Predictors of under-weight among children less than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan

Predictors of under-weight among children less than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of under-weight among children less than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan Francis Eriga, Godfrey Gulom, John Bosco Alege This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2065097/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Underweight is a public health problem globally, and more severe in South Sudan with wide regional differences. In Nimule border town, which represents other border towns in South Sudan, data on underweight among children below two years is unavailable. Thus, this study set out to assess determinants of underweight among children less than 24 months in Nimule boarder town, Pageri County, Eastern Equatoria State, South Sudan. Methods: An analytical cross-sectional study was conducted in Nimule boarder town targeting 390 children below two years. Systematic sampling and simple random sampling methods were used. Data were collected through a researcher-administered questionnaire with both open and closed ended questions. Data was entered in EpiData and then exported into Statistical Package for Social Sciences research (SPSS) version 20 for analysis. Descriptive data analysis was conducted and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was conducted with the Chi-squared and Fisher's exact tests for categorical independent variables, and the student’s t-test for numerical variables. Finally, multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%. Results: Out of 390 participants, 112 (28.7%) were under weight. The study showed primary (aOR, 0.38; 95% CI, 0.12-1.18; P=0.095) and secondary (aOR, 0.37; 95% CI, 0.12-1.17; P=0.091 levels of education were associated with underweight but not tertiary level of education (aOR, 0.76; 95% CI, 0.21-2.74; p = 0.671). Household income of 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10-0.68; P =0.006) and above 10,000 (aOR, 0.11; 95% CI, 0.04-0.28; P<0.001) South Sudanese pounds, supplementary feeding before 6 months (aOR; 0.01; 95% CI, 0.02-0.05; P<0.001) were associated with underweight and irregular hand washing (aOR; 2.17; 95% CI, 1.14-4.11; P=0.018) was associated with increased odds of underweight. Conclusions: This study established a high prevalence of underweight. Maternal levels of education particularly primary, secondary, higher household incomes in excess of 5,000 South Sudanese pounds were protective against underweight. While irregular hand washing was a risk factor for underweight. Birth weight low children under 24 months determinants Figures Figure 1 1. Background According to the Global Nutrition report (2018), malnutrition remains a severe problem, especially under nutrition, which is one of the major causes of child mortality globally. Besides, it seems that the world is not on track to achieve the target of reducing malnutrition by 40%, as a result, it remains unacceptably high across all regions of the world [ 1 ]. According to the Global burden of diseases, approximately 200 deaths per 100,000 in children less than five years are due to childhood under nutrition, equivalent of 21% total deaths in this age bracket [ 2 ]. In South East Asia, under nutrition continues to be an alarming public health concern especially in Pakistan, Bangladesh, and India [ 3 ]. In Pakistan, under nutrition is responsible for 428 deaths per 100,000 in children less than five years [ 2 ]. Besides, A Save the Children report (2012) in the UK revealed that 96% of the children less than two years do not receive the adequate diet recommended [ 4 ]. Similarly, Indonesia has been ranked the fifth highest of stunted children globally, as a result, one in every three children are stunted implying 9.7 million children under five are malnourished [ 5 ]. In the same report, about three million under-five children are wasted and two in every three children below two years of age are anemic. There is no clear data for monitoring progress on the target of reducing the incidence of low birth weight (LBW) by 30%. In the WHO African Region, 26 of the member countries with data have LBW rates in excess of 10%. This seemingly may need an underestimation of the LBW burden. This is because population groups with high socioeconomic status are more likely to deliver in maternity facilities under the care of skilled birth attendants where birth weight is measured, compared to groups with lower socioeconomic status who often deliver at home and are more likely to have babies with low birth weight [ 6 ]. Among most Sub-Saharan African countries, the prevalence of wasting among children below five years of age remained below the emergency threshold level, though at the poor nutritional threshold level of 6.5% for East Africa [ 7 ]. In another review, it was also observed that an estimated 60 million under-five children in developing countries were found to be stunted, out of which 11 million were Nigerian children. The