1. Introduction
Malnutrition remains a major public health problem in low- and middle-income countries (LMICs) [
1]. It is the most important risk factor for the load of disease affecting about 300,000 deaths per year directly and indirectly and accounting for more than half of all deaths in children [
2]. Nowadays, child malnutrition is the most shocking problem challenging the majority of LMICs [
3] and one of the most common reasons of child death in LMICs [
4]. Malnutrition alone is accountable for over half of the losses in children under five in LMICs [
5].
Malnutrition occurs when the body does not receive the appropriate quantity of nutrients that are essential to keep the organs and tissues healthy and operational [
6,
7]. A number of studies [
8,
9,
10] indicate that children and females are the prime sufferers of malnutrition. Children are said to be malnourished if they are undernourished or over nourished, but most of the time malnutrition happens when people are undernourished [
11,
12]. The main causes for undernutrition, especially in children, are poverty, non-existence of food, frequent sicknesses, unsuitable suckling practices, absence of care and underprivileged cleanliness [
12]. Inadequate nutrients in the first two years of life can cause a child’s body to become sluggish and can stunt intellectual growth for the rest of his or her life. A short period of insufficient nutrients, along with sickness or infection, can rapidly make a child seriously undernourished [
13].
Poor nutrition at childhood obstructs a child’s bodily and intellectual development that eventually causes the malicious cycle of intergenerational undernutrition [
14,
15]. Undernutrition is a soundless killer that is under testified, under identified and, also, under arranged [
16]. For every minute of each day, five children die due to undernutrition [
17,
18].
Reducing undernutrition in children under five remains major challenge in LMICs [
18]. A projected 230 million children under five are understood to be habitually malnourished in LMICs [
19]. Correspondingly, around 54% of losses among children of this age group are thought to be related to malnourishment in LMICs [
20]. In sub-Saharan Africa, 41% of children under five were undernourished in 2016 and losses from malnourishment were rising on regular basis [
20,
21].
Results from the 2016 Ethiopian Demographic and Health Survey (EDHS) indicate that stunting (chronic undernutrition) and being underweight (chronic and acute undernourishment) was seen in 38% and 24% of children less than five years old, respectively [
22]. Undernutrition in children is one of the most severe public health challenges in Ethiopia [
23]. For example, almost one in every 17 babies born in Ethiopia (59 per 1000) will not live to rejoice its first anniversary, and one in every eleven children (88 per 1000) will die before its fifth birthday [
23].
Even though the problem of child undernutrition in Ethiopia has been sufficiently recognized, the severity and the explanations behind it are quite scanty. There is also a discrepancy between studies concerning the predictors of undernutrition. This discrepancy might be because of the insertion and/or elimination of some variables. Estimations might also vary based on various variables and types of data and estimation methods. Even though these overall realities are clear, the detailed factors that lead to undernutrition in children under five in Ethiopia have received little research attention. Consequently, this paper aims to investigate the socio-economic, demographic, health and environmental factors associated with undernutrition among children aged 6–59 months in Ethiopia. The specific objectives of the study were:
To identify the socio-economic, demographic, health and environmental factors that lead to undernutrition among under five children in Ethiopia;
To examine the level of within-household and between-household differences in determinants of undernutrition of children under five and
To examine the level of within-regional and between-regional differences in determinants of undernutrition in children under five.
4. Discussion
This paper investigated the socio-economic, demographic, health and environmental factors associated with undernutrition among children aged 6–59 months in Ethiopia. This study found that place of residence, employment status of the mother, educational status of the mother, the mother’s nutritional status, age of the child, birth order of the child, source of water and having diarrhea and fever were the most important factors significantly associated with child undernutrition in Ethiopia. This finding is similar with studies conducted in Ethiopia [
1,
23,
26,
27].
The study shows, there are household- and regional-level discrepancy in undernutrition among children under five, and it is perceived that children living in rural areas of the country are at more risk of undernutrition. This result was supported by studies conducted in Ethiopia [
27,
28]. Consequently, it is good to support health care and food security programs in rural areas to directly address food insecurity and undernutrition problems of the low income and exposed people in the rural areas of the country. The result also showed that children of mothers with no formal education were highly exposed to undernutrition in Ethiopia. This outcome is reliable with research conducted in Ethiopia [
1,
26]. Therefore, it is advantageous to increase mothers’ admittance to learn in all regions in order to address the difficulty of refining their income receiving capacity and also improving the excellence of care and responsiveness they can afford to their children.
The study revealed that children from working mothers are at a greater danger of undernutrition. This finding is similar to findings of previous studies [
26,
28,
29]. The reason for this may be that the time allotted to earn income might be at the expense of time spent in serving and caring for children, and most mothers work in the informal sectors and in lower status jobs. Therefore, it is useful to develop a policy for mothers to have sufficient time after giving birth and to provide formal and qualified jobs. Children greater than 6 months old had greater risk of undernutrition compared to other age groups. This finding supports the study conducted in Ethiopia and south Asia [
9,
14,
15,
16]. The reason for this might be that breastfeeding occurs in the initial periods of child growth. Thus, efforts should be made to communicate through different programs, such as health and nutritional training, the significance of suckling breast milk solely up to 6 months and later familiarizing other additional nutrient affluent diets.
Strengths and Limitations
The rigorous analytical and statistical methodologies used in this study are its strength. This adds to the credibility of our work. We also present a clear methodological technique, making our research repeatable. The findings of this study can be applied to all Ethiopian children under five, because it used a nationally representative dataset. Nonetheless, our study contains some significant flaws; therefore interpretation of the results should be performed with caution. We cannot demonstrate causality between the various variables because the DHS dataset used a cross-sectional design. We can only claim associations among the studied variables.
5. Conclusions
The findings indicate that education, birth order, employment, wealth status, place of residence, nutritional status, source of drinking water and diarrhea are associated with undernutrition of children under five. It is therefore useful to support health care and food security programs in rural areas to directly address the food insecurity and undernutrition problems of the low-income and exposed people in rural areas of the country. The education sector must increase mothers’ admission to learning in all regions in order to overcome difficulties by refining the value of care and consideration they can give to their children. The health sector should make efforts to communicate through different programs, such as health and nutritional training, the significance of suckling breast milk solely up to 6 months and later familiarizing other additional nutrient affluent diets.