Maternal and Child Health Journal (2022) 26:2210–2220

https://doi.org/10.1007/s10995-022-03467-6

REVIEW PAPER

Under‑Nutrition and Associated Factors Among Lactating Mothers

in Ethiopia: A Systematic Review and Meta‑analysis
Bekahegn Girma1 · Jemberu Nigussie1 · Alemayehu Molla2 · Moges Mareg3

Accepted: 18 July 2022 / Published online: 30 August 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
Introduction Under-nutrition (body mass index < 18.5 kg/m2) is a global problem with an increasing trend in recent years.
The burden is high in low and middle-income countries, especially in Africa. Lactating mothers are among the most vulner-
able groups for under nutrition; particularly in sub-Saharan Africa. In Ethiopia, the prevalence of under-nutrition among
this group is inconsistent and inconclusive. Therefore, we aimed to assess the pooled prevalence of under-nutrition and its
associated factors among lactating mothers in Ethiopia.
Methods To write this review and meta-analysis, we followed the preferred reporting items for systematic review and meta-
analysis guidelines. Primary articles were searched from PubMed, Hinari, Cochrane Library, science direct databases, Google,
and Google scholar. STATA version 16 software and a standardized Microsoft excel format were used for analysis and data
extraction, respectively. Heterogeneity between studies was checked. To determine the pooled prevalence of under-nutrition,
we used a random-effect model. Begg’s and Egger’s tests were done to detect publication bias. Subgroup analysis was also
steered and association was uttered by a pooled odds ratio with 95% CI.
Results The pooled prevalence of under-nutrition among lactating mothers was 23.84% [95% CI (19.40, 28.27)]. Educational
status (no formal education) {Pooled OR 2.30 [95% CI (1.34, 3.96)]} was significantly associated with under-nutrition.
Conclusion The pooled prevalence of under-nutrition was high. Maternal educational status was significantly associated
with under-nutrition. Therefore, the federal ministry of health and the concerned stakeholders should give attention to these
most vulnerable groups and strengthen the implementation of the previously designed strategies.

Keywords Lactating mothers · Under nutrition · Factors · Ethiopia · Meta-analysis

Abbreviations Significance Statement

BMI Body mass index
CI Confidence interval Several single studies were conducted in low and middle-
NNP National Nutrition Program income countries including Ethiopia on under-nutrition.
OR Odd ratio In Ethiopia, a strategic plan under the National Nutrition
SNNP South Nations and Nationalities People Program (NNP) by the year 2015 was designed to drop
the prevalence of under-nutrition from 27 to 19 percent.
However, the plan is not achieved yet, and the prevalence
of under-nutrition among lactating mothers is inconsistent
and inconclusive. Therefore, to support the 2030 Sustain-
able developmental plan achievement, conducting this type
* Bekahegn Girma
[email protected] of summarized review is helpful. Therefore, we aimed to
conduct this study in Ethiopia.
1
Department of Nursing, College of Medicine and Health
Science, Dilla University, Dilla, Ethiopia
2
Department of Psychiatry, College of Medicine and Health
Science, Dilla University, Dilla, Ethiopia
3
Department of Reproductive Health, School of Public Health,
College of Medicine and Health Science, Dilla University,
Dilla, Ethiopia

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Maternal and Child Health Journal (2022) 26:2210–2220 2211