severity of childhood malnutrition was observed to steadily increase from 11% in 2003 to 18% in 2013 for wasting; 24% in 2003 to 29% in 2013 for underweight, nevertheless, there was a decline from 42% in 2003 to 37% in 2013 for stunted children [ 8 ]. In this review it was observed that high rates of mortality of malnourished children in Sub-Saharan Africa result from factors such as low intake of calories, high rates of Human Immuno Virus/Acquired Immunodeficiency Syndrome (HIV and AIDS), political instability, conflicts among groups and poor implementation of government policies [ 8 ]. In addition, Malnutrition in developing countries is accountable for about one in five of all disability-adjusted life years, and Nigeria was ranked amongst the ten countries with the highest prevalence of underweight, stunting and wasting in children below five years [ 9 ]. In Uganda, the burden of childhood malnutrition is more prevalent in rural areas compared to the urban areas, 29% (2.2 million) of the children suffered from stunting [low height-for-age], Uganda Bureau of Statistics [ 10 ]. While in terms of economic loss yearly, Uganda loses 1.8 trillion shillings equivalent of 6% of the country's Gross Domestic Product (DGP) in treatment, management, and prevention of childhood malnutrition [ 11 ]. In addition, childhood malnutrition is associated with premature deaths and consequential life-course perspective in economic development [ 12 ]. In South Sudan, malnutrition is a serious public health problem where approximately 200,000 children below five years are at risk of malnutrition [ 5 ]. As a result, South Sudan ranks 15th highest in the world in terms of mortality rates for children below five years [ 13 ]. Similarly, one in every seventh South Sudanese child dies before their fifth birthday due to diarrheal diseases and the burden of malnutrition is substantial with its rate-exceeding the 15% threshold of WHO [ 14 ]. Besides, in 2014, the burden of moderate acute malnutrition increased by 44.7% from 123, 3832 to 675, 4003, and over 900,000 children were severely malnourished; hence, the burden is more in Jonglei, Upper Nile and Unity states [ 13 ]. In Torit State particularly Nimule boarder town, there is limited information on the burden of malnutrition especially underweight among children below two years of age. 2. Methods Study setting and design This study used analytical cross-sectional study design to determine the proportion of children below 24months who are underweight in Nimule border town. The study also determined factors associated with underweight. The exposure and the outcome data was collected at the same point in time. This study was conducted in Nimule border town, Magwi County, Eastern Equatoria State, South Sudan. Nimule is located at border with the Republic of Uganda in Magwi County, Torit State [ 15 ]. Sample size, and sampling procedure The study targeted mothers and caretakers of children less than 24 months in Nimule border town, Magwi County, Eastern Equatoria, in South Sudan. All mothers and caretakers of children less than two years who had growth monitoring cards and voluntarily consented to participate in the study, and had spent at least three months in the study area were eligible to participate in the study. The researcher used Open Epi software for sample size estimation. The sample size of 390 was established on expected result estimation of about 50% positive (underweight) and 50% negative (normal weight) with 95% confidence that the true frequency lies between 45 and 55% since there is no previous estimate of Underweight among children less than 24 months in Nimule border town. Systematic sampling technique with random start method was used in order to provide equal opportunity for the participants to participate in the study. The systematic sampling technique was first used to obtain the interval which was conducted by dividing 1000 (study population) by 390 (sample size). Thereafter, table of random numbers were generated against the name of the mothers and caretakers through simple random techniques to identify the number where the interval will start and pick every 2 unit at regular intervals. In this study, data were obtained from both primary and secondary sources. This involved face to face interviews with the participants and child’s information were obtained from the growth monitoring cards. Data collection and quality control measures A researcher administered interview was used to collect data. In this method, the researcher conducted face to face interviews with the respondents so that those who were unable to read and write were easily helped. Besides, this method also reduced the chances of high non-response rate by the target population. Semi Structured questionnaires were used to obtain reliable data from study participants. This tool enabled the researcher to generate well-structured set of responses that were easily coded and statistically analyzed as well as generating in-depth knowledge, attitude and opinions from the respondents to compliment and strengthen