Fikadu et al.

BMC Public Health 2014, 14:800

http://www.biomedcentral.com/1471-2458/14/800

RESEARCH ARTICLE Open Access

Factors associated with stunting among children

of age 24 to 59 months in Meskan district,
Gurage Zone, South Ethiopia: a case-control study
Teshale Fikadu1, Sahilu Assegid2 and Lamessa Dube2*

Abstract
Background: Stunting is one of the major causes of morbidity among under-five children Knowledge about risk
factors of stunting is an important precondition for developing and strengthening nutritional intervention strategies.
The purpose of this study was to assess factors associated with stunting among children of age 24 to 59 months in
Meskan District of Gurage Zone, South Ethiopia.
Methods: Community based case-control study was conducted among children of age 24 to 59 months. A multistage
sampling technique was used to select the study participants. Cases were stunted children while controls were not
stunted children. A total of 121 cases and 121 controls were studied.. Data were analyzed using SPSS 16.0 statistical
software.
Results: Children living in households with eight to ten [Adjusted Odds Ratio (AOR) = 4.44, 95% CI: 1.65, 11.95] and five
to seven [AOR = 2.97, 95% CI: 1.41, 6.29] family members were more likely to be stunted than those living in households
with two to four family members. Similarly, children living in households with three under-five children [AOR = 3.77, 95%
CI: 1.33, 10.74] were more likely to develop stunting than those living in households with one under-five child. Children
whose mothers worked as merchants [AOR = 4.03, 95% CI: 1.60, 10.17] were more likely to be stunted than children
whose mothers worked as house wives. Children who breast fed for <2 years [AOR = 5.61, 95% CI: 1.49, 11.08] were more
likely to be stunted than those who breast fed ≥2 years. Children who were exclusively breast fed for <6 months [AOR =
3.27, 95% CI: 1.21, 8.82]were more likely to develop stunting than children who were exclusively breast fed for the first 6
months. Children who bottle fed [AOR =3.30, 95% CI: 1.33, 8.17)] were more likely to be stunted than children who fed
their complementary food using spoon/cup.
Conclusions: Family size, number of under-five children in the household, maternal occupation, duration of exclusive
breastfeeding, duration breast feeding, and method of feeding complementary food were independently associated with
stunting. Thus, public health intervention working on improving child nutrition should consider these determinants.
Keywords: Stunting, Children, Factors, Ethiopia

Background The three main indicators used to define undernutrition,

Adequate provision of nutrients is crucial to ensure good i.e., stunting, underweight and wasting; that represent
physical & mental development as well as for long-term different histories of nutritional insult to the child and
health. Undernutrition accounts 35% of all deaths among measured by height for age, weight for height and weight
under-five children. More than 2 million under-five chil- for age indexes respectively. Stunting is a measure of
dren die each year due to undernutrition [1]. Under- chronic malnutrition. Undernutrition in low and middle-
nutrition refers to a state resulting from a relative or income countries was high. Both stunting & underweight
absolute deficiency of one or more essential nutrients. are highest in Eastern Africa. About 42% of children in
sub-Saharan Africa and 182 million (32.5%) children in
* Correspondence: dubelamessa@yahoo.com
2 developing countries were undernourished and the stunt-
College of Public Health and Medical Sciences, Department of
Epidemiology, Jimma University, Jimma 378, Ethiopia ing trend was stagnant in Africa from1990 to 2010 [2-6].
Full list of author information is available at the end of the article

