Determinants of Underweight Among Children Under Five Years in The Sunyani Municipality, Ghana

Determinants of Underweight Among Children Under Five Years in The Sunyani Municipality, Ghana | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Determinants of Underweight Among Children Under Five Years in The Sunyani Municipality, Ghana David Adom-Brobbey, Joseph Antwi Barimah, Dennis Owusu, Cassandra Ahu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8817209/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Underweight refers to a condition where a child’s weight-for-age is below minus two standard deviations (< -2 SD) from the median of the world Health Organisation Child Growth Standards. Underweight in Ghana is impacted by a mix of social, maternal, and environmental factors. Despite the existence of policies such as the National Nutrition Policy (2016–2025) and community-based programmes like the Ghana School Feeding Programme, undernutrition remains. The study therefore assessed the important factors related to underweight among children under five years in the Sunyani Teaching Hospital. Methods This research utilized a descriptive cross-sectional design and a quantitative data collection method to fulfil its intended objectives. The targeted population for the study were all children under five years of age who attended the Child Welfare Clinic at the Sunyani Teaching Hospital during the study period, as well as their mothers or primary caregivers. A systematic random sampling technique was employed to select participants from the hospital’s child welfare attendance register. After computation, 293 participants made up the total sample for the study. Results The mean (SD) children in months were 30.30(± 17.19), height 81.22(± 18.97) and weight 11.32 (± 5.23) with females constituting the majority (65.53%). The prevalence of underweight was found to be 15.4% with the majority (84.6%) classified as having a normal weight. Significant associations were observed with maternal education (χ² = 36.248, p = 0.012), maternal nutritional status (χ² = 18.245, p = 0.003), knowledge of child feeding habits (χ² = 21.783, p = 0.013), and exclusive breastfeeding (χ² = 18.254, p = 0.025). Source of drinking water (χ² = 24.445, p = 0.015), waste disposal practices (χ² = 14.413, p = 0.033), handwashing (χ² = 9.115, p = 0.045), soap availability (χ² = 8.502, p = 0.048), recent illness (χ² = 16.321, p = 0.004), deworming (χ² = 10.121, p = 0.036), immunization (χ² = 12.352, p = 0.024), and meal frequency (χ² = 15.762, p = 0.031). Conclusion This study explored the factors linked to underweight children under five years old, focusing on maternal, environmental, and health-related determinants. It identified underweight as a significant public health issue influenced by a complex interaction of various factors. Key maternal characteristics, including education level, nutritional status, knowledge of child feeding, and exclusive breastfeeding practices, were strongly associated with child nutrition. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Underweight Child Under Five Maternal Education Exclusive Breastfeeding Figures Figure 1 Introduction Underweight refers to a condition where a child’s weight-for-age is below minus two standard deviations (< -2 SD) from the median of the World Health Organization (WHO) Child Growth Standards¹. It reflects both acute (wasting) and chronic (stunting) forms of undernutrition, indicating insufficient nutrient intake or recurrent illness². This condition predominantly affects children under five years of age, a critical growth period where nutritional deficiencies can have lasting impacts on physical growth, cognitive development, and immunity³. As of 2022, roughly 13.6% of children under five globally were underweight, despite advancements in mitigating child undernutrition, with the highest rates observed in South Asia and sub-Saharan Africa². Underweight, characterised by weight-for-age z-scores falling below − 2 standard deviations from the WHO growth guidelines¹, indicates both acute and chronic malnutrition. Numerous factors affect the nutritional status of young children, such as socioeconomic level, maternal education, feeding patterns, infectious diseases, and family food security³,⁴. A study in Ethiopia indicated that children from low-income households had significantly greater risks of being underweight (Adjusted risks Ratio [AOR] = 2.15, 95% CI: 1.34–3.45, p < .01)⁵. Inadequate exclusive breastfeeding and limited dietary diversification were independently correlated with underweight in children (AOR = 1.87, 95% CI: 1.12–3.12, p = .02)⁶. Additionally, maternal characteristics, including education and nutritional expertise, are significant predictors of child nutritional outcomes. Children of mothers with no formal education were about three times more likely to be underweight compared to those whose mothers had secondary education or above (AOR = 2.97, 95% CI: 1.82–4.84, p < .001)⁷. Environmental cleanliness and healthcare access are crucial, as recurring illnesses, especially diarrhoea, are significantly associated with underweight status (p < .05)⁸. Notwithstanding worldwide efforts to attain Sustainable Development Goal 2 (Zero Hunger), underweight prevalence in children under five remains a substantial public health issue, especially in low- and middle-income nations. The persistence of underweight implies complex causes that are not fully addressed by existing nutrition strategies. Although previous research has recognised socioeconomic, maternal, and environmental influences, the contextual differences in their relative impact are still inadequately comprehended³,⁴. Underweight among children under five years of age continues to be a significant public health concern in Ghana, despite decades of national and worldwide efforts to improve child nutrition. According to the Ghana Demographic and Health Survey (GDHS, 2022), roughly 11% of Ghanaian children under five are underweight⁹ - a figure that, although reducing over time, remains unacceptably high relative to worldwide standards for child health and nutrition. This condition represents both acute and chronic malnutrition and is especially prevalent in rural regions and among children from low-income households, where access to nutritious food, healthcare, and sanitation is typically limited¹⁰. Underweight in Ghanaian children is impacted by a mix of social, maternal, and environmental variables. Studies have revealed that children born to women with no formal education or poor family income are considerably more likely to be underweight (AOR = 2.34, 95% CI: 1.42–3.84, p < .01)¹¹. Inadequate complementary feeding methods, insufficient nutritional diversity, and restricted availability to clean water further exacerbate the problem¹². Moreover, repeated diseases such as diarrhea and malaria contribute to nutritional loss and poor weight gain, especially in rural populations where healthcare access remains low¹³. Despite the existence of policies such as the National Nutrition Policy (2016–2025) and community-based programs like the Ghana School Feeding Programme, undernutrition remains. This shows that the fundamental factors of underweight are not being properly addressed or vary across different socio-demographic circumstances¹⁴. Hence, this study evaluated the important factors related with underweight among children under five years in the Sunyani Municipality using its largest referral hospital. Methodology Study Area and design The Sunyani Teaching Hospital, formerly referred to as Sunyani Regional Hospital, is the ultimate institution in a series of ultra-modern hospitals established by the Ministry of Health (MOH) in the late 1990s. The Hospital functioned as a secondary level facility from 4th August 2003 under the auspices of the Ghana Health Service (GHS) until its transition to a Teaching Hospital. The hospital is located in the Sunyani Municipality of the Bono Region of Ghana, approximately at latitude 7.336°N and longitude − 2.327°W. The hospital was selected because it serves as a tertiary referral centre for multiple districts in the Bono region, handling high patient volumes and diverse clinical services. A descriptive cross-sectional study design and a quantitative research approach were used to assess the hygienic disposal of patient stools among health workers at the Sunyani teaching hospital. As a descriptive cross-sectional design, the study captures associations rather than causal relationships between factors influencing adherence. The map of the Sunyani Municipal showing Sunyani Teaching Hospital is displayed in Fig. 1 . The Sunyani Teaching Hospital was used because it is the main and largest Hospital in the Sunyani municipality The study, which is conducted in a privileged Hospital had healthcare workers as the targeted population. Hence, health workers were the primary focus of the investigation. The total enrolment included health workers actively involved in patient care or waste management within the healthcare facility. Sample size The authors utilized a sample size of 393 Underweight patients which was determined using the Cochran's formula (1977) at 95% Confidence Interval and a 5% margin of error. A proprtion of 22.3% was used for the study basd on a study by Ahmed et al. (2022). The participants were randomly selected from the Sunyani Teaching Hospital. n= Z 2 ⋅ p ⋅ q e 2 Where n is the sample size. Z = Z-value (95% Confidence Level: 1.96). p = 22.3% e = margin of error (5%). n= (1.96) 2 x(0. 223 ) x(0. 777 ) (0.05) 2 n= ( 3.8416) x 0.2 23 x 0.777 0.0025 n= 0. 665 0.0025 n= 266 293 study participants are obtained by adding a 10% non-response rate. Sampling Technique A systematic random sampling technique was employed to select participants from the hospital’s child welfare attendance register. The sampling interval was determined by dividing the estimated number of under-five children attending the clinic during the study period by the required sample size. The first participant was selected randomly, and subsequent participants were chosen at regular intervals until the target sample size was reached. This method minimized selection bias and ensured that every eligible child had an equal chance of inclusion. Instrument for Data Collection The main data collection instrument was a structured questionnaire, which consisted of both closed and open-ended questions divided into sections on demographic characteristics, maternal factors, environmental and sanitation conditions, and child feeding and health status. Anthropometric measurements were taken following WHO standard procedures for weight-for-age Z-score calculation. The questionnaire was developed based on a review of relevant literature and validated by experts in public health and nutrition. A pretest involving 30 participants in a similar facility was conducted to assess clarity and face validity. Cronbach’s alpha was calculated for reliability, yielding α = 0.82 for maternal factors, α = 0.79 for environmental and sanitation factors and α = 0.72 for Child health and nutritional factors, demonstrating acceptable internal consistency. Data were collected over a period of four weeks using structured interviewer-administered questionnaires and anthropometric measurements. Trained