In this study, 40% (95% CI, 36.0, 43.0) of children were stunted. This indicates the high magnitude of stunting in food secured households which showed that food security is necessary but not the only solution to tackle under-nutrition. This finding is consistent with the national report (38%) [9] and studies done in Shashemene hospital (38.3%) [21], Guto Gida District (41.78%) [22], rural Ethiopia (41.7%) [23] and Indonesia (37%) [24].
On the other hand, this prevalence is lower than the study findings in Ethiopia those reported the prevalence of stunting ranged from 45.8%–57.1% [16, 25, 26], Uganda (51%) [27], Nepal (55.7) [28] and Vietnam (44.3%) [29]. The discrepancy might be due to the difference in the study subjects. This study was conducted among children who lived in the food secured households but the previous studies were done in both food secure and insecure households.
Whereas, this finding is higher than the study findings in Afambo district (32.2%) [30], Kenya (23.3%) [7], Northern Ghana (28.2%) [31], Indonesia (35.1%) [32] and Brazil (9.1%) [33]. The high prevalence of stunting in this study might be due to the socio-demographic and cultural difference among the respondents. In this study, majority of the respondents have no formal education which in turn affects child feeding practice and health-seeking behavior.
The prevalence of underweight was 19.8% (95% CI: 17.1, 22.6). This finding is in line with the study findings in Haramaya district (21%) [25], Uganda (20.7%) [27] and Northern Ghana (19.3%) [31]. On the other hand, it is lower than the study findings in Ethiopia those reported the magnitude of underweight ranging from 23.5%–39.5% [9, 22, 26, 30, 34], Nepal (37%–41.4%) [28, 35] and Vietnam (31.8%). This might also be due to time gap and the difference between the study subjects and child feeding practice. Whereas, it is higher than the study findings in Indonesia (12%) [24] and Brazil (9.8%) [33]. This discrepancy might be due to the difference in the study settings.
In this study, the prevalence of wasting was 11.6% (95% CI: 9.5, 13.7). This finding is in agreement with the study findings in Ethiopia (9.7%–13.4%) [17, 22, 23, 25], Northern Ghana (9.9%) [31] and Indonesia (12%) [24]. On the other hand, it is lower than the study findings in Tahtay Adiyabo Woreda (17.8%) [26], Shashemene hospital (25.2%) [21], Nepal (18,6%) [28] and Vietnam (11.9%). Whereas, it is higher than the study findings in Lalibela (8.9%) [34], Uganda (5.2%) [27] and Brazil (2.6%) [33].
Educational status of the mother was significantly associated with stunting. Children whose mothers have no formal education were more likely to be stunted compared with children whose mothers have formal education. This finding was consistent with previous study findings in Ethiopia [21, 26], Nigeria [36], Iran [37] and Vietnam [29]. This might be due to the fact that educated mothers have a higher probability to expose and understand nutrition messages than non-educated mothers. Besides, educated mothers were more likely to have autonomy, which in turn influences health-related decisions and purchasing food items that improve the child’s access to good quality food.
Children who take less than four food groups per day had a higher probability to have stunting than children who take four or more food groups. This finding is supported by the study findings in Guto Gida district, Ethiopia [22], Ghana [31] and Nepal [38]. The possible explanation to this is that children who take undiversified food were less likely to meet the nutrient requirement which results in failure to thrive.
Hand washing practice of the mother has a positive significant association with stunting. Children whose mothers do not wash their hands before food preparation were at a higher risk to have stunting than their counterparts. This finding is similar to the study finding in Uganda [27]. Hand washing during the critical periods is essential to prevent diarrhea and other infectious diseases among children, which in turn reduce the probability of having stunting.
Children who live in the households where solid wastes managed by scattering in the field had a higher probability to be stunted compared with children who live in the household solid wastes managed by burning. This finding is in agreement with the study finding in Brazil in which poor environmental sanitation was a strong predictor of stunting [33]. This is because solid wastes lying around the household attracts flies, rats, and other creatures that in turn spread infectious disease. Illness affects the nutritional status of children.
Children who were ill in the prior 2 weeks of data collection day were more likely to have wasting than children who were not ill. This finding is consistent with previous study findings in developing countries [16, 25, 26, 36, 39, 40]. This is due to the fact that illness decreases appetite and interfere digestion and absorption of nutrients which directly lead to under-nutrition and by reducing the immune response it exacerbates illness.
Children whose mothers do not attend ANC during pregnancy had a higher probability to be wasted compared with their counterparts. This finding is supported by previous study findings in Ethiopia [25, 30, 41]. The reason for this is mothers who have ANC visit were more likely to get nutrition education which directly affects child feeding practice and health-seeking behavior.
Children who take food less than four times per day were 2 times more likely to develop wasting than their counterparts who took four or more meals per day. This finding is similar to the study finding in Nepal [38]. This is because children who take less than four meals daily were less likely to meet nutrient demand which results in failure to gain weight.
Place of delivery was another predictor for wasting. Children who were born at home had greater probability to be wasted than children who were born at the health institution. This finding is consistent with the study finding in Burundi [42]. Mothers who give birth at home were less likely to get nutrition messages. This directly affects their child feeding practice. Poor feeding practice in turn predispose to under-nutrition.
Children who live in the household have no television were more likely to be stunted and wasted than their counterparts. This finding is in line with the study finding in Ethiopia [43]. Mothers who have television can access information about child feeding practice and health related issues from the media which directly affect feeding practice and health-seeking behavior.