Maternal Disempowerment and Sever Food Insecurity as Determinants of Undernutrition Among 6-36 Month Old Children in Gurage Zone, Southern Ethiopia: Case-Control Study
Globally, malnutrition is one of the most common causes of morbidity and mortality in children under the age of five year. The relative importance of each of the known risk factors of malnutrition including household food insecurity is likely to vary between settings. However, to the best of authors’ knowledge, there is no sound empirical study that simultaneously investigates the relative importance of maternal disempowerment and food insecurity on the risk of undernutrition in 6 -36 month old children in the study area. Therefore, this study was aimed to examine role of maternal disempowerment and food insecurity on under nutrition in 6-36 month old children living in Gurage Zone. To achieve study objective, Hospital based unmatched case–control study was conducted among 6-36 month old children who visited to the selected health facility of Gurage zone. A total of 346 (116 cases and 232 controls) children were included in the study. Case participants were selected consecutively; control participants were selected by systematic sampling technique. Data were collected by using interviewer administered structured questionnaire with anthropometric measurement instrument and entered into EPI data v 3.1 and analyzed using SPSS v 21. Crude and adjusted odds ratios were calculated through simple and binary multiple logistic regressions model. The result showed that undernutrition among children was significantly associated with high maternal disempowerment [AOR 6.53 (2.77-15.34)] and severe food insecurity [AOR 2.79 (1.29.04)]. Generally, the study concluded that maternal disempowerment and severe food insecurity were independently associated with under nutrition among 6-36 month old children living in study area. Besides, Hence, enhancing the household food security and promoting mother to decide lonely or jointly with their husband on issue that affects their own self or child health, resource allocation and freedom of mobility is important to prevent under nutrition in 6-36 month old children.
Andamlak Dendir Egata,
Maternal Disempowerment and Sever Food Insecurity as Determinants of Undernutrition Among 6-36 Month Old Children in Gurage Zone, Southern Ethiopia: Case-Control Study, Journal of Food and Nutrition Sciences.
Vol. 6, No. 2,
2018, pp. 46-57.
Bhatia P. Measuring and Interpreting Malnutrition and Mortality. Rome: World food program, Nutrition Service 2005.
Solomon B. Assessment and analysis of macro and cross-cutting issues contributing to malnutrition. Washington, DC, USA: International Food Policy Research Institute, 2005.
National nutrition programme June 2013-june 2015: 2014, Addis Ababa.
Mercedes de Onis DB, Monika. Levels & Trends in Child Malnutrition. Geneva World Health Organization and UNICEF, 2012.
Blössner M, de Onis, Mercedes. Quantifying the health impact of malnutrition at national and local levels. Geneva: World Health Organization, 2005.
Robert E, Cesar G, Susan P etal. Maternal and child under nutrition and overweight in low income and middle-income countries. Journal of Lancet. 2013; 382 (9890): 427–451.
The 2007 housing and population census of Ethiopia. Addis Ababa, Ethiopia Central Statistical Agency 2007.
Ethiopia: situation analysis for Transform Nutrition: 2013.
Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia: Central Statistical Agency, 2012.
Girmay M. Prevalence and predictors of under nutrition among infants aged six and twelve months in Butajira, Ethiopia: The P-MaMiE Birth Cohort. BMC Public Health. 2010; 10:27.
Eticha K. Prevalence and Determinants of Child Malnutrition [partial fulfillment of the requirements of the degree of Masters of Public Health]: Addis Ababa University; 2007.
Haroon S, Tim De M, Michel L. Garenne etal. What‘s new? Investigating risk factors for severe childhood malnutrition in a high HIV prevalence South African setting. Scand Journal of Public Health Supply. 2010; 69:96-106.
Benson T. Framework document for a National Nutrition Strategy for Ethiopia. International Food Policy Research Institute. Addis Ababa. 2005.
Sisay M. World Vision programme for severe acute malnutrition in SNNPR. 2014.
WHO/UNICEF Joint Monitoring Programmed (JMP) for Water Supply and Sanitation. 2008.
Stephenson. Burden of Infection on Growth Failure. Journal of Nutrition. 1999; 129 (2): 534–38.