© 2014 Fikadu et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
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Undernutrition can best be described in Ethiopia as a purpose of this study was to assess factors associated
long term year round phenomenon due to chronic inad- with stunting among children of age 24 to 59 months in
equacies of food combined with high levels of illness in Meskan district for the development and improvement
under-five children which 44.0%, 29.0% & 10.0% were of implementation and intervention strategies to reduce
stunted; underweight and wasted respectively [7]. Simi- child mortality and morbidity.
larly 53.6%, 32.7% & 7.0% of children aged 24 to
59 months were stunted, underweight and wasted re- Methods
spectively [7]. Study setting, design and sampling
Studies show that stunting is associated with deprived A community based case-control study was conducted
attention, memory impairment, reduced learning, and from February to March 2013 in Meskan district,
memory in children, low school enrollment, and de- Gurage Zone, South Ethiopia. The district is located at
creased higher cognitive functioning with a slowing in 135 kilometers south of Addis Ababa (the capital city of
the rate of cognitive development. These finally result in Ethiopia). It had an estimated total population of 228,852
low adult wages and lost productivity [8-10]. and under-five children of 35,724 from this about 61%
The causes of malnutrition are numerous and multifa- (21970) were between the ages of 24 to 59 months in the
ceted. These causes are intertwined with each other and year 2012/13 which is projected from 2007 Ethiopia Cen-
are hierarchically related. The most immediate determi- tral Statistical Agency. The district has a total of 50 func-
nants are poor diet and disease which are themselves tioning health institutions (2 hospital 8 health center and
caused by a set of underlying factors; household food se- 40 health posts).
curity, maternal/child caring practices and access to Cases were stunted children aged 24 to 59 months:
health services and healthy environment. These under- height-for age z- score below -2SD from the median
lying factors themselves are influenced by the basic fac- height of the WHO reference population. While Controls
tors (socio-economic and political conditions) [2,11]. were children aged 24 to 59 months without stunting.
Undernutrition are multiple and inextricably linked to Sample size was calculated using Epi info version 7 by
poverty (low socioeconomic status). Many studies re- assuming the proportion of mother with educational sta-
vealed that lowest prevalence of stunting was found tus of primary or less among controls and cases were
among children from families with higher per capital in- 70.4% and 91.3% respectively [30], 95% CI, 80% power,
come (socioeconomic status) [12-14]. When a child lives case to control ratio of 1:1, design effect of 2 and
in an area of low income level the chance of disease in- accounted for 10% possible non-response. The total
crease and these diseases can increase the risk of stunt- sample size was 242 (121 cases and 121 controls). To
ing [15]. More children suffering from stunting were calculate sample size, maternal education was chosen as
observed among mothers of low educational levels than an independent variable since it gave maximum sample
those with high educational levels [13,16,17]. Under- five size and study conducted in Uganda was used because
children living in a household with large family were at we did not find the proportions among cases and con-
higher risk of being stunted. Similarly, under- five chil- trols of there was neither a study done of children ages
dren living in households with more than one under-five of 24-59 months in Ethiopia. Design effect was used.
were more likely to be stunted [12,13,17]. Studies con- The reason is two steps were required to reach or iden-
ducted in Ethiopia and abroad reported that the quan- tify the study participants.
tity, frequency, and type of supplementary feeding, birth A multistage sampling technique was used. Two urban