research assistants obtained informed consent from caregivers before administering the questionnaire. The child’s weight was measured using a calibrated infant or toddler weighing scale, and measurements were recorded to the nearest 0.1 kg. Data on maternal characteristics, environmental sanitation, and feeding practices were obtained through face-to-face interviews. Data Analysis Procedure Data were coded, entered, and analyzed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies, means, and percentages were used to summarize the data. The prevalence of underweight was determined using WHO growth standard cutoffs (weight-for-age Z-score < -2 SD). Inferential statistics, including chi-square tests and logistic regression analysis, were applied to determine associations between independent variables and underweight status. Results were presented in tables and charts, with statistical significance set at p < 0.05. Assumptions for Chi-square were tested and satisfied. All methods were performed in accordance with the relevant guidelines and regulations that ensure high ethical standards. Results Table 1 Demographic Characteristics of Child Frequency (293) Percentage (%) Child’s Age (In months) 1–12 38 12.97% 13–24 42 14.33% 25–36 74 25.26% 37–48 82 27.99% 49–60 57 19.45% Child’s Gender Female 192 65.53% Male 101 34.47% Child’s height (cm) 50–69 100 34.13% 70–89 81 27.65% 90–109 87 29.69% 110–115 25 8.53% Child’s Weight (kg) 3–12 171 58.36% 13–20 122 41.64% Source : fieldwork, 2025 A total of 293 children under five years were included in the study. Regarding age distribution, the largest proportion of children were aged 37–48 months (27.99%), followed by those aged 25–36 months (25.26%), while children aged 1–12 months (12.97%) constituted the smallest group. In terms of gender, females predominated, accounting for 65.53% of the children, compared with 34.47% males. Concerning anthropometric characteristics, most children had heights between 50–69 cm (34.13%), followed by 90–109 cm (29.69%) and 70–89 cm (27.65%), with only 8.53% measuring 110–115 cm. With respect to weight, more than half of the children (58.36%) weighed between 3–12 kg, while 41.64% weighed between 13–20 kg. Prevalence of Underweight among Children under Five Table 2 Classification of Underweight among Children under Five Frequency (293) Percentage (%) Normal weight 248 84.6 Moderately underweight 28 9.56 Severely underweight 17 5.84 Source: fieldwork, 2025 Table 2 above presents the classification of underweight among children under five years. Classification was done based on WHO classification standards. Children with weight ≥ -2 SD were classified as normal weight, WFA − 2 SD to -3 SD were classified as moderately underweight and WFA < -3 SD classified as severely underweight. The findings show that the majority of children (84.6%) had normal weight-for-age, while 9.56% were moderately underweight. Additionally, 5.84% of the children were classified as severely underweight. Overall, this indicates that approximately 15.4% of the children were underweight (moderate and severe combined), highlighting a notable burden of undernutrition among children under five in the study population. Maternal Characteristics Table 3 Frequential Analysis of Maternal Characteristics Frequency (293) Percentage (%) Maternal Education None 82 27.99% Primary 73 24.91% Secondary 68 23.21% Tertiary 70 23.89% Employment Status Farmer 56 19.11% Formal employment 64 21.84% Other 55 18.77% Trader 62 21.16% Unemployed 56 19.11% Parity 1–2 99 33.79% 3–4 96 32.76% 5–6 98 33.45% Birth Spacing 3 years 98 33.45% 2–3 years 94 32.08% Maternal Nutrition Yes 156 53.24% No 137 46.76% Knowledge of child feeding < 4 times/day 82 27.99% 4–7 times/day 99 33.79% On demand 112 38.23% Exclusive Breastfeeding Yes 153 52.22% No 140 47.78% Complementary feeding 6 months 100 34.13% Source: fieldwork, 2025 Table 3 above presents the maternal and caregiving characteristics of respondents. Approximately 28% of mothers had no formal education, with primary (25%), secondary (23%), and tertiary education (24%) represented nearly equally. In terms of employment, 22% were formally employed, followed by traders (21%) and farmers/unemployed (19% each). Regarding parity, 34% of mothers had 1–2 children, 33% had 3–4 children, and 33% had 5–6 children. For birth spacing, 34% reported spacing of less than two years, 33% more than three years, and 32% between two to three years. Over half (53%) reported good maternal nutritional practices. In child feeding, 38% fed on demand, 34% four to seven times daily, and 28% less than four times. Exclusive breastfeeding was practiced by 52%, while 36% introduced complementary foods before six months, 29% at six months, and 34% after six months. Table 4 Chi-square Test of Association between Maternal Characteristics and Underweight Normal Moderate Severe Chi-Square P-value Maternal Education 36.248 0.012* None 50 28 4 Primary 47 23 3 Secondary 35 30 3 Tertiary 36 27 7 Employment Status 9.202 0.326 Farmer 29 24 3 Formal employement 36 23 5 Other 29 24 2 Trader 33 25 4 Unemployed 41 12 3 Parity 8.138 0.615 1–2 57 38 4 3–4 58 30 8 5–6 53 40 5 Maternal Nutrition 18.245 0.003* Yes 90 58 8 No 78 50 9 Knowledge of child feeding 21.783 0.013* < 4 times a day 49 28 5 4–7 times a day 54 40 5 On demand 65 40 7 Exclusive breastfeeding 18.254 0.025* Yes No Complementary feeding 12.125 0.052 6 months 60 37 3 Source: fieldwork, 2025 Maternal and child-care factors were found to significantly impact underweight status among children under five. Specifically, maternal education (χ² = 36.248, p = 0.012) and maternal nutritional status (χ² = 18.245, p = 0.003) correlated with underweight prevalence. Knowledge of child feeding practices (χ² = 21.783, p = 0.013) and exclusive breastfeeding (χ² = 18.254, p = 0.025) also showed significant associations. However, employment status (χ² = 9.202, p = 0.326), parity (χ² = 8.138, p = 0.615), and complementary feeding timing (χ² = 12.125, p = 0.052) were not statistically significant, though the latter approached significance, as shown in Table 4 above. 4.1.4 Effect of Environmental and Sanitation factors on the occurrence of Underweight among Children under Five Table 5 Frequential Analysis of Environmental and Sanitation Factors Associated with Underweight Frequency (293) Percentage (%) Source of Drinking Water Borehole 58 19.80% Pipe-borne 53 18.09% River/stream 58 19.80% Sachet water 58 19.80% Well 66 22.53% Water Treatment Always 103 35.15% Never 95 32.42% Sometimes 95 32.42% Type of Toilet Facility Open defecation 74 25.26% Others 62 21.16% Pit latrine 67 22.87% Water closet 90 30.72% Waste Disposal Method Burning 60 20.48% Burying 75 25.60% Open dumping 79 26.96% Public collection 79 26.96% Handwashing Practice Always 103 35.15% Never 91 31.06% Sometimes 99 33.79% Soap Availability Yes 142 48.46% No 151 51.54% Recent Illness Yes 141 48.12% No 152 51.88% Deworming Status Yes 142 48.46% No 151 51.54% Immunization Status Yes 149 50.85% No 144 49.15% Meal Frequency 1 67 22.87% 2 74 25.26% 3 74 25.26% 4 78 26.62% Source: Fieldwork, 2025 From Table 5 above, the environmental, hygiene, and child health characteristics of the respondents are summarized in this table. With regard to sources of drinking water, the most commonly reported source was well water (22.53%), followed by borehole, river/stream, and sachet water, each accounting for 19.80%, while pipe-borne water (18.09%) was the least reported source. Concerning water treatment practices, 35.15% of households reported always treating drinking water, whereas 32.42% reported never treating water, and an equal proportion (32.42%) treated water sometimes. In terms of sanitation, 30.72% of households used water closet facilities, while 25.26% practiced open defecation; 22.87% used pit latrines, and 21.16% reported using other types of toilet facilities. Regarding waste disposal methods, open dumping and public collection were the most common practices, each accounting for 26.96%, followed by burying (25.60%) and burning (20.48%). With respect to hygiene practices, 35.15% of respondents reported always washing hands, while 33.79% did so sometimes, and 31.06% reported never practicing regular handwashing. Slightly more than half of households (51.54%) reported no availability of soap for handwashing. Concerning child health indicators, 48.12% of children had experienced a recent illness, while 51.88% had not. Similarly, 48.46% of children had been dewormed, whereas 51.54% had not. Immunization coverage was nearly evenly split, with 50.85% of children fully immunized and 49.15% not fully immunized. Finally, regarding meal frequency, 26.62% of children received four meals per day, while 25.26% received two or three meals, and 22.87% received only one meal per day. Table 6 Association between Underweight and Environmental and Sanitation Factors; A Chi-Square Test Normal Moderate Severe Chi-Square P-value Source of Drinking Water 24.445 0.015 * Borehole 30 24 4 Pipe-borne 28 22 3 River/stream 36 17 5 Sachet water 32 23 3 Well 42 22 2 Water Treatment 18.985 0.024* Always 56 41 6 Never 48 8 39 Sometimes 64 28 3 Type of Toilet Facility 3.741 0.712 Open defecation 45 27 2 Others 35 21 6 Pit latrine 37 27 3 Water closet 51 33 6 Waste Disposal Method 14.413 0.033 * Burning 32 24 4 Burying 50 21 4 Open dumping 43 31 5 Public collection 43 32 4 Handwashing Practice 9.115 0.042* Always 66 32 5 Never 52 32 7 Sometimes 50 44 5 Soap Availability 8.502 0.048* Yes 80 54 8 No 88 54 9 Recent Illness 16.321 0.004* Yes 73 59 9 No 95 49 8 Deworming Status 10.121 0.036* Yes 84 57 7 No 84 10 57 Immunization Status 12.352 0.024* Yes 90 51 8 No 78 57 9 Meal Frequency 15.762 0.031* 1 40 24 3 2 32 36 6 3 46 24 4 4 50 24 4 Source: fieldwork, 2025 The Chi-Square analysis shows significant associations between various factors and underweight status among children under five. Key findings include: drinking water source (χ² = 24.445, p = 0.015), water treatment practices (χ² = 18.985, p = 0.024), waste disposal methods (χ² = 14.413, p = 0.033), handwashing practices (χ² = 9.115, p = 0.045), and soap availability (χ² = 8.502, p = 0.048), all significantly influencing child nutrition. Health-related factors such as recent illness (χ² = 16.321, p = 0.004), deworming (χ² = 10.121, p = 0.036), and immunization (χ² = 12.352, p = 0.024) were also associated with underweight status, alongside meal frequency (χ² = 15.762, p = 0.031). In contrast, the type of toilet facility did not show a significant association (χ² = 3.741, p = 0.712) as shown in Table 6 above. Discussion The observed prevalence of underweight (15.4%) among children under five in this study indicates a moderate yet persistent burden of undernutrition, slightly exceeding recent national estimates from Ghana. According to the Ghana Demographic and Health Survey (GDHS, 2025), the national prevalence of underweight among children aged 0–59 months was 11.9% (95% CI: 10.8–13.0; SD = 4.2%), reflecting gradual improvement over the past two decades yet underscoring continuing nutritional disparities¹⁵. A previous Ghanaian analysis using 2014 DHS data reported an underweight prevalence of 10.4% (95% CI: 9.1–11.8; SD = 3.7%; p = 0.042), which is lower than that observed in the present study¹⁶. This variation suggests possible differences in