the result that were generated from the study. This kind of questionnaire were easily answered by the study participants, and the different responses were easily compared. The research team ensured that data were checked daily for consistency and completeness. Questionnaires with missing data were discarded. Measurements Underweight was categorized using the WHO growth chart for children and is defined as being < − 2 SD from the median reference weight for age [ 16 ]. Weight were measured using electronic weighing scales (kg). Heights and lengths measurements were carried out using measurement boards (stadiometers in cm) while laying down given the fact that the children are less than 24 months or less than 85cm [ 17 ]. The child’s determinants like age was measured in months, child sex as male and female, Birth Interval was measured in months before the next child, immunization status verified from vaccination cards to establish whether immunized or not and child morbidity was measured by the periods or frequency of illness that the child experienced. While maternal factors like age was calculated in years, marital status was either single parent or married, Weight of the mother was determined by the body mass index, place of residence was either urban or peri-urban, education level was determined by asking whether the mother or caretaker completed primary, secondary, tertiary/university or none, and household income low or high was determine by the World Bank cut off point of 2 dollars a day per person. The nutritional practices like dietary practices was measured by the WHO defined minimum dietary diversity as the proportion of children aged (6–23 months) who received foods from at least four out of seven food groups. The seven food groups used in defining children’s minimum dietary diversity indicator are: (i) grains, roots and tubers; (ii) legumes and nuts; (iii) dairy products; (iv) flesh foods (meat/fish/poultry) (v) eggs (vi) vitamin A rich fruits and vegetables; and (vii) other fruits and vegetables. Breastfeeding practices was on demand and the months of exclusive breastfeeding, age of complementary feeding was either before or after six months, age at weaning is calculated by months at weaning, and Hygiene practices was determined by asking about the sanitation facilities like use of latrine and hand washing facilities after latrine use. Data analysis Data were doubled checked for completeness and coded before entry into EPI data and SSPS version 20 for analysis. ENA SMART was used to determine the prevalence of underweight. Descriptive data analysis was performed and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was performed with the Chi-squared and Fisher's exact test for categorical independent variables, and the Student's t-test for numerical variables. While multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%. The researcher conducted one day training for two research Assistants on how to conduct interviews, carry out measurements and also briefed them on research ethics, especially on how to seek for consent from study participants, and maintain confidentiality throughout the data collection process. The standardized translated questionnaires from English to Madi and local Arabic were then used for by the research assistants for data collection. Completed questionnaires were checked daily for accuracy, consistency and completeness. Pre-testing of at least 10% of the sample size questionnaires was conducted in the Dioceses of Torit primary Health Care center (PHCC) in Nimule boarder town prior to data collection. Ethical Issues Ethical approval to conduct this study was obtained from Clarke International University Research Ethics Committee. The researcher also sought for Ethical Review and Clearance by the local MoH Authority. Administrative clearance was provided by Nimule Hospital Director, and Catholic Diocese of Torit Primary Health Care Center. More importantly, the study participants’ consent from both adults and emancipated minors aged 14 to 17 were considered before interviewing them. Study respondents were assured of confidentiality as per the National guidelines for research involving humans as research participants (July, 2014). 3. Results 4.2 Prevalence of underweight based on weight-for-age z-scores by sex According to the result presented in (Fig. 1) below, 112 (29%) of the children were underweight while 278(71%) had normal body weight. Table 1 Prevalence of underweight based on weight-for-age z-scores by sex Variable All n = 390 Boys n = 193 Girls n = 197 Prevalence of underweight (<-2 z-score) 112(28.7% (24.5–33.4 95% C.I.) 62(32.6% (26.4–39.5 95% C.I.) (50) 24.9%(19.4–31.4 95% C.I. Prevalence of moderate underweight (=-3 z-score) 78 (20.0% (16.3–24.3 95% C.I.) 42 (21.8% (16.5–8.1 95% C.I.) 36 (18.3% (13.5–24.3 95% C.I.) Prevalence of severe underweight (<-3 z-score) 34 (8.7% (6.3–11.9 95% C.I.) 20 (10.9%(7.2–16.1 95% C.I.) (14) 6.6%(3.9–11.0 95% C.I.) Prevalence of underweight by age, based on weight-for-age z-scores Among the underweight children, 32.6% were boys as compared to girls 24.9%. In addition, the study found that 21.8% of the boys had moderate underweight unlike 10.9% who were severely underweight. Regarding girls, 18.3% were moderately underweight as compared to the 6.6% who were severely underweight (see Table 1 below) Table 2 Prevalence of underweight by age, based on weight-for-age z-scores Variable Total Severe underweight (= -3 and = -2 z score) Oedema Age No. No.