Background to 54.7% (Duko et al., 2018; Roba et al., 2016). Conse-

quently, providing summarized evidence is important for
Nutrition is a vital indicator of the complete health of policymakers to revise their strategies, strengthen the
a population and a pillar of development (Daba et al., implementation of the designed interventions and achieve
2013). Under-nutrition is more prevalent among children the global sustainable development plan goals 2.2 and 3.1
and women, especially in lactating and pregnant mothers. (Resolution, 2015). Therefore, this systematic review and
Under-nutrition is responsible for 3.5 million maternal and meta-analysis was aimed to assess the pooled prevalence
children deaths, 35% of children’s disease burden, 20% of of under-nutrition and its associated factors among lactat-
maternal mortality, and 11% of daily-adjusted life-years ing mothers in Ethiopia.
(DALYs) (Black et al., 2008). Maternal under-nutrition
is well-defined as having a body mass index (BMI)
of < 18.5 kg/m2 (Mtumwa et al., 2016). Methods
During lactation, there is a high need for energy and
nutrients, unless achieved, results in poor nutritional sta- Searching Strategy
tus, poor breast milk quality [7, 8] and also has a long term
impact on the health of the child and as well as to the com- Initially, databases were searched to check similar systematic
munity (Victora et al., 2008). Also, it increases the risk of reviews to avoid duplication using the website https://w ​ ww2.​
under-five mortality and morbidity (Demissie et al., 2003; le.​ac.​uk/​libra​ry/​find/​datab​ases/p/​Prosp​ero. Primary articles
Razak et al., 2013; Sanusi & Falana, 2009). were searched from PubMed, Hinari, Science Direct, and
Maternal under-nutrition is a serious public problem, Cochrane library databases. Moreover, grey literatures were
but more prevalent in sub-Saharan Africa, south-central, retrieved from Google and Google scholar. Furthermore, the
and southeastern Asia countries (Food & Agriculture reference lists of published articles were searched to recog-
Organization of the United Nations, 2019). In 2018, 10.8% nize other relevant articles that did not show in databases. To
of the world population were under-nourished, 19.9% decrease the number of unrelated studies during the search
in Africa (Egal, 2019). In the globe, the prevalence of process, the search was restricted to only ‘human studies’,
underweight among women ranges from 10 to 19% (Black and ‘women/mothers’ in the advanced search. The searching
et al., 2008). In Sub-Saharan African countries, 10–20% of primary articles was started on June 26, 2020, and ended
of women are under-nourished (Chaparro et al., 2014). on 30 April 2021. We used “Under-nutrition OR Under-
Even though all women have a risk for under nutrition, the weight AND lactating mothers AND Ethiopia” for objec-
burden is more common in lactating mothers due to more tive one and “Determinants OR factors OR predictors AND
energy and nutrient requirement than in pre-pregnancy and lactating mothers AND Ethiopia” for the second objective
pregnancy periods (Sarwar et al., 2013). Lactating mothers as keywords. This systematic review and meta-analysis
in low-income countries, are more vulnerable to under- included both published and unpublished articles that fulfill
nutrition, especially in South East Asia and sub-Saharan the eligibility criteria. During writing this review and meta-
Africa (Black et al., 2013; Haileslassie et al., 2013). In analysis, we used the Preferred Reporting Items for Sys-
Ethiopia, the prevalence of under-nutrition among women tematic reviews and Meta-Analyses (PRISMA) guidelines
is 20.6% (Ayana et al., 2015) and the prevalence of under- (Moher et al., 2009). Articles were downloaded into Endnote
nutrition among lactating mothers ranges from 5.6 to version X7 to maintain and manage citations, facilitate the
54.7% (Duko et al., 2018; Roba et al., 2016). review process, and check the duplication of articles.
Low level of educational status, food insecurity, low
dietary diversity score, low family income, and family size Inclusion and Exclusion Criteria
were some of factors of under-nutrition among lactating
mothers (Desyibelew & Dadi, 2019; Hasnat Milton et al., All observational studies (cross-sectional, case–control and
2010; Mtumwa et al., 2016; Mukunya et al., 2020). One cohort studies) conducted in Ethiopia among lactating moth-
of the target strategic plan under the National Nutrition ers were included. Moreover, articles reporting the preva-
Program (NNP) by the year 2015 of Ethiopia was to drop lence of under-nutrition (BMI < 18.5 kg/m2) and/or associ-
the prevalence of under nutrition from 27 to 19%, but not ated factors were included. Both published and unpublished
yet been achieved. full articles were considered. Both institutional and com-
Even though several studies were conducted in Ethio- munity-based studies were encompassed. Studies conducted
pia, all of the studies were single studies. There was a among both lactating and pregnant mothers were excluded.
wide range of discrepancies in under-nutrition prevalence Eligibility assessment was executed independently by BG
among lactating mothers in Ethiopia, ranging from 5.6 and JN in an unblinded identical manner based on the stated