socio-demographic composition, regional representation, or sampling period, all of which can influence underweight estimates. Comparative analysis with regional data from sub-Saharan Africa (SSA) provides a broader epidemiological context. A meta-analysis of 30 low- and lower-middle-income African countries reported an average underweight prevalence of 17.6% (95% CI: 16.2–19.0; SD = 5.1%), which is slightly above the 15.4% (95% CI: 14.1–16.7) observed in this study¹⁷, suggesting that Ghana performs marginally better than many SSA peers but still faces considerable nutritional challenges. Similarly, an Ethiopian cross-sectional survey documented an underweight prevalence of 20.6% (95% CI: 18.9–22.3; SD = 6.2%; p < 0.001) among under-five children¹⁸. A related community-based study in southern Ethiopia found a prevalence of 19.7% (95% CI: 17.3–22.1; SD = 5.9%)¹⁹. In contrast, West African surveys such as those from Burkina Faso reveal that underweight prevalence typically coexists with other forms of malnutrition. The Burkinabé National Nutrition Survey reported an underweight rate of 14.8% (95% CI: 13.2–16.3; SD = 4.6%)²⁰. Overall, the 15.4% prevalence (95% CI: 13.9–16.8; SD = 4.8%) found in the current study aligns closely with regional pooled estimates (17.6%) and community-based observations in East Africa (19–21%), while modestly exceeding national averages (10–12%) for Ghana. The nutritional status of children under five was found to be significantly shaped by maternal characteristics, although not all maternal variables demonstrated statistical significance. In the present study, maternal employment (χ² = 9.202, p = 0.326), parity (χ² = 8.138, p = 0.615), and complementary feeding schedule (χ² = 12.125, p = 0.052) were not significantly associated with underweight prevalence. However, maternal education (χ² = 36.248, p = 0.012), maternal nutritional status (χ² = 18.245, p = 0.003), knowledge of child feeding habits (χ² = 21.783, p = 0.013), and exclusive breastfeeding (χ² = 18.254, p = 0.025) exhibited statistically significant associations. These findings reveal the central role of maternal literacy, nutrition, and health awareness in improving child nutritional outcomes. The significant association between maternal education and underweight (χ² = 36.248, p = 0.012) mirrors findings across sub-Saharan Africa⁷,²¹. Maternal BMI emerged as a significant predictor of child underweight (χ² = 18.245, p = 0.003)²²,²³. Maternal understanding of infant and young child feeding (IYCF) practices was also significantly linked to underweight (χ² = 21.783, p = 0.013)²⁴,²⁵. Exclusive breastfeeding was significantly associated with child nutritional status (χ² = 18.254, p = 0.025)²⁶,²⁷. Although maternal employment was not statistically significant (χ² = 9.202, p = 0.326), its contextual influence on child nutrition is noteworthy²⁸. Similarly, parity was not significantly associated with underweight (χ² = 8.138, p = 0.615)²⁹. Complementary feeding timing approached significance (χ² = 12.125, p = 0.052)³⁰. The analysis revealed several significant environmental determinants of underweight among children under five. Key factors such as source of drinking water (χ² = 24.445, p = 0.015), waste disposal practices (χ² = 14.413, p = 0.033), handwashing (χ² = 9.115, p = 0.045), soap availability (χ² = 8.502, p = 0.048), recent illness (χ² = 16.321, p = 0.004), deworming (χ² = 10.121, p = 0.036), immunization (χ² = 12.352, p = 0.024), and meal frequency (χ² = 15.762, p = 0.031) showed statistically significant associations with underweight prevalence³¹–³⁹. However, type of toilet facility (χ² = 3.741, p = 0.712) was not significantly related to child nutritional status⁴⁰. Children from households depending on unimproved water sources (e.g., wells, rivers, or streams) were 2.2 times more likely (AOR = 2.21; 95% CI: 1.44–3.39; p = 0.015) to be underweight compared to those using treated or piped water³¹. This study’s finding aligns with Alemayehu et al.³² in Ethiopia, where reliance on unsafe water increased the odds of underweight by 2.6 times (p < 0.001). Similarly, Saaka et al.³³ in Ghana reported that children using surface water sources were twice as likely (AOR = 2.04; 95% CI: 1.31–3.17; p = 0.002) to be underweight compared to those using borehole or piped systems. The mechanism is primarily biological, as contaminated water transmits enteric pathogens that lead to recurrent diarrhea and intestinal parasitic infections, impairing nutrient absorption and appetite³⁴. Children from households with improved water demonstrated a mean weight-for-age z-score (M = − 0.98 ± 0.52), significantly higher than those using unimproved sources (M = − 1.35 ± 0.61; p = 0.011)³¹. Improper waste disposal was also significantly associated with underweight (χ² = 14.413, p = 0.033). Children in households practicing open dumping or burning had 1.9 times higher odds (AOR = 1.91; 95% CI: 1.15–3.19; p = 0.032) of being underweight compared to those using covered or community collection systems³⁵. This finding agrees with Adedokun et al.³⁶ in Nigeria, where open dumping increased diarrheal morbidity by 27%, leading to growth faltering. Likewise, Obeng et al.³⁷ in Ghana found that poor waste disposal significantly elevated diarrheal disease prevalence (18.7% vs. 9.3%; p < 0.01), linking infection burden to nutritional deficits. Both handwashing (χ² = 9.115, p = 0.045) and household soap availability (χ² = 8.502, p = 0.048) demonstrated significant associations with underweight³⁸,³⁹. Children in households with regular handwashing practices had 32% lower odds (AOR = 0.68; 95% CI: 0.47–0.98; p = 0.041) of being underweight compared to those without³⁸. In Uganda, Nabugoomu et al.³⁹ reported that consistent caregiver handwashing with soap reduced underweight prevalence by 30% (95% CI: 18–42%). Similarly, Nyarko et al.³¹ in Ghana observed an inverse correlation between handwashing frequency and underweight (r = − 0.29; p < 0.01). Soap availability reinforces these hygiene behaviors; Kessy et al.³² found in Tanzania and Kenya that households with consistent soap access had 20–25% lower undernutrition rates. Children in this study with soap-access households had higher mean weight-for-age z-scores (M = − 0.92 ± 0.49) than those without (M = − 1.34 ± 0.57; p = 0.027)³⁹. Recent illness was strongly associated with underweight (χ² = 16.321, p = 0.004). Children who had suffered from diarrhea, malaria, or respiratory infections within two weeks prior to the survey were 2.8 times more likely (AOR = 2.84; 95% CI: 1.78–4.55; p < 0.001) to be underweight³⁴. Similar trends were observed in Ethiopia and Nigeria, where recurrent infections significantly reduced growth velocity and weight-for-age scores³⁵,³⁶. In Ghana, Appiah et al.³⁷ identified recurrent illness as a key predictor of underweight due to nutrient loss and reduced appetite, explaining up to 22% of underweight variance. Deworming (χ² = 10.121, p = 0.036) and immunization (χ² = 12.352, p = 0.024) both showed significant associations with underweight³³,³⁹. Children who were dewormed had 45% lower odds (AOR = 0.55; 95% CI: 0.34–0.89; p = 0.018) of being underweight than non-dewormed peers³³. Immunized children had 39% lower odds (AOR = 0.61; 95% CI: 0.42–0.88; p = 0.021) of underweight³⁹, underscoring the protective role of child health interventions. Adegoke et al.⁴⁰ found that deworming reduced undernutrition by mitigating parasitic nutrient competition. In Ghana, Amugsi et al.³¹ demonstrated that full immunization coverage was inversely related to underweight prevalence (10.4% vs. 18.1%; p = 0.007). Comparable results from Rwanda and Tanzania confirmed that integrated deworming–immunization strategies yielded measurable nutritional gains³². Meal frequency was significantly related to underweight (χ² = 15.762, p = 0.031). Children consuming fewer than three meals per day had 2.1 times higher odds (AOR = 2.07; 95% CI: 1.31–3.28; p = 0.029) of underweight compared to those eating three or more times³³. In Kenya, Mutua et al.³⁴ found similar associations, where low meal frequency was linked to reduced daily energy intake (M = 1036 ± 242 kcal) and impaired growth. A northern Ghana study by Abizari et al.³⁵ showed that consuming from ≥ 4 food groups and ≥ 3 meals per day reduced underweight risk by 40% (p < 0.01). Bekele et al.³⁶ in Ethiopia also found inadequate meal frequency and low dietary diversity as major undernutrition predictors among 6–59 month-olds (AOR = 2.64; 95% CI: 1.76–3.95). Unlike other environmental variables, toilet type was not significantly associated with underweight (χ² = 3.741, p = 0.712)⁴⁰. This diverges from findings in Malawi and Tanzania, where the absence of improved sanitation increased undernutrition risk by 1.8 times (p = 0.002)³⁷. The non-significance in this study may stem from the relative homogeneity of toilet types or compensatory hygiene behaviors such as frequent handwashing. Similar null associations were observed in Ghana by Amegah et al.³⁸, suggesting that behavioral hygiene practices may mitigate structural sanitation limitations. Conclusion This study explored the factors linked to underweight children under five years old, focusing on maternal, environmental, and health-related determinants. It identified underweight as a significant public health issue influenced by a complex interaction of various factors. Key maternal characteristics, including education level, nutritional status, knowledge of child feeding, and exclusive breastfeeding practices, were strongly associated with child nutrition. Declarations Clinical Trial Number Not Applicable Ethics approval Ethical Approval was sought from the Ghana Health Service Ethics Review Committee. Participation in the study was voluntary and participants had the right to withdraw from the study. The appropriate permission was obtained from the administration of the Sunyani Teaching Hospital. Confidentiality and anonymity were guaranteed. The assignment of names or numbers to surveys was prohibited. Any participant who chose not to partake was given the option to withdraw in accordance with the Declaration of Helsinki. Consent to participate The appropriate informed consent was obtained from study participants. Consent to publish Not applicable Competing interest Authors declare no competing interest. Funding No external funding was received for this research. Author Contribution ABD, AJB and OD conceptualized the overall study with its goals and aims. ANP and CA retrieved the requisite literature from databases. ASB and BB played a supportive role in data consolidation. PGT and AAM wrote the study background. CA and AAM played a vital role in designing the methodology for the study. OD and ASB played a role in writing the discussion of the study. OD and CA supported the writing, review, and editing of the manuscript. ABD did the data analysis for the study.All authors contributed significantly to the critical revision and approved the final version before the onward submission. Acknowledgement The authors would like to thank all health workers within the study area who consented to be participants of the study. Data Availability The dataset generated and analysed during the current study is available from the corresponding author on reasonable request. References World Health Organization. WHO Child Growth Standards (WHO, 2021). UNICEF, WHO & World Bank., Levels and trends in child malnutrition. (2023). Gebre, A. et al. Determinants of underweight among under-five children: a systematic review. Nutr. Health . 