Undernutrition and Associated Factors among Under-five Children in Batu Town, Oromia Regional State, Ethiopia: A community-based cross-sectional study

Undernutrition and Associated Factors among Under-five Children in Batu Town, Oromia Regional State, Ethiopia: A community-based cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Undernutrition and Associated Factors among Under-five Children in Batu Town, Oromia Regional State, Ethiopia: A community-based cross-sectional study Amane Hussen, Amsal Ferede, Aster Yalew, Dawit Urgi, Limenih Habte, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3858012/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Enhancing nutrition significantly contributes to addressing sustainable development goals by reducing poverty. In Ethiopia, undernutrition is the leading cause of child illness and death. This study aimed to assess the prevalence and associated factors of undernutrition among children under-five years of age in Batu Town, Oromia, Ethiopia. A community-based cross-sectional study design with a simple random sampling technique was used to select 387 participants. ENA for SMART 2020 software was used to calculate the Z-score of Anthropometric Measurements. Binary logistic regression was employed to analyze the data and the outputs are presented using adjusted odds ratio with 95% confidence intervals (AOR, 95% CI). The magnitude of wasting, stunting, and underweight were 7.0%, 55.5%, and 27.0%, respectively. Being male [AOR = 1.86 (95% CI = 1.13–3.08)] and breastfeeding for over two years [AOR = 2.49 (95% CI = 1.22–5.12)] were the significant predictors of being underweight, whereas colostrum intake [AOR = 0.37 (95% CI = 0.15–0.94)] and good dietary diversity status [AOR = 0.45 (95% CI = 0.24–0.84)] were preventive factors. Similarly, colostrum intake [AOR = 0.09, (95% CI = 0.01–0.68])] and good dietary diversity status [AOR = 0.55 (95% CI = 0.33–0.94)] were preventive factors for stunting though children above 12 months [AOR = 2.89 (95% CI = 1.82–4.58] had increased odds of being stunted. However, in this study, family size [AOR = 3.54, 95% CI = 1.19–10.48] was the sole risk factor for wasting. Undernutrition was prevalent in Batu Town, exceeding regional and national rates. Boys are more affected. Moderate underweight and severe stunting are common. Breastfeeding, colostrum, and diversified diets help, while family size and child age increase the risk. To enhance children's nutritional status, tailored interventions such as promoting colostrum intake, and encouraging diversified diets are required. Health sciences/Health care Health sciences/Medical research Wasting Stunting Underweight Batu Town Under-five children Figures Figure 1 Figure 2 Background Sufficient nutrition is crucial for normal growth and development throughout infantile period. Currently, nutrition has increasingly been recognized as a basic pillar for social and economic development and more than half of sustainable development goals are related to nutrition because one-third of the world population is malnourished. Nutritional status is the result of complex interactions between food consumption and the overall status of health and healthcare practices and is influenced by three factors: food, health, and care( 1 – 4 ). More than 90% of the world’s stunted children live in Africa and Asia. Child malnutrition is associated with approximately 60% of under-five mortality in Sub-Saharan African countries. In 2015, developing countries reported that malnutrition was responsible for 27% of under-five deaths, and case fatality rates in hospitals treating severe acute malnutrition remained at 20–30%. Undernutrition is a major problem that accounts, directly or indirectly, for 60% of the 10.9 million deaths among children under the age of five worldwide. Above two-thirds of these deaths, which are frequently related to unsuitable feeding practices, occur throughout the first year of life( 5 – 8 ). Child development is commonly recognized as a key measure of people's nutritional state and well-being. Malnutrition prevents children from getting their full physical and mental capability. Health and physical consequences of malnutrition include delays in physical growth and motor development, lower intellectual quotient, greater behavioral problems, deficient social skills, and susceptibility to higher levels risk of developing chronic illnesses during adulthood life which may have intergenerational effects ( 9 – 12 ). Ethiopian demographic health survey data revealed poor child feeding practices throughout the country, as well as a serious condition regarding the nutritional status of children under the age of five, particularly in rural areas. In 2019, Ethiopian National Center for Health Statistics reference showed that the prevalence of wasting, stunting, and underweight were 7.0%, 37%, and 21%, respectively. Concerning the prevalence of undernutrition in the Oromia regional state, 4.7%, 35.6%, and 16.1% of the population were affected by wasting, stunting, and underweight respectively ( 13 – 16 ). Malnutrition is not a simple problem with a single and simple solution. The most immediate determinants are inadequate dietary intake and diseases which are themselves caused by a number of underlying factors: household food insecurity, poor maternal and child-caring practices, and lack of access to basic health services including lack of safe water supply and unhealthy living environments such as open defecation( 5 , 17 , 18 ). This indicated that undernutrition might have public health significance in the region as a result of multifactorial factors. Thus, this study was conducted to assess the magnitude of undernutrition and its associated factors among under-five children in Batu town. Methods and materials Study setting The study was conducted from August 15 to October 10, 2022, in Batu town also named as Ziway town. Batu town is found in Oromia region, Ethiopia. The town has 249,999 total population, among which, 125,925 were male and 124,074 were females; 8042 were children under one year of age, and 41,087 were children under five years of age. Melkawafiku, Malike Shalan, Batale, Washbula, Garbi Hidano, Abosa, and Warja Batale are its seven kebeles, with a total of 30,097 homes. Study design A community-based cross-sectional study design with both descriptive and analytical components was conducted. Study Participants All randomly selected under-five children with their mother/caregiver pairs from selected households residing in Batu Town for more than 6 months and who were available during the study periods. Sample size determination and Sampling technique Sample size adequate for determining the magnitude of undernutrition among under-five children was computed using single population proportion formula with finite source population correction. In the calculation prevalence of 35.5%( 19 ), 95% confidence level, 5% margin of error, and 10% compensation for possible non-response were assumed. Based on these assumptions, the sample size was determined to be 387. The adequacy of the sample size for identifying selected predictors of undernutrition was evaluated using post-hoc power analysis. Regarding the sampling technique, Batu town was purposively selected, then among seven kebeles, three kebeles were randomly selected, Malike Shalan, Abosa, and Garbi Hidano. The sample size was allocated by their relative number of under-five children. Health extensions housing registration was used to identify households with under-five children. Finally, households with eligible children were selected using a simple random sampling technique. For those households with more than one under-five child, one child was selected by using the lottery method. Data collectors visited the house on the next day when the children were not available at home and children who were not available during the second visit were recorded as non-response, and then nearby household was considered. We collected 8–10 sample children per day. Data Collection procedure and tool Data were collected by four trained health professionals who can speak both Amharic and Oromo language using pre-tested structured questionnaire. The questionnaire was prepared in English and translated into two local languages (Afan Oromo and Amharic) and re-translated back to English by an expert to check for its consistency. During data collection process language preference of caregivers was maintained. Assessment of Dietary Diversity Data on the frequency of foods was taken and dietary diversity was assessed based on the number of foods consumed from the seven food groups within the last 24 hours. The seven food groups considered were grains, roots, and tubers; legumes and nuts; dairy products; flesh foods (meats/fish/poultry); eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables( 20 ). Dietary Diversity Score (DDS) was collected and calculated as the sum of the number of different food items consumed by the under-five children aged between 6–59 months before the assessment from the total study participants. The food frequency questionnaire was used to ascertain the frequency of consumption of certain foods on the list on daily basis. Anthropometric Assessment: Weight of the under-five children was measured using a battery-powered digital scale (Seca 770, Hanover Germany) and heights were measured to the nearest 0.1 cm using a wooden height-measuring board with a sliding head bar or microtome tape following standard anthropometric techniques based on USA anthropometric indicators measurement guide. The weight and height of the under-five children were taken on the same day from each study subject using calibrated equipment and standardized techniques. The length was taken for those less than two years old children in a recumbent position and the height for those above two years children in an erect position. Measurement of height (length) was done in a lying position with a wooden board for children of age under two years (below 85 cm) and children above two years stature were measured in a standing position in centimeters to the nearest of 0.1 cm. The weight was measured using the weight scale. Those children, unable to stand being weighed on their own, were weighed with their mothers, and the mothers' weights were subtracted. The weight scale was checked before each measurement. Weight was measured with light clothing and no shoes to the nearest of 0.1 kg. Only children under 110 cm (a proxy for 5 years) and over 65 cm (a proxy for 6 months) were questioned to ascertain age using a detailed season calendar and the presence or absence of pitting edema was checked by pressing the child’s foot bilaterally and graded based on World Health Organization (WHO) reference. ENA-for-SMART Version 2020 was used to determine the level of nutritional status of study subjects based on WHO standards of 2006/2007. Data management and analysis Data were entered in to Epi Info version 7 and analyzed using the statistical package for Social Science (SPSS) version 21. The data were cleaned and prepared for analysis. Frequency distribution, mean, standard deviation & tables were used to summarize the data. Anthropometric data were entered and analyzed using the ENA-for-SMART 2020 software to determine the nutritional status of the study subjects using WHO 2006 standards. Predictors of under nutrition were identified using bivariable and multivariable logistic regression analyses. The p-value < 0.25 was taken as a cut-off point to select variables for the multivariate logistic regression model to control for potential confounders. Multicollinearity was checked using the cutoff point variance inflation factor (VIF) 0.05 and tolerance test greater than 0.1. The model fitness of the final logistic model was tested by using Hosmer and Lemeshow test at a value of > 0.05 and use Omnibus test < 0.05 to check the relative effects of independent variables on the outcome of interest. Adjusted Odds Ratio with 95% CI was used to measure association, and p-values less than 0.05 were taken as statistically significant. Ethical consideration The study was approved by the Institutional Ethical Review Board (IERB) of Adama Hospital Medical College. A letter of permission was taken from the Administration of Batu Town to Batu town selected kebeles. Information regarding the study was explained to the participants, including the study title, procedure, and duration, potential risks, and benefits of the study. Consent was obtained from every relevant authority in the study area and assent was