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Journal of Human Nutrition & Food Science

Cite this article: Moges B, Temam L, Assefa B, Doyore F (2016) Household Food Insecurity is the Main Correlate of Childhood Stunting in the Most Critical Period of Growth and Development in Silti Woreda, SNNPR Ethiopia. J Hum Nutr Food Sci 4(4): 1093.

*Corresponding authorBeminet Moges, Department of Public Health, Faculty of Medicine and Health Sciences, Wachemo University, Ethiopia, Tel: 251 912122934; Email:

Submitted: 07 June 2016

Accepted: 01 August 2016

Published: 11 August 2016

ISSN: 2333-6706

Copyright© 2016 Moges et al.

OPEN ACCESS

Research Article

Household Food Insecurity is the Main Correlate of Childhood Stunting in the Most Critical Period of Growth and Development in Silti Woreda, SNNPR EthiopiaBeminet Moges1*, Leyla Temam2, Biruk Assefa3, Feleke Doyore1

1Department of Public Health, Wachemo University, Ethiopia2Department of Nursing, Wachemo University, Ethiopia3Department of Midwifery, Wachemo University, Ethiopia

Abstract

Background: Food insecurity continues to be the most remarkable challenges of developing countries even though progress achieved in reduction of hunger in some countries, yet an unacceptably large number of people still lack the food they need for an active and healthy life. In Ethiopia, household food insecurity and stunting in under-five children were high prevalent problems. There is paucity of research evidences on the effect of household food insecurity on child stunting together with other predictors in the most critical period of child growth and development in the study area. Therefore, the aim of the study was to assess household food insecurity status and its determinants in Silti Woreda, SNNPR Ethiopia.

Methods: A community based cross-sectional study was conducted with stratified sampling technique and interviewer administered structured questionnaires was used to collect data. The data was entered using EPI INFO version 3.5.3, 2011. Analysis was done by SPSS version 20 and ENA for SMART, 2011 software. Significant association of variables was identified using bivariate and multivariate logistic regression analysis.

Results: Household Food insecurity status was 47.6% in the silti district. Stunted children were more likely live in food-insecure household than non-stunted counterpart (AOR=1.90;95% CI;1.16,3.13).Those household mothers with farmer (AOR=0.19;95% CI:0.05,0.81) and merchant occupation (AOR=0.22;95% CI:0.09,0.47) and household with merchant father (AOR= 0.10;95% CI:0.04,0.25) and self-employee (AOR= 0.29;95% CI: 0.11,0.75) were less likely became food insecure. Mother headed household (AOR=8.26; 95% CI: 1.97, 34.67), household who had no agricultural land (AOR= 8.29; 95%CI: 1.29,53.2) and no livestock (AOR=2.77;95%CI:1.23,6.24) were more likely food insecure.

Conclusion: This study revealed that nearly half of the households were food-insecure in the study area. Household food insecurity is the main correlates of childhood stunting in the most critical period of child growth and development. An integrated nutrition intervention which addresses job opportunities creation to generate income and expanding social protection to rural and urban areas together with designing programs which increases crops and animal production to enhance child feeding of mothers in the food-insecure households to halt childhood stunting among children aged 6-23months.

Keywords•Household food insecurity•Childhood stunting•Silti woreda•SNNPR ethiopia

ABBREVIATIONSANC: Antenatal care; AOR: Adjusted Odds Ratio; BF: Breast

feeding; CSA: Central Statistical Agency; COR: Crude Odds Ratio; EDHS: Ethiopian Demographic and Health Survey; ENA: Emergency Nutrition Assessment; FAO: Food and Agriculture Organization; FMOH: Federal Minster Of Health; HAZ: Height -for-age; IYCF: Infant and Young Child Feeding; SMART: Standardized Monitoring and Assessment of Relief and Transitions; SNNPR: South Nation Nationality Peoples Region; SPSS: Statistical Software for Social Sciences; UNICEF: United Nations Children’s Fund; WHO: World Health Organization

INTRODUCTIONFood insecurity continued to be the major challenges of the

world and an unacceptably large number of people still lack the food they need for an active and healthy life. Recently, FAO estimate indicated that globally about 795 million people, just over one in nine were undernourished. The vast majority of these 780 million people’s lives in developing countries and in Sub-Saharan Africa, 23.2 percent of the population, are estimated to be undernourished [1].

