24 months and
participate due to illness, and children with physical older was measured in a standing-up position. The
125 Mohamed Arab Abdilahi et al.: Prevalence of Acute Malnutrition and Associated Factors Among Under-Five
Children in Gursum District, Somali Region, Ethiopia

measurements were made while the child was in bare-foot 416 (78.6%) had multiple wives.
and without hair covers and braids affecting the
measurement. The recording was measured to the nearest Table 1. Socio-demographic characteristics of the respondents from
communities of Gursum District, Somali region, 2019.
0.1 cm.
Characteristics Frequency
Category Percentage %
2.5. Statistical Analysis of participant (n=529)
Male 505 95.5
The completeness and consistency of the data were Head of the HH
Female 24 4.5
checked then data were coded and double entered in to EPI Maternal age
15-34 397 75.0
Data 3.1. And exported into SPSS version 20 statistical 35-49 132 25.0
Married 517 97.7
software for analysis. Marital status
Divorced/widowed 12 2.3
Anthropometric data were calculated by using WHO Muslim 524 99.0
Anthro 2010 software and WHZ score was also been Religion
Others 5 1.0
generated based on the WHO child growth standards which Mother's level of Formal education 64 12.1
was introduced recently in 2006 transported to SPSS. Bi- education No formal education 465 87.9
Paternal level of formal education 326 61.6
variable logistic regression was used (p-value less than 0.25)
education No formal education 203 38.4
as candidate to see the association between each Mother's House wife 474 89.6
independent variable and the outcome variable. occupation Worker 55 10.4
Multivariable logistic regression analysis was used to Paternal Farmers 309 58.4
control for all possible confounders and to identify occupation Non-farmer worker 220 41.6
Individual 523 98.9
independent predictors of Acute malnutrition. Odds ratio Decision -making
Jointly/common 6 1.1
along with 95% confidence interval were estimated to Yes 416 78.6
measure the strength of the association. Level of statistical Polygamous
No 113 21.4
significance was declared at P-Value less or equal to 0.05. No of under-five >3 110 20.8
Multicollinearity effect was checked and variables with children in the
<3 419 79.2
HH
SE >2 were removed from analysis. Final model was
Low 198 37.4
constructed using enter logistic regression method. All Monthly income Medium 170 31.1
models were checked for their fitness using Hosmer and High 161 30.4
Leme show goodness of fit test. Family size
<5 155 29.3
>5 374 70.7
2.6. Ethical Considerations
3.2. Maternal Characteristics
Ethical clearance was obtained from the College of
Health Sciences of Jigjiga University, Research and Ethical As showed Table 2, the mean age of the mothers was 29.6
Review Committee (RERC). Then, officials at different years (SD±6.0). Majority, 397 (75.0%) of mothers were in
levels in the study area were communicated through letters the age group of 15-34 years. Almost all, 521 (98.5%) of
from Somali Regional Health Bureau. Letters of permission mothers did not take extra food during pregnancy or lactation
were obtained from district administrative and health and 110 (20.2%) did not have good health status during their
offices. Verbal informed consent was obtained from each pregnancy. vast majority, 371 (70.1%) of mothers visited
participant prior to the interview after explaining the health facilities for antenatal care during pregnancy of the
purpose of the study. child in the present study. (Table 2)

Table 2. Maternal characteristics of the respondents from communities of

3. Result Gursum District, Somali region, 2019.

3.1. Demographic and Socio-economic Conditions Characteristics Category Number %

<4 288 54.6
How many childrenhave born
From the total 541 planned study participants, complete >4 241 45.4
Yes 8 1.5
responses were obtained from 529, with a response rate of Extra food during pregnancy
No 521 98.5
97.7%. As described in Table 1, male headed household Yes 371 70.1
(HHs) were 505 (95.5%) and females were 24 (4.5%). The ANC visit
No 158 29.9
majority, 517 (97.9%) of the respondents were married. Health status of mother
Sick 110 20.2
Average family size was 6.32 persons (SD±1.7), while Good 419 79.8
374 (70.7%) of the HHs have more than five family
3.3. Child Feeding Practices Characteristics
members. About 20.8 percent of the HHs had three
children under-five years of age. Majority of the Out of the total study subject 529 children aged 6-59
respondents were Somali ethnic group (99%) and with months, two hundred seventy-nine (52.7%) were female, and
regard to religious views, 99.6% were Muslim Christians. the rest 250 (47.3%) were male in sex. The mean age of
Regarding educational status, 87.9% of the mothers had children was 29.25 months (SD±13.2). Among the study
no formal education. Out of the total study participants
 Science Journal of Public Health 2020; 8(4): 123-129 126

participants, 518 (97.7%) of children were delivered at home water. from the total of 283 (53.5%) of households require
and 11 (2.3%) children were delivered at health facilities. No greater than 30 minutes fetching water from these sources.
oedema case was recorded in the study area two weeks prior With regarding to treating drinking water in households,
to or during the data collection period. As indicated in table 3. majority of HHs (517) 97.7% were not treat water.
From the total study participants, breastfeeding practice was Concerning about toilet facilities, Majority of households 364
initiated immediately after birth for 437 (82.6%) children. (68.8%) had no latrine. In this study district, wooden slap of
378 (71.5%) children had received pre-lactation food or latrine is the most commonly being utilized and almost all
fluids. And about 365 (69%) children didn’t receive households were wash hand after toilet. Regarding waste
colostrum’s at birth. Most of the children, 437 (80.7%) disposal system, 210 (39.7%) and 319 (60.3%) households
children were exclusively breastfeed until six months of age were dispose garbage in a pit and open field, respectively.
(Table 3). (table 4)