(%) No.(%) No.(%) No. (%) 6–12 266 15(5.6) 46(17.3) 205(77.1) 0(0.0) 13–24 124 20(16.1) 30(24.2) 74(59.7) 0(0.0) Total 390 35(9.0) 76(19.5) 279(71.7) 0(0.0) The prevalence of underweight by age indicates that 15(5.6%) of the children aged 6 to 12 years were severely underweight as compared to the 20(16.1%) aged 13 to 24 months. while, 46(17.3%) of the children aged 6 to 12 months were moderately underweight unlike 30(24.2%) aged 13 to 24 months ( Refer to Table 2 above ). 3.1 Child’s determinants associated with underweight Table 3 Child’s Determinants Associated with Underweight Variables Underweight No. (%) Normal weight No. (%) Total No. (%) P-value Sex of the Child 0.141 Male 62(55.4) 131(47.1) 193(49.5) Female 50(44.6) 147(52.9) 197(50.5) Age of the child 0.738 6 to 12 months 75(67.0) 191(68.7) 266(68.2) 13 to 24 months 37(33.0) 87(31.3) 124(31.8) Birth interval 0.196 First birth 41(36.6) 88(31.7) 129(33.1) Less than 12 months 42(37.5) 108(38.8) 150(38.5) 12 months 24 months 21(18.8) 42(63.0) 63(16.2) 25 months and above 8(7.1) 40(14.4) 48(12.3) Child ever suffered disease past six months 0.990 Yes 108(96.4) 268(96.4) 376(96.4) No 4(3.6) 10(3.6) 14(3.6) Child received recommended Immunization 0.566 Yes 83(74.1) 198(71.2) 281(72.1) No 29(25.9) 80(28.8) 109(27.9) Source primary field data 2019 The frequency distribution of the child determinants presented in (Table 3 above ) indicated that 193 (49.5%) of the respondents had baby boys while 197(50.5%) had baby girls. Regarding birth interval, 150(38.5%) of the respondents had spaced their children less than 12 months while 48(12.3%) were spaced 25 months and above. In addition, almost all 376(96.4%) of the children had suffered from any disease in the past six months. 204 (52.3%) of the children had suffered from diarrhea, 31(7.9%) acute respiratory infection, 35(9.0%) upper respiratory infection, 256(65.6%) malaria and 52(13.3%) suffered from other diseases. Besides, 281(72.1%) of the had received recommended immunization services as compared to the 109 (27.9%). The study established that all the children had received polio and BCG vaccines. Meanwhile, 387(99.2%) of the children were given hepatitis B vaccine, 282(72.3%) measles, 385(98.7%) DPT and 382(97.9%) had whooping cough. The child’s determinants were analyzed to assess their association with underweight in Nimule border town, South Sudan. However, the study finding indicated that none of the child’s determinants had any significant effect on underweight. ( Refer to Table 3 above ). 3.2 Maternal factors associated with underweight Table 4 Maternal factors associated with under weight Variables Underweight Normal weight Total P-value No. (%) No. (%) No. (%) Age of the mothers/caretakers 0.129 15 to 24 55(49.1) 160(57.6) 215(55.1) 25 and above 57(50.9) 118(42.4) 175(44.9) Marital Status 0.200 Married 100(89.3) 259(93.2) 359(92.1) Divorced/separated 12(10.7) 19(6.8) 31(7.9) Residence 0.104 Rural 76(67.9) 164(59.0) 240(61.5) Urban 36(32.1) 114(41.0) 150(38.5) Highest level of education 0.011 Primary 40(35.7) 88(31.7) 128(32.8) Secondary 50(44.6) 91(32.7) 141(36.2) Tertiary 15(13.4) 53(19.1) 68(17.4) Non-formal Education 7(6.3) 46(16.5) 53(13.6) Monthly household income < 0.001 Less or equals 4900 23(20.5) 131(47.1) 154(39.5) 5000 to 10000 31(27.7) 93(33.5) 124(31.8) Above 10000 58(51.8) 54(19.4) 112(28.7) Mother’s BMI 0.613 Underweight 10(8.9) 20(7.2) 30(7.7) Normal 75(67) 200(71.9) 275(70.5) Overweight/obese 27(24.1) 58(20.9) 85(21.8) Source primary field data 2019 Table 4 above presents maternal factors associated with underweight. Among the 390 respondents who participated in this study, 215 (55.1%) were aged between 15 to 24 years while 175 (44.9%) lie between 25 to 59 years with the mean of 1.45 ± 0.498. 359 (92.1%) of the participants were married, while 31(7.9%) were either divorced or separated. 240(61.5%) of the participants lived in peri-urban setting as compared to the 150(38.5) living in urban setting. The majority of participants have basic level of education with only 64 (17.4%) reached tertiary level, 141(36.2%) completed secondary level while 128(32.8%) ended in primary and the remaining 53(13.6%) had no formal education. The findings also indicated that only 112 (28.7%) of the entire participants had household income above 10,000 South Sudan Pounds. The analysis of maternal factors indicated that mother/caretaker’s education level had a significant association with underweight (P = 0.011). Monthly household income has also shown a highly significant (P = < 0.001) effect on the prevalence of underweight. However, maternal/caretaker’s factors like age, marital status, residences, and BMI were not associated with underweight. 