Food insecurity exists when people lack access to sufficient amounts of safe and nutritious food and therefore is not

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consuming enough food for an active and healthy life. This may be due to the unavailability of food, inadequate purchasing power, or inappropriate utilization at the household level [2]. At the household level, food insecurity was related to low socio-economic status which is characterized as having low monthly income, low educational level, large household size, unemployment among adult members, and single female head, and one that is renting and also inadequate dietary intake, and poor nutritional status [3,4].

Ethiopia has come a long way in reducing food insecurity, widespread poverty and food insecurity still persist [5]. Chronic and acute food insecurity is prevalent, especially among rural populations and smallholder farmers and about 10 percent of Ethiopia’s citizens are chronically food insecure. Evidence suggested that Food insecurity patterns in Ethiopia are seasonal and linked to rainfall patterns, with hunger trends declining significantly after the rainy seasons [6,7].

Evidence from research on the effect of household food insecurity on child nutrition is concentrated in high-income settings and has produced mixed results. However, household food insecurity together with the inadequate child and maternal care, and the lack of access to health, safe water, and sanitation services are the key underlying causes of the child under nutrition as it was stated in UNICEF conceptual framework [8]. Malnutrition is an underlying cause in the deaths of more than 3.5 million children under the age of 5 each year in the world and taking the most recent available data for the years 2015, 25% in world and in Eastern and Southern Africa, 39% of under-five children were stunted [9].

Childhood stunting is an indicator of chronic malnutrition, meaning long-term nutritional deficiency resulting from lack of adequate dietary intake over a long period of time and/or recurrent illness and the first 1,000 days of life beginning with conception, through a mother’s pregnancy and up until the age of two is the most critical period in a child’s development. In early childhood stunting results in diminished cognitive and physical development, which puts children at a disadvantage for the rest of their lives [10-12].

In Ethiopia stunting is continued to be one of the most important public health problems in Ethiopia and the prevalence of stunting in under five children was 44.4%% nationally and 41 % in SNNPR in 2011 and it is very high prevalent public health problem based on WHO criteria [13]. There is paucity of research evidences on the effect of household food insecurity on child stunting with combination of other predictors in the most critical period of child growth and development in the study area. The result will serve as baseline data for program managers, decision makers and advocators to design an integrated nutrition intervention.

MATERIALS AND METHODSA total of 422 Households with their respected mother-child

(age 6-23month) pair were included in the study. The study was conducted in Silti woreda SNNPR Ethiopia and data was collected from April 2 to June 5, 2015, which was during the Bega/ post-harvest season. The questionnaires were collected by trained health workers and supervision was done by expert supervisors.

The data was collected for 21 days. Ethical clearance was obtained from ethical review committee of Wachemo University and official permission letter was sent to Silti woreda Health office then to Kebles in which the actual data collection was performed.

Study design

A Community based cross-sectional quantitative study design was conducted. Structured interviewer administered closed ended questionnaire which was adapted from FANTA, UNICEF, and FAO after reviewing different kinds of a literature of similar studies. The household food security level was measured using the Household Food Insecurity Access Scale (HFIAS) with scores ranging from 0 to 27 by household level. The HFIAS scores obtained from households were categorized into two main levels namely, “Food secure,” and “Food insecure’’ which combination of 3 levels (“mildly food insecure” ,”moderately food insecure” and “severely food insecure,”) based on the HFIAS guideline [14].