weight, sex, birth order and disease conditions like diar- and thirteen rural kebeles (the smallest administration
rhea were strongly associated with stunting among unit in Ethiopia) were selected out of 6 urban & 40 rural
under-five children [13,15,18-30]. Housing environment kebeles by simple random sampling technique (lottery
such as lack of safe water supply, access to a toilet facil- method) after stratifying the district in to urban and
ity and inadequate sanitation were among the factors rural kebeles. All children of age 24 to 59 months living
that increased the risk of stunting [20,25]. in selected kebeles were measured for their z-score of
Comprehensive knowledge about the risk factors of height for age and categorized as stunted and not
stunting in local context is vital to reduce stunting rate, stunted to generate sampling frames for cases and con-
to develop prevention strategies and strengthen nutrition trols by a census conducted prior to the actual data col-
intervention programs. Despite higher prevalence of lection. During the census 15,316 households were
stunting among children age 24 to 59 months, there are included from the 15 selected kebeles. A total of 7,367
limited studies that reports about risk factors of stunting (3,445 stunted and 3,922 not stunted) children between
among children age 24 to 59 months separately. Besides age of 24 to 59 months were measured for height for
neither case-control nor cohort study was done to iden- age. The total sample size of cases (stunted children)
tify risk factors of stunting in the district. Thus the was allocated proportionally to the selected kebeles
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based on number of stunted children identified during tabulations were used to check consistency. Composite
census. Then simple random sampling method (gener- scales were constructed to represent a single construct.
ated by computer) was used to recruit cases from each In this study current maternal knowledge as a proxy of
selected kebele. A control was selected from the next past maternal knowledge was assessed by eleven know-
house (neighbor) using a code of house number in as- ledge questions on breast feeding (time of initiation, exclu-
cending order. If two or more eligible controls were sive breast feeding and duration breast feeding) and
found in the same household then one of them was se- complementary feeding practices (time of starting,
lected randomly. method of feeding and frequency). If a mother responds
correctly < 60%, 60%-75% and > 75% of the total know-
Measurements ledge questions, she is considered as having poor, fair and
Thirty health extension workers were trained to carry god knowledge respectively. Wealth index was computed
out a census to identify source population of cases and as a composite indicator of living standard based on vari-
controls group, via interviewing the mother and obtain- ables related to ownership of selected household assets,
ing the anthropometric measurements of each child. agricultural land, quantity of livestock and materials used
During the census health extension workers measured for housing construction. The computation was made
the height and identified the age of each child aged be- using principal component analysis and a single continu-
tween 24 and 59 months. Height was measured in a ous variable was generated by summing up the principal
standing-up position to the nearest 0.1 cm using a components into one. Quartiles of wealth index were
standard vertical board with a detachable sliding head- generated using the composite score.
piece. In rural areas it is very difficult to get the age cor- After cleaning data for inconsistencies and missing
rectly. This may leads to misclassification of cases and values, descriptive statistics were done. Then after, bi-
controls. Thus ages of children were estimated using Ex- variate analysis was done for all explanatory variables to
panded Program of Immunization registration book or identify those associated with children stunting. Vari-
immunization card when possible and asking the mother. ables with p-value less than 0.25 in the bivariate analysis