taken from every participant. Confidentiality was kept during the study period by eliminating personal identity from the data collection. Children who were diagnosed with undernutrition during data collection were linked to appropriate treatment unit for further evaluation and treatment. Operational Definition Underweight is weight for age, stunting is height for age, and wasting is weight for height, which are < SD of the WHO Growth Standard chart (21). Exclusive breastfeeding (EBF): feeding a child only breast milk without anything else for the first six months of life, with the exception of medicines for therapeutic purpose( 22 ). Good dietary diversity score: children were classified as having good dietary diversity scores if they had consumed four and more from seven food groups( 22 ). Results Socio-economic and demographic characteristics A total of 371 mothers/caretakers participated in the study making a response rate of 96%. The mothers’ mean (± standard deviation) age was 26.0(± 4.1) years. Majority, 297(80.1%) of the children’s mothers were married. Nearly half, 183 (49.3%) of the mothers attended primary school. About three-fourth, 269(72.5%) of the mothers were housewives in their occupation. More than half, 232(62.5%) of the children were living in households of less than five family. Nearly one-fifth, 63(17.0%) of the children were living in food-insecure households and more than half, 2029 (56.3%) did not have livestock in their households (Table 1 ). Table 1 Socio-Demographic Characteristics of Mothers/Caretakers of under-five children in Batu town, 2022 (n = 371) Variables Description Frequency (n) Percentage (%) Maternal/caretaker Age 15–24 years 161 43.4 25–34 years 175 47.2 ≥ 35 years 35 9.4 Mean ± SD = 26.0 ± 4.1 years Marital status Single 14 3.8 Married 297 80.1 Divorced/Separated 35 9.4 Widowed 25 6.7 Mothers Educational Status Unable to read and write 112 30.2 Primary Education (1–8th Grade) 183 49.3 Secondary education & TVET (9 − 12th Grade) 59 15.9 Higher Education (College / University) 17 4.6 Fathers Educational Status Unable to read and write 33 8.9 Primary education (1–8th Grade) 193 52.0 Secondary education (9–12th Grade) 89 24.0 Higher education (University/College) 56 15.1 Mothers Occupation Housewife 269 72.5 Merchant 76 20.5 Government employee 15 4.0 Others* 11 3.0 Average monthly income < 1000 ETB 117 31.5 1000–2000EBR 185 49.9 ≥ 2000 EBR 69 18.6 Family Size ≤ 4 139 37.5 ≥ 5 232 62.5 Household Food Security Not Secured 63 17.0 Secured 308 83.0 Livestock availability No 209 56.3 Yes 162 43.7 Other* - daily laborer, Private employee Maternal Obstetric and Child Characteristics Three hundred eleven (83.8%) mothers had a history of 2–3 times antenatal care (ANC) visit during their pregnancy period. About two-thirds of their last children, 265 (71.4%) were born at the health facility. Almost half of the mothers, 167 (45.0%), do not know their child's birth weight, however, 104 (28.0%) reported that their child had a normal birth weight. One hundred fifty-seven (42.3%) of the children were in age groups of 12–23 months. Nearly half, 177(47.7%) of the mothers had two under-five children (Table 2 ). Table 2 Maternal obstetric and child characteristics in Batu town, 2022 (n = 371) Variables Description Frequency (n) Percentage (%) Number of ANC visit during last pregnancy Once 43 11.6 2–3 times 311 83.8 ≥ 4 times 17 4.6 Place of delivery Home 106 28.6 Health center 184 49.6 Hospital 65 17.5 Private clinic 16 4.3 Birth weight of last child 4 kg 55 14.9 Unknown 167 45.0 Child age < 12 months 110 29.6 12–23 months 157 42.3 24–59 months 104 28.1 Sex of the child Male 163 43.9 Female 208 56.1 Number of under-five children One 172 46.4 Two 177 47.7 Three or more 22 5.9 Birth order 1st Baby 172 46. 3 2nd – 3rd Baby 169 45.6 4th – 6th Baby 30 8.1 Birth interval between the last 2 children (n = 199) < 24 months 65 32.7 24 months or more 134 67.3 Immunization status Not immunized 58 15.6 Immunized 313 84.4 Diarrheal disease in last 3 month Yes 166 44.7 No 205 55.3 Febrile illness in last 3 month Yes 97 26.1 No 274 73.9 Child feeding and caring practice-related factors Most under-five children, 350 (94.3%), received colostrum, and more than half of the children, 201(54.2%), breastfeeding began within an hour after delivery. One hundred eleven (29.6%) of the mothers did not provide pre-lacteal feeding for their infants. Cow milk is the most common type of pre-lacteal feed given to children by mothers, accounting for 166 (63.6%), followed by butter (25.3%). About half, 182(49.1%) of the children practiced exclusive breastfeeding for less than 6 months and only 145 (39.1%) of the children continued breast milk intake for greater or equal to 24 months. Furthermore, half 188(50.7%) of the children initiated complementary feeding at the age of 6 months. Regarding the child’s dietary diversity status, more than half, 204 (55%) of the children received 4 or more food groups. Nearly half, 178 (48.0%) of the children had meal frequency of three or more times in the last 24 hours (Table 3 ). Table 3 Child Feeding and Care practice-related Characteristics of Under-five Children in Batu town, 2022 (n = 371) Variables Description Frequency(n) Percentage(%) Colostrum intake No 21 5.7 Yes 350 94.3 Breastfeeding initiation time Within an hour 201 54.2 After one hour of birth 106 28.6 After a day of birth 64 17.3 Pre-lacteal feeding Yes 261 70.4 No 110 29.6 Types of pre-lacteal feed (n = 261) Cow milk 166 63.6 Bottled water 29 11.1 Others (butter) 66 25.3 Exclusive breastfeeding for 6 months No 189 50.9 Yes 182 49.1 Initiation time of complementary feeding 0–5 months 183 49.3 At 6 months 188 50.7 The maximum length of breastfeeding 12 months 61 16.4 12–23 months 165 44.5 ≥ 24 months 145 39.1 The material used to feed complementary food Spoon with bowel 161 43.4 Cup 22 5.9 Hand 67 18.1 Bottle 121 32.6 Nutrition education on breastfeeding No 172 46.4 Yes 199 53.6 Nutrition education on complementary feeding No 190 51.2 Yes 181 48.8 Dietary diversity score < 4 food groups 167 45.0 ≥ 4 food groups 204 55.0 Meal frequency of children < 2 times per day 193 52.0 ≥ 3 times per day 178 48.0 Environmental health characteristics of households All the households of the study participants had access to drinking water. Pipe water was the primary source of water for 260 (70.1%) of the houses. Furthermore, nearly half of the mothers/caretakers, 183(49.3%), washed their hands before serving the child and 138 (37.2%) washed after toilet use, and 157(42.3%) of the study participants had a toilet facility in their households (Table 4 ). Table 4 Environmental health characteristics of the households of under-five children in Batu town, 2022 (n = 371) Variables Description Frequency(n) Percentage(%) Main source of water Unprotected Spring/wells 111 29.9 pipe water (private/public) 260 70.1 Time of handwashing After latrine use 138 37.2 Before preparing food 50 13.5 Before serving food to a child 183 49.3 Availability of latrine No 214 57.7 Yes 157 42.3 Waste disposal system Open field 146 39.4 Pit 197 53.1 Burning 28 7.5 Prevalence of Undernutrition The overall prevalence of underweight was 27.0% (95%CI = 22.7–31.7%), out of which 37 (10.0%) were severely underweight (< -3SD), 63(17.0%) moderately underweight ( -3SD) and the mean (± SD) was − 0.92(± 1.52). The prevalence of underweight was higher among males than females. The overall prevalence of stunting was 55.5% (95% CI = 50.4–60.5%), out of which 152 (41.0%) were severely stunted (< -3SD), 54 (14.6%) moderately stunted (< -2SD and ≥ -3SD), and the mean (± SD) was − 2.16(± 2.47). The prevalence of stunting was higher among boys 94(57.7%) as compared to girls 112(53.8%) (Fig. 1 ). The overall prevalence of acute malnutrition (wasting) was 7.0% (95% CI = 4.8–10.1%), out of which 8(2.2%) had severe acute malnutrition (< -3SD), 18 (4.9%) of the children had moderate acute malnutrition (< -2SD and ≥ -3SD), and the mean (± SD) was 0.60(± 1.66) (Fig. 2 ). Factors associated with undernutrition In multivariate logistic regression analysis, sex of the child, colostrum intake, dietary diversity status, and maximum duration of breastfeeding were the factors associated with underweight at a p-value of < 0.05. Male children were nearly twice more likely to be affected with underweight as compared to female children [AOR = 1.86 (95% CI = 1.13–3.08)]. Children who received colostrum in the first days of life were 63% less likely to be underweight later than those children who did not take colostrum [AOR = 0.37 (95% CI = 0.15–0.94)]. The other factor associated with being underweight was dietary diversity status. Children who had good dietary diversity status were 55% less likely to be underweight than their counterparts [AOR = 0.45 (95% CI = 0.24–0.84)]. Under-five children who breastfed for over two years were 2.49 times more likely to be underweight compared to those who stopped before two years [AOR = 2.49 (95% CI = 1.22–5.12)] (Table 5 ). Factors associated with stunting In multivariable logistic regression analysis, age of the child, colostrum intake, and dietary diversity status were factors associated with stunting. Children between 12 and 59 months were nearly 3 times more likely to be stunted compared to infants under 12 months old. [AOR = 2.89 (95% CI = 1.82–4.58]. Similarly, those under-five children who took colostrum during the early infancy period were 91% less likely to be stunted than those who did not take colostrum [AOR = 0.09, (95% CI = 0.01–0.68])]. On the contrary, those children who had good dietary diversity status were 45% less likely to be affected with stunting than their counterparts [AOR = 0.55 (95% CI = 0.33–0.94)] (Table 5 ). Factors associated with acute malnutrition (wasting) Only family size was associated with acute malnutrition in a multivariable logistic regression analysis. Under-five children from households with more than five family members were 3.54 times more likely to be acutely malnourished than children from households with five or fewer members [AOR = 3.54, 95% CI = 1.19–10.48] (Table 5 ). Table 5 Factor associated with undernutrition among under-five children in Batu town, 2022 (n = 371) a) Associated factors of Underweight Variables Category Underweight status COR (95%CI) AOR (95%CI) Underweight Not Underweight Child Age < 12 months 46(12.4%) 64(17.3%) 1 12–59 months 54(14.6%) 207(55.8%) 0.36(0.22, 1.02) Child Sex Female 50(13.5%) 158(42.6%) 1 1 Male 50(13.5%) 113(30.5%) 1.39(0.88, 2.22) 1.86(1.13, 3.08) ** Timely initiation of breast milk within 1 hour No 41(11.1%) 129(34.8%) 1 Yes 59(15.9%) 142(38.3%) 1.31(0.82, 2.08) Colostrum intake No 9(2.4%) 12(3.2%) 1 1 Yes 91(24.5%) 259(69.8%) 0.47(0.19, 1.15) 0.37(0.15, 0.94) * Exclusive Breastfeeding for 6 months No 46(12.4%) 143(38.5%) 1 Yes 54(14.6%) 128(34.5%) 1.31(0.82, 2.08) Timely initiation of Complementary feeding at 6 months No 57(15.4%) 126(34.0%) 1 Yes 43(11.6%) 145(39.1%) 0.66(0.41, 1.04) Dietary diversity status Poor 31(11.9%) 86(33.1%) 1 1 Good 20(7.7%) 123(47.3%) 0.45(0.24, 0.84) 0.45(0.24, 0.84) ** Maximum duration of Breastfeeding < 2 years 53(14.3%) 173(46.6%) 1 1 ≥ 2 years 47(12.7%) 98(26.4%) 1.56(0.98, 2.49) 2.49(1.22, 5.12) ** b) Associated factors of Stunting Variables Category Stunting status COR (95%CI) AOR (95%CI) Stunted Not stunted Household food security No 17(4.6%) 46(12.4%) 1 Yes 83(22.4%) 225(60.6%) 0.57(0.32, 1.01) Child age <12 months 41(11.1%) 69(18.6%) 1 1 12–59 months 165(44.5%) 96(25.9%) 2.89(1.82, 4.59) 2.89(1.82, 4.58)*** Birth spacing < 2 years 15(7.5%) 50 (25.1%) 1 ≥ 2 years 38(19.1%) 96(48.2%) 0.55(0.30, 1.01) Pre-lacteal feeding Yes 68(18.3%) 193(52.0%) 1 No 32(8.6%) 78(21.0%) 0.53(0.34, 0.83) Colostrum intake No 9(2.4%) 12(3.2%) 1 1 Yes 91(24.5%) 259(69.8%) 0.06(0.01, 0.43) 0.09(0.01, 0.68)* Dietary diversity status Poor 31(11.9%) 86(33.1%) 1 1 Good 20(7.7%) 123(47.3%) 0.48(0.29, 0.82) 0.55(0.33, 0.94)* Number of ANC Visit ≤ 3 108(41.5%) 9(3.5%) 1 ≥ 4 138(53.1%) 5(1.9%) 2.71(0.87, 8.48) c) Associated factors of Wasting Variables Category Wasting Status COR (95%CI) AOR (95%CI) Wasted Not Wasted Child age <12 months 11(3.0%) 99(26.7%) 1 12– 59 months 15(4.)