Anthropometric measurement

Height for age was measured using length measurement for children in recumbent position and the measurement was taken to the nearest 0.1 cm using UNICEF standard Height Measuring Board (Stadiometer) with the subjects shoeless and confirmation of the measurement was done based on the standard. The child’s age was collected from the mother and confirmed by using a birth certificate or vaccination cards and also we were used a “local-events calendar”. ENA SMART Software was used to compute nutrition indices and the results were classified according to World Health Organization 2006 cut-off points. Childhood stunting among children was defined as HAZ less than 2 SD below the 2006 WHO growth standards [11,15].

Data processing and analysis

Data was entered, using EPI INFO version 3.5.3 and analysis were done by using SPSS version 20. Anthropometric measurement data was entered and analyzed by Emergency Nutrition Assessment (ENA) for SMART 2011 software. To evaluate the level of significant association between household food insecurity and childhood stunting and to identify other determinants of household food insecurity status, binary logistic regressions analysis was applied and the variables (p ≤ 0.25) found to have an association with the outcome variable were entered into a multivariate analysis which uses to control confounding factors. Finally, the variables which have significant association were identified on the basis of p-value ≤ 0.05 and AOR, with 95% CI to measure the strength of the associations.

RESULTS

Socio-demographic characteristics of the sample

A total of 422 households’ mothers and children aged 6-23 months pair were included in the analysis with response rate 100%. The mean age of the mother was 29.40 and SD ± 5.07 months. Of the respondents of the study, 365 (86.5%) were Muslim and 398 (94.3) were Silte in an ethnic group. From the total number of the children mothers, the majority (60.2%) were found in age group 25-34years, 416 (98.6%) were married, 309 (73.2%) were housewives and 272 (64.5%) mothers had primary education. Concerning fathers of children, 149 (35.3%)

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were farmers and father with primary education level were 227 (53.8%). One hundred fifty-seven (37.2%) children were found in the age group 6-11months and female child accounts 227 (53.8). The rural household accounts 302 (71.6%) and 140 (33.2%) households were classified as having poor wealth status. The detail was presented in Table (1).

Health care and food related characteristics

From mothers of children 233 (55.2%) were attended 4 times and more Antenatal care visits and 361 (85.5%) children were born at public health facility while 40 (9.5%) children were born at home. Among the study participated mothers, 183 (43.4%) had 2 children and 338 (80.1%) mothers were current breast feed their children. Concerning the households, 243 (57.6%) had Agricultural land size less than 2 hectares and 232 (55%) households had livestock also 221(52.4%) households were not grew vegetable in their garden. The detail was presented in Table (2).

Prevalence of stunting among 6-23months children in silti Woreda

The prevalence of stunting among 6-23 months old children was 39.3% (95%; C.I: 34.8 - 44.1). Boys were more stunted (21.8%) than girls (17.5%) among 6-23months old children according to WHO reference population.

Household Food insecurity status in silti district

Household Food insecurity status was 47.6% in the silti district. Ninety three (22%) of stunted children live in food insecure households but 35.1% non-stunted children live in food secure households (Figure 1).

Determinants of Household Food-insecurity in silti district

In the study, mother’s age, mother’s occupation and mother’s education, father’s occupation, household headship, household had livestock; household agricultural land ownership and children who are stunted were significantly associated with Household Food-insecurity status in bivariate analysis. The final result in multivariate analysis of this study confirmed that, children who are stunted, mother’s occupation, and father’s occupation household headship, household had livestock and agricultural land ownership were identified as significant determinants of household Food insecurity.

Childhood stunting status was identified as one of the major associated factors of food insecurity in the study and the result confirmed that, stunted children aged 6-23months were 2 times more likely live in food-insecure households than non-stunted counterpart (AOR=1.90;95% CI;1.16,3.13).

