The intention of this study was to measure the prevalence and associated factors of stunting among preschool children of shire Endassilasie. Stunting is a cumulative process that can begin in utero and continues to about three years after birth. In the study area, the prevalence of stunting was 35 %. There was a slight age difference in stunting between the study group as the prevalence was 18.1% and 16.9 among male and female respectively. Significant difference among age group was also detected marking higher prevalence among 24–47 months of age group (15.1%), followed by 48–59 months (10.4%) then the least among study participant were age group of less than 24 months with the prevalence of 9.5%.
The 35% stunting prevalence testifies that the population in this area is affected by high risk of malnutrition according to the WHO classification of severity of malnutrition [16]. The prevalence of stunting among the study population was almost the same when compared with the study conducted in other areas with reasonably high malnutrition burden. For instance the study conducted in Bangladesh, Indonesia and Pakistan showed the stunting prevalence of 36.1%, 33.7% and 55% respectively [18, 19, 24]. The same finding was also recorded in the study conducted at Jigjiga town Eastern Ethiopia showing 34.9% of under five were stunted [17]. However, the study conducted in northern part of Ethiopia showed the lower result when compared to the result obtained from this study. For example the detected prevalence in Libo Kemekem, Lalibela town, Wukro town and Medabay Zena were 49.4%, 47.3%, 49.2% and 56.7% respectively [20–23]. The difference could be attributed to the difference in the study period, variation in the age category of target populations, Geographic location and the recently initiated nutrition-sensitive intervention activities in the study area.
The finding our study was higher when compared to the study conducted in Southern part of Ethiopia. with this, the stunting prevalence of the study finding in Kembata, Hawassa and Wolaita Sodo shows 18.8%, 26.6% and 27% respectively [25–27]. In Ethiopia there is the difference in socioeconomic, culture, feeding habits, environmental factors, and public service utilization of the community in the study area between Southern and Northern part. Therefore, it’s believed that the difference in stunting prevalence might have been contributed by such variation in socio cultural differences between southern and northern part of the country. Additionally, the finding of this study showed that the stunting prevalence increases with the age of the child. This association is inline with other studies conducted in the North and Northwest Ethiopia [29, 30]. This might be due to the nutritional status of the mother since stunting has a chronic and cyclic nature. Additionally, poor dietary practice, weaning, lower and inappropriate breast and complementary feeding practices have an effect on child growth as age increases. The other possible explanation for the increased risk of stunting might be due to environmental factors like poor sanitation and hygiene practice which increase the risk of choric malnutrition.
There is also variation in stunting prevalence between male and female. This result in line with studies conducted in Ethiopia [31], Nigeria [32] and the sub-Saharan countries [33]. This could be because of social factors like favoritism towards daughters [33]. Environmental factors such as parasitic infections like intestinal helminths could be worse the existing malnutrition. Additionally, biological factors including the common child illness predominately affect males than females and this in turns contribute for the higher prevalence among males [31].
Choric malnutrition arises from multifaceted and interrelated circumstances in which food security is the core factor. The present study showed that monthly income was significantly associated with stunting. The odd of being stunted is substantially higher among the low income group. This finding suggests that a child’s health status depends upon the socio-economic status of their families. Similar association was seen in studies conducted in Holeta Town [34], Wolayta sodo [27], Lasta district [35]. This could be due to the fact that rich households have greater purchasing power of food to maintain the health of their children. However, being rich is not guaranteed according to the WHO report, stunting may also arise due to inadequate knowledge of food, feeding practices, inappropriate food allocation, and poor hygiene practices [36].
Additionally, this study identified that water source is one the factor associated with child stunting. Children from households using unprotected water sources are more likely to be stunted than children from households that are using protected sources. This is also supported by other similar studies conducted in Arba Mich[37], Medebay Zena [23]. Other study conducted out of Ethiopia showed similar finding; for instance study conducted in Tanzania [38], Zambia and other 59 countries [39] showed the same results. Unsafe drinking water causes diarrheal diseases thereby inhibiting nutrient absorption, which can lead to under nutrition and stunting.
Our results show that having enough time to prepare a meal is inversely associated with the child stunting. The odd of stunting among busy mothers to prepare a meal for their child is 3.8 times compared to children’s from mothers that have enough time to prepare meal. Consistent finding has been observed in studies conducted in Southern [25, 40] and Eastern [41] part of Ethiopia and Bangladesh [42]. This commonly related to the mother’s occupational status that impacts the intimacy with their child. Additionally, mothers who spent most of their time out of a home cannot provide sufficient care for their child. Therefore, busy mothers have short period to breastfeed their child, enforced to cease breastfeeding early that increase exposure to bottle feeding and improper complementary feeding practice.
This study also identified a significant association between stunting and time of breast feeding. Children who breast feed as per the feeding frequency have less chance of being stunted compared to children that feed in response to crying. A imilar association was seen in the studies conducted in Guto Gida of East Wollega [43], Sidama [44] and Lasta district [35]. Proper breastfeeding has an impact on averting early infant death as well as reducing child stunting. However, breast feeding practice could be affected by socioeconomic factors like low parental education especially mother’s education, mothers' employment and another poor socio-economic status.
Another identified association was family planning usage and child stunting. Mothers who use family planning have lower chance of having stunted children when compared to nonusers of family planning. This finding was in line with studies conducted in the Sodo Zuria District of Ethiopia [45] and India [46]. The observed association might be due to loss of macro and micronutrient that occurs due to repeated pregnancy, delivery and breast feeding. Moreover, unplanned childbearing could elevate the risk of intrauterine growth restriction (IUGR), low birth weight (LBW), premature birth, and small birth size [47].
Even though this study shows reliable finding when compared with domestic and international journals, it exhibits the following limitations. The study cannot declare a temporal relationship between stunting and other independent variables because cross-sectional design was used for this study. Even though standard procedures were used for the measurement of height/length, measurement errors are inevitable especially within evaluators. Moreover, there might be a recall bias in reporting the age of children.