This study findings revealed that the prevalence of stunting, underweight and wasting among children aged 6–23 months were 49.9%, 34.8% and 13.4% among Dalit, while 39.0%, 25.0% and 8.7% among Non-Dalit respectively. The prevalence of severe stunting, underweight and wasting were 18.1%, 11.4% and 2.0% in Dalit whereas 12.0%, 4.0% and 2.0% in Non-Dalit. These proportions become higher than the finding from South Africa, Maldives Sri Lanka, Ghana and Nepal Northwest Ethiopia, but it gets lower than India. The findings of under-nutrition among Dalit became similar to the study findings of South Ethiopia. This undernutrition findings got supported from the findings of province 2 of Nepal. In Nepal, the trend of under-nutrition was decreasing from 1996 to 2016, but not satisfactory level. The different in the prevalence of stunting, wasting and underweight in Dalit and Non-Dalit might be due to education of mother and father, knowledge on child feeding duration of food sufficiency and utilization of health services. Undernutrition increases risk of the child mortality as well as child morbidity and impair cognitive and physical development. So this findings is also suggested that it remains a severe public health concern.
The findings from the multivariable logistics regression analysis stated that stunting were not significantly associated with birth interval, family type, fathers’ education, household owning agriculture land, mothers' occupation, and place of delivery in Non-Dalit. The study reveals that the stunting got protected among children aged 6–11 compared to 12–23 months in Non-Dalit. This result was in line with a study conducted in Ethiopia and Indonesia. This result got reinforced by the result of somewhere else. Similarly, the findings showed that the underweight was also protected among 6–11 months as compared to 12–23 months in Dalit. The findings got supported from the study of Pakistan, Indonesia. Undernutrition is less among children younger than six months because child nutrition depends upon the breastfeeding. In Nepal, some of the children got breast milk a year by their own mother. In this age, the practices of child feeding remain the major contributor to under-nutrition[36, 38].
The result from the multivariable logistics regression analysis revealed that stunting were not found significantly associated with timely initiation of complementary feeding, media exposure, knowledge on child feeding and ANC visit in Dalit. This study findings stated that the stunting were more likely among children living with the nuclear family than joint family in Dalit. The findings of study got reinforced from the study conducted in Nepaland Kenya. An approximately one-fourth of the child mothers (24.1%) were working as a daily wage/labor among Dalit. At the time, mothers might not be able to care properly to their children. Those mothers who were working in the field setting were keeping with them were not feeding frequently, which might affect on feeding practices of the child. Children are not living in a single family who get appropriate care by someone (for example-grand-parents) during busy of her/his mother.
This result indicated that stunting was more likely among mother who did not visit ANC than mother who visited ANC in Non-Dalit. This result gets reinforced by a study conducted in Indonesia. Recommended ANC visit might support to improve knowledge regarding appropriate feeding practices of the child and got a chance to proper counseling regarding child nutrition and utilization of health services, resulting optimal feeding of the child and decreases undernutrition.
The findings of study showed that stunting was more likely among mother who did not expose to media than mother who exposed to media among Non-Dalit. This result got reinforced by the findings of Bangladesh. Similarly, the findings stated that underweight was more likely among mother who did not expose to media as compared to mother who expose to media among Dalit and Non-Dalit. Different studies showed that inadequate feeding practices were significantly associated among the mothers who have limited exposure to media, which means positive effect of media on child feeding[42, 43]. Media might be as an effective for promoting child feeding practices and also enhance knowledge on health and nutrition of the child. Furthermore, it might help in reduction of under-nutrition among children.
The result from the multivariable logistics regression analysis revealed that underweight were not found significantly associated with family type, household owning agriculture land, father education, main source of family income, minimum acceptable diet (MAD), MDD and child illness past two weeks in Dalit. The findings indicated that the underweight was more likely among child mother who did not have knowledge on child feedings as compared to mother who have knowledge on child feeding in Dalit. This findings got reinforced from the results of Nigeria. Lack of the knowledge among mother was a key barriers for adequate child feeding practices[43, 45]. In addition, this study showed secondary and above level maternal education was very low (11.7%). Appropriate complementary feeding practices such diversified food and minimum acceptable diets were associated with child under-nutrition. It shows lack of information regarding dietary diversity as well as frequency of nutrient taking practices. So, maternal awareness and education help to improve nutritional status among children by improving knowledge on child feeding.
The result revealed that underweight was more likely among the family with less than a year duration of food sufficiency as compared to the family with a year or more than a year duration of food sufficiency. The findings of a study state that food insecurity is associated with underweight in Iran. The families having sufficient food might feed adequately to their children. The findings revealed that wasting was found less likely among children having birth interval up to two years as compared to children having birth interval above two years among Non-Dalit. This findings became contrast with a study conducted Ethiopia. The proportion of wasting was high among children 24 months while it is not significant. The evidence showed that lower the birth interval is higher risk of mortality and morbidity[49, 50]; but not all. When mothers get feed elder child and at the same time they also feed younger, therefore wasting might be protected among children with birth interval up to two years.
This findings of study showed that wasting was more likely among children who were not recommended minimum meal frequency as compared to child who got recommended MMF among Dalit. This findings got supported from the result of Ethiopia and Indonesia. This study revealed that about one-fourth of the Dalit child mother were daily wages/labour. The mothers who were working in the field setting and keeping a child did not feed frequently. Similarly, only two-fifth of Dalit child mother had an appropriate knowledge on child feeding practices. Inappropriate knowledge among mothers was an important barriers for adequate complementary feeding practices[43, 45]. Likewise, only one-tenth of the Dalit mothers had secondary and above education. Some of the findings of study showed that mother education was associated with inappropriate child feeding practices and wasting. So, appropriate child feeding practices could help in reduction of undernutrition.
This cross sectional comparative study demonstrated the prevalence and associated factors of stunting, wasting and underweight for Dalit and Non-Dalit. Obviously, the study is not free from the some of the limitation. The questions related socio-economic, health, knowledge and complementary feeding practices were not observed, based on the mother response which might be affected by recall and social desirability bias.