In the study mother’s occupation fund one of the determinants of household food insecurity, household whose mother had work as farmer 81% (AOR=0.19;95% CI:0.05,0.81), merchant 78% (AOR=0.22;95% CI:0.09,0.47) less likely to be food insecure as compared with household had Housewife mothers or no occupation. Comparing from father headed, household who had mother headed were 8 times more likely became food insecure (AOR=8.26;95% CI:1.97,34.67). The result of analysis confirmed

Table 1: Socio-demographic economic characteristics of children 6-23 months and parents in Silti Woreda, SNNPR Ethiopia, 2015 (n=422).

Variables Frequency PercentMother’s age in years

15-24 74 17.525-34 254 60.235-49 94 22.3

Marital status of the motherMarried 416 98.6Divorced 4 0.9Widowed 2 0.5Ethnicity

Silte 398 94.3Gurage 14 3.3Amhara 6 1.4Oromo 4 0.9

ReligionMuslim 365 86.5

Orthodox 49 11.6Protestant 8 1.9

Mother's educationNo education 104 24.6

Primary 272 64.5Secondary 35 8.3

More than secondary 11 2.6Mother's occupation

Housewife 309 73.2Farmer 12 2.8

Merchant 60 14.2Government employee 17 4.0

Self-employee 24 5.7Father's education

No education 91 21.6Primary 227 53.8

Secondary 53 12.6More than secondary 51 12.1Father's occupation

Farmer 149 35.3Merchant 97 23.0

Government employee 86 20.4Self-employee 90 21.3

Children’s age in month6-11 157 37.2

12-17 141 33.418-23 124 29.4

Sex of ChildMale 195 46.2

Female 227 53.8Residence

Urban 120 28.4Rural 302 71.6

Wealth IndexPoor 140 33.2

Middle 123 29.1Rich 159 37.7

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Figure 1 Household food insecurity status and childhood stunting status among children 6 to 23 months in Silti Woreda, SNNPR Ethiopia, 2015.

Table 2: Health care and food related characteristics among households, parents and children 6 to 23 months in Silti Woreda, SNNPR Ethiopia, 2015(n=422).

Variables Frequency PercentANC visits of mother

None 17 4.01-3 172 40.8

4 and above 233 55.2Mothers place of delivery

Public facility 361 85.5Private facility 21 5.0

Home 40 9.5HHds number of child

One 94 22.3Two 183 43.4

Three and more 145 34.4Current BF status

No 84 19.9Yes 338 80.1

HHds grew vegetable in their garden

No 221 52.4Yes 201 47.6

Agricultural land size ownedNot had land 167 39.6

Less than 2hectares 243 57.62 and above hectares 12 2.8

Household Had livestockNo 190 45.0Yes 232 55.0

that father occupation is also one of the significant risk factors, in study household whose father had occupation of merchant 90% [AOR= 0.10;95% CI:0.04,0.25] and self-employee 71% [AOR= 0.29;95% CI: 0.11,0.75] less likely became food insecure than farmer father.

Agricultural land ownership is a significant determinants of household food insecurity, household who had no agricultural land were 8 times [AOR= 8.29; 95%CI: 1.29, 53.2] and had agricultural land size less than 2hectare 6 times [AOR= 6.27; 95%CI: 1.09, 36.3] more likely to be food insecure than had

agricultural land size of 2 and above hectares. The detail was presented in Table (3).

DISCUSSIONIn this study, Household Food-insecurity status was 47.6%

in the silti Woreda. The household food insecurity status in this study was higher than the study conducted in Malaysia, 16.1 % [16], Bangladesh, 32.4% and Vietnam, 40.3% [17] and Rwanda, 21 % [18] households were food insecure. On the other hand, household food insecurity status in the study was lower than study conducted in Northern Ghana, 54% [19], Kenya, 82.1% [20], In Nigeria, 65% [21],in Ethiopia,66.4% [17], in Farta District, Northwest Ethiopia, 70.7% [22], in Tigrai, 68.8% [23], Addis Ababa, 58.16% [24] and In South Nation Nationality People Region of Ethiopia as indicated by the studies in Wolita, 74.2 % [25] and in Sidama districts, 82 % [26] of households were food insecure which was measured by HFIAS. This difference might be due to population difference, sample characteristics in which some of them used rural or urban only but in this study we used both urban and rural sample and primary data and difference in socio-economic factors appear most likely to explain the prevalence of food insecurity.