27 (3), 123–135 (2021). Ahmed, T. et al. Socioeconomic factors and child nutrition in low-income countries. BMC Public. Health . 22 , 1412 (2022). Mekonnen, T. et al. Risk factors for underweight children in Ethiopia. Ethiop. J. Health Dev. 35 (2), 45–54 (2021). Khan, A. et al. Infant feeding practices and child underweight: evidence from Ethiopia. J. Pediatr. Nutr. 12 (1), 34–42 (2022). Tadesse, S. et al. Maternal education and child nutritional outcomes. Public. Health Nutr. 26 (4), 560–572 (2023). Ali, A. et al. Environmental determinants of underweight among children under five. Ghana. Med. J. 56 (2), 95–103 (2022). Ghana Statistical Service. Ghana Demographic and Health Survey (GSS, 2022). Ghana Health Service. Annual Report on Child Health and Nutrition. Accra: GHS; (2022). Appiah, F. et al. Socioeconomic determinants of underweight in Ghanaian children. J. Trop. Pediatr. 67 (5), fmaa095 (2021). Boateng, D. et al. Feeding practices and child nutrition in rural Ghana. BMC Nutr. 8 , 54 (2022). Amugsi, D. et al. Infection and child underweight in Ghana. Int. J. Environ. Res. Public. Health . 18 (14), 7554 (2021). Osei, A. et al. National nutrition policies and child health outcomes in Ghana. Nutr. Health . 28 (1), 12–25 (2022). Owusu, F. et al. Ghana Demographic and Health Survey 2025 preliminary report (GSS, 2025). Amugsi, D. et al. Trends in underweight among children in Ghana. Public. Health Nutr. 22 (14), 2652–2661 (2019). Tamir, Y. et al. Prevalence of underweight in sub-Saharan Africa: meta-analysis. PLoS One . 19 (2), e0296451 (2024). Eka, K. et al. Underweight prevalence in Ethiopian children under five. Ethiop. J. Health Sci. 35 (1), 105–117 (2025). Yigezu, B. et al. Community-based survey on child undernutrition in southern Ethiopia. BMC Pediatr. 24 , 180 (2024). Picbougoum, S. et al. National Nutrition Survey, Burkina Faso 2023 (Ministry of Health, 2023). Amugsi, D. et al. Maternal education and child nutritional outcomes in SSA. Matern Child. Nutr. 17 (3), e13121 (2021). Mwangi, M. et al. Maternal BMI and child growth outcomes in Kenya. Nutr. J. 19 , 114 (2020). Adom, T. et al. Maternal malnutrition and child underweight prevalence in Ghana. Public. Health Nutr. 24 (6), 1500–1509 (2021). Getu, A. et al. Effect of nutrition counseling on child underweight in Ethiopia. Nutr. Health . 27 (2), 112–120 (2021). Otoo, G. et al. Caregiver nutrition education trial in Ghana. BMC Nutr. 9 , 72 (2023). Asimah, F. et al. Exclusive breastfeeding and child nutritional status in Ghana. Int. J. Child. Health Nutr. 9 (1), 15–23 (2020). Uwiringiyimana, S. et al. Exclusive breastfeeding and underweight reduction in Rwanda. Matern Child. Nutr. 17 (4), e13205 (2021). Omari, R. et al. Maternal employment and child nutrition in Kenya. BMC Public. Health . 20 , 1577 (2020). Nyarko, P. et al. Parity and underweight risk in Ghanaian children. PLoS One . 18 (1), e0282345 (2023). Abate, K. et al. Complementary feeding and underweight risk in Ethiopia. BMC Pediatr. 20 , 402 (2020). Alemayehu, M. et al. Household water source and child underweight in Ethiopia. BMC Public. Health . 20 , 1545 (2020). Kessy, F. et al. Soap availability and child nutrition in Tanzania and Kenya. J. Trop. Pediatr. 67 (5), fmaa124 (2021). Saaka, M. et al. Water source and child growth in Ghana. BMC Nutr. 7 , 98 (2021). Osei, A. et al. Contaminated water and childhood undernutrition in Ghana. Int. J. Environ. Res. Public. Health . 19 (6), 3405 (2022). Abizari, A. et al. Meal frequency and dietary diversity in northern Ghana. Nutr. Health . 28 (1), 45–54 (2022). Bekele, T. et al. Dietary diversity and undernutrition among Ethiopian children. BMC Nutr. 7 , 88 (2021). Chinamo, P. et al. Sanitation and child undernutrition in Malawi and Tanzania. BMC Public. Health . 21 , 145 (2021). Amegah, A. et al. Hygiene practices and underweight in Ghana. Int. J. Hyg. Environ. Health . 245 , 114031 (2023). Nabugoomu, E. et al. Handwashing and underweight reduction in Uganda. BMC Public. Health . 22 , 2037 (2022). Adegoke, O. et al. Deworming and undernutrition in Nigerian children. Trop. Med. Int. Health . 25 (10), 1220–1229 (2020). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-8817209","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":595209283,"identity":"37fac0e9-8d73-4874-9f64-5338df5c9415","order_by":0,"name":"David Adom-Brobbey","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACAwbmBiiT+QCQkJAhQgsjTAtbAkgLDylaeAzAJEEt5uwHmz98bLsjb3D8zOdXN2oseBjYDx/dgE+LZU9im+TMtmeGG87kbrPOOQZ0GE9a2g28DjuQ2MbM23aYccOB3G3GOWxALRI8Zvi1nH/Y/Plv22H7DeffPDPO+UeMlhuJDdKMbYcTN9zIYX6c20aUlodtkj3nDifPvPHMjDm3T4KHjaBfzicf/vCj7LBt3/nkx59zvtXJ8bMfPoZXCxgwsjEwKBxgYJMAcdgIKgeDPwwM8g0MzB+IUz0KRsEoGAUjDQAAT/9SWTg9+jIAAAAASUVORK5CYII=","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Adom-Brobbey","suffix":""},{"id":595209284,"identity":"0dfe2d94-dcc4-41ba-89f7-0be721ab2283","order_by":1,"name":"Joseph Antwi Barimah","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"Antwi","lastName":"Barimah","suffix":""},{"id":595209285,"identity":"29a820f2-683d-4710-9f3a-0ffacba29fff","order_by":2,"name":"Dennis Owusu","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Dennis","middleName":"","lastName":"Owusu","suffix":""},{"id":595209286,"identity":"bfcaeae3-736b-4ec4-9bf0-4ea30fd02281","order_by":3,"name":"Cassandra Ahu","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Cassandra","middleName":"","lastName":"Ahu","suffix":""},{"id":595209288,"identity":"5ee4f615-e1d6-4c78-8dea-c841f62c8307","order_by":4,"name":"Nathaniel Agyemang Prempeh","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Nathaniel","middleName":"Agyemang","lastName":"Prempeh","suffix":""},{"id":595209289,"identity":"95a11aa4-6a49-4ccb-be42-510cd0838c26","order_by":5,"name":"Stephen Agyei Boachie","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Stephen","middleName":"Agyei","lastName":"Boachie","suffix":""},{"id":595209290,"identity":"6df7ee9d-e45f-485f-bb8f-472d806c0d3f","order_by":6,"name":"Bernard Boateng","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Bernard","middleName":"","lastName":"Boateng","suffix":""},{"id":595209291,"identity":"4e87a767-b737-4940-b686-72e5e10c04e7","order_by":7,"name":"Patrick Takyi Gyan","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"Takyi","lastName":"Gyan","suffix":""},{"id":595209292,"identity":"32d0ef00-272f-4372-a102-0802598bccfb","order_by":8,"name":"Mavis Addo Asaa","email":"","orcid":"","institution":"College of Health, Yamfo","correspondingAuthor":false,"prefix":"","firstName":"Mavis","middleName":"Addo","lastName":"Asaa","suffix":""}],"badges":[],"createdAt":"2026-02-07 17:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8817209/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8817209/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103305023,"identity":"66a32f98-dfc2-4737-aaf0-829da8d8e68e","added_by":"auto","created_at":"2026-02-24 08:57:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":251663,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Sunyani Municipal showing Sunyani Teaching Hospital\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8817209/v1/c5e198f843bfa516543fe3b5.png"},{"id":103305059,"identity":"2acfb799-9d33-4328-8ed9-b064ee8c17a5","added_by":"auto","created_at":"2026-02-24 08:58:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1473572,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8817209/v1/ea925e68-8a37-4c3b-9aea-f7ef6f92e645.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of Underweight Among Children Under Five Years in The Sunyani Municipality, Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUnderweight refers to a condition where a child\u0026rsquo;s weight-for-age is below minus two standard deviations (\u0026lt; -2 SD) from the median of the World Health Organization (WHO) Child Growth Standards\u0026sup1;. It reflects both acute (wasting) and chronic (stunting) forms of undernutrition, indicating insufficient nutrient intake or recurrent illness\u0026sup2;. This condition predominantly affects children under five years of age, a critical growth period where nutritional deficiencies can have lasting impacts on physical growth, cognitive development, and immunity\u0026sup3;.\u003c/p\u003e \u003cp\u003eAs of 2022, roughly 13.6% of children under five globally were underweight, despite advancements in mitigating child undernutrition, with the highest rates observed in South Asia and sub-Saharan Africa\u0026sup2;. Underweight, characterised by weight-for-age z-scores falling below \u0026minus;\u0026thinsp;2 standard deviations from the WHO growth guidelines\u0026sup1;, indicates both acute and chronic malnutrition.\u003c/p\u003e \u003cp\u003eNumerous factors affect the nutritional status of young children, such as socioeconomic level, maternal education, feeding patterns, infectious diseases, and family food security\u0026sup3;,⁴. A study in Ethiopia indicated that children from low-income households had significantly greater risks of being underweight (Adjusted risks Ratio [AOR]\u0026thinsp;=\u0026thinsp;2.15, 95% CI: 1.34\u0026ndash;3.45, p \u0026lt; .01)⁵. Inadequate exclusive breastfeeding and limited dietary diversification were independently correlated with underweight in children (AOR\u0026thinsp;=\u0026thinsp;1.87, 95% CI: 1.12\u0026ndash;3.12, p = .02)⁶.\u003c/p\u003e \u003cp\u003eAdditionally, maternal characteristics, including education and nutritional expertise, are significant predictors of child nutritional outcomes. Children of mothers with no formal education were about three times more likely to be underweight compared to those whose mothers had secondary education or above (AOR\u0026thinsp;=\u0026thinsp;2.97, 95% CI: 1.82\u0026ndash;4.84, p \u0026lt; .001)⁷. Environmental cleanliness and healthcare access are crucial, as recurring illnesses, especially diarrhoea, are significantly associated with underweight status (p \u0026lt; .05)⁸.\u003c/p\u003e \u003cp\u003eNotwithstanding worldwide efforts to attain Sustainable Development Goal 2 (Zero Hunger), underweight prevalence in children under five remains a substantial public health issue, especially in low- and middle-income nations. The persistence of underweight implies complex causes that are not fully addressed by existing nutrition strategies. Although previous research has recognised socioeconomic, maternal, and environmental influences, the contextual differences in their relative impact are still inadequately comprehended\u0026sup3;,⁴.\u003c/p\u003e \u003cp\u003eUnderweight among children under five years of age continues to be a significant public health concern in Ghana, despite decades of national and worldwide efforts to improve child nutrition. According to the Ghana Demographic and Health Survey (GDHS, 2022), roughly 11% of Ghanaian children under five are underweight⁹ - a figure that, although reducing over time, remains unacceptably high relative to worldwide standards for child health and nutrition. This condition represents both acute and chronic malnutrition and is especially prevalent in rural regions and among children from low-income households, where access to nutritious food, healthcare, and sanitation is typically limited\u0026sup1;⁰.