In this study, the prevalence of malnutrition and associated factors in Amhara region was assessed. The prevalence of stunting, underweight and wasting in Amhara region was 46.3%, 28.4% and 9.8%, respectively. In this study, stunting and underweight are higher than that of the studies conducted in Ethiopia which were 38.3% and 23.3% [8], in Dale district 25.6% and 19% [15], Takusa district 36.5% and 19.5% [16], respectively. The prevalence of stunting and underweight in this study is higher than the finding reported in Nairobi Peri-Urban Slum 30.2% and 14.9% [17], respectively. This could be due to there is a difference in obstacles to under-nutrition such as cultural differences and other socio-demographic characteristics. The prevalence of wasting in this study is lower compared to the study conducted in Ethiopia 10.1% [8], in Haramaya district 10.7% [14], in Dale Woreda 14% [15], in Pakistan 10.7% [18] and Kilimanjaro Region, Tanzania 24.7% [5]. The prevalence reported in this study is higher compared to the one reported by Nairobi Peri-Urban slum 4.5% [17]. This divergence might be due to the difference in socioeconomic background, variation in sample birth weight, dietary habits and type of meals among the study population.
About 23.1% of children were both stunting and underweight, 7.3% were both underweight and wasting, and only 4.5% of children had all the three conditions. The prevalence of both stunting and underweight at this study is higher than compared to the study conducted in Ethiopia 19.47% [8] but lower than the study conducted in Kilimanjaro Region, Tanzania 33% [5]. The prevalence of all the three conditions at this finding is lower than the study conducted in Kilimanjaro Region, Tanzania 12% [5], but higher than in Ethiopia 3.87% [8]. The variation might be due to socioeconomic background, geographical characteristics of the study area, access to health care, cultural difference in dietary habits and care practices.
Among the factors considered in this study, Age of child in months, birth weight of the child at birth, mother highest education level, sex of household head and sources of drinking water were associated with stunting. The log odds of stunting were higher among children in the age group of 25–47 months and 48–59 months respectively as compared to the age group of 0– 24months. This finding is in line with the studies conducted in Ethiopia [8], in Haramaya district [14], in Pakistan [18] and Kilimanjaro Region, Tanzania [5]. Compared to children > 4 kg birth weight at birth, the odds of stunting among children in the 2.5-4 kg birth weight was 0.01 times lower. The odds of stunting among children in the < 2.5 kg birth weight at birth were 1.60 times higher compared to children’s > 4 kg birth weight at birth. This finding is supported by a study conducted previously in SNNPR, Ethiopia. [19].
The risk of stunting among children whose mothers attended secondary education was 0.70 times less compared to children whose mothers did not attend education. This finding is consistent with the study conducted in Bangladesh [20] and in Pakistan [18]. This is because if the level of education of the mother is low, her decision making and her contribution to the total family income will be low. This leads to the children stunting. The risk of stunting among children whose father household head was 0.49 times less compared to children whose mother household headed. Children from households that used unimproved drinking water were 1.47 times more likely to be at risk of stunting than children from households that used improved water. This finding is supported by the result of similar studies conducted in Haramaya District, Eastern Ethiopia [14].
The birth weight of the child at birth was associated with under-weight (P < 0.05). The risk of being underweight was 1.36 times more likely among children that were aged 48–59 months than those aged 0–24 months. This finding is supported by the study conducted in Ethiopia [8]. The risk of being underweight for children whose mother attended primary and secondary education were 0.23 and 0.35 times lower than children whose mothers who did not attend formal education respectively. This finding is supported by the study conducted in Ethiopia [8] and in Pakistan [18]. The sources of discrepancy might be due to maternal education contributes to proper infant feeding practices. Educated mothers might also have better income.
Children from a household with rich economic status were 0.09 times less likely to be under-weight compared to children living in a household with poor household economic status. This finding is supported by the study conducted in Ethiopia [8] and in Pakistan [18]. Children from rural areas were 1.16 times more likely to be underweight compared to children from urban areas. This finding is in agreement with the study conducted in Takusa district, Northwest Ethiopia [16]. The remarkable difference in the rate of underweight among rural and urban children might be differences in living circumstances, deviations in early screening of mothers at child conception in urban areas compared with rural areas, exposure to poor dietary diversity and greater risks of infections among rural children. Female children were 1.06 times more likely to be under-weighted as compared to male children. This study is against the studies conducted in Ethiopia [8], in Pakistan [18], in Bule Hora district, South Ethiopia [21] and in Dale Woreda, southern Ethiopia [15]. Children who were born with a < 2.5 kg birth weight were 1.80 times more likely to be under-weighted than children born > 4 kg birth weight and children who had born with 2.5-4 kg birth weight were 1.56 times more likely to be underweight than children born > 4 kg birth weight. This finding is in agreement with the study conducted in Ethiopia [8] and in Dale Woreda, southern Ethiopia [15].
Results of the multivariable binary logistic regression model showed that the type of toilet facility and sex of household head were significantly associated with wasting. Children living in a household with improved toilet type were 0.48 less likely to be wasting compared to children living in a household with unimproved toilet type. This finding is in agreement with finding in Bule Hora district, South Ethiopia [21]. Children from a male household head were 1.99 times higher compared to children from a female household head. Children of the rich household were 0.32 times less likely to be wasting compared to children living in a household with poor household economic status. This finding is supported by the study conducted in Ethiopia [8] and in Pakistan [18].
The risk of wasting was 1.08 and 1.52 times higher among children of 25–47 and 48–59 months than those 0–24 months, respectively. This finding is supported by the studies conducted in Dale Woreda, southern Ethiopia [15] and Kilimanjaro Region, Tanzania [5]. The odds of being wasting of children from rural areas were 1.18 times higher compared to children from urban areas. The variation might be due to food preference, food consumption patterns and inequalities in dietary diversity between urban and rural areas. This finding is consistent with the study conducted in Haramaya District, Eastern Ethiopia [14]. The odds of wasting were 0.04 times lower among female children than male children. This study is in line with the studies conducted in Bule Hora district, South Ethiopia [21], in Dale Woreda, southern Ethiopia [15], in Kilimanjaro Region, Tanzania [5] and Pakistan [18]. The odds of wasting was 1.17 times higher among children who lived in household members of > 4 children who had lived in household members of 1–2. This finding is in line with the study conducted in Dale Woreda, southern Ethiopia [15]. The probable reason is that when there are too many children who are living together in the family, there may be a tendency for under-nutrition to occur.
This study showed that among stunting, underweight, and wasting children, 41.5%, 45.8%, and 35.0% were anemic respectively. These findings are lower than compared with the study conducted in Ethiopia 61%, 64.3% and 68.2% respectively [8]. Moreover, the percentages of stunting, underweighting and wasting were lower among anemic children as compared to no-anemic children. Stunting children were 1.31 times more likely to be anemic compared to those of not stunting. Underweight children were 0.36 times less likely to be anemic compared to those of not underweight. Wasting children were 1.80 times more likely to be anemic compared to those of not wasting. These findings are supported by the study conducted in Ethiopia [8]. In the current study, anemia and malnutrition of children were highly associated with that anemic children were more likely to be malnutrition as compared to non-anemic [22].