Childhood stunting was identified as one of the major associated factors of food insecurity in the result of the study, stunted children were 2 times more likely to live in food-insecure households than non-stunted counterpart. The result was supported by studies in Malaysia [16], Bangladesh [17], Nigeria, [16], Kenya [27], Pakistan [28]. However, studies in Northern Gahana [19], Southeastern Kenya [27] and in East and West Gojjam Zones of Amhara Region, Ethiopia [29] opposing the association between Household Food insecurity and childhood stunting. The possible justification for this might be stunting in most critical period of child growth and development 6-23months main components in which the time child going to start complementary feeding based on WHO Infant and young child feeding (IYCF) recommendation and children from food insecure households may had a lower intake of energy rich foods and nutrients because of its effects child develops failure in linear growth which is irreversible for the rest of his life that is stunting or chronic under nutrition. The inter-relationship between the two main pillars of nutritional problems may indicate that, interventions to address child hood stunting may become more successful if they include explicit interventions to enhance household food security.

The study revealed that, Household food-insecurity was also associated with socio-demographic and food related determinants. In the study mother’s occupation was one of the determinants of household food insecurity; household whose mother had work as farmer 81% and merchant 78% less likely to be food insecure as compared with household had Housewife mothers or no occupation [30]. The analysis also confirmed that, household whose father had occupation of merchant 90% and self-employee 71% less likely became food insecure than farmer father. The result is supported by study in South Africa study revealed that, households who lack of full-time employment of the head of the household were significantly associated with an increased risk of having a food-insecure household [31] and also study in Addis Ababa which indicated that mothers who are

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Table 3: Determinants of Household Food insecurity in Silti Woreda, SNNPR Ethiopia, 2015 (n=422).

Explanatory VariablesHH Food insecurity

COR 95% CI AOR 95% CI P-ValueYes No

Childhood Stunting

Non-stunted 108 148 1 1

Stunted 93 73 1.75(1.18,2.59) 1.90(1.16,3.13) 0.011*

Household headship

Father 180 217 1 1

Mother 21 4 6.33(2.13,18.7) 8.26(1.97,34.67) 0.004*

Mother's occupation

Housewife 151 158 1 1

Farmer 5 7 0.75(0.23,2.41) 0.19(0.05,0.81) 0.024*

Merchant 17 43 0.41(0.23,0.76) 0.22(0.09,0.47) <0.000*

Government employee 7 10 0.73(0.27,1.97) 0.94(0.18,4.86) 0.937

Self-employee 21 3 7.33(2.14,25.1) 3.63(0.92,14.4) 0.066

Father's occupation

Farmer 77 72 1 1

Merchant 36 61 0.55(0.33,0.93) 0.10(0.04,0.25) <0.000*

Government employee 55 31 0.53(0.31,0.91) 0.41(0.14,1.21) 0.107

Self-employee 57 33 1.62(0.95,2.76) 0.29(0.11,0.75) 0.010*

Agricultural land size owned

Not had land 102 65 7.85(1.67,36.9) 8.29(1.29,53.2) 0.026*

Less than 2hectare 97 146 3.32(0.71,15.5) 6.27(1.09,36.3) 0.040*

2 and above hectare 2 10 1 1

Household Had livestock

No 118 72 2.94(1.97,4.38) 2.77(1.23,6.24) 0.014*

Yes 83 149 1 1*Statistically significant at p-value<0.05; 1 is Odds ratio for reference category.

unemployed were highly likely to become food insecure than employed mothers [22]. This might be due to, those household with mother’s farmer or merchant and also father’s merchant or self-employee had income related occupation which may foster household purchasing ability variety of foods in items and households also they can get adequate quantity of food than households who had mothers no occupation and also farmer fathers. Also, those household with farmer fathers they become subsistence producing, limited access to markets, and low in opportunities for income generation and also disparities between urban and rural communities wealth another reason. In opposite of this findings, study in Malaysia indicated that no significant association was reported between the status of household food insecurity and the employment status of the mother [16].