The indices were calculated using WHO Anthroplus ver- were included in a backward stepwise logistic regression
sion 3.2.2 statistical software. procedure. Odds ratios (95% confidence intervals) were
Data were collected using structured questionnaire via calculated to determine the association between stunting
face to face interview with participant’s mothers or care and independent variables. Model fitness was assessed
takers. In this study the following independent variables using Hosmer and Lemeshow test (p = 0.697). Collinear-
or factors were assessed: religion, ethnicity, wealth index, ity and interaction between independent variables were
family size, parental age, marital status, parental occupa- checked and not found. Data were presented using
tion, maternal knowledge, number of under-five children, tables.
source of drinking water, availability of toilet, waste dis-
posal, antenatal care, place of delivery, immunization sta- Ethical consideration
tus, time of initiation of breast feeding, duration of The ethical clearance was obtained from Jimma Univer-
exclusive breast feeding, duration of breast feeding, time sity, Ethical review board. Written consent was obtained
of initiation of complementary feeding, type of comple- from caretakers of under-five children. Child with no
mentary food, method of complementary feeding and treated diarrhea, respiratory tack infection and fever/
number of meal per day, diarrhea, malaria and acute re- malaria were referred to nearby health centre.
spiratory tract infections. In addition to these age, sex,
type of birth (singleton or multiple), birth order of the Results
child were also assessed. The questionnaire was initially A total of 242 children (121cases and 121 controls) were
prepared in English and translated into local language, participated in this study. All of the study participants
then retranslated to check consistency. The instrument were singleton birth. Sixty five (53.7%) of cases as well
was pre-tested in 5% of sample size in non-selected kebele. as controls were male. The median birth orders of cases
The data were collected by five data collectors who have & controls were 4 and 3 respectively. Hundred thirteen
first degree in public health after two days training. Filled (93.4%) of children’s mothers were Gurage by their eth-
questionnaires were checked daily for its completeness by nicity. Majority of participants’ mothers, 97(80.2%) of
supervisors. cases and 90(74.3%) of controls, were Muslim by reli-
gion. Mothers of 68(56.2%) and 59(48.8%) of cases and
Data analysis controls were illiterate respectively. Nearly two fifth of
Data were checked for completeness, edited, coded and the controls’ mothers were house wife (Table 1).
entered into Epi data version 3.1 and exported to SPSS Study participants (children) living in households with
16.0 statistical software for analysis. Frequencies and cross eight to ten [Adjusted Odds Ratio (AOR) = 4.44, 95% CI:
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Table 1 Socio-demographic characteristics of the study Table 1 Socio-demographic characteristics of the study
participants and their mothers in Meskan district, Gurage participants and their mothers in Meskan district, Gurage
Zone, South Ethiopia, March 2013 Zone, South Ethiopia, March 2013 (Continued)
Variable Case control Number of under 5 children
p-value
Nº (%) Nº (%) 1 41(33.9) 66(54.5)
Sex 0.001
2 60(49.6) 48(39.7)
Male 65(53.7) 65(53.7) 0.89
3 20(16.5) 7(5.8)
Female 56(46.3) 56(46.3)
Birth order
Ethnicity
1-3 53(43.8) 61(50.4) 0.36
Gurage 113(93.4) 113(93.4) 0.80
Above 3 68(56.2) 60(49.6)
Other than Gurage 8(6.6) 8(6.6)
Maternal Religion
Muslim 97(80.2) 90(74.4) 1.65, 11.95] and five to seven [AOR = 2.97, 95% CI: 1.41,
0.47 6.29] family members were more likely to be stunted
Orthodox 16(13.2) 18(14.9)
than those living in households with two to four family
Protestant 8(6.6) 13(10.7)
members. Similarly, children living in households with
Maternal education three under-five children [AOR = 3.77, 95% CI: 1.33,
Illiterate 68(56.2) 59(48.8) 0.31 10.74] were more likely to develop stunting than those