%) 246(66.3%) 0.55(0.24, 1.24) Family Size < 5 4(1.1%) 135(36.4%) 1 1 ≥ 5 22(5.9%) 210(56.6%) 3.54(1.19, 10.48) 3.54(1.19, 10.48) * Monthly Income < 1000 EBR 9(2.4%) 108(29.1% 1 1000–2000 EBR 15(4.0%) 170(45.8%) 0.36(0.08, 1.71) ≥ 2000 EBR 2(0.5%) 67(18.1%) 0.34(0.07, 1.52) NB- *p ≤ 0.05, significant; **p ≤ 0.01, very significant; ***p ≤ 0.001, highly significant Discussion The purpose of this study was to examine the prevalence and factors associated with undernutrition among under-five children in the study setting. According to the findings of this study, 27.0% of the children were underweight, 55.5% were stunted, and 7.0% were wasted. The prevalence of underweight in this study (27.0%) was comparable to findings in Bule Hora district (29.2%)( 23 ), Northeast Ethiopia(28%)( 24 ), Addis Ababa (25.5%)( 25 ) and Afar (24.8%)( 17 ). However, it was lower than the findings from Shashamene referral hospital (49.2%)( 26 ), Taytay Adiyabo Woreda of Tigray Ethiopia (37.4%)( 27 ) and Tawila Locality in North Sudan (35.6%)( 8 ). Conversely, was higher than in Bure Town of Northwest Ethiopia (14.30%)( 16 ) and Shinille Woreda, Ethiopian Somali (20.0%)( 28 ). The possible reasons for this discrepancy might be socioeconomic differences, variations in study periods, dietary habits, and childcare practices, cultural differences, and the varying distribution of risk factors across different geographic settings. The prevalence of stunting reported in this study (55.5%) was comparable to findings from Taytay Adiyabo Woreda, Tigray Ethiopia (57.1%)( 27 ) and Northeast Ethiopia (50.2%)( 24 ). However, it was higher than the study conducted in Afar (43.1%)( 17 ), Tawila Locality in North Sudan (48.9%)( 8 ), Bule Hora District (47.6%)( 23 ), Bure town, Northwest Ethiopia (24.9%)( 16 ), Shinille woreda, Ethiopian Somali (33.4%)( 28 ), Meskan District Gurage Zone, Ethiopia (24.9%)( 29 ) and Shashamene referral hospital (38.3%)( 26 ). The observed variation in findings across studies may stem from factors beyond differences in children's genetic potential for maximum height, such as variations in maternal dietary habits during pregnancy and lactation, infant and young child feeding practices (IYCF) in the study area, educational and cultural differences, and the impact of targeted policies. The prevalence of wasting of this study was 7.0%, falling within the medium public health significance range of 5% to < 10%( 30 ). This finding was comparable with the results from 2019 Ethiopia demographic and health survey (EDHS) (7.1%)( 13 ), Wukro town Tigray Ethiopia (7.2%)( 31 ) and East Rural Ethiopia (7.4%)( 32 ). However, it was lower than in Bure Town, Northwest Ethiopia (11.1%)( 16 ), Taytay Adiyabo Woreda of Tigray Ethiopia(17.8%)( 27 ), Afar Northeast Ethiopia ( 16.2%)( 17 ), Tawila Locality in North Sudan (14.7%)( 8 ), Bule Hora District, South Ethiopia (13.4%)( 23 ), Shinille Woreda, Ethiopian Somali Region (20%)( 28 ) and Shashamene referral hospital(25.2%)( 26 ). These discrepancies in findings may stem from various factors, including differences in study design, socioeconomic status, child feeding practices, and disease incidence. Specific examples include disparities in feeding habits, implementation of infant and child feeding policies, physiological demands related to growth spurts, and the impact of targeted policies. In this study, the odds of being underweight was 1.8 times higher among males than females. This finding in line with a study conducted in Afar Northeast Ethiopia, Bule Hora district, South Omo zone, Ethiopia and Pakistan( 17 , 23 , 33 , 34 ). This might be due to differences in eating habits, energy expenditure that male might be engage in more physically demanding activities, and vulnerable to health problems than female children. We found that children who received colostrum in the first days of life were 63% less likely to be underweight later on than those children who did not take colostrum. This finding was supported by a study done in Afar Northeast Ethiopia, Afambo district, Northeast Ethiopia, and developing countries ( 17 , 35 , 36 ). This might be because colostrum acts as a nutritional and immunological fortress for newborns, safeguarding them from early infections that can undermine their journey towards healthy growth. The other predictors for underweight was dietary diversity score. Children who had good dietary diversity status were 55% less likely to be underweight than their counterparts. This is in line with a result from Addis Ababa, Ghana, Tanzania and Sub-Saharan Africa ( 25 , 37 – 39 ). The possible explanation for this is that eating a diversified foods ensures children get the essential nutrients they need to grow. The current study also found that under-five children who breastfed for more than two years were at higher risk of underweight compared to those who weaned before two years. This contradicts with finding from Northwest Ethiopia( 40 ) which reported breastfeeding beyond 2 years was preventive for underweight and Pakistan( 41 ) which reported there was no association between duration of breastfeeding and underweight. Our finding, however, should be interpreted with caution as there might be some unmeasured confounders. Further research is necessary to elucidate this relationship while accounting for confounding variables. The finding from this study highlighted that children above 12 months were more likely to be stunted compared to those between 6 and 12 months. This finding was in line with the findings from different parts of Ethiopia including Menz Gera Midir district, pastoralist community of Northeast and Northern Tigray ( 24 , 42 – 44 ) as well as East African district, China, and India( 45 – 47 ). The possible reason could be due to increased nutrient demands, limited dietary diversity, and heightened exposure to infections in older children. The other factors associated with stunting was colostrum intake in the first days of child life. Children who received colostrum was 91% less likely to be stunted than their counter parts. This is in line with the findings from Wolayita and Afar region, Ethiopia( 48 , 49 ). This could be because colostrum is high in nutrients and contains antibodies that act as a natural defense against illnesses. Missing out on colostrum in the early stages puts children at risk of growth problems and illness, both of which can contribute to stunting. The current study indicated that dietary diversity of complementary feeding was also among the determinants of child stunting. Child with good dietary diversity status was 45% less likely to be stunted that their counter parts. This is supported by a study conducted Gedeo zone, East and West Gojjam and South Ari district in Ethiopia ( 50 – 52 ). Beyond Ethiopia, the finding was in line with different studies in Yogyakarta, Tanzania, Indonesia and Bangladesh ( 38 , 53 – 55 ). The possible reason could be that good dietary diversity helped children grow taller because they got the right mix of nutrients, and also kept them healthy and able to fight off infections and improve their overall nutritional well-being. Children in larger families (≥ 5) had a 4-fold higher risk of wasting compared to those in smaller families (less than 5). This is in line with the finding from Ethiopia (Wonago woreda, Liban District, and rural community in Southwest Ethiopia, and West Ethiopia)( 56 – 59 ). The possible explanation for this could be larger families often face resource constraints, potentially impacting the quality and quantity of food available for each child. This, combined with decreased provision of childcare and parental attention to hygiene practices, can increase vulnerability to infections that exacerbate undernutrition. Limitations of the study Two limitations warrant consideration. First, the study lacked some information such as deworming, vitamin supplementation status, and maternal nutritional status. Second, recall bias may be present in responses to questions about past events. Conclusions The prevalence of undernutrition among children under-five poses a significant public health challenge in Batu town. Stunting (55.5%) and underweight (27%) rates exceed both Oromia regional and national figures (EDHS 2019). Wasting prevalence (7%) aligns with national figures but remains above the Oromia regional level. Notably, males experience higher undernutrition across all types. Within the underweight category, most children fall into the moderate classification, while most stunted children were found as severe. Sex, breastfeeding duration, and family size influence underweight, while colostrum intake, and dietary diversity were preventive effects. The risk factor for stunting was child age, with colostrum and dietary diversity were found to be preventive factors. Family size was the single most important factor for wasting. Recommendations Ethiopia's Ministry of Health, its partners, and communities need to develop age-appropriate interventions to address stunting risks at all stages of early childhood development. They should also carry out focused interventions to address gender differences in undernutrition and investigate the factors that contribute to higher family size-related undernutrition risks. Healthcare workers and media need to promote early and exclusive breastfeeding practices, emphasizing the importance of colostrum intake. They need also to promote diversified diets, particularly for young children and pregnant/breastfeeding mothers. Abbreviations ANC Antenatal Care AOR Adjusted Odd Ratio CI Confidence Interval. DDS Dietary Diversity Score EDHS Ethiopia Demographic and Health Survey IYCF Infant and Young Child Feeding OR Odds Ratio SD Standard Deviation SPSS Statistical Package for Social Science VIF Variance Inflation Factor WHO World Health Organization Declarations Acknowledgment First, we would like to express our deepest thanks and gratitude to the study participants. Our acknowledgment also goes to data collectors and supervisors. Authors' contributions AH conceived and designed the study; collected, analyzed, and interpreted the data; and drafted the manuscript. DE, AF, AY, LH and DU involved in the designing of the study supervision of the fieldwork and the data analysis and drafted the manuscript. All the authors critically reviewed the manuscript for intellectual content and approved the final manuscript. Funding Not applicable Availability of data and material The dataset analyzed during the current study is available from the corresponding author on reasonable request. Ethics approval and consent to participate Ethical clearance was obtained from the Institutional Ethical Review Board of Adama Hospital Medical College. Prior to data collection, informed consent was obtained from the mothers of the children. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable Competing interests The authors declare no competing interest. References Grosso G, Mateo A, Rangelov N, Buzeti T, Birt C. Nutrition in the context of the Sustainable Development Goals. European journal of public health. 2020;30(Supplement_1):i19–23. Hoseini BL, Saeidi M, REZAEI AM, Khademi G. Child Malnutrition at Different World Regions in (1990-2013). 2015 [cited 2023 Dec 27]; Available from: https://www.sid.ir/en/VEWSSID/J_pdf/5074020152110.pdf Binns C, Lee MK, Low WY, Zerfas A. The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region. 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Available from: https://www.ajol.info/index.php/pamj/article/view/237933 Egata G, Berhane Y, Worku A. Seasonal variation in the prevalence of acute undernutrition among children under five years of age in east rural Ethiopia: a longitudinal study. BMC Public Health. 2013 Dec;13(1):864. Tadesse A, Hailu D, Bosha T. Nutritional status and associated factors among pastoralist children aged 6–23 months in Benna Tsemay Woreda, South Omo zone, Southern Ethiopia. Int J Nutr Food Sci. 2018;7(1):11–23. Khan GN, Turab A, Khan MI, Rizvi A, Shaheen F, Ullah A, et al. Prevalence and associated factors of malnutrition among children under-five years in Sindh, Pakistan: a cross-sectional study. BMC Nutr. 2016 Dec;2(1):69. Liben ML, Abuhay T, Haile Y. The role of colostrum feeding on the nutritional status of preschool children in Afambo District, Northeast Ethiopia: descriptive cross sectional study. Eur J Clin Biomed Sci. 2016;2(6):87–91. Herber C, Bogler L, Subramanian SV, Vollmer S. Association between milk consumption and child growth for children aged 6–59 months. Scientific reports. 2020;10(1):6730. Ali Z, Abu N, Ankamah IA, Gyinde EA, Seidu AS, Abizari AR. Nutritional status and dietary diversity of orphan and non – orphan children under five years: a comparative study in the Brong Ahafo region of Ghana. BMC Nutr. 2018 Dec;4(1):32. Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr. 2019 Dec;19(1):518. Aboagye RG, Seidu AA, Ahinkorah BO, Arthur-Holmes F, Cadri A, Dadzie LK, et al. Dietary diversity and undernutrition in children aged 6–23 months in Sub-Saharan Africa. Nutrients. 