The children's stunting level for 6-59 months in the district of Dubti, Afar, was 39.5%. The prevalence of severe and mild stunting was 9.93% and 29.6%, respectively. The level of stunting is designated to be very serious or critical in the study area, according to the WHO classification , which implied that stunting in Ethiopia remains a major public health challenge. The result is in line with the national prevalence of stunting, which shows 38% prevalence of stunting among under five children . However, the prevalence was lower than other studies conducted in the district of Hadibu Abote, Oromia region, reported to be 47.6% ; in the district of Bule Hora, South Ethiopia, 47.6% ; and 67.8% in the district of Asayita district, Eastern Ethiopia ; 56.6% in the district of Medebay Zana district, Northern Ethiopia ; 49.1% in the district of Libo-Kemekem, North-west Ethiopia . However, the finding was higher than the prevalence of stunting which was reported in Afambo district of Eastern Ethiopia, 32.2% ; the study done in Dollo Ado district 34.4% , another study conducted in eastern Ethiopia which showed prevalence of 34.4% [29, 30]; a study conducted in Delanta district in Ethiopia which reported a 22.1% prevalence of stunting . The discrepancy could be due to differences in the participants' geographic characteristics, period of study and other socio-economic characteristics. The consumption of milk and milk products in the study area could help to children growing and thereby minimize stunting, as verified by the scholarly article . This could be helpful to fight for improving nutritional status of children in the nomadic community, where a large population of cattle, sheep, goats, and camels are found.
Our study shows, as the child's age increases, so is the likelihood that it will stunt. Scholarly articles in Ethiopia and elsewhere in other parts of the globe [33-35] support the finding. Because stunting has a persistent and cyclical aspect, poor nutritional practice, weaning, lower and insufficient breast and complementary feeding methods have been undermined and become ineffective as the age of the child rises, this further induces stunting. Another possible explanation for increased risk of stunting in older children may be due to unhygienic preparation of supplementary foods which exposes children to recurrent infections. Restricted access to safe drinking water in the study area often exposes these children to varied types of infections and diarrheal diseases that raise the risk of chronic malnutrition even further.
In addition, this study indicated that household children who were poor in economic status were at higher risk of stunting. The finding is supported by similar studies in Ethiopia [34, 36], and elsewhere in Africa . It is well understood that poor people are suffering from poor diet, inadequate schooling, poor clothing, poor hygiene and health, resulting in children suffering from failures in growth . Policies seeking to increase the number of animals in the nomadic culture are therefore crucial in combating malnutrition. Increasing animal health by raising awareness about the prevention and control of animal diseases, improving access to animal health facilities and, most importantly, piling up animal fodder is necessary.
This study suggested that children born from households who drink from unimproved water sources (river) were at higher risk of stunting compared to children from households who drink from safer sources. The finding is corroborated by similar studies in Ethiopia, which showed that households who drink water from an unprotected source were more stunted than their counterparts [26, 34]. The possible explanation could be lack of safe water that exposes these children to varied types of infections and diarrheal diseases that increase the risk of chronic malnutrition even further. Improving access to improved water sources is very important to combat the problem of malnutrition in the area. The study stressed that non-nutrition-specific interventions are of paramount importance in improving the problem.
In this study it is found that early initiation of breast feeding for the inborn is associated with stunting. Children whose mothers started breastfeeding within one hour after birth were less suffering from stunting. It is generally recommended that children start breast feeding immediately after birth to improve the child nutritional status. This may be because early breastfeeding initiation helps for effective breastfeeding via increased secretion and breast milk output which will provide the developing baby with adequate nutrient like colostrum . Colostrum provides the infant with natural immunity and also has an input in reducing hypoglycaemia and hypothermia which in turn has a devastating effect on the infant's health status [31, 37]. This study re-affirms the WHO recommendation which underscores the significance of timely breastfeeding on child health . This finding is supported by similar studies conducted in Tigray, Northern Ethiopia ; in Indonesia . These findings show early initiation of breastfeeding as a method of early-life maternal treatment and best nutrient that can minimize the risk of stunting. Early breastfeeding is one of the entrances to successful later breastfeeding and ensures that children are provided enough food intake . Therefore, in order to promote child health and improve the nutritional status of children, health education should be provided to mothers about the value of breastfeeding their infants immediately after birth, during post-natal care, and by health extension workers and the women health development armies.
Moreover, the study revealed that exclusive breast feeding is one of the significant predictors of stunting. Children who hadn't been breastfed exclusively for at least 6 months were 2.57 times more likely to get stunted. The study corporates similar studies performed in different areas among under five children [40-43]. The probable reason is that inappropriate timing for introducing certain kinds of complementary food to a child can affect its nutritional status because its digestive and immune systems are not yet mature. Previous implementation of supplements, in particular under unhygienic conditions, may be a major cause of malnutrition . Exclusive breastfeeding is very important, especially in the area where the sanitation status is very low to prevent infections that could impede the child's development. For its benefit, therefore, the mothers should be advised and the enabling environment should be established which promotes optimal breastfeeding.
This study suggested that lack of sufficient food diversity was found to be a stunting indicator. Children who have consumed less optimal dietary diversity are 93% more likely to be stunted. Various similar studies conducted in Ethiopia and elsewhere support this finding [44-46]. Therefore this study indicates that malnutrition can be minimized by increasing complementary food dietary diversity. Households should be trained and encouraged to include sufficient and diverse foods that can meet the child's need for energy and nutrients. Since pastoral community owns a large number of cattle, it is imperative to provide their children with milk.
The study has the limitations set out below. Because of the studies cross sectional design, we cannot declare a temporal relationship between the stunting and other independent variables. Standard procedures have been used for height / length measurement but errors in measurement are inevitable, especially within assessors. In addition, a recall bias can occur in the reporting age of Children live in rural villages. Nevertheless, we have tried to confirm the age reported in the immunization card if available.