3.3 Nutritional practices associated with Underweight associated with underweight Table 5 Nutritional practices Associated with Underweight Variables Underweight No. (%) Normal weight No. (%) Total No. (%) P-Value Feeding the baby entirely on Family food? 0.812 Yes 107(95.5) 264(95) 371(95.1) No 5(4.5) 14(5.0) 19(4.9) Method of feeding the baby 0.584 Breastfeeding exclusively 7(6.3) 14(5.0) 21(5.4) Mixed method feeding 101(90.2) 248(89.2) 349(89.5) Replacement feeding 3(2.7) 7(2.5) 10(2.6) No Milk substitutes 1(0.9) 9(3.2) 10(2.6) Health education conducted on breastfeeding? 0.196 Yes 79(70.5) 177(63.7) 256(65.6) No 33(29.5) 101(36.3) 134(34.4) Frequency of hand washing before breastfeeding <0.001 Always 78(69.6) 100(36.0) 178(45.6) Irregularly 34(30.4) 148(53.2) 182(46.7) Do not wash 0(0.0) 30(10.8) 30(7.7) Breast Feeding duration 0.502 BF < 2 years 64(56.2) 158(56.8) 221(56.7) BF 2 years + 49(43.8) 120(43.2) 169(43.3) 25 months and above 16(14.3) 18(6.5) 34(8.7) Safe versus unsafe water sources 0.575 Safe water 110(98.2) 275(98.9) 385(98.7) unsafe water 2(1.8) 3(1.1) 5(1.3) Age of supplementing child's food(months) < 0.001 Exclusive breastfeeding only 4(3.6%) 31(11.2%) 35(9.0) Before 6 months 56(50.0%) 8(2.9%) 64(16.4%) At 6 months 52(46.4%) 206(74.1%) 258(66.2) After 6 months 0(0.0%) 33(111.9%) 33(8.5%) Source primary field data 2019 Table 5 above presents data on nutritional practices Associated with underweight in this study. The study established that the majority of the respondents 371(95.1%) fed their children on entirely family food while 19(4.9%) did not. However, 44(11.3%) of the children were fed more than three times a day while less than half 156(40.0%) of them were fed twice a day. Regarding breastfeeding practices, 21(5.4%) of the children were exclusively breastfed while 349(89.5%) had both breast milk and milk substitutes. Besides, more than half 256(65.6%) of the respondents were encouraged by staffs to look for signs of breastfeeding. Yet, 171(43.8%) of the respondents were advised every time to see whether the baby seemed hungry as compared to 12(3.1%) were advised to breastfeed two to three times a day. 317(81.3%) of the respondents agreed that they have given anything other than breast milk to their baby. The study also revealed that 35(9.0%) of the mothers practiced exclusive feeding only despite their children being six months and above, 64(16.4%) of the children were started on food supplements before six months, 258(66.2%) started their children as recommended by WHO at 6 months while 33(8.5%) where started after six months. While according to the bivariate analysis, nutrition practices associated with underweight, frequency of hand washing before breastfeeding and age of supplementing has shown a highly significant (P = < 0.001) association on underweight. In this study, out of the 9 participants who admitted to have not initiated complementary feeding at 6 months as recommended by WHO, 4 of them acknowledged “ that in South Sudan the price of food items is very high, while the rest attributed this to lack of enough money to purchase food items”. Conversely, nutritional practices such as feeding the baby entirely on family food, method of feeding the baby, health education conducted on breastfeeding, breast feeding duration and source of drinking water were not associated with underweight. 3.4 Multivariate Analysis of Significance Factors associated with underweight Table 6 model summary of factors associated with underweight in children 24 months Variables Binary logistic regression analysis Unadjusted Adjusted uOR 95% CI P-value aOR 95% CI P-value Respondents highest level of education Non-formal education Ref Ref Primary 0.33 0.14–0.81 0.004 0.38 0.12–1.18 0.095 Secondary 0.27 0.12–0.66 0.215 0.37 0.12–1.17 0.091 Tertiary 0.54 0.20-1-43 0.76 0.21–2.74 0.671 Respondents monthly household income Min to 4900 Ref Ref 5000 to 10000 0.41 0.21–0.80 0.009 0.26 0.10–0.68 0.006 Above 10000 0.13 0.06–0.25 < 0.001 0.11 0.04–0.28 < 0.001 Frequency of hand washing before breastfeeding Always Ref Ref Irregularly 3.39 2.11–5.46 < 0.001 2.17 1.14–4.11 0.018 Do not wash 1 1 Age of supplementing your child’s food Exclusive breastfeeding only Ref Ref Less than 6 months 0.02 0.01–0.07 < 0.001 0.01 0.02–0.05 < 0.001 6 Months 0.51 0. 