2021;13(10):3431. Girma A, Woldie H, Mekonnen FA, Gonete KA, Sisay M. Undernutrition and associated factors among urban children aged 24–59 months in Northwest Ethiopia: a community based cross sectional study. BMC Pediatr. 2019 Dec;19(1):214. Syeda B, Agho K, Wilson L, Maheshwari GK, Raza MQ. Relationship between breastfeeding duration and undernutrition conditions among children aged 0–3 Years in Pakistan. International Journal of Pediatrics and Adolescent Medicine. 2021;8(1):10–7. Gebreayohanes M, Dessie A. Prevalence of stunting and its associated factors among children 6–59 months of age in pastoralist community, Northeast Ethiopia: A community-based cross-sectional study. PloS one. 2022;17(2):e0256722. Alemayehu M, Tinsae F, Haileslassie K, Seid O, Gebregziabher G, Yebyo H. Undernutrition status and associated factors in under-5 children, in Tigray, Northern Ethiopia. Nutrition. 2015;31(7–8):964–70. Takele K, Zewotir T, Ndanguza D. Understanding correlates of child stunting in Ethiopia using generalized linear mixed models. BMC Public Health. 2019 Dec;19(1):626. Agho KE, Akombi BJ, Ferdous AJ, Mbugua I, Kamara JK. Childhood undernutrition in three disadvantaged East African Districts: a multinomial analysis. BMC Pediatr. 2019 Dec;19(1):118. Zhang Y, Huang X, Yang Y, Liu X, Yang C, Wang A, et al. Double burden of malnutrition among children under 5 in poor areas of China. PLoS One. 2018;13(9):e0204142. Purohit L, Sahu P, Godale LB. Nutritional status of under-five children in a city of Maharashtra: a community based study. Int J Community Med Public Health. 2017;4(4):1171–8. Kidane W, Facha W, Negash K. Prevalence and predictors of stunting among children of age between 6 to 23 months in four districts of Wolaita Zone, Southern Ethiopia. 2020 [cited 2023 Dec 31]; Available from: https://repository.amref.ac.ke/handle/123456789/541 Mulaw GF, Adem OS, Belachew AB. Determinants of Stunting among Children Aged 6-23 Months of Age in Pastoral Community, Afar Region, Ethiopia: Unmatched Case-Control Study. 2020; Argaw D, Kabthymer RH, Endale T, Wudneh A, Meshesha MD, Hirbu JT, et al. Stunting and associated factors among primary school children in Ethiopia: school-based cross-sectional study. International Journal of Africa Nursing Sciences. 2022;17:100451. Motbainor A, Worku A, Kumie A. Stunting is associated with food diversity while wasting with food insecurity among underfive children in East and West Gojjam Zones of Amhara Region, Ethiopia. PloS one. 2015;10(8):e0133542. Toma TM, Andargie KT, Alula RA, Kebede BM, Gujo MM. Factors associated with wasting and stunting among children aged 06–59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study. BMC Nutr. 2023 Feb 24;9(1):34. Nai HME, Renyoet BS. Poor dietary diversity is associated with stunting among children 6–23 months in area of Mergangsan public health center, Yogyakarta. Journal of nutritional science and vitaminology. 2020;66(Supplement):S398–405. Basri H, Hadju V, Zulkifli A, Syam A, Indriasari R, Helmiyanti S. Dietary diversity, dietary patterns and dietary intake are associated with stunted children in Jeneponto District, Indonesia. Gaceta Sanitaria. 2021;35:S483–6. Hasan M, Islam MM, Mubarak E, Haque MdA, Choudhury N, Ahmed T. Mother’s dietary diversity and association with stunting among children <2 years old in a low socio‐economic environment: A case–control study in an urban care setting in Dhaka, Bangladesh. Maternal & Child Nutrition. 2019 Apr;15(2):e12665. Habtamu E, Chilo D, Desalegn D. Determinants of wasting among children aged 6–59 months in Wonago woreda, south Ethiopia. A facility-based unmatched case-control study. PloS One. 2022;17(6):e0269380. Gemechu DS, Worku Y, Alemu A, Gerema U. Determinants of severe acute malnutrition among children aged 6–59 months in the pastoral community of Liban District, Guji Zone, Oromia Regional State, Southeastern Ethiopia: a case–control study. Journal of Nutritional Science. 2021;10:e101. Bidira K, Tamiru D, Belachew T. Anthropometric failures and its associated factors among preschool-aged children in a rural community in southwest Ethiopia. Plos one. 2021;16(11):e0260368. Ayana AB, Hailemariam TW, Melke AS. Determinants of acute malnutrition among children aged 6–59 months in Public Hospitals, Oromia region, West Ethiopia: a case–control study. BMC Nutr. 2015 Dec;1(1):34. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3858012","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":268574333,"identity":"d607d8b5-b2a5-4793-820f-821b76663721","order_by":0,"name":"Amane Hussen","email":"","orcid":"","institution":"Batu General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amane","middleName":"","lastName":"Hussen","suffix":""},{"id":268574334,"identity":"647e899f-8781-48e9-91c1-8ab5e2f4ad7d","order_by":1,"name":"Amsal Ferede","email":"","orcid":"","institution":"Madda Walabu University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amsal","middleName":"","lastName":"Ferede","suffix":""},{"id":268574335,"identity":"f00ca20c-b058-4110-b6d0-536021ccd3e4","order_by":2,"name":"Aster Yalew","email":"","orcid":"","institution":"Madda Walabu University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aster","middleName":"","lastName":"Yalew","suffix":""},{"id":268574336,"identity":"b344a3f4-2971-4aff-92a6-dc1571fe2dd8","order_by":3,"name":"Dawit Urgi","email":"","orcid":"","institution":"Adama Hospital Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dawit","middleName":"","lastName":"Urgi","suffix":""},{"id":268574337,"identity":"78d37b9b-9a52-4609-b538-33724a916b41","order_by":4,"name":"Limenih Habte","email":"","orcid":"","institution":"Madda Walabu University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Limenih","middleName":"","lastName":"Habte","suffix":""},{"id":268574338,"identity":"7da865f8-c827-407c-b78d-cb06cac49eaa","order_by":5,"name":"Daba Ejara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYDCCAzxAAoTZG4CEgQUpWngOgLRIEKsFBCQSwCRhHXzHzx788EHGLp9/5vOrG34USDDwt3cn4NUieSYvWXIGT7LljNs5ZTd7gA6TOHN2A14tBgdyDKR5eJgNGG7npN3gAWoxkMgloOX8G+Pff3jqDeRvnkm7+YcoLTdyzKQZeA4bGNxgP3abKFskb7xLs+zhOW5geCaH7baMgQQPQb/wnc89fONnT7WB3PHjz26++WMjx9/ei18LGDD2gEgeAzBJWDkY/AAR7A+IVD0KRsEoGAUjDQAA4SNJ7e7+q/QAAAAASUVORK5CYII=","orcid":"","institution":"Madda Walabu University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Daba","middleName":"","lastName":"Ejara","suffix":""}],"badges":[],"createdAt":"2024-01-12 19:45:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3858012/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3858012/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50105312,"identity":"c7ac1c9e-0af7-4cef-9be7-c933682f9a58","added_by":"auto","created_at":"2024-01-24 15:42:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":87642,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHeight for age of under-five children in Batu town, 2022 (n=371).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3858012/v1/8bd8ca490861208afb02b005.jpg"},{"id":50104478,"identity":"f35e1d24-a281-4a65-8e20-dd269fda21dc","added_by":"auto","created_at":"2024-01-24 15:34:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104109,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eWeight for height under-five children in Batu town, 2022 (n=371).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3858012/v1/3fdc41afb0a400e1954fe53e.jpg"},{"id":65665648,"identity":"2218647c-50f1-43ab-aa95-128ec85ed42f","added_by":"auto","created_at":"2024-10-01 06:02:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1341041,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3858012/v1/22edc0cf-defc-4b23-b0a6-73cf775dd42b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Undernutrition and Associated Factors among Under-five Children in Batu Town, Oromia Regional State, Ethiopia: A community-based cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eSufficient nutrition is crucial for normal growth and development throughout infantile period. Currently, nutrition has increasingly been recognized as a basic pillar for social and economic development and more than half of sustainable development goals are related to nutrition because one-third of the world population is malnourished. Nutritional status is the result of complex interactions between food consumption and the overall status of health and healthcare practices and is influenced by three factors: food, health, and care(\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMore than 90% of the world\u0026rsquo;s stunted children live in Africa and Asia. Child malnutrition is associated with approximately 60% of under-five mortality in Sub-Saharan African countries. In 2015, developing countries reported that malnutrition was responsible for 27% of under-five deaths, and case fatality rates in hospitals treating severe acute malnutrition remained at 20\u0026ndash;30%. Undernutrition is a major problem that accounts, directly or indirectly, for 60% of the 10.9\u0026nbsp;million deaths among children under the age of five worldwide. Above two-thirds of these deaths, which are frequently related to unsuitable feeding practices, occur throughout the first year of life(\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChild development is commonly recognized as a key measure of people's nutritional state and well-being. Malnutrition prevents children from getting their full physical and mental capability. Health and physical consequences of malnutrition include delays in physical growth and motor development, lower intellectual quotient, greater behavioral problems, deficient social skills, and susceptibility to higher levels risk of developing chronic illnesses during adulthood life which may have intergenerational effects (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthiopian demographic health survey data revealed poor child feeding practices throughout the country, as well as a serious condition regarding the nutritional status of children under the age of five, particularly in rural areas. In 2019, Ethiopian National Center for Health Statistics reference showed that the prevalence of wasting, stunting, and underweight were 7.0%, 37%, and 21%, respectively. Concerning the prevalence of undernutrition in the Oromia regional state, 4.7%, 35.6%, and 16.1% of the population were affected by wasting, stunting, and underweight respectively (\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMalnutrition is not a simple problem with a single and simple solution. The most immediate determinants are inadequate dietary intake and diseases which are themselves caused by a number of underlying factors: household food insecurity, poor maternal and child-caring practices, and lack of access to basic health services including lack of safe water supply and unhealthy living environments such as open defecation(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This indicated that undernutrition might have public health significance in the region as a result of multifactorial factors. Thus, this study was conducted to assess the magnitude of undernutrition and its associated factors among under-five children in Batu town.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe study was conducted from August 15 to October 10, 2022, in Batu town also named as Ziway town. Batu town is found in Oromia region, Ethiopia. The town has 249,999 total population, among which, 125,925 were male and 124,074 were females; 8042 were children under one year of age, and 41,087 were children under five years of age. Melkawafiku, Malike Shalan, Batale, Washbula, Garbi Hidano, Abosa, and Warja Batale are its seven kebeles, with a total of 30,097 homes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA community-based cross-sectional study design with both descriptive and analytical components was conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eAll randomly selected under-five children with their mother/caregiver pairs from selected households residing in Batu Town for more than 6 months and who were available during the study periods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination and Sampling technique\u003c/h2\u003e \u003cp\u003eSample size adequate for determining the magnitude of undernutrition among under-five children was computed using single population proportion formula with finite source population correction. In the calculation prevalence of 35.5%(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), 95% confidence level, 5% margin of error, and 10% compensation for possible non-response were assumed. Based on these assumptions, the sample size was determined to be 387. The adequacy of the sample size for identifying selected predictors of undernutrition was evaluated using post-hoc power analysis. Regarding the sampling technique, Batu town was purposively selected, then among seven kebeles, three kebeles were randomly selected, Malike Shalan, Abosa, and Garbi Hidano. The sample size was allocated by their relative number of under-five children. Health extensions housing registration was used to identify households with under-five children. Finally, households with eligible children were selected using a simple random sampling technique. For those households with more than one under-five child, one child was selected by using the lottery method. Data collectors visited the house on the next day when the children were not available at home and children who were not available during the second visit were recorded as non-response, and then nearby household was considered. We collected 8–10 sample children per day.