Literate 53(43.8) 62(51.2) living in households with one under-five child. Children
Maternal Occupation whose mothers worked as merchants [AOR = 4.03, 95%
CI: 1.60, 10.17] and farmers [AOR = 3.92, 95% CI: 1.89,
Farmer 50(41.3) 38(31.4)
0.01 8.16] were more likely to be stunted than children whose
Merchant 26(21.5) 14(11.6)
mothers worked as house wives. Children who breast
House wife 45(37.2) 69(57.0) fed for less than two years [AOR = 5.61, 95% CI: 1.49,
Father Occupation 11.08] were more likely to be stunted than those who
Farmer 102(84.3) 99(81.8) 0.73 breast fed for two or more years. Children who were ex-
Merchant 19(15.7) 22(18.2) clusively breast fed for less than six months [AOR =
3.27, 95% CI: 1.21, 8.82] and greater than six months
Maternal age (in years)
[AOR = 7.62, 95% CI: 1.80, 12.23] were more likely to
20-24 6(5.0) 9(7.4)
develop stunting than children who were exclusively
25-29 52(43.0) 43(35.5) 0.63 breast fed for the first 6 months. Children who bottle
30-34 31(25.6) 37(30.6) fed [AOR =3.30, 95% CI: 1.33, 8.17)] and fed by hand
above 35 32(26.4) 32(26.4) [AOR = 3.04, 95% CI: 1.46, 6.32] were more likely to be
Marital status stunted than children who fed their complementary food
using spoon/cup (Table 2).
Married 110(90.9) 118(97.5) 0.27
Divorced/Widowed 11(9.1) 3(2.5)
Discussion
Wealth index This study intended to identify the factors associated to
1st Quartile 35(28.9) 24(19.8) stunting among children age of 24 to 59 months using
2 nd
Quartile 36(29.8) 26(21.5) 0.02 analytic study design. However, certain limitations may
3rd Quartile 29(24.0) 31(25.6) arise in the study such as recall bias and absence of data
on: maternal nutrition, heights of the mothers, house-
4th Quartile 21(17.4) 40(33.1)
hold food security and parasitic infections. There may be
Family size
also misclassification of case and control, because of it is
2-4 24(19.8) 44(36.4) very difficult to get accurate age in country like Ethiopia.
0.02
5-7 73(60.3) 60(49.6) Efforts were made to get accurate age by asking for
8-10 24(19.8) 17(14) immunization card of the participants during the census.
Children age (in months) Lastly, since case-control study design was employed, it
does not enable to establish temporality.
24-35 48(39.7) 30(24.8)
0.01 In this study participants living in households with
36-47 48(39.7) 46(38.0)
high number of under-five children were about 4 times
48-59 25(20.6) 45(37.2) more likely to develop stunting than those living in
households with least number of under-five children.
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Table 2 Factors independently associated with stunting among children of age 24 to 59 months in Meskan district,
Gurage Zone, South Ethiopia, March 2013
Variable Case Control Crude OR Adjusted OR
Nº (%) Nº (%) (95% CI) (95% CI)
Family size
2-4 (ref.) 24(19.8) 44(36.4) - -
5-7 73(60.3) 60(49.6) 2.231(1.22, 4.08)** 2.97(1.41, 6.29)**
8-10 24(19.8) 17(14) 2.59(1.17, 5.74)* 4.44(1.65, 11.95)**
Number of under 5 children
1 (ref.) 41(33.9) 66(54.5) - -
2 60(49.6) 48(39.7) 2.01(1.17, 3.47)* 1.88(0.97, 3.61)
3 20(16.5) 7(5.8) 4.60(1.79, 11.83)** 3.77(1.33, 10.74)*
Maternal Occupation
Farmer 50(41.3) 38(31.4) 2.018(1.15, 3.55)** 3.92(1.89, 8.16)**
Merchant 26(21.5) 14(11.6) 2.85(1.35, 6.03)* 4.03(1.60, 10.17)**
House wife (ref.) 45(37.2) 69(57.0) - -
Duration of breast feeding
< 24 months 16(13.2) 4(3.3) 4.46(1.44, 10.8)** 5.61(1.49, 11.08)*
≥ 24 months(ref.) 105(86.8) 117(96.7) - -
Duration of EBF
For 6 months (ref.) 86(71.1) 105(86.8) - -
Below 6 months 21(17.4) 13(10.7) 1.972(0.93, 4.17) 3.27(1.21, 8.82)*
Above 6 months 14(11.6) 3(2.5) 5.69(1.58, 10.5)** 7.62(1.80, 12.23)**
Method of feeding
Spoon & Cup (ref.) 50(41.3) 77(63.6) - -
Bottle 29(24.0) 14(11.6) 3.190(1.54, 6.62)** 3.30(1.33, 8.17)**
Hand 42(34.7) 30(24.8) 2.16(1.19, 3.88)** 3.04(1.46, 6.32)**
Variables included in the adjusted model are wealth index, child age, diarrhea, ARI, type of complementary food, number of food group, delivery attendance,
mother hand washing practice, source of drinking water and maternal knowledge.
*p < 0.05, **p < 0.01, (ref.) - reference category.