17-1.51 0.225 0.48 0.15–1.54 0.216 Above 6 months 1 1 Table 6 above presents the model summary of factors associated with underweight in children under 24 months. Mothers/caretakers with primary (aOR, 0.38; 95% CI, 0.12–1.18; P = 0.095) and secondary (aOR, 0.37; 95% CI, 0.12–1.17; P = 0.091) levels of education had reduced odds of underweight compared to those with no formal education. However, tertiary level of education was not associated with reduced odds of underweight (aOR, 0.76; 95% CI, 0.21–2.74; p = 0.671). In regards to monthly household income, participants with household incomes that ranged from 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10–0.68; P = 0.006) and those with incomes above 10,000 (aOR, 0.11; 95% CI, 0.04–0.28; P < 0.001) South Sudanese pounds compared with those with incomes less than 5000 South Sudanese pounds had reduced odds of underweight. Participants who irregularly wash their hands before breast-feeding their children below 2 years had increase odds of underweight compared to those who always wash their hands. However, there was no different between participants who always washed hands before breastfeeding their children and those who do not wash their hands. Participants who began supplementary feeding before six months of age (aOR; 0.01; 95% CI, 0.02–0.05; P < 0.001), and those who started at 6 months (aOR, 0.48; 95% CI, 0.15–1.54; P = 0.216), had reduce likelihood of underweight compared to those who exclusively breastfed their children. Conversely, there was no association between participants who started supplementary feeding after six months and those who exclusively breastfed their children. 4. Discussion In this study the prevalence of underweight was 28.7% with more boys presenting with underweight compared to girls. A community based cross-sectional study conducted in Western Ethiopia established a much lower prevalence of underweight among under-two children of 8.9%. The study further indicated that the prevalence of underweight among children under the age of one year was 15.1%. Males (9.7%) and were more malnourished than females (8.2%), which is similar to findings from this study. As compared with children in the age group less than six months, the risk of underweight was about 2.6 times higher for children in age groups over one year [ 18 ]. On the contrary, a cross-sectional study conducted in South India among 500 participants observed that females were actually found to be more underweight (27.95%) compared to the males 20.29% [ 19 ]. These contrasting findings between this study and that in India could be due to some cultural inclination of the communities where these studies were conducted. The cultural preference of a particular gender (girls or boys) on the basis of being sources of wealth or heir to succeed the father means, little attention maybe given to any gender that is not of preference especially in regards to duration of breastfeeding. The need to conceive a baby girl or boy might compel the mother into early cessation of breastfeeding which in turn exposes the child to underweight. Therefore, this study finding is not a surprise because in South Sudan, the girl child is valued more compared to the boy child. This study also revealed that Underweight was higher in children less than one year compared to those above one year. This is in agreement with findings from a cross-sectional study conducted among 500 participants in rural area of South India which indicated that the prevalence of underweight was higher in children < 1 year of age (37.2%) compared with other age groups [ 3 ]. This could be because children above one year have other sources food to feed on apart from the breast milk compared to less than one-year children who mostly depends on breast milk. This study showed that increase in mothers/caretaker’s level of education was protective against underweight. These findings are consistent with findings from two other similar studies; a cross sectional study, and a case–control conducted in Ethiopia, were in both studies; age of the child and education status of the mother were statistically significant predictors of underweight [ 18 – 20 ]. Similarly, a community based cross-sectional study conducted in Ethiopia among 384 participants also showed that for any unit increase in maternal education (diploma and higher), the odds of their children getting underweight reduces by 81% more than those whose level of education is below diploma level [ 21 ]. This could be due to their positive health seeking behaviour because participants who attained at least some formal level of education have a higher chance of being well informed about the ways to provide care to their children, show positive practices with regard to hygiene, breast feeding and empowered decision making in health compared to those who never had any formal education. Additionally, this study established that households with higher income of at least 5,000 South Sudanese Pounds was associated with reduced likelihood of underweight. A study conducted in Pakistan, revealed a significant association between household wealth and underweight, thus, more cases of underweight were reported in the poorest households compared to those in the wealthiest household [ 22 ]. Similarly, findings from this study are consistent with several studies conducted in various countries in Sub-Saharan Africa. For instance, in Malawi, results from analysis of individual-level and community-level effects on childhood undernutrition established that children in communities with a low and medium income had higher chances of being undernourished compared to those from households with low-income levels [ 23 ]. The consistency in these findings could be because mothers who have reasonable amount of money are able