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Collection procedure and tool\u003c/h2\u003e \u003cp\u003eData were collected by four trained health professionals who can speak both Amharic and Oromo language using pre-tested structured questionnaire. The questionnaire was prepared in English and translated into two local languages (Afan Oromo and Amharic) and re-translated back to English by an expert to check for its consistency. During data collection process language preference of caregivers was maintained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Dietary Diversity\u003c/h2\u003e \u003cp\u003eData on the frequency of foods was taken and dietary diversity was assessed based on the number of foods consumed from the seven food groups within the last 24 hours. The seven food groups considered were grains, roots, and tubers; legumes and nuts; dairy products; flesh foods (meats/fish/poultry); eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Dietary Diversity Score (DDS) was collected and calculated as the sum of the number of different food items consumed by the under-five children aged between 6–59 months before the assessment from the total study participants. The food frequency questionnaire was used to ascertain the frequency of consumption of certain foods on the list on daily basis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric Assessment:\u003c/h2\u003e \u003cp\u003eWeight of the under-five children was measured using a battery-powered digital scale (Seca 770, Hanover Germany) and heights were measured to the nearest 0.1 cm using a wooden height-measuring board with a sliding head bar or microtome tape following standard anthropometric techniques based on USA anthropometric indicators measurement guide. The weight and height of the under-five children were taken on the same day from each study subject using calibrated equipment and standardized techniques. The length was taken for those less than two years old children in a recumbent position and the height for those above two years children in an erect position. Measurement of height (length) was done in a lying position with a wooden board for children of age under two years (below 85 cm) and children above two years stature were measured in a standing position in centimeters to the nearest of 0.1 cm. The weight was measured using the weight scale. Those children, unable to stand being weighed on their own, were weighed with their mothers, and the mothers' weights were subtracted. The weight scale was checked before each measurement. Weight was measured with light clothing and no shoes to the nearest of 0.1 kg. Only children under 110 cm (a proxy for 5 years) and over 65 cm (a proxy for 6 months) were questioned to ascertain age using a detailed season calendar and the presence or absence of pitting edema was checked by pressing the child’s foot bilaterally and graded based on World Health Organization (WHO) reference. ENA-for-SMART Version 2020 was used to determine the level of nutritional status of study subjects based on WHO standards of 2006/2007.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eData were entered in to Epi Info version 7 and analyzed using the statistical package for Social Science (SPSS) version 21. The data were cleaned and prepared for analysis. Frequency distribution, mean, standard deviation \u0026amp; tables were used to summarize the data. Anthropometric data were entered and analyzed using the ENA-for-SMART 2020 software to determine the nutritional status of the study subjects using WHO 2006 standards. Predictors of under nutrition were identified using bivariable and multivariable logistic regression analyses. The p-value \u0026lt; 0.25 was taken as a cut-off point to select variables for the multivariate logistic regression model to control for potential confounders. Multicollinearity was checked using the cutoff point variance inflation factor (VIF) 0.05 and tolerance test greater than 0.1. The model fitness of the final logistic model was tested by using Hosmer and Lemeshow test at a value of \u0026gt; 0.05 and use Omnibus test \u0026lt; 0.05 to check the relative effects of independent variables on the outcome of interest. Adjusted Odds Ratio with 95% CI was used to measure association, and p-values less than 0.05 were taken as statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e The study was approved by the Institutional Ethical Review Board (IERB) of Adama Hospital Medical College. A letter of permission was taken from the Administration of Batu Town to Batu town selected kebeles. Information regarding the study was explained to the participants, including the study title, procedure, and duration, potential risks, and benefits of the study. Consent was obtained from every relevant authority in the study area and assent was taken from every participant. Confidentiality was kept during the study period by eliminating personal identity from the data collection. Children who were diagnosed with undernutrition during data collection were linked to appropriate treatment unit for further evaluation and treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definition\u003c/h2\u003e \u003cp\u003eUnderweight is weight for age, stunting is height for age, and wasting is weight for height, which are \u0026lt; SD of the WHO Growth Standard chart (21).\u003c/p\u003e \u003cp\u003eExclusive breastfeeding (EBF): feeding a child only breast milk without anything else for the first six months of life, with the exception of medicines for therapeutic purpose(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGood dietary diversity score: children were classified as having good dietary diversity scores if they had consumed four and more from seven food groups(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e "},{"header":"Results","content":"\u003ch2\u003eSocio-economic and demographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 371 mothers/caretakers participated in the study making a response rate of 96%. The mothers’ mean (± standard deviation) age was 26.0(± 4.1) years. Majority, 297(80.1%) of the children’s mothers were married. Nearly half, 183 (49.3%) of the mothers attended primary school. About three-fourth, 269(72.5%) of the mothers were housewives in their occupation. More than half, 232(62.5%) of the children were living in households of less than five family. Nearly one-fifth, 63(17.0%) of the children were living in food-insecure households and more than half, 2029 (56.3%) did not have livestock in their households (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Mothers/Caretakers of under-five children in Batu town, 2022 (n = 371)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDescription\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFrequency (n)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ePercentage (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMaternal/caretaker Age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15–24 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25–34 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 35 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMean ± SD = 26.0 ± 4.1 years\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMothers Educational Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Education (1–8th Grade)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education \u0026amp; TVET (9 − 12th Grade)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher Education (College / University)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFathers Educational Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education (1–8th Grade)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education (9–12th Grade)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher education (University/College)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMothers Occupation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAverage monthly income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 1000 ETB\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000–2000EBR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 2000 EBR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily Size\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≤ 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHousehold Food Security\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Secured\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecured\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLivestock availability\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eOther* - daily laborer, Private employee\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eMaternal Obstetric and Child Characteristics\u003c/h2\u003e\u003cp\u003eThree hundred eleven (83.8%) mothers had a history of 2–3 times antenatal care (ANC) visit during their pregnancy period. About two-thirds of their last children, 265 (71.4%) were born at the health facility. Almost half of the mothers, 167 (45.0%), do not know their child's birth weight, however, 104 (28.0%) reported that their child had a normal birth weight. One hundred fifty-seven (42.3%) of the children were in age groups of 12–23 months. Nearly half, 177(47.7%) of the mothers had two under-five children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal obstetric and child characteristics in Batu town, 2022 (n = 371)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDescription\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFrequency (n)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ePercentage (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of ANC visit during last pregnancy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2–3 times\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 4 times\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePlace of delivery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth center\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate clinic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBirth weight of last child\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 2.5kg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5–4 kg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 4 kg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChild age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 12 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12–23 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex of the child\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of under-five children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThree or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBirth order\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st Baby\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46. 