Comparing from father headed, household who had mother headed were 8 times more likely became food insecure. Similar studies In Rwanda [18] in Farta District, Northwest Ethiopia [19] Study in densely populated areas that of Sidama and Wolayta Zones Southern Ethiopia [32] also support the association of households headed by females were more likely to be food insecure than male headed. This might be due to mother who are head of the household might be they are forced to engage both house services such as preparation and feeding their children

and whole family and also responsible to outdoor activities to earn income for the entire family so that this double burden of activities with lack of husbands support economically made them unable to handle effectively and may lead to household food insecurity [33].

Agricultural land ownership is a significant determinant of household food insecurity, household who had no agricultural land were 8 times more likely to be food insecure than had agricultural land size of 2 and above hectors. The association is supported by study in Laelymachew woreda, Central Zone of Tigrai, Ethiopia confirmed that total cultivated land unit negatively related to food insecurity [23]. The possible justification for this might be due to those households who had agricultural land may had high wealth and income which helps the households to farm which increase food production or they can lend the land for other investors in contrary those households who had no land cannot able cultivate food products for household consumption which is main component of food insecurity that is inadequate food availability and also they don’t get income after selling produced crops in their farms.

The other significant factor which determine household food insecurity is Household ownership of livestock, household who

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had no livestock were 3 times more likely food insecure than who had livestock. The finding is supported by study in Southeastern Kenya [27], Farta District, Northwest Ethiopia [22] and in Laelymachew woreda, Central Zone of Tigrai, Ethiopia [23] which indicated, households that had few or absence of livestock were more likely to be food insecure than households that had more than high livestock owned. This might be due to households had livestock have better chance to earn more income from livestock production. This in turn enables the household’s to purchase foods when they are encountered food shortage and they can invest in purchase of farm inputs that increases food production, and thus ensuring food-security at household level. In this study, access to food which is main component of food insecurity measurement in HFIAS varies by the season and also the cross sectional nature of the study prevents it from making causal inferencemay be considered as a potential limitation of the study.

CONCLUSIONThe study revealed that nearly half of the households were

food insecure in the silti woreda, SNNPR Ethiopia. Household food insecurity and stunting among children age 6-23months which are the most critical period of child growth and development showed a significant association. An integrated nutrition intervention which addresses job opportunities creation to generate income and expanding social protection to rural and urban areas together with designing programs which increases crops and animal production to enhance child feeding of mothers in the food-insecure households to halt childhood stunting among children aged 6-23months.More over further research needed to determine others potential determinants of household food insecurity status using strong designs such as longitudinal studies.

AUTHORS CONTRIBUTION BM, LT and BA participated in the conception of the study,

collection of data in the field, data analysis, and drafting of the manuscript BM and FD contributed to the study design, interpretation of the data, and writing of the paper. All authors participated in the revision of the manuscript and approved the version submitted for publication.

ACKNOWLEDGMENTThis study received funds from Wachemo University research

and community service and the authors want to extend his heartfelt gratitude to Silti District Health offices and all Kebele officials and also all participants of the research for their support.

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Moges B, Temam L, Assefa B, Doyore F (2016) Household Food Insecurity is the Main Correlate of Childhood Stunting in the Most Critical Period of Growth and Development in Silti Woreda, SNNPR Ethiopia. J Hum Nutr Food Sci 4(4): 1093.

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