Brown, K. Nutrition and Infection, Prologue and Progress since 1968—Diarrhea and Malnutrition. Journal of Nutrition. 2003; 133 (1): 328–32.
Anju, Sidney R, Carol B. Measuring Women‘s Empowerment as a Variable in International Development. Research and training institute. 2002; 1 (1): 17-26.
Agnes R, Quisumbing S, Ruth S etal. Empowering women to achieve food security. Washington, DC: international food policy research institute, 2001.
FAO, IFAD, and ILO Gender Dimensions of Agricultural and Rural Employment: Differentiated Pathways out of Poverty. Rome: FAO, IFAD, and ILO 2010.
Asian Development Bank. Gender equality and food security—women‘s empowerment as a tool against hunger Mandaluyong City, Philippines: Asian Development Bank, 2013.
Smith, Ramakrishna U, Ndiaye A etal. The Importance of Women‘s Status for Child Nutrition in Developing Countries. Washington, DC: IFPRI 2003.
Sethuraman K. The Role of Women‘s Empowerment and Domestic Violence in Child Growth and Under nutrition in a Tribal and Rural Community International Center for Research on Women. 2008.
Schmidt E. The Effect of Women‘s Intrahousehold Bargaining Power on Child Health Outcomes in Bangladesh: Colgate University; 2012.
Bhagowalia P Menon P Quisumbing R. What Dimensions of Women‘s Empowerment Matter Most for Child Nutrition? The International food policy research institute, 2012.
Kamiya Y. Socioeconomic Determinants of Nutritional Status of Children in Lao PDR: Effects of Household and Community Factors. Journal of Health and Population Nutrition. 2011; 29 (4): 339-34.
Dereje N. determinants of severe acute malnutrition among under five children in Shashogo woreda, southern Ethiopia: community based a matched case control study. International Journal of Research 2014; 1 (6): 2348-6848.
Ross-S, Hannah M. Maternal Autonomy as a Protective Factor in Child Nutritional Outcome in Tanzania. Atlanta, Georgia: Georgia State University; 2010.
Gudina E, Yemane B and Alemayehu W. Predictors of acute undernutrition among children aged 6 to 36 months in east rural Ethiopia: a community based nested case - control study BMC Pediatrics. 2014; 14: 91.
Bantamen G. Assessment of Factors Associated with Malnutrition among under Five Years Age Children at Michael Worde, Northwest Ethiopia: A Case Control Study. Journal of Nutrition and Food Science. 2014; 4: 256.
A de Villiers, M. Senekal. Determinants of growth failure in 12-24-month-old children in a high-density urban slum community in East London, South Africa European Journal of Clinical Nutrition 2002; 56 (12): 1231-41.
Mona S. Paula Glenda A etal. Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India. Marten Child Nut. 2005; 5 (1): 64-74.
Rushdie R. Intrahousehold Resource Allocation in Egypt: Does Women‘s Empowerment Lead to Greater Investments in Children? Economic Research Forum; Cairo 2004.
Priya B, Agnes R, Vidhya S etal. Unpacking the Links between Women's Empowerment and Child Nutrition: Evidence Using Nationally Representative Data from Bangladesh Independent Consultant, New Delhi 2010.
Jennifer A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access Indicator Guide (v. 3). Washington, D. C: 2007.
Akoto O, Pooja P, David S etal. Household food insecurity and nutritional status of children aged 6 to 23 months in Kailali District of Nepal. United Nations University Food and Nutrition Bulletin. 2010; 31 (4).
Saaka M, Osman M. Does Household Food Insecurity Affect the Nutritional Status of Preschool Children Aged 6–36 Months. International Journal of Population Research. 2013.
Kathmandu. Household food insecurity is highly prevalent and predicts stunting among preschool children and anemia among their mothers, in Baitadi district of Nepal. Nepal: 2010.
Leonardo S. Relationship between food insecurity and nutritional status of Brazilian children under the age of five. Rev Bras Epidemiol. 2013; 16 (4):984-86.