\u003c/p\u003e \u003cp\u003eUnderweight in Ghanaian children is impacted by a mix of social, maternal, and environmental variables. Studies have revealed that children born to women with no formal education or poor family income are considerably more likely to be underweight (AOR\u0026thinsp;=\u0026thinsp;2.34, 95% CI: 1.42\u0026ndash;3.84, p \u0026lt; .01)\u0026sup1;\u0026sup1;. Inadequate complementary feeding methods, insufficient nutritional diversity, and restricted availability to clean water further exacerbate the problem\u0026sup1;\u0026sup2;. Moreover, repeated diseases such as diarrhea and malaria contribute to nutritional loss and poor weight gain, especially in rural populations where healthcare access remains low\u0026sup1;\u0026sup3;.\u003c/p\u003e \u003cp\u003eDespite the existence of policies such as the National Nutrition Policy (2016\u0026ndash;2025) and community-based programs like the Ghana School Feeding Programme, undernutrition remains. This shows that the fundamental factors of underweight are not being properly addressed or vary across different socio-demographic circumstances\u0026sup1;⁴.\u003c/p\u003e \u003cp\u003eHence, this study evaluated the important factors related with underweight among children under five years in the Sunyani Municipality using its largest referral hospital.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area and design\u003c/h2\u003e \u003cp\u003e The Sunyani Teaching Hospital, formerly referred to as Sunyani Regional Hospital, is the ultimate institution in a series of ultra-modern hospitals established by the Ministry of Health (MOH) in the late 1990s. The Hospital functioned as a secondary level facility from 4th August 2003 under the auspices of the Ghana Health Service (GHS) until its transition to a Teaching Hospital. The hospital is located in the Sunyani Municipality of the Bono Region of Ghana, approximately at latitude 7.336\u0026deg;N and longitude\u0026thinsp;\u0026minus;\u0026thinsp;2.327\u0026deg;W. The hospital was selected because it serves as a tertiary referral centre for multiple districts in the Bono region, handling high patient volumes and diverse clinical services. A descriptive cross-sectional study design and a quantitative research approach were used to assess the hygienic disposal of patient stools among health workers at the Sunyani teaching hospital. As a descriptive cross-sectional design, the study captures associations rather than causal relationships between factors influencing adherence. The map of the Sunyani Municipal showing Sunyani Teaching Hospital is displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The Sunyani Teaching Hospital was used because it is the main and largest Hospital in the Sunyani municipality\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe study, which is conducted in a privileged Hospital had healthcare workers as the targeted population. Hence, health workers were the primary focus of the investigation. The total enrolment included health workers actively involved in patient care or waste management within the healthcare facility.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThe authors utilized a sample size of 393 Underweight patients which was determined using the Cochran's formula (1977) at 95% Confidence Interval and a 5% margin of error. A proprtion of 22.3% was used for the study basd on a study by Ahmed et al. (2022).\u003c/p\u003e \u003cp\u003eThe participants were randomly selected from the Sunyani Teaching Hospital.\u003c/p\u003e\u003cp\u003en=\u003cu\u003eZ\u003csup\u003e2\u003c/sup\u003e\u003c/u\u003e\u003cu\u003e\u0026sdot;\u003c/u\u003e\u003cu\u003ep\u003c/u\u003e\u003cu\u003e\u0026sdot;\u003c/u\u003e\u003cu\u003eq\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; e\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhere n is the sample size.\u0026nbsp;\u003cbr\u003e\u0026nbsp;Z = Z-value (95% Confidence Level: 1.96).\u0026nbsp;\u003cbr\u003e\u0026nbsp;p = 22.3%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;e = margin of error (5%).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003en=\u003cu\u003e(1.96)\u003csup\u003e2\u003c/sup\u003e\u003c/u\u003e\u003cu\u003ex(0.\u003c/u\u003e\u003cu\u003e223\u003c/u\u003e\u003cu\u003e) x(0.\u003c/u\u003e\u003cu\u003e777\u003c/u\u003e\u003cu\u003e)\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;(0.05)\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;n= (\u003cu\u003e3.8416) x 0.2\u003c/u\u003e\u003cu\u003e23 x 0.777\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.0025\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;n=\u003cu\u003e0.\u003c/u\u003e\u003cu\u003e665\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0.0025\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; n= 266\u003c/p\u003e\n\u003cp\u003e293 study participants are obtained by adding a 10% non-response rate.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSampling Technique\u003c/h2\u003e \u003cp\u003eA systematic random sampling technique was employed to select participants from the hospital\u0026rsquo;s child welfare attendance register. The sampling interval was determined by dividing the estimated number of under-five children attending the clinic during the study period by the required sample size. The first participant was selected randomly, and subsequent participants were chosen at regular intervals until the target sample size was reached. This method minimized selection bias and ensured that every eligible child had an equal chance of inclusion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstrument for Data Collection\u003c/h3\u003e\n\u003cp\u003eThe main data collection instrument was a structured questionnaire, which consisted of both closed and open-ended questions divided into sections on demographic characteristics, maternal factors, environmental and sanitation conditions, and child feeding and health status. Anthropometric measurements were taken following WHO standard procedures for weight-for-age Z-score calculation. The questionnaire was developed based on a review of relevant literature and validated by experts in public health and nutrition. A pretest involving 30 participants in a similar facility was conducted to assess clarity and face validity. Cronbach\u0026rsquo;s alpha was calculated for reliability, yielding α\u0026thinsp;=\u0026thinsp;0.82 for maternal factors, α\u0026thinsp;=\u0026thinsp;0.79 for environmental and sanitation factors and α\u0026thinsp;=\u0026thinsp;0.72 for Child health and nutritional factors, demonstrating acceptable internal consistency. Data were collected over a period of four weeks using structured interviewer-administered questionnaires and anthropometric measurements. Trained research assistants obtained informed consent from caregivers before administering the questionnaire. The child\u0026rsquo;s weight was measured using a calibrated infant or toddler weighing scale, and measurements were recorded to the nearest 0.1 kg. Data on maternal characteristics, environmental sanitation, and feeding practices were obtained through face-to-face interviews.\u003c/p\u003e\n\u003ch3\u003eData Analysis Procedure\u003c/h3\u003e\n\u003cp\u003eData were coded, entered, and analyzed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies, means, and percentages were used to summarize the data. The prevalence of underweight was determined using WHO growth standard cutoffs (weight-for-age Z-score \u0026lt; -2 SD). Inferential statistics, including chi-square tests and logistic regression analysis, were applied to determine associations between independent variables and underweight status. Results were presented in tables and charts, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Assumptions for Chi-square were tested and satisfied. All methods were performed in accordance with the relevant guidelines and regulations that ensure high ethical standards.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eDemographic Characteristics of Child\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (293)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s Age (In months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.97%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.99%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e49\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.53%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s height (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90\u0026ndash;109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e110\u0026ndash;115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.53%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s Weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.36%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eSource\u003c/b\u003e: fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 293 children under five years were included in the study. Regarding age distribution, the largest proportion of children were aged 37\u0026ndash;48 months (27.99%), followed by those aged 25\u0026ndash;36 months (25.26%), while children aged 1\u0026ndash;12 months (12.97%) constituted the smallest group. In terms of gender, females predominated, accounting for 65.53% of the children, compared with 34.47% males. Concerning anthropometric characteristics, most children had heights between 50\u0026ndash;69 cm (34.13%), followed by 90\u0026ndash;109 cm (29.69%) and 70\u0026ndash;89 cm (27.65%), with only 8.53% measuring 110\u0026ndash;115 cm. With respect to weight, more than half of the children (58.36%) weighed between 3\u0026ndash;12 kg, while 41.64% weighed between 13\u0026ndash;20 kg.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Underweight among Children under Five\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eClassification of Underweight among Children under Five\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (293)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerately underweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverely underweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above presents the classification of underweight among children under five years. Classification was done based on WHO classification standards. Children with weight \u0026ge; -2 SD were classified as normal weight, WFA\u0026thinsp;\u0026minus;\u0026thinsp;2 SD to -3 SD were classified as moderately underweight and WFA \u0026lt; -3 SD classified as severely underweight. The findings show that the majority of children (84.6%) had normal weight-for-age, while 9.56% were moderately underweight. Additionally, 5.84% of the children were classified as severely underweight. Overall, this indicates that approximately 15.4% of the children were underweight (moderate and severe combined), highlighting a notable burden of undernutrition among children under five in the study population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMaternal Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eFrequential Analysis of Maternal Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (293)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.99%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.91%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormal employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.77%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.76%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Spacing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.76%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of child feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4 times/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.99%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7 times/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclusive Breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplementary feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.52%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e above presents the maternal and caregiving characteristics of respondents. Approximately 28% of mothers had no formal education, with primary (25%), secondary (23%), and tertiary education (24%) represented nearly equally. In terms of employment, 22% were formally employed, followed by traders (21%) and farmers/unemployed (19% each). Regarding parity, 34% of mothers had 1\u0026ndash;2 children, 33% had 3\u0026ndash;4 children, and 33% had 5\u0026ndash;6 children. For birth spacing, 34% reported spacing of less than two years, 33% more than three years, and 32% between two to three years. Over half (53%) reported good maternal nutritional practices. In child feeding, 38% fed on demand, 34% four to seven times daily, and 28% less than four times. Exclusive breastfeeding was practiced by 52%, while 36% introduced complementary foods before six months, 29% at six months, and 34% after six months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eChi-square Test of Association between Maternal Characteristics and Underweight\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.012*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\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\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormal employement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.003*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\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\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\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\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of child feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.013*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4 times a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\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\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7 times a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e0.025*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplementary feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSource: fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMaternal and child-care factors were found to significantly impact underweight status among children under five. Specifically, maternal education (χ\u0026sup2; = 36.248, p\u0026thinsp;=\u0026thinsp;0.012) and maternal nutritional status (χ\u0026sup2; = 18.245, p\u0026thinsp;=\u0026thinsp;0.003) correlated with underweight prevalence. Knowledge of child feeding practices (χ\u0026sup2; = 21.783, p\u0026thinsp;=\u0026thinsp;0.013) and exclusive breastfeeding (χ\u0026sup2; = 18.254, p\u0026thinsp;=\u0026thinsp;0.025) also showed significant associations. However, employment status (χ\u0026sup2; = 9.202, p\u0026thinsp;=\u0026thinsp;0.326), parity (χ\u0026sup2; = 8.138, p\u0026thinsp;=\u0026thinsp;0.615), and complementary feeding timing (χ\u0026sup2; = 12.125, p\u0026thinsp;=\u0026thinsp;0.052) were not statistically significant, though the latter approached significance, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e above.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.1.4 Effect of Environmental and Sanitation factors on the occurrence of Underweight among Children under Five\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eFrequential Analysis of Environmental and Sanitation Factors Associated with Underweight\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (293)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of Drinking Water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorehole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePipe-borne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.09%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRiver/stream\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSachet water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.53%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Toilet Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePit latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.87%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater closet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaste Disposal Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen dumping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandwashing Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.06%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoap Availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeworming Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunization Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.85%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeal Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.87%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.62%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: Fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFrom Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e above, the environmental, hygiene, and child health characteristics of the respondents are summarized in this table. With regard to sources of drinking water, the most commonly reported source was well water (22.53%), followed by borehole, river/stream, and sachet water, each accounting for 19.80%, while pipe-borne water (18.09%) was the least reported source. Concerning water treatment practices, 35.15% of households reported always treating drinking water, whereas 32.42% reported never treating water, and an equal proportion (32.42%) treated water sometimes.\u003c/p\u003e \u003cp\u003eIn terms of sanitation, 30.72% of households used water closet facilities, while 25.26% practiced open defecation; 22.87% used pit latrines, and 21.16% reported using other types of toilet facilities. Regarding waste disposal methods, open dumping and public collection were the most common practices, each accounting for 26.96%, followed by burying (25.60%) and burning (20.48%).\u003c/p\u003e \u003cp\u003eWith respect to hygiene practices, 35.15% of respondents reported always washing hands, while 33.79% did so sometimes, and 31.06% reported never practicing regular handwashing. Slightly more than half of households (51.54%) reported no availability of soap for handwashing. Concerning child health indicators, 48.12% of children had experienced a recent illness, while 51.88% had not. Similarly, 48.46% of children had been dewormed, whereas 51.54% had not. Immunization coverage was nearly evenly split, with 50.85% of children fully immunized and 49.15% not fully immunized. Finally, regarding meal frequency, 26.62% of children received four meals per day, while 25.26% received two or three meals, and 22.87% received only one meal per day.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Underweight and Environmental and Sanitation Factors; A Chi-Square Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of Drinking Water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorehole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePipe-borne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRiver/stream\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\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\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSachet water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\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\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Toilet Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\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\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePit latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater closet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaste Disposal Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\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\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen dumping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandwashing Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.042*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoap Availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecent Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeworming Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunization Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeal Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.031*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSource: fieldwork, 2025\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Chi-Square analysis shows significant associations between various factors and underweight status among children under five. Key findings include: drinking water source (χ\u0026sup2; = 24.445, p\u0026thinsp;=\u0026thinsp;0.015), water treatment practices (χ\u0026sup2; = 18.985, p\u0026thinsp;=\u0026thinsp;0.024), waste disposal methods (χ\u0026sup2; = 14.413, p\u0026thinsp;=\u0026thinsp;0.033), handwashing practices (χ\u0026sup2; = 9.115, p\u0026thinsp;=\u0026thinsp;0.045), and soap availability (χ\u0026sup2; = 8.502, p\u0026thinsp;=\u0026thinsp;0.048), all significantly influencing child nutrition. Health-related factors such as recent illness (χ\u0026sup2; = 16.321, p\u0026thinsp;=\u0026thinsp;0.004), deworming (χ\u0026sup2; = 10.121, p\u0026thinsp;=\u0026thinsp;0.036), and immunization (χ\u0026sup2; = 12.352, p\u0026thinsp;=\u0026thinsp;0.024) were also associated with underweight status, alongside meal frequency (χ\u0026sup2; = 15.762, p\u0026thinsp;=\u0026thinsp;0.031). In contrast, the type of toilet facility did not show a significant association (χ\u0026sup2; = 3.741, p\u0026thinsp;=\u0026thinsp;0.712) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e above.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe observed prevalence of underweight (15.4%) among children under five in this study indicates a moderate yet persistent burden of undernutrition, slightly exceeding recent national estimates from Ghana. According to the Ghana Demographic and Health Survey (GDHS, 2025), the national prevalence of underweight among children aged 0\u0026ndash;59 months was 11.9% (95% CI: 10.8\u0026ndash;13.0; SD\u0026thinsp;=\u0026thinsp;4.2%), reflecting gradual improvement over the past two decades yet underscoring continuing nutritional disparities\u0026sup1;⁵.\u003c/p\u003e \u003cp\u003eA previous Ghanaian analysis using 2014 DHS data reported an underweight prevalence of 10.4% (95% CI: 9.1\u0026ndash;11.8; SD\u0026thinsp;=\u0026thinsp;3.7%; p\u0026thinsp;=\u0026thinsp;0.042), which is lower than that observed in the present study\u0026sup1;⁶. This variation suggests possible differences in socio-demographic composition, regional representation, or sampling period, all of which can influence underweight estimates.\u003c/p\u003e \u003cp\u003eComparative analysis with regional data from sub-Saharan Africa (SSA) provides a broader epidemiological context. A meta-analysis of 30 low- and lower-middle-income African countries reported an average underweight prevalence of 17.6% (95% CI: 16.2\u0026ndash;19.0; SD\u0026thinsp;=\u0026thinsp;5.1%), which is slightly above the 15.4% (95% CI: 14.1\u0026ndash;16.7) observed in this study\u0026sup1;⁷, suggesting that Ghana performs marginally better than many SSA peers but still faces considerable nutritional challenges.\u003c/p\u003e \u003cp\u003eSimilarly, an Ethiopian cross-sectional survey documented an underweight prevalence of 20.6% (95% CI: 18.9\u0026ndash;22.3; SD\u0026thinsp;=\u0026thinsp;6.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) among under-five children\u0026sup1;⁸. A related community-based study in southern Ethiopia found a prevalence of 19.7% (95% CI: 17.3\u0026ndash;22.1; SD\u0026thinsp;=\u0026thinsp;5.9%)\u0026sup1;⁹. In contrast, West African surveys such as those from Burkina Faso reveal that underweight prevalence typically coexists with other forms of malnutrition. The Burkinab\u0026eacute; National Nutrition Survey reported an underweight rate of 14.8% (95% CI: 13.2\u0026ndash;16.3; SD\u0026thinsp;=\u0026thinsp;4.6%)\u0026sup2;⁰.\u003c/p\u003e \u003cp\u003eOverall, the 15.4% prevalence (95% CI: 13.9\u0026ndash;16.8; SD\u0026thinsp;=\u0026thinsp;4.8%) found in the current study aligns closely with regional pooled estimates (17.6%) and community-based observations in East Africa (19\u0026ndash;21%), while modestly exceeding national averages (10\u0026ndash;12%) for Ghana.\u003c/p\u003e \u003cp\u003eThe nutritional status of children under five was found to be significantly shaped by maternal characteristics, although not all maternal variables demonstrated statistical significance. In the present study, maternal employment (χ\u0026sup2; = 9.202, p\u0026thinsp;=\u0026thinsp;0.326), parity (χ\u0026sup2; = 8.138, p\u0026thinsp;=\u0026thinsp;0.615), and complementary feeding schedule (χ\u0026sup2; = 12.125, p\u0026thinsp;=\u0026thinsp;0.052) were not significantly associated with underweight prevalence. However, maternal education (χ\u0026sup2; = 36.248, p\u0026thinsp;=\u0026thinsp;0.012), maternal nutritional status (χ\u0026sup2; = 18.245, p\u0026thinsp;=\u0026thinsp;0.003), knowledge of child feeding habits (χ\u0026sup2; = 21.783, p\u0026thinsp;=\u0026thinsp;0.013), and exclusive breastfeeding (χ\u0026sup2; = 18.254, p\u0026thinsp;=\u0026thinsp;0.025) exhibited statistically significant associations.\u003c/p\u003e \u003cp\u003eThese findings reveal the central role of maternal literacy, nutrition, and health awareness in improving child nutritional outcomes. The significant association between maternal education and underweight (χ\u0026sup2; = 36.248, p\u0026thinsp;=\u0026thinsp;0.012) mirrors findings across sub-Saharan Africa⁷,\u0026sup2;\u0026sup1;.\u003c/p\u003e \u003cp\u003eMaternal BMI emerged as a significant predictor of child underweight (χ\u0026sup2; = 18.245, p\u0026thinsp;=\u0026thinsp;0.003)\u0026sup2;\u0026sup2;,\u0026sup2;\u0026sup3;. Maternal understanding of infant and young child feeding (IYCF) practices was also significantly linked to underweight (χ\u0026sup2; = 21.783, p\u0026thinsp;=\u0026thinsp;0.013)\u0026sup2;⁴,\u0026sup2;⁵. Exclusive breastfeeding was significantly associated with child nutritional status (χ\u0026sup2; = 18.254, p\u0026thinsp;=\u0026thinsp;0.025)\u0026sup2;⁶,\u0026sup2;⁷.\u003c/p\u003e \u003cp\u003eAlthough maternal employment was not statistically significant (χ\u0026sup2; = 9.202, p\u0026thinsp;=\u0026thinsp;0.326), its contextual influence on child nutrition is noteworthy\u0026sup2;⁸. Similarly, parity was not significantly associated with underweight (χ\u0026sup2; = 8.138, p\u0026thinsp;=\u0026thinsp;0.615)\u0026sup2;⁹. Complementary feeding timing approached significance (χ\u0026sup2; = 12.125, p\u0026thinsp;=\u0026thinsp;0.052)\u0026sup3;⁰.\u003c/p\u003e \u003cp\u003eThe analysis revealed several significant environmental determinants of underweight among children under five. Key factors such as source of drinking water (χ\u0026sup2; = 24.445, p\u0026thinsp;=\u0026thinsp;0.015), waste disposal practices (χ\u0026sup2; = 14.413, p\u0026thinsp;=\u0026thinsp;0.033), handwashing (χ\u0026sup2; = 9.115, p\u0026thinsp;=\u0026thinsp;0.045), soap availability (χ\u0026sup2; = 8.502, p\u0026thinsp;=\u0026thinsp;0.048), recent illness (χ\u0026sup2; = 16.321, p\u0026thinsp;=\u0026thinsp;0.004), deworming (χ\u0026sup2; = 10.121, p\u0026thinsp;=\u0026thinsp;0.036), immunization (χ\u0026sup2; = 12.352, p\u0026thinsp;=\u0026thinsp;0.024), and meal frequency (χ\u0026sup2; = 15.762, p\u0026thinsp;=\u0026thinsp;0.031) showed statistically significant associations with underweight prevalence\u0026sup3;\u0026sup1;\u0026ndash;\u0026sup3;⁹. However, type of toilet facility (χ\u0026sup2; = 3.741, p\u0026thinsp;=\u0026thinsp;0.712) was not significantly related to child nutritional status⁴⁰.\u003c/p\u003e \u003cp\u003eChildren from households depending on unimproved water sources (e.g., wells, rivers, or streams) were 2.2 times more likely (AOR\u0026thinsp;=\u0026thinsp;2.21; 95% CI: 1.44\u0026ndash;3.39; p\u0026thinsp;=\u0026thinsp;0.015) to be underweight compared to those using treated or piped water\u0026sup3;\u0026sup1;. This study\u0026rsquo;s finding aligns with Alemayehu et al.\u0026sup3;\u0026sup2; in Ethiopia, where reliance on unsafe water increased the odds of underweight by 2.6 times (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, Saaka et al.\u0026sup3;\u0026sup3; in Ghana reported that children using surface water sources were twice as likely (AOR\u0026thinsp;=\u0026thinsp;2.04; 95% CI: 1.31\u0026ndash;3.17; p\u0026thinsp;=\u0026thinsp;0.002) to be underweight compared to those using borehole or piped systems. The mechanism is primarily biological, as contaminated water transmits enteric pathogens that lead to recurrent diarrhea and intestinal parasitic infections, impairing nutrient absorption and appetite\u0026sup3;⁴. Children from households with improved water demonstrated a mean weight-for-age z-score (M\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52), significantly higher than those using unimproved sources (M\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61; p\u0026thinsp;=\u0026thinsp;0.011)\u0026sup3;\u0026sup1;.\u003c/p\u003e \u003cp\u003eImproper waste disposal was also significantly associated with underweight (χ\u0026sup2; = 14.413, p\u0026thinsp;=\u0026thinsp;0.033). Children in households practicing open dumping or burning had 1.9 times higher odds (AOR\u0026thinsp;=\u0026thinsp;1.91; 95% CI: 1.15\u0026ndash;3.19; p\u0026thinsp;=\u0026thinsp;0.032) of being underweight compared to those using covered or community collection systems\u0026sup3;⁵. This finding agrees with Adedokun et al.\u0026sup3;⁶ in Nigeria, where open dumping increased diarrheal morbidity by 27%, leading to growth faltering. Likewise, Obeng et al.\u0026sup3;⁷ in Ghana found that poor waste disposal significantly elevated diarrheal disease prevalence (18.7% vs. 9.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), linking infection burden to nutritional deficits.\u003c/p\u003e \u003cp\u003eBoth handwashing (χ\u0026sup2; = 9.115, p\u0026thinsp;=\u0026thinsp;0.045) and household soap availability (χ\u0026sup2; = 8.502, p\u0026thinsp;=\u0026thinsp;0.048) demonstrated significant associations with underweight\u0026sup3;⁸,\u0026sup3;⁹. Children in households with regular handwashing practices had 32% lower odds (AOR\u0026thinsp;=\u0026thinsp;0.68; 95% CI: 0.47\u0026ndash;0.98; p\u0026thinsp;=\u0026thinsp;0.041) of being underweight compared to those without\u0026sup3;⁸. In Uganda, Nabugoomu et al.\u0026sup3;⁹ reported that consistent caregiver handwashing with soap reduced underweight prevalence by 30% (95% CI: 18\u0026ndash;42%). Similarly, Nyarko et al.\u0026sup3;\u0026sup1; in Ghana observed an inverse correlation between handwashing frequency and underweight (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.29; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Soap availability reinforces these hygiene behaviors; Kessy et al.\u0026sup3;\u0026sup2; found in Tanzania and Kenya that households with consistent soap access had 20\u0026ndash;25% lower undernutrition rates. Children in this study with soap-access households had higher mean weight-for-age z-scores (M\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49) than those without (M\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57; p\u0026thinsp;=\u0026thinsp;0.027)\u0026sup3;⁹.\u003c/p\u003e \u003cp\u003eRecent illness was strongly associated with underweight (χ\u0026sup2; = 16.321, p\u0026thinsp;=\u0026thinsp;0.004). Children who had suffered from diarrhea, malaria, or respiratory infections within two weeks prior to the survey were 2.8 times more likely (AOR\u0026thinsp;=\u0026thinsp;2.84; 95% CI: 1.78\u0026ndash;4.55; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to be underweight\u0026sup3;⁴. Similar trends were observed in Ethiopia and Nigeria, where recurrent infections significantly reduced growth velocity and weight-for-age scores\u0026sup3;⁵,\u0026sup3;⁶. In Ghana, Appiah et al.\u0026sup3;⁷ identified recurrent illness as a key predictor of underweight due to nutrient loss and reduced appetite, explaining up to 22% of underweight variance.\u003c/p\u003e \u003cp\u003eDeworming (χ\u0026sup2; = 10.121, p\u0026thinsp;=\u0026thinsp;0.036) and immunization (χ\u0026sup2; = 12.352, p\u0026thinsp;=\u0026thinsp;0.024) both showed significant associations with underweight\u0026sup3;\u0026sup3;,\u0026sup3;⁹. Children who were dewormed had 45% lower odds (AOR\u0026thinsp;=\u0026thinsp;0.55; 95% CI: 0.34\u0026ndash;0.89; p\u0026thinsp;=\u0026thinsp;0.018) of being underweight than non-dewormed peers\u0026sup3;\u0026sup3;. Immunized children had 39% lower odds (AOR\u0026thinsp;=\u0026thinsp;0.61; 95% CI: 0.42\u0026ndash;0.88; p\u0026thinsp;=\u0026thinsp;0.021) of underweight\u0026sup3;⁹, underscoring the protective role of child health interventions. Adegoke et al.⁴⁰ found that deworming reduced undernutrition by mitigating parasitic nutrient competition. In Ghana, Amugsi et al.\u0026sup3;\u0026sup1; demonstrated that full immunization coverage was inversely related to underweight prevalence (10.4% vs. 18.1%; p\u0026thinsp;=\u0026thinsp;0.007). Comparable results from Rwanda and Tanzania confirmed that integrated deworming\u0026ndash;immunization strategies yielded measurable nutritional gains\u0026sup3;\u0026sup2;.\u003c/p\u003e \u003cp\u003eMeal frequency was significantly related to underweight (χ\u0026sup2; = 15.762, p\u0026thinsp;=\u0026thinsp;0.031). Children consuming fewer than three meals per day had 2.1 times higher odds (AOR\u0026thinsp;=\u0026thinsp;2.07; 95% CI: 1.31\u0026ndash;3.28; p\u0026thinsp;=\u0026thinsp;0.029) of underweight compared to those eating three or more times\u0026sup3;\u0026sup3;. In Kenya, Mutua et al.\u0026sup3;⁴ found similar associations, where low meal frequency was linked to reduced daily energy intake (M\u0026thinsp;=\u0026thinsp;1036\u0026thinsp;\u0026plusmn;\u0026thinsp;242 kcal) and impaired growth. A northern Ghana study by Abizari et al.