Table 3. Child feeding practices characteristics of the respondents from Table 4. Environmental health characteristics of the respondents from
communities of Gursum District, Somali region, 2019. communities of Gursum District, Somali region, 2019.

Frequency Characteristics Category Number %

Characteristics Category
N % protected water 252 47.4
Yes 529 100 Drinking water
Breast feeding ever Unprotected water 277 52.6
No 0 0.0
> 30 minutes 283 53.5
Immediate 437 82.6 Time to obtain drinking water
Initiation of breast feeding of < 30 minutes 246 46.5
After 1 to 24 hrs 51 9.6
the child Yes 12 2.3
After days 41 7.8 Utilization of treated water
>8 times 382 72.2 No 517 97.7
Frequency of BF
< 8 times 147 27.8 Yes 165 31.2
Availability of latrine
Yes 164 31.0 No 364 68.8
Colostrum feeding
No 365 69.0 washing hands before and after Yes 529 100
> 12 months 313 52.7 feeding No 0 0.00
Duration of breast feeding
< 12 months 216 47.3
Water only 521 98.5
Yes 378 71.5 Material used hand washing
Pre-lacteal feed Water with soap 8 1.5
No 151 28.5
Water 381 100 Having proper waste disposal Yes 210 39.7
Type of pre-lactation management (observation)
Other milk, butter 0 0.00 No 319 60.3
<6->8 months 341 64.5
Initiation of CF 6-8 months 188 35.5 3.5. Nutritional Status of the Children
< 3 times 160 30.2
Frequency of CF feeding
>3 times 369 69.8 Prevalence of acute malnutrition among children aged 6-
Bottle feeding 278 52.6 59 months in the study area were 21.2%. Acute malnutrition
Method of feeding
Others 251 47.4
was higher among female under-five children compared to
Yes 15 2.8
Had child separate feed plate males.
No 514 97.2
MDD 24 hours before the < 4 food items 370 69.9
survey ≥ 4 food items 159 30.1 3.6. Factors Associated with Wasting
6-23 194 36.7
Child's age 24-35 148 28.0 As indicated below, the bi-variate analysis showed that
36-59 187 35.3 family size, maternal education, status of polygamy,
Child's sex
Female 279 52.7 colostrum feeding, method of feeding, pre-lacteal feeding
Male 250 47.3 child sex, diarrheal status, birth interval and waste disposal
Mother 479 90.5
Relationship with the child management were significantly associated with wasting
Caregiver 50 9.5
>2 years 294 55.4 (Table 5).
Birth interval Based on the multivariate regression analysis of this study
<2 years 235 44.6
Place of delivery
Home 518 97.9 revealed that children whose mother no formal education
health facility 11 2.1 were 1.87 times more risk to have acute malnutrition as
Yes 517 97.7
Took vaccination compared to children whose mothers had formal education
No 12 2.3
Yes 506 97.9 (AOR=1.870 (1.065, 3.286). Children who had diarrhoea two
Vaccination card availability weeks before interview were 2.4 times risk of acute
No 11 2.1
Diarrheal status of child
Yes 110 20.8 malnutrition as compared to children had not diarrhoea
No 419 79.2 (AOR=2.469; 95% CI: 1.487, 4.100). Also this study
Yes 416 78.6
Fever status of child indicated that children who had not fed colostrum were 2.26
No 113 21.4
times more likely to be wasted as compared to children who
3.4. Environmental Health Characteristics of Households were receiving colostrum feeding (AOR: 2.26; 95%CI: 1.404,
3.646). children from family size more than 5 were 1.72
Almost half and above of the main sources of drinking times more risk to have acute malnutrition as compared to
water used by households, 277 (52.6%) were unprotected children from family size less than five (AOR=1.720 (1.058,
127 Mohamed Arab Abdilahi et al.: Prevalence of Acute Malnutrition and Associated Factors Among Under-Five
Children in Gursum District, Somali Region, Ethiopia

2.797). Also, this study indicated that children who were compared to the children who were feed cup or teaspoon
bottle feeding were more like to develop acute malnutrition (AOR: 3.297; 95%CI: 1.944, 5.591).

Table 5. Factors associated of wasting among under five children in Gursum district, Somali Region. 2019 (n=529).