Francis Lwanga RKW, Joseph KB Matovu etal. Food Security and Nutritional Status of Children Residing in Sugarcane Growing Communities of East-Central Uganda: A Crosssectional Study. Journal of Food Security. 2015; 3 (2): 34-39.
Ariana P, Maureen M. Black, Carol B etal. Food Insecurity and Risk of Poor Health among US-Born Children of Immigrants. American Journal of Public Health 2009; 99 (3): 556–562.
Ihab Ali, Rohana Jalil, Wan M etal. Association between household food insecurity and nutritional outcomes among children in Northeastern of Peninsular Malaysia. Journal of Nutrition Research and Practice. 2014; 8 (3): 304-11.
Michelle Hackett HM-Q, 1 and Martha Cecilia Álvarez 2. Household food insecurity associated with stunting and underweight among preschool children in Antioquia, Colombia. Pan America Journal of Public Health 2009; 25 (6): 506–10.
Paudel, Pradhan B, Wagle R, etal. Risk Factors for Stunting Among Children: A Community Based Case Control Study in Nepal. Kathmandu University Medical Journal. 2012; 39 (3): 18-24.
World Health Report 2007. A Safer Future: Global Public Health Security in the21st Century. Geneva: WHO, 2007.
World Bank report 2007. Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action. Washington, DC: World Bank, 2006.
Prüss Üstün and C. Corvalán. Preventing Disease through Healthy Environments: Towards an Estimate of the Environmental Burden of Disease. Geneva: World Health Organization, 2006.
International Bank for Reconstruction and Development report 2008. Environmental health and child survival: epidemiology, economics, experiences. Washington, DC: World Bank, 2008.
Mandefro A, Mohammed T and Lamessa D. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia. Journal of BioMedCentral Public Health. 2015; 15:14.
Olagunju F, Fakayode S, Sola-Ojo F. Prevalence and Determinants of Malnutrition among Under-five Children of Farming Households in Kwara State, Nigeria. Journal of Agricultural Science. 2011; 3 (3): 173.
WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of Breastfeeding on Infant and Child Mortality Due to Infectious Diseases in Less Developed Countries: A Pooled Analysis Lancet. 2000.
Solomon A, Zemene T. Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiopian Journal of Health and Development. 2008; 22 (1): 21-5.
Aklima J Shelby Y, Ahmad M etal. Prevalence and Determinants of Chronic Malnutrition among Preschool Children: A Cross-sectional Study in Dhaka City, Bangladesh. Journal of Health Population Nutrition. 2011; 29 (5): 494-499.
Mandefro A, Mohammed T and Lamessa D. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia: Journal of BioMedCentral Public Health. 2015; 15:41.
Teshale F, Sahilu A and Lamessa Dube. Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia a case-control study. Journal of BioMedCentral Public Health. 2014; 14: 800.
Solomon Demissie, Amare Worku. Magnitude and factors associated with malnutrition in children 6-59 months of age in pastoral community of Dollo Ado district, Somali region, Ethiopia. Science Journal of Public Health. 2013 1 (4):175-83.
Hong R, Banta E and Betancourt J. Relationship between household wealth inequality and chronic childhood under-nutrition. International Journal for Equity in Health 2006; 5:15.
Kanjilal B, Mazumdar G, Mukherjee M etal. Nutritional status of children in India: Household socio-economic condition as the contextual determinant. International Journal for Equity in Health. 2010; 9:19.
Masiye F, Chama C, Chitah B. Determinants of Child Nutritional Status in Zambia: An Analysis of a National Survey. University of Zambia 2006.
Jejeebhoy S. Women‘s autonomy in rural India: Its dimensions, determinants and influence in the context of India: Women‘s empowerment and demographic processes. New York: Oxford University Press. 2000.
Gender Inequality and Women‘s Empowerment; In-depth Analysis of the Ethiopian Demographic and Health Survey 2005. Ethiopian Society of Population Studies. 2008.
UNICEF. «Strategy for Improved Nutrition of Children and Women in Developing countries». A Policy Review. New York. 1990.
Elham K, Kavosi Z, Aliasghar N, etal. Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars province, Iran. International Journal of Health Policy and Development. 2014; 3 (2):71-6.