In this study, attempt was made to demonstrate the effects of children and households’ characteristics on children composite index anthropometric failure (CIAF) by considering its dependency with household wealth index (HHWI). A single CIAF was computed from the three classical anthropometric indices and recoded into binary outcome as they have a multidimensional nature [14]. Bivariate binary logistic regression model was employed to determine the effects of covariates on CIAF and HHWI. Based on this model and exploratory data analysis, significant dependency between CIAF and HHWI was noticed. This study demonstrated that child CIAF has significant association with household wealth index given other children’s and households’ characteristics.
This study reveals that the prevalence of child CIAF in Ethiopia was high (46.7%) and which has been also discussed in previous studies [3, 5, 14, 21]. This study found that region in Ethiopia has significant effect on child CIAF and household wealth index. The risk of child CIAF in Tigray was higher than Oromia (OR = 0.60), Somalie (OR = 56), Gambela (OR = 0.67), SNNPR (OR = 0.52), Hararie (OR = 0.60) and Addis Ababa (OR = 0.44). This finding of the study was consistent with different domestic research [5, 22], that reported children who are living in Tigray region have a higher risk of child CIAF compared to children living in Oromia, Somalie, Gambela, SNNPR, Harari, and Addis Ababa. Place of residence has significantly associated with household wealth index. Studies done by Tekile et al., Talukder, and Silveira et al. [4, 5, 21] states that compared to children from middle class and rich households, the likelihood of switching status from malnourished to nourished nutritional status was lower for children from poor household. This indicates that children who were living in rural area is more likely to be CIAF than children living in urban area. This is because of limited infrastructure that enables to affect a family to access food, health-care facility, exchange desired commodities, and so on. This finding was also in line with studies done in Bangladesh and Ethiopia [4].
As education level of mothers and husbands/partners getting higher, the likelihood of child exposed to CIAF was lower. Children whose mothers and husband/partners had never attended education were more likely to exposed to CIAF compared to children whose mothers and husband/partners had primary, and secondary and higher education which was consistent with studies conducted in Ethiopia [5, 22]. These studies reported that children whose mothers had never attended education were significantly more likely to be stunted, underweight, and/or under nutrition as compared to children whose mothers had primary, and secondary and above education level. Moreover, religion of the household was also an important determinate that significantly associated with child CIAF.
The result showed that a child whose household religion orthodox was less likely to be CIAF and more likely to be rich compared to its counterpart. Whereas the reality in Ethiopia shows that the majority Muslim and protestant households were lived in urban area whereas the majority orthodox households are living in rural area where health care facilities, child feeding practice, access to improved water, and so on are less accessible and poverty is very high (OR for urban versus rural is 15.49). Mostly mothers in rural area are participated in farming activities and giving less attention to feed and care of their child. Beyond to this, orthodox mothers are commonly fasting during their prenatal and postnatal period. Therefore, the pre-specified and other issues may be responsible for child CIAF whose household beliefs orthodox than other religious in contrast of this study. In addition, the household who drank improved water were more likely to be rich compared to the household who drank unimproved water.
The existence of CIAF was significantly differ within sex of child and multiple of birth i.e., males were more likely to be CIAF compared to females and multiple birth children were more likely to be CIAF compared to single birth. This result is in line with studies done at Ethiopia and Favelas Brazil [5, 11]. On the other hand, compared to children who drank unimproved water, children who drank improved water were less likely to belonging in poor household and this led to less likely to be CIAF, which is supported by previous study findings [11, 14]. Like a study done in Ethiopia [5], number of under five children in the household was an important determinant effect on child CIAF. Children from a household having two under five children were 1.21 times more likely to be CIAF compared to a household having one under five children.
Unlike a study in Ethiopia and Brazil [5, 11], mothers age at first birth and child age were insignificantly associated with child CIAF in this study. This may because of the methodology difference, i.e., in this study a bivariate binary logistic regression accounting the dependency of a single CIAF and household wealth index was employed whereas the previous studies were used binary and ordinal univariate logistic regression.
Mothers’ body mass index was significantly associated with child CIAF which in line with a study done by Silveira et al. [21] and they stated that short height and poor weight of mothers were associated with child malnutrition. Moreover, this study found that anemic children were more exposed to CIAF compared to non-anemic children that in line with a study done in Ethiopia [22].