Wasting
Variable Category COR (95% CI) AOR (95% CI)
Stunted %) Normal (%)
<5yrs 45 (27.4) 119 (72.6) 1.00 1.00
Family size
>5yrs 67 (18.4) 298 (81.6) 1.682 (1.090, 2.594) 1.720 (1.058, 2.797) **
Formal education 32 (34.0) 62 (66.0) 1.00 1.00
Maternal education
Non-formal education 80 (18.4) 355 (81.6) 2.290 (1.402, 3.741) 1.870 (1.065, 3.286) **
Yes 85 (24) 331 (79.6) 1.223 (0.746, 2.003) 1.207 (0.699, 2.086)
Polygamy
No 27 (23.9) 86 (76.1) 1.00 1.00
Yes 52 (31.7) 112 (68.3) 1.00 1.00
Colostrum feeding
No 60 (16.4) 305 (83.6) 2.360 (1.538, 3.628) 2.263 (1.404, 3.646) **
Yes 89 (23.5) 289 (76.5) 1.714 (1.036, 2.836) 0.575 (0.322, 1.027)
Pre-lacteal feeding
No 23 (15.2) 128 (84.8) 1.00 1.00
Bottle feeding 24 (10.9) 197 (89.1) 3.283 (2.010, 5.363) 3.297 (1.944, 5.591) **
Method of feeding
Not B/feeding 88 (28.6) 220 (71.4) 1.00 1.00
Female 74 (24.9) 223 (75.1) 1.00 1.00
Child's sex
Male 38 (16.4) 194 (83.6) 1.694 (1.096, 2.620) 1.289 (0.797, 2.084)
Yes 71 (17.4) 336 (82.6) 2.395 (1.520, 3.774) 2.469 (1.487, 4.100) **
Diarrhoea
No 41 (33.6) 81 (66.4) 1.00 1.00
>=2yrs 70 (24.8) 212 (75.2) 1.00 1.00
Birth interval
< 2yrs 42 (17.0) 205 (83.0) 1.612 (1.060, 2.473) 1.432 (0.884, 2.319)
Waste disposal Yes 35 (16.7) 175 (83.3) 1.00 1.00
management No 77 (24.1) 242 (75.9 1.591 (1.020, 2.481) 1.571 (0.947, 2.606)

AOR=Adjusted Odd Ratio; CI=Confidence Interval, COR=Crude Odd Ratio; *=p-value < 0.05.

Gedeo Zone, Ethiopia [31] Libokemkem district, Amhara

4. Discussion region [32] Study done Shashogo Woreda, Southern Ethiopia
The prevalence of acute malnutrition was high 21.2% [33], Hawassa Zuria District, Southern Ethiopia [34], Somali
(17.54, 24.726) in the district. This study noted that family Region, Ethiopia [15], study done Ethiopia [22] Bula hora
size, maternal education, colostrum feeding, method of district, Ethiopia [14] other study done Ethiopia [35] Ethiopia
feeding and diarrheal status was statistically significant [36]. This could be attributed to the fact that Educated
associated for acute malnutrition. mothers might be more nutritionally literate and might have
This study showed that the prevalence of acute more knowledge of child feeding practices.
malnutrition was higher compared to others studies done The study also revealed that Presence of diarrhea in the
different corner Ethiopia [20-23] The differences in the last two weeks was significantly associated with acute
prevalence of malnutrition among children could be malnutrition. In this study, presence of diarrhea increased a
attributed to the difference in the method of data collection, risk of acute malnutrition in 2.4-folds as compared when not
sample size, study subjects or may be due to socioeconomic diarrhea. This was consistent with study done Afghanistan
and seasonal variation as compared with the present study. [28]. Also the finding of this study was in line with studies
The prevalence of acute malnutrition is relatively higher than done Ethiopia revealed that diarrhea increases the risk of
the national figure while almost similar with the regional acute malnutrition almost two to five times more likely than
figure and study done Somali region and study done in India those who had not diarrhea [20, 21, 30, 33, 37, 38]. This may
[24, 25]. be attributed to vicious cycle relationship between infectious
Even though the prevalence of acute malnutrition in this diseases and nutritional status. Presence of diarrhea and fever
study was high, it was lower as compared to studies causes loss of appetite and decreased intake of food which
conducted in Kilimanjaro Region, Tanzania [26] Ethiopia in intern leads to weight loss and the children quickly become
Dolo-Ado Somali region [15]. Hawassa South Ethiopia [13], undernourished. On the other hand undernourished status
Mai-Aini Eritrean Refugees’ Camp, Northern Ethiopia [27]. further leads to the occurrence of diarrhea and other
In this study, maternal educational status was significantly infectious diseases due to immune decline.
associated with acute malnutrition. Children whose mothers This study also indicated that, there was significant
had no formal education were 1.8 times at risk to have acute association between lack of colostrum feeding and wasting.
malnutrition as compared to those children have literate The odds of wasting were 2.26 times higher children who
mothers. This was in line with studies done in Afghanistan had not fed colostrum than those had fed colostrum. This was
[28], in Nigeria [29]. Similar findings revealed that maternal consistent with study done in India [39]. Also, study done
education has negative relationship to acute malnutrition [30] Ethiopia [40]. This is probably colostrum provides protective
effect to the newborn and infants because colostrum is highly
 Science Journal of Public Health 2020; 8(4): 123-129 128

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