This is consistent with community based studies con- and improper complementary food, which may have a
ducted in southern Brazil and South Africa [12,17]. large negative effect on the growth children. Our results
Similarly children living in households with eight to ten are not consistent with studies that had shown a protect-
family members were 4.44 and living in household with ive effect of maternal employment by increasing income
five to seven family members were 2.97 times more and female autonomy. Employment may also positively
likely to develop stunting compared with those living in influence food security, quality of diet and use of health
household with two to four family members. This might services [21]. The difference is probably due to the fact
be due to resource depletion which exposed to poverty that factors like child caring practice were overlooked in
and decrement in food availability and also suggesting the previous study.
that there is more competition for available food when The likelihood of stunting was` higher among children
the household is large. This is in line with studies con- who exclusively breast fed below or above the age of six
ducted in Northeastern Brazil, South Africa and Ethiopia months compared with who exclusively breast fed for six
[13,17,18]. But which is inconsistent with study con- months. This finding was in line with study conducted
ducted in Uganda [30]. different areas [17,20,23]. Inappropriate timing for intro-
Children whose mothers worked as merchant and ducing some kinds of complementary food to a child
farmer were more likely to develop stunting than chil- may affect his/her nutritional status because his/her di-
dren whose mothers worked as house wives. This might gestive and immune systems are not yet mature. Intro-
be due to decreased contact time to the child that brings ducing supplements before earlier, especially under
short period of exclusive breast feeding, early cessation unhygienic conditions, could be an important cause of mal-
of breast feeding, increase exposure to bottle feeding nutrition. On the other hand some studies demonstrated
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that association was not observed [22,30]. The difference 5. Underwood BA: Health and Nutrition in Women, Infants, and Children:
is probably due to difference in study design as well as Overview of the Global Situation and the Asian Enigma. Nutr Rev 2002,
60:5.
geographical difference. 6. Onis MO, Blossner M, Borghi E: Prevalence and trends of stunting among
Our study showed that feeding complementary food pre-school children, 1990–2020. NS Public Health Nutrition 2011,
using bottle and by hand increases the risk of stunting 15(1):142–148.
7. Central Statistical Agency [Ethiopia] and ICF International: Ethiopia
among children. This finding is consistent with other Demographic and Health Survey 2011. Addis Ababa, Ethiopia and
studies conducted in our country [23] in which feeding Calverton, Maryland, USA: Central Statistical Agency and ICF
using bottle and hand were associated with increase the International; 2012.
8. Jesmin A, Yamamoto SS, Malik AA, Haque A: Prevalence and Determinants
odds stunting. of Chronic Malnutrition among Preschool Children. J Health Popul Nutr
2011, 29(5):494–499.
9. Dewey KG, Begum KB: Long-term consequences of stunting in early life.
Conclusion Mat Child Nutri 2011, 7(3):5–18.
This study showed number of under-five children, family 10. Kar BR, Rao SL, Chandramouli BA: Cognitive development in children with
members, maternal occupation, duration of breast feed- chronic protein energy malnutrition. BMC Behavioral and Brain Functions
2008, 4:31.
ing, duration of exclusive breast feeding & method of 11. Morris SS, Cogill B, Uauy R: Effective international action against under
feeding complementary food were independently associ- nutrition: why has it proven so difficult and what can be done to
ated with stunting. Thus, national public health interven- accelerate progress. Lancet 2008, 371:608–621.
12. Vitolo MR, Gama CM, Bortolini GA, Campagnolo PD, Dranchler ML: Some
tion programmer and stakeholder working on improving
risk factors associated with overweight, stunting and wasting among
child nutrition should focus on these determinants to re- children under 5 years old. J Pediatr 2008, 84(3):251–257.
duce stunting. Health extension workers shall educate 13. Cristina R, Israel P, Sa Leal V, Oliveira JS, Cristina S, Augusta LA, Rissin A, Filho
MB: Determinants of stunting in children under five in Pernambuco,
mothers/caretakers on the importance of exclusive breast
Northeastern Brazil. Rev Saude Publica 2011, 45(6):1079–1087.
feeding, methods of complementary feeding and adequate 14. Zottarelli LK, Sunil TS, Rajaram S: Influence of parental and socioeconomic
spacing between children. Program planner and policy factors on stunting in children under 5 years in Egypt. Eastern
makers should consider & strengthen collaboration and Mediterranean 2007, 13(6):1330–1342.