to afford nutritious foods and provide a balance diet for their children compared to those who do not have any sources of income. Probably that explains why various studies have similar findings on the variable of levels of income or household wealth. This is also in line with opinions of 4/9 of the mothers who had not given any supplementary foods to their children even at 6 months. When asked to explain the reason for not supplementing, they testified “in South Sudan everything including food items are bought from the market expensively which we cannot afford. A 21-year-old mother said my baby does not want to eat our family food. I wish to make something different like porridge and eggs for her but my husband and I cannot afford enough food for the family to eat even twice a day” This study had proven that mothers or care takers who irregularly wash hands before breastfeeding their children had increased odds of underweight. This finding is similar to those of another study conducted in Ethiopia among 480 participants where it established that Children of caregivers/mothers who did not practice hand washing after latrine use were found to be 6.7 times as likely to be underweight as their counterparts whose caregivers did wash their hands [ 24 ]. This could be because one of the major causes of diarrheal disease common in children 6 to 24 months old, happened as a result of bacterial contamination of complementary foods. Mothers or caretakers who irregularly washed before feeding their children are likely to contaminate the foods while preparing it or transmit infection through unclean utensils, such as cups, spoons and bowls, used for storing and serving young children's food. This study showed that introduction of supplementary feeding before six months of age and at six months was protective against underweight compared to those who exclusively breastfed at six months and those who were introduced complementary feedings after six months. This finding is consistent with the WHO recommendation which states that children should be introduced to supplementary feeding at six months. However, the practice of responsive feeding in WHO complementary guidelines means a child who expresses interest for food even before six months can receive supplementary feeding. This is because at 6 months, the child’s requirements for energy and nutrients starts to exceed what is provided by breast milk [ 25 ]. On the contrary, a cross sectional study conducted across Lebanon among 1000 participants, indicated no risk of diarrhoeal diseases associated with the early introduction of nonmilk supplements, [ 26 ]. In conclusion, this study showed that the prevalence of underweight in children less than 24 months in Nimule town council is high (28.7%). This result falls within WHO underweight high prevalence cut-off values (20–29%) for public health significance. As the mothers or caretaker’s level of education reduces the chances of their children becoming underweight. Monthly household income of at least 5,000 South Sudanese pounds was associated with reduced likelihood of underweight in children. Mothers or caretakers who irregularly washed hands before breastfeeding their children had increased odds of underweight and the introduction of supplementary feeding before six months of age and at six months was protective against children being underweight. Findings from this study strengthens the evidence base for MoH Government of South Sudan and the development/Implementing partners to focus on nutrition in children below two years of age. There is need to strengthen the affirmative action efforts to empower the girls and women, through education for instance. Empowerment of girls through formal education is beneficial for maternal and child health outcomes immediately or later in their life. Importantly, empowerment of girls through formal education also increases their chances for jobs and hence improves their earning which is preventive against underweight. Alternatively, this study also recommends for multi sectorial approaches targeting women’s socioeconomic status by introducing income generating activities that could improve household food security. There is need to have access to safe and clean water and to educate households and community members on personal hygiene so as to cut down the fecal oral transmission of diseases among children. Finally, children should be introduced to supplementary feeding at six months as recommended by WHO. However, in line with IMCI guidelines also, when a child expresses interest in food, he/she can be introduced into supplementary feeding before six months since both are protective against underweight. Declarations Ethics Approval and consent to participate Ethical approval to conduct this study was obtained from Clarke International University Research Ethics Committee. The Principal Investigator also sought for Ethical Review and Clearance by the National Ministry of Health IRB in South Sudan. Administrative clearance was provided by Nimule Hospital Director, and Catholic Diocese of Torit