PLOS ONE · 6 authors, 6 centres
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This community-based cross-sectional study in an NSA-implemented district of Ethiopia found moderate child undernutrition, with stunting at 24.1%, wasting at 8.87%, and underweight at 19.95%. Wasting was higher than the national average, while stunting and underweight were lower. Key protective factors included NSA program participation, adequate child dietary diversity, and ANC visits, while household food insecurity and diarrhea were significant risk factors.
**Background:** Malnutrition remains a critical public health challenge globally and in Ethiopia. Despite a decline in stunting from 51% to 37% between 2005 and 2019, undernutrition persists. Nutrition-Sensitive Agriculture (NSA) programs aim to address underlying causes of malnutrition by improving food availability, accessibility, and dietary diversity. However, evidence on the prevalence of child undernutrition in NSA-implemented districts in Ethiopia was limited. This study aimed to assess the prevalence of undernutrition and its associated factors among children aged 6–59 months in an NSA-implemented district in the Basona district, North Shewa Zone, Amhara region.
**Methods:** A community-based cross-sectional study was conducted from May to June 2021. A total of 422 mother-child pairs with children aged 6–59 months were enrolled using systematic sampling from four randomly selected sub-districts in the Basona Worena district. Data were collected using the Open Data Kit (ODK) platform and analyzed using Stata version 16. Anthropometric indices were calculated using WHO-Anthro. Household food insecurity was assessed using the HFIAS tool, and child dietary diversity was measured using a 24-hour recall based on seven food groups. Multivariable logistic regression was used to identify factors associated with stunting, wasting, and underweight. Statistical significance was set at p < 0.05.
**Key Results:** A total of 406 respondents participated (response rate 96.2%). The prevalence of stunting was 24.1% (95% CI: 19.9–28.4), wasting was 8.87% (95% CI: 6.3–12.1), and underweight was 19.95% (95% CI: 16.2–24.2). Male children had higher stunting (29.10%) than females (19.3%). Only 26.11% of households were NSA beneficiaries, and 26.85% of children had adequate dietary diversity (≥4 food groups). Household food insecurity prevalence was 34.73%.
Factors significantly associated with stunting included: maternal age at first birth ≥20 years (AOR: 0.40, 95% CI: 0.21–0.73), richest wealth quintile (AOR: 0.02, 95% CI: 0.003–0.13), family size ≥5 (AOR: 2.72, 95% CI: 1.28–5.80), child age 36–47 months (AOR: 6.41, 95% CI: 1.60–25.67) and 48–59 months (AOR: 5.75, 95% CI: 1.38–23.99), owning no agricultural land (AOR: 3.15, 95% CI: 1.55–6.41), and no ANC visit (AOR: 4.49, 95% CI: 1.80–11.19).
For wasting, protective factors were being an NSA beneficiary (AOR: 0.12, 95% CI: 0.02–0.96) and adequate child dietary diversity (AOR: 0.06, 95% CI: 0.01–0.48). Diarrhea in the past two weeks was a strong risk factor (AOR: 6.27, 95% CI: 2.59–15.15).
For underweight, significant factors included maternal age 35–44 years (AOR: 3.82, 95% CI: 1.15–12.67) and >44 years (AOR: 17.04, 95% CI: 3.25–89.35), child age 24–35 months (AOR: 7.99, 95% CI: 1.68–38.00), 36–47 months (AOR: 7.51, 95% CI: 1.51–37.38), and 48–59 months (AOR: 12.30, 95% CI: 2.32–65.75), decreased feeding frequency during pregnancy (AOR: 3.82, 95% CI: 1.64–8.91), household food insecurity (AOR: 3.31, 95% CI: 1.73–6.32), and diarrhea (AOR: 1.27, 95% CI: 1.05–4.91).
**Clinical Implications:** The study found that undernutrition in this NSA-implemented district is a moderate public health problem. Wasting prevalence (8.87%) exceeded the national average (7%), while stunting (24.1%) and underweight (19.95%) were lower than national averages (37% and 21%, respectively). The findings suggest that NSA programs may have a protective effect against wasting, and that improving child dietary diversity, promoting ANC visits, preventing diarrheal disease, and ensuring household food security are critical interventions. Healthcare providers should focus on behavioral change communication to increase dietary diversity, ANC attendance, and reduce diarrheal illness. The authors recommend quasi-experimental or experimental studies to further establish causal associations between NSA programs and child undernutrition.