Analysis of Malnutrition among Children under Five Years across Contrasting Agroecosystems of Northwest Ethiopia: Application of Structural Equation Modeling

Biruk Yazie Wubetie; Atsushi Tsunekawa; Nigussie Haregeweyn; Mitsuru Tsubo; Zerihun Nigussie; Taye Minichil Meshesha; Takeshi Abe

doi:10.3390/nu16081208

Analysis of Malnutrition among Children under Five Years across Contrasting Agroecosystems of Northwest Ethiopia: Application of Structural Equation Modeling

Nutrients. 2024 Apr 18;16(8):1208. doi: 10.3390/nu16081208.

Authors

Biruk Yazie Wubetie^{1

2}, Atsushi Tsunekawa³, Nigussie Haregeweyn⁴, Mitsuru Tsubo³, Zerihun Nigussie², Taye Minichil Meshesha^{1

5}, Takeshi Abe⁴

Affiliations

¹ The United Graduate School of Agricultural Sciences, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan.
² College of Agriculture and Environmental Sciences, Bahir Dar University, Bahir Dar P.O. Box 5501, Ethiopia.
³ Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan.
⁴ International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan.
⁵ School of Civil and Water Resources Engineering, Debre Markos Institute of Technology, Debre Markos University, Debre Markos P.O. Box 269, Ethiopia.

Abstract

Child malnutrition remains a public health challenge in developing countries, but a comprehensive understanding of its burden and its determinants in specific local contexts is generally lacking. This study examined the prevalence of malnutrition and its determinants among children aged <5 years across contrasting agroecosystems in northwest Ethiopia. A community-based cross-sectional study involving 400 respondents was employed. Data were collected through semi-structured questionnaires and anthropometric measurements, complemented with focus group discussions and key informant interviews. The direct and indirect effects of the determinants of malnutrition were examined using structural equation modeling (SEM). The overall prevalence of child malnutrition, measured using the Composite Index of Anthropometric Failure, was 49%, with notable variation across agroecosystems (from 36.1% [midland with red soil] to 59% [lowland and valley fragmented]). Disease experience had significant positive direct effects on malnutrition. Dietary intake had negative and significant total (direct and indirect) effects on malnutrition, partially mediated through disease experience. Serial mediation in SEM analysis revealed significant indirect relationships between malnutrition and food security, feeding and care practices, household environment, health services, maternal diet, maternal empowerment, household wealth, and nutrition-sensitive agricultural practices. In conclusion, child malnutrition was highly prevalent and higher among children in the lowland and valley fragmented agroecosystem, characterized by unfavorable agro-climatic conditions, lower wealth status, poor health services access, and higher disease (particularly malaria) exposure. This study demonstrates the dynamics and multifaceted nature of malnutrition, highlighting the importance of considering geographical differences when planning interventions for childhood malnutrition and its determinants.

Keywords: Ethiopia; child malnutrition; dietary intake; dryland; structural equation modeling.

MeSH terms

Agriculture
Anthropometry
Child Nutrition Disorders* / epidemiology
Child, Preschool
Cross-Sectional Studies
Ethiopia / epidemiology
Female
Humans
Infant
Latent Class Analysis
Male
Nutritional Status
Prevalence
Socioeconomic Factors

Grants and funding

JPMJSA1601/Science and Technology Research Partnership for Sustainable Development (SATREPS, grant number JPMJSA1601) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan.