We found that the prevalence of wasting was 34.2% among children aged 6–23 months, of which; 12% were severely wasted. The main predictors of wasting were occupation of the father, time of initiation of complementary feeding, time of breastfeeding initiation, immunization status of the child, educational level of the mother/caregiver and ANC service follow-up of mother during her last pregnancy. Further, we assessed socio-demographic factors, infant related factor, maternal related factors, environmental factors and MUAC related factors. As the result, presence of occupation of the father, time of initiation of complementary feeding, time of breastfeeding initiation, child immunization, educational level of mothers/caregivers and ANC service during last pregnancy mother being used were significantly associated with wasting among children aged 6-23 months.
We found that more than 1 in 3 children were wasted (34.2%). This finding was much closer to a prevalence of study done in Gojjam zone, Amhara (35.5 %,) (6), in 12 kebeles in the kersa HDSS (Eastern Ethiopia) (16.8%) (26), in libokemkem Likeke District, Amhara Region, Ethiopia (7.10%) (21), Sidama zone, Ethiopia (20.5%) (15), wukro town, Tigray regional 28(7.2%) (17). The reasons for this discrepancy might be attributed to the difference in geographical location among the study areas and methodology including sampling techniques. For instance, our current study was conducted in wasting endemic area with a high rate of malnutrition. That could be related repeatedly occurring droughts and civil wars compared the neighbor countries like Ethiopia and also socio-economic differences such as religion, culture and feeding habits. In general, the population living in malnutrition endemic areas have a greater chance to occur in malnutrition. In contrast, those living in low-rate wasting areas have a low probability of being wasting, which can lead to a low prevalence of wasting.
However, our current study finding of prevalence of wasting was lower than a study done at Bule-hora district, south Ethiopia (47.6) (7), Sindh, Pakistan (48.2%) (20), Haramaya district eastern Ethiopia (45.8 %) (45), west Gojjam zone, east Gojjam zone (44.7%) (19). Belesa District, northwest Ethiopia (57.7%) (13), in Dabat HDSS site Amhara Ethiopia (58.1%) (12). The difference in the prevalence might be due to, study periods, study designs and economic differences between the study areas as well as better implementation of improved wasting interventions including to enhance availability and maintenance of occupation of the father, increasing the awareness of feeding exclusive breastfeeding, increasing midwiferies skills to motivate delivery mother in sake of feeding a birth child to feed colostrum immediately, to enhance awareness campaigns of child immunization, and to increase the level of mothers/caregivers educational level and empowering mothers to attend ANC during their pregnancy in our study area. Based on proposal communication on of the regional health office, this difference may be due to better availability of supplementary feeding in Garowe, good health awareness of the community, increase educational level of mothers/caregivers, midwiferies skills and expanded health service coverage and utilization in Garowe city.
Our findings showed that the status of wasting children was significantly associated with among those children their father’s occupation is a daily labor had a significant association with wasting. This finding in line/similar with a previous study in Gonder town, Ethiopia (1), which found that those children whose fathers were daily labor were highly likely to increase risk of wasting among children aged 6-23 months
we observed that, the time of initiation of complementary feeding had a significant association with wasting. This finding was agreed with a previous study in Gondar Town (1), and in East Belesa District, northwest Ethiopia. (13). which found that children were not exclusive breastfeed or mothers/caregivers started feeding other foods before six months had significantly increase the risk of wasting among children aged 6-23 months.
The finding of current study indicated that, children who were breastfeed colostrum after a birth some hours later but less than 24 hours (pre-lacteal feeding) had a significantly association with wasting. similar finding was reported at East belesa district, northwest Ethiopia (13) and Dubti district samara (16). Which found that children those mothers give pre-lacteal feeding to their children had significantly increase the risk of wasting among children aged 6-23 months.
In this study, children did not take immunization had a significance of association with wasting compared the immunized mothers/caregivers. This was corroborated with previous studies in Wonsho Woreda, Southern Ethiopia (8), Mecha district Ethiopia (10) and Dubti district, Samara (16). Which found that children did not take immunization had significantly increase the risk of wasting among children aged 6-23 months. Furthermore, Children whose mothers were uneducated had a significantly association with wasting, compared with educated mothers/caregivers. This finding was in line with previous evidences in libokemkem Amhara district, Ethiopia (21), Dodoma region, Tanzania (23), Mecha District, Amhara Regional State, (10), which found that children whose mothers/caregivers were uneducated had significantly increased the risk of wasting among children aged 6-23 months, while the other hand a finding study in Sindh, Pakistan (20). They found that children who were educated mothers had no significant associated with wasting among children aged 6-23 Besides, mothers did not visit ANC last pregnancy had a significant association with wasting compared children those whose mothers take ANC during last. The current finding was agreed with previous studies in Merhabete woreda (district), North Shewa zone (2) and Haramaya district, eastern Ethiopia (45). That found positively associated with wasting among children aged 6-23.
Overall, timely intervention strategy is a mandatory and should be focus on the World Health Organization (WHO) recommendations, in this study although majority of the fathers occupation is a daily labor, time of initiation of complementary feeding, time of breastfeeding initiation, children’s doesn’t take immunization, mothers those are uneducated level and mother hadn’t attend ANC service, so the health care providers in the region and stakeholders should create health awareness campaigns on the importance of attending ANC service for mothers, specifically target pregnant women during routine care visits, every children to complete exclusive breastfeeding, enhance midwiferies skill to increase immediate feeding of colostrum, immunization of the child to reduce the rate of wasting, to increase level of educational mother and create job vacancies to increase the fathers income of the family because most of daily labor father are difficult to get secure money that they can feed their families.
Strength and limitations of the study
There might be potential recall bias among respondents answering questions relating to events happening in the past. we tried to control the bias through care full selection of the research questions, choosing appropriate data collection method, getting feedback from may respondent and double check data thoroughly double entry). And the measuring scales were well calibrated and standardized to overcome this problem. And since the study was community based and interview was conducted by going house to house, it can be represented community