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2212 Maternal and Child Health Journal (2022) 26:2210–2220

inclusion and exclusion criteria. We solved disagreements by 1997). To declare publication bias’s statistical signifi-
consensus and discussion with the two remaining authors. cance, we used a P-value < 0.05. After a comprehensive
examination of the included studies, the heterogeneity of
the studies was assessed by ­I2 test statistics. ­I2 statistics
Outcome Measures
described the total variation across studies and declared
low, moderate, and high heterogeneity if it is < 50,
This systematic review and meta-analysis has two objectives.
50–75%, and > 75%, respectively (Higgins et al., 2003).
The first was to estimate the pooled prevalence of under-
nutrition among lactating mothers in Ethiopia, calculated
Statistical Method and Analysis
by dividing the number of lactating mothers with this prob-
lem by the total number of lactating mothers included in the
We extracted essential data from each study using Microsoft
study and multiplied by 100. All articles included in this
excel spreadsheet, and the data were exported to STATA soft-
review and meta-analysis used BMI score (< 18.5 kg/m2) to
ware version 16 for analysis. The standard error of prevalence
assess under-nutrition among lactating mothers. The second
for each original article was calculated using the binomial
objective was to determine the pooled effects of factors on
distribution formula. The effect size of the meta-analysis was
under-nutrition. In this systematic review and meta-analysis,
the prevalence of under-nutrition and OR of the associated
variables identified as a factor in two and above studies were
factors. We used a random-effect model for analysis (Boren-
included in this meta-analysis. To express the pooled effects,
stein et al., 2009). To check the source of heterogeneity, we
we used the odds ratio (OR), calculated from the 2 × 2 table.
conducted a leave-one study-out sensitivity analysis and sub-
group analysis (Bown & Sutton, 2010; Marušić et al., 2020;
Quality Assessment and Data Extraction
Patsopoulos et al., 2008). The effect of the selected associ-
ated factors on the outcome variable was examined using
Newcastle Ottawa Scale was used to assess the quality of
separate groups of meta-analysis. To describe the features of
the included studies (Peterson et al., 2011). BG and JN have
the included articles and to display the finding of this review
appraised the studies independently using the above tool. The
and meta-analysis, we used texts, tables, forest plots, and OR
tool has the following parameters sampling strategy, inclusion/
and 95% confidence intervals (CI).
exclusion criteria, sample size, cut-offs, and reference for assess-
ing lactating mothers under-nutrition status, measures to identify
under-nutrition, and covariates included in statistical models. The
tool comprised ten standards for rating different quality elements.
Results
After quality assessment, studies with high quality (scored six
Searching Strategy and Study Selection
and above out of ten) were included into analysis. During quality
assessment, any discrepancies were solved through discussion,
The algorithm used for this review and meta-analysis yielded
by taking the average result of the two appraisers and by giving
262 primary articles, extracted from PubMed, Hinari,
the decision for the remaining two authors.
Cochrane library, science direct databases, and Google
The necessary data were extracted separately using a stand-
Scholar and Google. Of which, 148 articles were excluded
ardized Microsoft Excel data extraction format by two authors
due to duplication and during title and abstract screening.
(BG and JN).We used two data extraction formats, one for
A total of 20 articles were selected for full article reading
each objective. For example, for the prevalence of under-
and 2 records were additionally removed due to there were
nutrition the data extraction format comprised author name,
conducted in lactating and pregnant mothers together (Gebre
publication year, the studies region/country, study design,
et al., 2018; Serbesa et al., 2019). Lastly, 18 articles were
sample size, response rate, outcome measurement tool, study
selected for the final review and meta-analysis (Abeya et al.,
quality score, and prevalence of under-nutrition. We also used
2018; Alemayehu et al., 2015; Bekele et al., 2020; Berihun
two-by-two tables to extract data for objective two. During
et al., 2017; Boke et al., 2021; Desalegn et al., 2018; Duko
the data extraction period, any incongruities between the two
et al., 2018; Engidaw et al., 2019; Haidar et al., 2003; Haile-
authors (BG and JN) were resolved through twofold checking
slassie et al., 2013; Hundera et al., 2015; Julla et al., 2018;
the variable data together, and third author invitation.
Kibr, 2020; Roba et al., 2016; Sitotaw et al., 2017; Tikuye
et al., 2019; Zerihun et al., 2016) (Fig. 1).
Publication Bias and Heterogeneity
Study Characteristics and Systematic Review
Both methods assessed publication bias, funnel plots, the
subjective method used to test for asymmetry (Sterne &
Except one study (Desalegn et al., 2018), all included arti-
Egger, 2001), and Egger’s statistical test (Egger et al.,
cles were cross-sectional studies. The study was conducted