3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd – 3rd Baby\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th – 6th Baby\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBirth interval between the last 2 children (n = 199)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 24 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 months or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eImmunization status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot immunized\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmunized\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiarrheal disease in last 3 month\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFebrile illness in last 3 month\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eChild feeding and caring practice-related factors\u003c/h2\u003e\u003cp\u003eMost under-five children, 350 (94.3%), received colostrum, and more than half of the children, 201(54.2%), breastfeeding began within an hour after delivery. One hundred eleven (29.6%) of the mothers did not provide pre-lacteal feeding for their infants. Cow milk is the most common type of pre-lacteal feed given to children by mothers, accounting for 166 (63.6%), followed by butter (25.3%). About half, 182(49.1%) of the children practiced exclusive breastfeeding for less than 6 months and only 145 (39.1%) of the children continued breast milk intake for greater or equal to 24 months. Furthermore, half 188(50.7%) of the children initiated complementary feeding at the age of 6 months. Regarding the child’s dietary diversity status, more than half, 204 (55%) of the children received 4 or more food groups. Nearly half, 178 (48.0%) of the children had meal frequency of three or more times in the last 24 hours (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChild Feeding and Care practice-related Characteristics of Under-five Children in Batu town, 2022 (n = 371)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDescription\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFrequency(n)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ePercentage(%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eColostrum intake\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e350\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBreastfeeding initiation time\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithin an hour\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter one hour of birth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter a day of birth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-lacteal feeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTypes of pre-lacteal feed (n = 261)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCow milk\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBottled water\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (butter)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExclusive breastfeeding for 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInitiation time of complementary feeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0–5 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThe maximum length of breastfeeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12–23 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 24 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThe material used to feed complementary food\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpoon with bowel\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCup\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHand\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBottle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNutrition education on breastfeeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNutrition education on complementary feeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDietary diversity score\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 4 food groups\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 4 food groups\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeal frequency of children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 2 times per day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 3 times per day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eEnvironmental health characteristics of households\u003c/h2\u003e\u003cp\u003eAll the households of the study participants had access to drinking water. Pipe water was the primary source of water for 260 (70.1%) of the houses. Furthermore, nearly half of the mothers/caretakers, 183(49.3%), washed their hands before serving the child and 138 (37.2%) washed after toilet use, and 157(42.3%) of the study participants had a toilet facility in their households (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEnvironmental health characteristics of the households of under-five children in Batu town, 2022 (n = 371)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDescription\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFrequency(n)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ePercentage(%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain source of water\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnprotected Spring/wells\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epipe water (private/public)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime of handwashing\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter latrine use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore preparing food\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore serving food to a child\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAvailability of latrine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWaste disposal system\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen field\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurning\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003ePrevalence of Undernutrition\u003c/h2\u003e\u003cp\u003eThe overall prevalence of underweight was 27.0% (95%CI = 22.7–31.7%), out of which 37 (10.0%) were severely underweight (\u0026lt; -3SD), 63(17.0%) moderately underweight (\u0026lt;-2SD and \u0026gt; -3SD) and the mean (± SD) was − 0.92(± 1.52). The prevalence of underweight was higher among males than females. The overall prevalence of stunting was 55.5% (95% CI = 50.4–60.5%), out of which 152 (41.0%) were severely stunted (\u0026lt; -3SD), 54 (14.6%) moderately stunted (\u0026lt; -2SD and ≥ -3SD), and the mean (± SD) was − 2.16(± 2.47). The prevalence of stunting was higher among boys 94(57.7%) as compared to girls 112(53.8%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eThe overall prevalence of acute malnutrition (wasting) was 7.0% (95% CI = 4.8–10.1%), out of which 8(2.2%) had severe acute malnutrition (\u0026lt; -3SD), 18 (4.9%) of the children had moderate acute malnutrition (\u0026lt; -2SD and ≥ -3SD), and the mean (± SD) was 0.60(± 1.66) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eFactors associated with undernutrition\u003c/h2\u003e\u003cp\u003eIn multivariate logistic regression analysis, sex of the child, colostrum intake, dietary diversity status, and maximum duration of breastfeeding were the factors associated with underweight at a p-value of \u0026lt; 0.05. Male children were nearly twice more likely to be affected with underweight as compared to female children [AOR = 1.86 (95% CI = 1.13–3.08)]. Children who received colostrum in the first days of life were 63% less likely to be underweight later than those children who did not take colostrum [AOR = 0.37 (95% CI = 0.15–0.94)]. The other factor associated with being underweight was dietary diversity status. Children who had good dietary diversity status were 55% less likely to be underweight than their counterparts [AOR = 0.45 (95% CI = 0.24–0.84)]. Under-five children who breastfed for over two years were 2.49 times more likely to be underweight compared to those who stopped before two years [AOR = 2.49 (95% CI = 1.22–5.12)] (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eFactors associated with stunting\u003c/h2\u003e\u003cp\u003eIn multivariable logistic regression analysis, age of the child, colostrum intake, and dietary diversity status were factors associated with stunting. Children between 12 and 59 months were nearly 3 times more likely to be stunted compared to infants under 12 months old. [AOR = 2.89 (95% CI = 1.82–4.58]. Similarly, those under-five children who took colostrum during the early infancy period were 91% less likely to be stunted than those who did not take colostrum [AOR = 0.09, (95% CI = 0.01–0.68])]. On the contrary, those children who had good dietary diversity status were 45% less likely to be affected with stunting than their counterparts [AOR = 0.55 (95% CI = 0.33–0.94)] (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eFactors associated with acute malnutrition (wasting)\u003c/h2\u003e\u003cp\u003eOnly family size was associated with acute malnutrition in a multivariable logistic regression analysis. Under-five children from households with more than five family members were 3.54 times more likely to be acutely malnourished than children from households with five or fewer members [AOR = 3.54, 95% CI = 1.19–10.48] (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor associated with undernutrition among under-five children in Batu town, 2022 (n = 371)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ea) Associated factors of Underweight\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnderweight status\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95%CI)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95%CI)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot Underweight\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild Age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 12 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(12.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64(17.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(14.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e207(55.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36(0.22, 1.02)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild Sex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(13.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158(42.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(13.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113(30.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.39(0.88, 2.22)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.86(1.13, 3.08) **\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTimely initiation of breast milk within 1 hour\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(11.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129(34.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(15.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142(38.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31(0.82, 2.08)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eColostrum intake\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(2.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(3.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(24.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e259(69.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47(0.19, 1.15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37(0.15, 0.94) *\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExclusive Breastfeeding for 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46(12.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143(38.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(14.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128(34.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31(0.82, 2.08)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTimely initiation of Complementary feeding at 6 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(15.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126(34.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(11.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(39.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66(0.41, 1.04)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDietary diversity status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(11.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86(33.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(7.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123(47.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45(0.24, 0.84)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.45(0.24, 0.84) **\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMaximum duration of Breastfeeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53(14.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e173(46.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(12.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98(26.