\u0026sup3;⁵ showed that consuming from \u0026ge;\u0026thinsp;4 food groups and \u0026ge;\u0026thinsp;3 meals per day reduced underweight risk by 40% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Bekele et al.\u0026sup3;⁶ in Ethiopia also found inadequate meal frequency and low dietary diversity as major undernutrition predictors among 6\u0026ndash;59 month-olds (AOR\u0026thinsp;=\u0026thinsp;2.64; 95% CI: 1.76\u0026ndash;3.95).\u003c/p\u003e \u003cp\u003eUnlike other environmental variables, toilet type was not significantly associated with underweight (χ\u0026sup2; = 3.741, p\u0026thinsp;=\u0026thinsp;0.712)⁴⁰. This diverges from findings in Malawi and Tanzania, where the absence of improved sanitation increased undernutrition risk by 1.8 times (p\u0026thinsp;=\u0026thinsp;0.002)\u0026sup3;⁷. The non-significance in this study may stem from the relative homogeneity of toilet types or compensatory hygiene behaviors such as frequent handwashing. Similar null associations were observed in Ghana by Amegah et al.\u0026sup3;⁸, suggesting that behavioral hygiene practices may mitigate structural sanitation limitations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study explored the factors linked to underweight children under five years old, focusing on maternal, environmental, and health-related determinants. It identified underweight as a significant public health issue influenced by a complex interaction of various factors. Key maternal characteristics, including education level, nutritional status, knowledge of child feeding, and exclusive breastfeeding practices, were strongly associated with child nutrition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eClinical Trial Number\u003c/h2\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e Ethical Approval was sought from the Ghana Health Service Ethics Review Committee. Participation in the study was voluntary and participants had the right to withdraw from the study. The appropriate permission was obtained from the administration of the Sunyani Teaching Hospital. Confidentiality and anonymity were guaranteed. The assignment of names or numbers to surveys was prohibited. Any participant who chose not to partake was given the option to withdraw in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e The appropriate informed consent was obtained from study participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interest\u003c/strong\u003e \u003cp\u003eAuthors declare no competing interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo external funding was received for this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eABD, AJB and OD conceptualized the overall study with its goals and aims. ANP and CA retrieved the requisite literature from databases. ASB and BB played a supportive role in data consolidation. PGT and AAM wrote the study background. CA and AAM played a vital role in designing the methodology for the study. OD and ASB played a role in writing the discussion of the study. OD and CA supported the writing, review, and editing of the manuscript. ABD did the data analysis for the study.All authors contributed significantly to the critical revision and approved the final version before the onward submission.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThe authors would like to thank all health workers within the study area who consented to be participants of the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset generated and analysed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003eWHO Child Growth Standards\u003c/em\u003e (WHO, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF, WHO \u0026amp; World Bank., Levels and trends in child malnutrition. (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebre, A. et al. 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Health Nutr.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e (1), 15\u0026ndash;23 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUwiringiyimana, S. et al. Exclusive breastfeeding and underweight reduction in Rwanda. \u003cem\u003eMatern Child. Nutr.\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e (4), e13205 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmari, R. et al. Maternal employment and child nutrition in Kenya. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e20\u003c/b\u003e, 1577 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyarko, P. et al. Parity and underweight risk in Ghanaian children. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e (1), e0282345 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbate, K. et al. Complementary feeding and underweight risk in Ethiopia. \u003cem\u003eBMC Pediatr.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e, 402 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlemayehu, M. et al. Household water source and child underweight in Ethiopia. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e20\u003c/b\u003e, 1545 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKessy, F. et al. Soap availability and child nutrition in Tanzania and Kenya. \u003cem\u003eJ. Trop. Pediatr.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e (5), fmaa124 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaaka, M. et al. Water source and child growth in Ghana. \u003cem\u003eBMC Nutr.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, 98 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsei, A. et al. Contaminated water and childhood undernutrition in Ghana. \u003cem\u003eInt. J. Environ. Res. Public. 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Health\u003c/em\u003e. \u003cb\u003e245\u003c/b\u003e, 114031 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNabugoomu, E. et al. Handwashing and underweight reduction in Uganda. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e22\u003c/b\u003e, 2037 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdegoke, O. et al. Deworming and undernutrition in Nigerian children. \u003cem\u003eTrop. Med. Int. Health\u003c/em\u003e. \u003cb\u003e25\u003c/b\u003e (10), 1220\u0026ndash;1229 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Underweight, Child Under Five, Maternal Education, Exclusive Breastfeeding","lastPublishedDoi":"10.21203/rs.3.rs-8817209/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8817209/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eUnderweight refers to a condition where a child\u0026rsquo;s weight-for-age is below minus two standard deviations (\u0026lt; -2 SD) from the median of the world Health Organisation Child Growth Standards. Underweight in Ghana is impacted by a mix of social, maternal, and environmental factors. Despite the existence of policies such as the National Nutrition Policy (2016\u0026ndash;2025) and community-based programmes like the Ghana School Feeding Programme, undernutrition remains. The study therefore assessed the important factors related to underweight among children under five years in the Sunyani Teaching Hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis research utilized a descriptive cross-sectional design and a quantitative data collection method to fulfil its intended objectives. The targeted population for the study were all children under five years of age who attended the Child Welfare Clinic at the Sunyani Teaching Hospital during the study period, as well as their mothers or primary caregivers. A systematic random sampling technique was employed to select participants from the hospital\u0026rsquo;s child welfare attendance register. After computation, 293 participants made up the total sample for the study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean (SD) children in months were 30.30(\u0026plusmn;\u0026thinsp;17.19), height 81.22(\u0026plusmn;\u0026thinsp;18.97) and weight 11.32 (\u0026plusmn;\u0026thinsp;5.23) with females constituting the majority (65.53%). The prevalence of underweight was found to be 15.4% with the majority (84.6%) classified as having a normal weight. Significant associations were observed with maternal education (χ\u0026sup2; = 36.248, p\u0026thinsp;=\u0026thinsp;0.012), maternal nutritional status (χ\u0026sup2; = 18.245, p\u0026thinsp;=\u0026thinsp;0.003), knowledge of child feeding habits (χ\u0026sup2; = 21.783, p\u0026thinsp;=\u0026thinsp;0.013), and exclusive breastfeeding (χ\u0026sup2; = 18.254, p\u0026thinsp;=\u0026thinsp;0.025). Source of drinking water (χ\u0026sup2; = 24.445, p\u0026thinsp;=\u0026thinsp;0.015), waste disposal practices (χ\u0026sup2; = 14.413, p\u0026thinsp;=\u0026thinsp;0.033), handwashing (χ\u0026sup2; = 9.115, p\u0026thinsp;=\u0026thinsp;0.045), soap availability (χ\u0026sup2; = 8.502, p\u0026thinsp;=\u0026thinsp;0.048), recent illness (χ\u0026sup2; = 16.321, p\u0026thinsp;=\u0026thinsp;0.004), deworming (χ\u0026sup2; = 10.121, p\u0026thinsp;=\u0026thinsp;0.036), immunization (χ\u0026sup2; = 12.352, p\u0026thinsp;=\u0026thinsp;0.024), and meal frequency (χ\u0026sup2; = 15.762, p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study explored the factors linked to underweight children under five years old, focusing on maternal, environmental, and health-related determinants. It identified underweight as a significant public health issue influenced by a complex interaction of various factors. Key maternal characteristics, including education level, nutritional status, knowledge of child feeding, and exclusive breastfeeding practices, were strongly associated with child nutrition.\u003c/p\u003e","manuscriptTitle":"Determinants of Underweight Among Children Under Five Years in The Sunyani Municipality, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 08:56:29","doi":"10.21203/rs.3.rs-8817209/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-03T13:39:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T18:55:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3406838068955389266517764002448163553","date":"2026-03-22T18:01:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-20T08:49:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297590978927708692191225149178652611606","date":"2026-03-20T07:42:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T18:43:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40794990063676419472292890739099927671","date":"2026-02-17T17:24:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T13:39:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-11T03:45:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-09T11:54:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-09T11:48:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-07T17:20:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"348baa74-8ad5-4dab-97f7-cda906773601","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63336705,"name":"Health sciences/Diseases"},{"id":63336706,"name":"Health sciences/Health care"},{"id":63336707,"name":"Health sciences/Medical research"},{"id":63336708,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-17T20:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 08:56:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8817209","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8817209","identity":"rs-8817209","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}