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Maternal and Child Health Journal (2022) 26:2210–2220 2213

Articles archived from PubMed, Hinari,

Identification
Science direct and Cochrane library
databases, and from Google scholar and
Google (n = 262)

Articles after duplication removed

(n = 168)
Screening

Records screened (n = 168) Records excluded by

title and abstract
(n = 148)

2 Studies excluded due

Records selected for full to their study population
Eligibility

text reading (n = 20) was pregnant and

lactating women

Studies included in Meta-analysis

Included

(n = 18)

Fig. 1  Flow diagram of the studies included in the review of lactating women under-nutrition in Ethiopia, 2021

among 8912 Ethiopian lactating mothers. In this review Oromia (Abeya et al., 2018; Alemayehu et al., 2015; Bekele
and meta-analysis, the included articles had a sample size et al., 2020; Duko et al., 2018; Hundera et al., 2015; Zerihun
ranging from 216 (Roba et al., 2016) to 1140 (Haidar et al., et al., 2016), four were from SNNP (Boke et al., 2021; Julla
2003). Ten (55.5%) of the included studies used a simple et al., 2018; Kejela et al., 2019; Tikuye et al., 2019), three
random sampling technique (Abeya et al., 2018; Boke et al., were from Tigray (Desalegn et al., 2018; Haileslassie et al.,
2021; Duko et al., 2018; Haidar et al., 2003; Haileslassie 2013; Sitotaw et al., 2017), three were from Amhara (Beri-
et al., 2013; Hundera et al., 2015; Julla et al., 2018; Kibr, hun et al., 2017; Engidaw et al., 2019; Kibr, 2020) and two
2020; Roba et al., 2016; Zerihun et al., 2016). Nine (50%) were from Addis Ababa (Haidar et al., 2003), and Tigray and
of the included studies were conducted in 2018 and then Oromia regions (Roba et al., 2016) together.
after (Abeya et al., 2018; Bekele et al., 2020; Boke et al., The highest prevalence of under nutrition among lactat-
2021; Desalegn et al., 2018; Duko et al., 2018; Engidaw ing mothers was reported from a study done in Tigray and
et al., 2019; Julla et al., 2018; Kejela et al., 2019; Kibr, 2020; Oromia region jointly (54.7%) (Roba et al., 2016) and the
Sitotaw et al., 2017; Tikuye et al., 2019). Single study were least was from the Oromia region (5.6%) (Duko et al., 2018)
conducted before 2010 (Haidar et al., 2003). Regarding (Table 1).
the region where the study conducted 6 (33.3%) were from

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Table 1  Summary of the included articles to assess the prevalence of under-nutrition and associated factors among lactating mothers in Ethiopia,
2021 (n = 18)
Author’s name (year) Study design Region Sample size Sampling technique Prevalence (%) Quality score

Engidaw et al. (2019) Cross sectional Amhara 266 Systematic 17.9 7

Abeya et al. (2018) Cross sectional Oromia 662 Simple 19.5 6
Julla et al. (2018) Cross sectional SNNP 422 Simple 15.8 7
Alemayehu et al. (2015) Cross sectional Oromia 355 Census 40.6 6
Haileslassie et al. (2013) Cross sectional Tigray 400 Simple 25.0 8
Duko et al. (2018) Cross sectional Oromia 484 Simple 5.6 7
Sitotaw et al. (2017) Cross sectional Tigray 464 stratified 21.2 8
Tikuye et al. (2019) Cross sectional SNNP 478 Multi-stage 17.4 7
Hundera et al. (2015) Cross sectional Oromia 317 Simple 20.0 6
Bekele et al. (2020) Cross sectional Oromia 545 Systematic 17.7 10
Desalegn et al. (2018) Longitudinal Tigray 575 Multi-stage 33.6 8
Kibr et al. (2020) Cross sectional Amhara 423 Simple 21.7 6
Zerihun et al. (2016) Cross sectional Oromia 638 Simple 21.5 8
Kejela et al. (2019) Cross sectional SNNP 445 Systematic 26.1 6
Roba et al. (2016) Cross sectional T&O 216 Simple 54.7 9
Haidar et al. (2003) Cross sectional AA 1140 Simple 27.1 7
Boke et al. (2021) Cross sectional SNNP 414 Simple 21.2 8
Berihan et al. (2017) Cross sectional Amhara 668 systematic 25.6 8