15. Reyes H, Perez-Cuevas R, Sandoval A, Castillo R, Santos JI, Doubova SV,
coordination of nutritional program that aimed to alleviate Gonzalo G: The family as a determinant of stunting in children living in
nutritional deficiencies and family health program. conditions of extreme poverty: a case- control study. BMC Public Health
2004, 4(57). doi:10.1186/1471-2458-4-57.
Competing interests 16. Das S, Sahoo H: An Investigation into Factors Affecting Child Under
The authors declare that they have no competing interests. nutrition in Madhya Pradesh. Anthropologist 2011, 13(3):227–233.
17. Mamabolo RL, Alberts M, Steyn NP, Waal HA, Levitt NS: Prevalence and
determinants of stunting and overweight in 3-year-old black South
Authors' contributions African children residing in the Central Region of Limpopo Province,
FT involved from the inception to design, acquisition of data, analysis and South Africa. Public Health Nutr 2005, 8(5):501–508.
interpretation, drafting the manuscript, SA involved in the inception to 18. Umeta M, Clive EW, Hans V, Haidar J, Joseph H: Factors Associated with
design, analysis and interpretation and revise the manuscript. LD involved in Stunting in Infants Aged 5–11 Months in the Dodota-Sire District, Rural
the inception to design, analysis and interpretation and revises and edits the Ethiopia. J Nutri 2002, 133:1064–1069.
manuscript for the final submission. All authors read and approved the final
19. Ergin F, Okyay P, Atasoylu G, Beser E: Nutritional status and risk factors of
manuscript.
chronic malnutrition in children under five years of age in Aydin. Turkish
J Pediatr 2007, 49:283–289.
Acknowledgements 20. Kamal M: Socio-economic Determinants of Severe and Moderate
We would like to extend our deepest gratitude to the Jimma University for Stunting among Under-Five Children of Rural Bangladesh. Mal J Nutr
financing this study. Our appreciation goes to the data collectors and 2011, 17(1):105–118.
supervisors. Lastly, our special thanks also go to mothers who participated in 21. Willey AB, Cameron N, Norris AS, Pettifor JM, Griffiths PL: Socio-
the study. economic predictors of stunting in preschool children: a population-
based study from Johannesburg and Soweto. S Afr Med J 2009,
Author details 99:450–456.
1
Arba Minch Health Science College, Arba Minch, Ethiopia. 2College of Public 22. Farid-ul-Hasnain S, Sophie R: Prevalence and risk factors for Stunting
Health and Medical Sciences, Department of Epidemiology, Jimma University, among children under 5 years: a community based study from Jhangara
Jimma 378, Ethiopia. town, Dadu Sindh. JPMA 2010, 60(1):41–44.
23. Teshome B, Kogi-Makau W, Getahun Z, Taye G: Magnitude and
Received: 26 November 2013 Accepted: 29 July 2014 determinants of stunting in children under-five years of age in food
Published: 7 August 2014 surplus region of Ethiopia: The case of West Gojam Zone. Ethiop J Health
Dev 2009, 23(2):98–106.
References 24. Abuya BA, Ciera J, Kimani-Murage E: Effect of mother’s education on
1. World Health Organization: Maternal, Infant and Young Child Nutrition. child’s nutritional status in the slums of Nairobi. BMC Pediatr 2012,
Geneva: 2011. 12:80.
2. Black RE, Allen LH, Bhutta ZA, Caulfield LE, Onis M, Ezzati M, Mathers C, 25. Taguri A, Betilmal I, Mahmud SM, Ahmed AM, Goulet O, Galan P, Hercberg
Rivera J: Maternal and child under nutrition: global and S: Risk factors for stunting among under-fives in Libya. Public Health Nutr
regional exposures and health consequences. Lancet 2008, 2009, 12(8):1141–1149.
371(9608):243–260. 26. Muchina EN, Waithaka PM: Relationship between breastfeeding practices
3. UNDP: Children Malnutrition and Horizontal Inequalities in Sub-Saharan Africa. and nutritional status of children aged 0-24 months in Nairobi, Kenya.
2012. AJFAND 2011, 10(4):2358–2378.
4. World Health Organization: Nutrition for Health and Development: A Global 27. Awogbenja MD, Ugwuona FU: Feeding Practices and Nutritional Status of
Agenda for Combating Malnutrition. Geneva: 2000. Under- Five Children in Nasarawa State, Nigeria. PAT 2010, 6(1):23–35.
Fikadu et al. BMC Public Health 2014, 14:800 Page 7 of 7
http://www.biomedcentral.com/1471-2458/14/800

28. Ramli, Agho KE, Inder KJ, Bowe SJ, Jacobs J, Dibley MJ: Prevalence and risk
factors for stunting and severe stunting among under-fives in North
Maluku province of Indonesia. BMC Pediatr 2009, 9:64.
29. Prema R, Hema SG: Under nutrition & risk of infections in preschool
children. Indian J Med Res 2009, 130:579–583.
30. Turyashemererwa FM, Kikafunda JK, Agaba E: Prevalence of Early
Childhood Malnutrition and Influencing Factors in Peri-Urban Areas of
Kabarole District, Western Uganda. AJFAND 2009, 9:4.

doi:10.1186/1471-2458-14-800
Cite this article as: Fikadu et al.: Factors associated with stunting among
children of age 24 to 59 months in Meskan district, Gurage Zone, South
Ethiopia: a case-control study. BMC Public Health 2014 14:800.

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