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56(0.98, 2.49)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.49(1.22, 5.12) **\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eb) \u003cb\u003eAssociated factors of Stunting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCategory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eStunting status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCOR (95%CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAOR (95%CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eStunted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNot stunted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHousehold food security\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(4.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(12.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(22.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225(60.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57(0.32, 1.01)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;12 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(11.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(18.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12–59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165(44.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(25.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.89(1.82, 4.59)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.89(1.82, 4.58)***\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBirth spacing\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(7.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (25.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 2 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(19.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(48.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55(0.30, 1.01)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePre-lacteal feeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(18.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193(52.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(8.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78(21.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53(0.34, 0.83)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eColostrum intake\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(2.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(3.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(24.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e259(69.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06(0.01, 0.43)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09(0.01, 0.68)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDietary diversity status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(11.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86(33.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(7.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123(47.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48(0.29, 0.82)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.55(0.33, 0.94)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of ANC Visit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≤ 3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108(41.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(3.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138(53.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(1.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.71(0.87, 8.48)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ec) \u003cb\u003eAssociated factors of Wasting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCategory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eWasting Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCOR (95%CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAOR (95%CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eWasted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNot Wasted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild age\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;12 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(3.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99(26.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12– 59 months\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(4.)%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e246(66.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55(0.24, 1.24)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily Size\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(1.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135(36.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(5.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210(56.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.54(1.19, 10.48)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.54(1.19, 10.48) *\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 1000 EBR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(2.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(29.1%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000–2000 EBR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(4.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170(45.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36(0.08, 1.71)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 2000 EBR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(0.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(18.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34(0.07, 1.52)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNB- *p ≤ 0.05, significant; **p ≤ 0.01, very significant; ***p ≤ 0.001, highly significant\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to examine the prevalence and factors associated with undernutrition among under-five children in the study setting. According to the findings of this study, 27.0% of the children were underweight, 55.5% were stunted, and 7.0% were wasted.\u003c/p\u003e \u003cp\u003eThe prevalence of underweight in this study (27.0%) was comparable to findings in Bule Hora district (29.2%)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), Northeast Ethiopia(28%)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), Addis Ababa (25.5%)(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and Afar (24.8%)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). However, it was lower than the findings from Shashamene referral hospital (49.2%)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Taytay Adiyabo Woreda of Tigray Ethiopia (37.4%)(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and Tawila Locality in North Sudan (35.6%)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Conversely, was higher than in Bure Town of Northwest Ethiopia (14.30%)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Shinille Woreda, Ethiopian Somali (20.0%)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The possible reasons for this discrepancy might be socioeconomic differences, variations in study periods, dietary habits, and childcare practices, cultural differences, and the varying distribution of risk factors across different geographic settings.\u003c/p\u003e \u003cp\u003eThe prevalence of stunting reported in this study (55.5%) was comparable to findings from Taytay Adiyabo Woreda, Tigray Ethiopia (57.1%)(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and Northeast Ethiopia (50.2%)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, it was higher than the study conducted in Afar (43.1%)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), Tawila Locality in North Sudan (48.9%)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Bule Hora District (47.6%)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), Bure town, Northwest Ethiopia (24.9%)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Shinille woreda, Ethiopian Somali (33.4%)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Meskan District Gurage Zone, Ethiopia (24.9%)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) and Shashamene referral hospital (38.3%)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The observed variation in findings across studies may stem from factors beyond differences in children's genetic potential for maximum height, such as variations in maternal dietary habits during pregnancy and lactation, infant and young child feeding practices (IYCF) in the study area, educational and cultural differences, and the impact of targeted policies.\u003c/p\u003e \u003cp\u003eThe prevalence of wasting of this study was 7.0%, falling within the medium public health significance range of 5% to \u0026lt;\u0026thinsp;10%(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This finding was comparable with the results from 2019 Ethiopia demographic and health survey (EDHS) (7.1%)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Wukro town Tigray Ethiopia (7.2%)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and East Rural Ethiopia (7.4%)(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). However, it was lower than in Bure Town, Northwest Ethiopia (11.1%)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Taytay Adiyabo Woreda of Tigray Ethiopia(17.8%)(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), Afar Northeast Ethiopia \u003cb\u003e(\u003c/b\u003e16.2%)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), Tawila Locality in North Sudan (14.7%)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Bule Hora District, South Ethiopia (13.4%)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), Shinille Woreda, Ethiopian Somali Region (20%)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and Shashamene referral hospital(25.2%)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). These discrepancies in findings may stem from various factors, including differences in study design, socioeconomic status, child feeding practices, and disease incidence. Specific examples include disparities in feeding habits, implementation of infant and child feeding policies, physiological demands related to growth spurts, and the impact of targeted policies.\u003c/p\u003e \u003cp\u003eIn this study, the odds of being underweight was 1.8 times higher among males than females. This finding in line with a study conducted in Afar Northeast Ethiopia, Bule Hora district, South Omo zone, Ethiopia and Pakistan(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This might be due to differences in eating habits, energy expenditure that male might be engage in more physically demanding activities, and vulnerable to health problems than female children.\u003c/p\u003e \u003cp\u003eWe found that children who received colostrum in the first days of life were 63% less likely to be underweight later on than those children who did not take colostrum. This finding was supported by a study done in Afar Northeast Ethiopia, Afambo district, Northeast Ethiopia, and developing countries (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). This might be because colostrum acts as a nutritional and immunological fortress for newborns, safeguarding them from early infections that can undermine their journey towards healthy growth. The other predictors for underweight was dietary diversity score. Children who had good dietary diversity status were 55% less likely to be underweight than their counterparts. This is in line with a result from Addis Ababa, Ghana, Tanzania and Sub-Saharan Africa (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The possible explanation for this is that eating a diversified foods ensures children get the essential nutrients they need to grow. The current study also found that under-five children who breastfed for more than two years were at higher risk of underweight compared to those who weaned before two years. This contradicts with finding from Northwest Ethiopia(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) which reported breastfeeding beyond 2 years was preventive for underweight and Pakistan(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) which reported there was no association between duration of breastfeeding and underweight. Our finding, however, should be interpreted with caution as there might be some unmeasured confounders. Further research is necessary to elucidate this relationship while accounting for confounding variables.