Hint T&O—Tigray and Oromia, SNNP south nation nationalities and people, AA Addis Ababa, Simple simple random sampling technique, sys-
tematic: random sampling technique, Multi-stage multi-stage random sampling technique, Stratified stratified random sampling technique, Qual-
ity score out of 10

Prevalence of Under‑Nutrition Among Lactating ­(I2 = 82.84%; P < 0.001) between studies which selected
Women there population with systematic random sampling tech-
niques as compared to others techniques (Table 2).
To estimate the pooled prevalence of under-nutrition among
lactating mothers, eighteen studies were included. The het- Factors Associated with Under‑Nutrition Among
erogeneity seen between studies included in this review was Lactating Mothers
high ­(I2 = 95.76% and P < 0.001). Due to this heterogene-
ity, we used random-effects model to estimate the pooled In this review and meta-analysis, we included significant fac-
prevalence of under-nutrition, 23.84 [95% CI (19.40, 28.27)] tors at least in two primary studies. Dietary diversity, food
(Fig. 2). insecurity, maternal educational status, age, family income,
In this review and meta-analysis, publication bias was postnatal care service, and family size were significant fac-
confirmed by Egger’s test (P: 0.001) and unsymmetrical tors for under-nutrition. However, only food insecurity and
Funnel plot (Fig. 3). But after we removed the highly vary- educational status were held all the necessary data to con-
ing two studies (Duko et al., 2018; Roba et al., 2016), the struct 2 × 2 tables and reported with similar categories across
pooled prevalence of under-nutrition was 23.16 [95% CI studies. The remaining factors were reported with different
(20.09, 26.22)], and the result of Begg’s and Egger’s test types and didn’t have exposed and unexposed group data.
results was P: 0.62 and P: 0.12, respectively. Therefore, due to this reason, we assess the association of
Subgroup analysis was done by region, publication year, the two mentioned factors that contain pertinent data to cal-
sampling technique and design type. Thus, the estimated culate their effect.
pooled prevalence of under-nutrition was high in a study Among factors included in the meta-analysis, food inse-
conducted in two regions jointly (Tigray and Oromia) curity was identified as factor in two studies (Bekele et al.,
54.7% [95% CI (47.85, 61.55)], and the least was in SNNP 2020; Tikuye et al., 2019), and educational status was rec-
20.02 [95% CI (15.57, 24.47)]. The minimum heterogene- ognized as a factor for under-nutrition in four studies (Abeya
ity between studies was seen among studies conducted in et al., 2018; Kejela et al., 2019; Tikuye et al., 2019; Zerihun
Amhara region, Ethiopia (­ I2 = 72.09% and p < 0.226). Stud- et al., 2016). In this meta-analysis, illiterate lactating Ethio-
ies conducted in 2017 and before had high heterogeneity pian mothers had 2.3 times more risk of developing under-
­(I2 = 96.86%; p < 0.001. Lastly, there was low heterogeneity nutrition as compared to their counterparts {OR 2.30 [95%

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Maternal and Child Health Journal (2022) 26:2210–2220 2215

Fig. 2  The pooled prevalence of under-nutrition among lactating mothers in Ethiopia, 2021

and under-nutrition {OR 3.35 [95% CI (0.63, 17.76)]}

(Fig. 5).

Discussion

This review and meta-analysis aimed to assess the pooled

prevalence of under-nutrition and its associated factors
among lactating mothers in Ethiopia. The pooled preva-
lence of under-nutrition was 23.84% [95% CI (19.40,
28.27)]. This finding was similar with studies done in seven
African countries (12.6–31.9%), systematic review done in
Africa (23.5%) (Desyibelew & Dadi, 2019), Iran (26.11%)
(Mardani et al., 2020) and rural Vietnam (23.7%) (Nakamori
Fig. 3  Funnel plot to assess publication bias for lactating mother’s
under-nutrition in Ethiopia, 2021 et al., 2009). However, it was high as compared to stud-
ies done in Uganda (8.2%) (Mukunya et al., 2020), India
(16.9%) (Khan & Khan, 2012), Bangladesh (16.1%) (Khan
CI (1.34, 3.96)]}, and I­ 2 = 82.8% and P: < 0.001 (Fig. 4). & Khan, 2012), Indonesia (9%) (Madanijah et al., 2016),
However, there was no association between food insecurity Ethiopia among women (20.6%) (Ayana et al., 2015) and the
global standard acceptable malnutrition rate (10%) (World

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Table 2  Subgroup analysis Variables Characteristics No. of studies Prevalence (95% CI) Heterogeneity
findings on prevalence of under
nutrition among Lactating I2 (%) P value
women in Ethiopia, 2021
(n = 18) Region Oromia 6 21.03 (12.37, 26.69) 96.43 < 0.001
SNNP 4 20.02 (15.57, 24.47) 82.53 < 0.001
Tigray 3 26.60 (19.37, 33.83) 90.5 < 0.001
Amhara 3 21.99 (17.66, 26.32) 72.09 0.226
Addis Ababa 1 27.1 (24.37, 29.83) – –
Tigray & Oromia 1 54.7 (45.44, 63.96) – –
Publication year 2017 and before 9 27.90 (20.78, 35.02) 96.86 < 0.001
After 2017 9 20.04 (15.42, 24.66) 91.57 < 0.001
Design type Institutional based 4 23.02 (18.59, 27.45) 80.6 < 0.001
Community based 14 24.18 (18.4, 29.96) 96.73 < 0.001
Sampling technique Simple 10 23.00 (15.98, 30.02) 96.86 < 0.001
Systematic 4 21.87 (17.31, 26.44) 82.84 < 0.001
Stratified 1 40.60 (35.40, 45.80) – –
Multistage 2 25.47 (9.60, 41.35) 97.37 < 0.001
Census 1 21.20 (17.45, 24.95) – –
Overall pooled prevalence of under-nutrition 18 23.84 (19.40, 28.27) 95.76 < 0.001

Institution based: studies done with in institutions; Community based: studies done with in the community
(home to home)

Health Organization, 2013). The reason might be lactating Tanzania (Mtumwa et al., 2016). Moreover, it was similar
mothers are more vulnerable due to double the burden to to a systematic review done on adolescents under-nutrition
meet the requirement of their and their child’s nutrients and (Berhe et al., 2019). This might be because of that illiterate
energy need, the difference in sample size for instance in mothers have inadequate nutritional knowledge, low eco-
Uganda, 1356 women, health service quality variation, cul- nomic status, high household burden, and low decision-mak-
tural and socioeconomic variation. ing ability which leads to low use of health care facilities,
This finding was low as compared to the WHO report of accessibility of nutritious food, and low health-promoting
Ethiopia (26.9%) (World Health Organization, 2017). This behaviour (Haseen, 2010; Kshatriya & Acharya, 2016).
might be due to improvement in service delivery quality in Even though this study is a systematic review and meta-
recent years in Ethiopia evidenced with high prevalence of analysis, it has some limitations. Some of which were high
undernutrition among studies done in 2017 and before. heterogeneity across studies, publication bias and almost all
This meta-analysis assessed the association of food inse- of studies included in this review and meta-analysis were
curity and maternal educational status with the outcome cross sectional which couldn’t show the temporal relation-
variable. Even though Ethiopia is one of the food-insecure ship between the outcome and independent variables.
countries, and 10% of Ethiopian citizens are chronically
food insecure (Birara et al., 2015). Although the finding of
a review and meta-analysis done in Africa revealed that food Conclusion
insecurity is a significant factor for under-nutrition among
women. In this study, food insecurity hadn’t any association The pooled prevalence of under-nutrition among lactating
with under-nutrition {OR 3.35 [95% CI (0.63, 17.76)]}. This mothers was high compared to the national and global fig-
might be because of only two studies were included in this ures. Maternal education status was identified as a signifi-
review and meta-analysis to check this fact. cant predictor of under-nutrition. To decrease this burden,
In the present study, maternal educational status was the federal ministry of health and strake holders should
identified as a significant factor for under-nutrition among strengthen their follow-up on implementing the designed
lactating mothers. Illiterate lactating mothers had 2.3 times strategies for this particular group since they are more vul-
more risk for under-nutrition as compared to literate moth- nerable among all women. Furthermore, since in Ethiopia,
ers {Pooled OR 2.30 [95% CI (1.34, 3.96)]}. This finding 40.4% of women are illiterate (Ethiopian Public Health
was similar to the food and agriculture organization (FAO) Institute & ICF, 2019) long-term plan should be designed
study across countries (FAO & ADB, 2013), studies done in to increase the access to education for women. That was
India (Pal et al., 2017), Uganda (Mukunya et al., 2020), and one of the goals of the global sustainable development plan,