\u003c/p\u003e \u003cp\u003eThe finding from this study highlighted that children above 12 months were more likely to be stunted compared to those between 6 and 12 months. This finding was in line with the findings from different parts of Ethiopia including Menz Gera Midir district, pastoralist community of Northeast and Northern Tigray (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) as well as East African district, China, and India(\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The possible reason could be due to increased nutrient demands, limited dietary diversity, and heightened exposure to infections in older children. The other factors associated with stunting was colostrum intake in the first days of child life. Children who received colostrum was 91% less likely to be stunted than their counter parts. This is in line with the findings from Wolayita and Afar region, Ethiopia(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). This could be because colostrum is high in nutrients and contains antibodies that act as a natural defense against illnesses. Missing out on colostrum in the early stages puts children at risk of growth problems and illness, both of which can contribute to stunting.\u003c/p\u003e \u003cp\u003eThe current study indicated that dietary diversity of complementary feeding was also among the determinants of child stunting. Child with good dietary diversity status was 45% less likely to be stunted that their counter parts. This is supported by a study conducted Gedeo zone, East and West Gojjam and South Ari district in Ethiopia (\u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Beyond Ethiopia, the finding was in line with different studies in Yogyakarta, Tanzania, Indonesia and Bangladesh (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). The possible reason could be that good dietary diversity helped children grow taller because they got the right mix of nutrients, and also kept them healthy and able to fight off infections and improve their overall nutritional well-being.\u003c/p\u003e \u003cp\u003eChildren in larger families (\u0026ge;\u0026thinsp;5) had a 4-fold higher risk of wasting compared to those in smaller families (less than 5). This is in line with the finding from Ethiopia (Wonago woreda, Liban District, and rural community in Southwest Ethiopia, and West Ethiopia)(\u003cspan additionalcitationids=\"CR57 CR58\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). The possible explanation for this could be larger families often face resource constraints, potentially impacting the quality and quantity of food available for each child. This, combined with decreased provision of childcare and parental attention to hygiene practices, can increase vulnerability to infections that exacerbate undernutrition.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eTwo limitations warrant consideration. First, the study lacked some information such as deworming, vitamin supplementation status, and maternal nutritional status. Second, recall bias may be present in responses to questions about past events.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe prevalence of undernutrition among children under-five poses a significant public health challenge in Batu town. Stunting (55.5%) and underweight (27%) rates exceed both Oromia regional and national figures (EDHS 2019). Wasting prevalence (7%) aligns with national figures but remains above the Oromia regional level.\u003c/p\u003e\n\u003cp\u003eNotably, males experience higher undernutrition across all types. Within the underweight category, most children fall into the moderate classification, while most stunted children were found as severe. Sex, breastfeeding duration, and family size influence underweight, while colostrum intake, and dietary diversity were preventive effects. The risk factor for stunting was child age, with colostrum and dietary diversity were found to be preventive factors. Family size was the single most important factor for wasting.\u003c/p\u003e\n\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\n \u003ch2\u003eRecommendations\u003c/h2\u003e\n \u003cp\u003eEthiopia\u0026apos;s Ministry of Health, its partners, and communities need to develop age-appropriate interventions to address stunting risks at all stages of early childhood development. They should also carry out focused interventions to address gender differences in undernutrition and investigate the factors that contribute to higher family size-related undernutrition risks. Healthcare workers and media need to promote early and exclusive breastfeeding practices, emphasizing the importance of colostrum intake. They need also to promote diversified diets, particularly for young children and pregnant/breastfeeding mothers.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Antenatal Care\u003c/p\u003e\n\u003cp\u003eAOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted Odd Ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;Confidence Interval.\u003c/p\u003e\n\u003cp\u003eDDS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dietary Diversity Score\u003c/p\u003e\n\u003cp\u003eEDHS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Ethiopia Demographic and Health Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIYCF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp;Infant and Young Child Feeding\u003c/p\u003e\n\u003cp\u003eOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Odds Ratio\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Standard Deviation\u003c/p\u003e\n\u003cp\u003eSPSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Statistical Package for Social Science\u003c/p\u003e\n\u003cp\u003eVIF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Variance Inflation Factor\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, we would like to express our deepest thanks and gratitude to the study participants. Our acknowledgment also goes to data collectors and supervisors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAH conceived and designed the study; collected, analyzed, and interpreted the data; and drafted the manuscript. DE, AF, AY, LH and DU involved in the designing of the study supervision of the fieldwork and the data analysis and drafted the manuscript. All the authors critically reviewed the manuscript for intellectual content and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Institutional Ethical Review Board of Adama Hospital Medical College. Prior to data collection, informed consent was obtained from the mothers of the children. All methods were performed in accordance with the relevant guidelines and regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGrosso G, Mateo A, Rangelov N, Buzeti T, Birt C. Nutrition in the context of the Sustainable Development Goals. European journal of public health. 2020;30(Supplement_1):i19\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eHoseini BL, Saeidi M, REZAEI AM, Khademi G. Child Malnutrition at Different World Regions in (1990-2013). 2015 [cited 2023 Dec 27]; Available from: https://www.sid.ir/en/VEWSSID/J_pdf/5074020152110.pdf\u003c/li\u003e\n \u003cli\u003eBinns C, Lee MK, Low WY, Zerfas A. 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Prevalence and predictors of stunting among children of age between 6 to 23 months in four districts of Wolaita Zone, Southern Ethiopia. 2020 [cited 2023 Dec 31]; Available from: https://repository.amref.ac.ke/handle/123456789/541\u003c/li\u003e\n \u003cli\u003eMulaw GF, Adem OS, Belachew AB. Determinants of Stunting among Children Aged 6-23 Months of Age in Pastoral Community, Afar Region, Ethiopia: Unmatched Case-Control Study. 2020;\u003c/li\u003e\n \u003cli\u003eArgaw D, Kabthymer RH, Endale T, Wudneh A, Meshesha MD, Hirbu JT, et al. Stunting and associated factors among primary school children in Ethiopia: school-based cross-sectional study. International Journal of Africa Nursing Sciences. 2022;17:100451.\u003c/li\u003e\n \u003cli\u003eMotbainor A, Worku A, Kumie A. Stunting is associated with food diversity while wasting with food insecurity among underfive children in East and West Gojjam Zones of Amhara Region, Ethiopia. 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Mother\u0026rsquo;s dietary diversity and association with stunting among children \u0026lt;2 years old in a low socio‐economic environment: A case\u0026ndash;control study in an urban care setting in Dhaka, Bangladesh. Maternal \u0026amp; Child Nutrition. 2019 Apr;15(2):e12665.\u003c/li\u003e\n \u003cli\u003eHabtamu E, Chilo D, Desalegn D. Determinants of wasting among children aged 6\u0026ndash;59 months in Wonago woreda, south Ethiopia. A facility-based unmatched case-control study. PloS One. 2022;17(6):e0269380.\u003c/li\u003e\n \u003cli\u003eGemechu DS, Worku Y, Alemu A, Gerema U. Determinants of severe acute malnutrition among children aged 6\u0026ndash;59 months in the pastoral community of Liban District, Guji Zone, Oromia Regional State, Southeastern Ethiopia: a case\u0026ndash;control study. Journal of Nutritional Science. 2021;10:e101.\u003c/li\u003e\n \u003cli\u003eBidira K, Tamiru D, Belachew T. Anthropometric failures and its associated factors among preschool-aged children in a rural community in southwest Ethiopia. Plos one. 2021;16(11):e0260368.\u003c/li\u003e\n \u003cli\u003eAyana AB, Hailemariam TW, Melke AS. Determinants of acute malnutrition among children aged 6\u0026ndash;59 months in Public Hospitals, Oromia region, West Ethiopia: a case\u0026ndash;control study. BMC Nutr. 2015 Dec;1(1):34.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Wasting, Stunting, Underweight, Batu Town, Under-five children","lastPublishedDoi":"10.21203/rs.3.rs-3858012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3858012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEnhancing nutrition significantly contributes to addressing sustainable development goals by reducing poverty. In Ethiopia, undernutrition is the leading cause of child illness and death. This study aimed to assess the prevalence and associated factors of undernutrition among children under-five years of age in Batu Town, Oromia, Ethiopia. A community-based cross-sectional study design with a simple random sampling technique was used to select 387 participants. ENA for SMART 2020 software was used to calculate the Z-score of Anthropometric Measurements. Binary logistic regression was employed to analyze the data and the outputs are presented using adjusted odds ratio with 95% confidence intervals (AOR, 95% CI). The magnitude of wasting, stunting, and underweight were 7.0%, 55.5%, and 27.0%, respectively. Being male [AOR\u0026thinsp;=\u0026thinsp;1.86 (95% CI\u0026thinsp;=\u0026thinsp;1.13\u0026ndash;3.08)] and breastfeeding for over two years [AOR\u0026thinsp;=\u0026thinsp;2.49 (95% CI\u0026thinsp;=\u0026thinsp;1.22\u0026ndash;5.12)] were the significant predictors of being underweight, whereas colostrum intake [AOR\u0026thinsp;=\u0026thinsp;0.37 (95% CI\u0026thinsp;=\u0026thinsp;0.15\u0026ndash;0.94)] and good dietary diversity status [AOR\u0026thinsp;=\u0026thinsp;0.45 (95% CI\u0026thinsp;=\u0026thinsp;0.24\u0026ndash;0.84)] were preventive factors. Similarly, colostrum intake [AOR\u0026thinsp;=\u0026thinsp;0.09, (95% CI\u0026thinsp;=\u0026thinsp;0.01\u0026ndash;0.68])] and good dietary diversity status [AOR\u0026thinsp;=\u0026thinsp;0.55 (95% CI\u0026thinsp;=\u0026thinsp;0.33\u0026ndash;0.94)] were preventive factors for stunting though children above 12 months [AOR\u0026thinsp;=\u0026thinsp;2.89 (95% CI\u0026thinsp;=\u0026thinsp;1.82\u0026ndash;4.58] had increased odds of being stunted. However, in this study, family size [AOR\u0026thinsp;=\u0026thinsp;3.54, 95% CI\u0026thinsp;=\u0026thinsp;1.19\u0026ndash;10.48] was the sole risk factor for wasting. Undernutrition was prevalent in Batu Town, exceeding regional and national rates. Boys are more affected. Moderate underweight and severe stunting are common. Breastfeeding, colostrum, and diversified diets help, while family size and child age increase the risk. To enhance children's nutritional status, tailored interventions such as promoting colostrum intake, and encouraging diversified diets are required.\u003c/p\u003e","manuscriptTitle":"Undernutrition and Associated Factors among Under-five Children in Batu Town, Oromia Regional State, Ethiopia: A community-based cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-24 15:34:53","doi":"10.21203/rs.3.rs-3858012/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ce5b5f7-ffc3-46c7-8636-6d5bdad1f155","owner":[],"postedDate":"January 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28290238,"name":"Health sciences/Health care"},{"id":28290239,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-10-01T05:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-24 15:34:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3858012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3858012","identity":"rs-3858012","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}