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Maternal and Child Health Journal (2022) 26:2210–2220 2217

Study

ID OR (95% CI)

Tikuye et al (2017) 2.98 (1.89, 4.68)

Abeya et al (2018) 3.78 (2.27, 6.32)

Kejela et al (2019) 2.36 (1.50, 3.70)

Zerihun et al (2016) 1.11 (0.75, 1.65)

Overall (I-squared = 82.8%, p = 0.001) 2.30 (1.34, 3.96)

NOTE: Weights are from random effects analysis

.1 1 10

Fig. 4  Association between maternal education status and under-nutrition among lactating mothers in Ethiopia, 2021

Study

ID OR (95% CI)

Bekele et al (2020) 7.84 (4.37, 14.06)

Tikuye et al. (2019) 1.44 (0.81, 2.56)

Overall (I-squared = 93.9%, p =< 0.001) 3.35 (0.63, 17.76)

NOTE: Weights are from random effects analysis

.1 1 10

Fig. 5  Association between household food insecurity and under-nutrition among lactating mothers in Ethiopia, 2021

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2218 Maternal and Child Health Journal (2022) 26:2210–2220

and it is essential to decrease the burden of under nutrition Black, R., Bhutta, Z., Bryce, J., Morris, S., & Victora, C. (2013). The
among lactating mothers. Lancet’s series on maternal and child undernutrition. The Lancet,
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M., Ezzati, M., Mathers, C., Rivera, J., & Maternal and Child
Supplementary Information The online version contains supplemen- Undernutrition Study Group. (2008). Maternal and child under-
tary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 10995-0​ 22-0​ 3467-6. nutrition: Global and regional exposures and health conse-
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undernutrition and associated factors among lactating mothers
Author Contributions BG and JN conceived the idea, participated in of Angecha District, Kembata Tembaro Zone, Southern Ethio-
data extraction, analysis, and draft writing. AM and MM participated pia. Journal of Nutrition and Metabolism. https://​doi.​org/​10.​
in the analysis, manuscript preparation, and revision. All authors read 1155/​2021/​66919​82
and approved the final version of the manuscript to be considered for Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R.
publication. (2009). Fixed-effect versus random-effects models. Introduction
to Meta-Analysis, 77, 85.
Bown, M. J., & Sutton, A. J. (2010). Quality control in system-
Funding Not applicable. atic reviews and meta-analyses. European Journal of Vascular
and Endovascular Surgery, 40(5), 669–677. https://​doi.​org/​10.​
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be accessed by contacting the corresponding author through this email Chaparro, C., Oot, L., & Sethuraman, K. (2014). Overview of the
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Competing Interests All authors declare that they have no competing associated factors in Guto Gida Woreda, East Wollega Zone,
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Ethical Approval Not applicable. cal comparison of levels and correlates of nutritional status
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What does it take to scale up nutrition action? World Health jurisdictional claims in published maps and institutional affiliations.
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