Primary Health Care Center (study sites). More importantly, the study participants. Importantly, voluntary and informed consent to participate in the study was obtained from the participants before the research assistants embarked on the interviews to collect data. Consent from both adults and emancipated minors aged 14 to 17 were considered before interviewing them. The study respondents were assured of confidentiality as per the National guidelines for research involving humans as research participants (July, 2014). Similarly, the entire data management process including the interviewing of participants, were performed in accordance with the relevant guidelines and regulations pertaining to research processes involving human subjects (for example- Declarations of Helsinki) Consent for Publication Not Applicable for the above section Availability of data and materials The dataset for this study are provided, it has been uploaded as a separate file. Competing interests There are no competing interests in this study, findings and the manuscript Funding Sources No funding from any institution was received for this study. This was a self-funded study. Acknowledgments Our first goes to the study participants for their time to participate in this study. Secondly, to the MoH South Sudan for allowing the stud to be conducted. Third, The Institute of Public Health and Management, Clarke International University, and lastly, The School of Public Health and Applied Human Sciences, Kenyatta University to which the authors are affiliated is acknowledged. Authors’ Contributions Eriga Francis conceptualized and designed the study, performed data analysis. John Bosco Alege provided overall technical research guidance from the onset of the concept up to writing of the manuscript. Eriga and Alege designed the methodology and wrote the draft manuscripts. Gulom Godfrey did the draft reviews and provided additional technical guidance that led to this final manuscript. References WHO 2018 Global Nutrition Report; Shining a light to spur action on nutrition. Available at: https://www.who.int/nutrition/globalnutritionreport/2018_Global_Nutrition_Report.pdf?ua=1 . GBD Compare. (2015). Available online: http://vizhub.healthdata.org/gbd-compare/ [Accessed on 30th May, 2019]. Akhtar S, Ahmed A, Randhawa MA, Atukorala S, Arlappa N, Ismail T, Ali Z. (2013). Prevalence of vitamin A deficiency in South Asia: Causes, outcomes, and possible remedies. J. Health Popul. Nutr. 31, 413–423 . The Save the Children. (2012). A Life Free from Hunger—Tackling Child Malnutrition; The Save the Children Fund: London, UK. FAO, IFAD, UNICEF, WFP and WHO. 2018. The State of Food Security and Nutrition in the World 2018 . Building climate resilience for food security and nutrition . Rome, FAO. Licence: CC BY-NC-SA 3.0 IGO. WHO. (2017). Nutrition in the WHO African Region. Brazzaville: World Health Organization; 2017. Licence: CC BY-NCSA 3.0 IGO. Pelletier DL, et al. The nutrition policy process: the role of strategic capacity in advancing national nutrition agendas. FoodNutr Bull. 2011;32(2 suppl2):S59–69. Kalu RE, Etim KD. (2018). Factors Associated with Malnutrition among under-five children in Developing Countries. A Review Global Journal of Pure and Applied Sciences Vol. 24, 2018: 69–74. Ocheke IE, Нandi P. (2015) Malnutrition in acutely ill children at the pediatric emergency unit in a tertiary hospital in Nigeria. Nigerian. Medical Journal 56: 113–117 . UBOS, and ICF., (2018). UNICEF. (2019) Nutrition: Scaling up high impact nutrition interventions. Available at: https://www.unicef.org/uganda/what-we-do/nutrition [Accessed on 3rd April, 2019]. Dewey KG, Begum K. (2011) Long-term consequences of stunting in early life. Maternal & child nutrition, 2011. 7(s3): p. 5–18. UNICEF/WFP. (2015) Scale-Up Nutrition Plan 1 Year Report South Sudan. WHO. (2015). Joint child malnutrition estimates - Levels and trends (2015 edition) http://www.who.int/nutgrowthdb/estimates2014/en (Accessed 13/4/2019). Amuru M. (2013). Response to the crisis in Madiland: Central government is responsible. Online available at http://www.southsudannation.com/response-to‐the‐crisis‐in‐madiland‐central‐ government is responsible/ [Accessed on 14th March, 2019]. WHO. (2017) ‘ Training Course on Child Growth Assessment: WHO Child Growth Standards Acknowledgements , 7. CDC. (2017) ‘Using the BMI-for-Age Growth Charts’, pp. 1–29.Children below Five Years of Age in Bure Town, West Gojjam Zone, Amhara National Regional State, Northwest Ethiopia’, 2016. Tsedeke Wolde Hailemariam. Prevalence of Underweight and its Determinant Factors of under Two Children in a Rural Area of Western Ethiopia. Food Sci Qual Manage www iiste org ISSN. 2014;Vol. 31:2224–6088. (Paper) ISSN 2225 – 0557 (Online). Leju J, Ladu C, Athiba LA, Yatta SL. (2018) “Impact of Malnutrition on Children Less Than Five Years of Age in Juba Payam (District), Republic of South Sudan.” American Journal of Food and Nutrition , vol. 6, no. 4 (2018): 103–107. doi: 10.12691/ajfn-6-4-2 . Hintsa S, Gereziher K. Determinants of underweight among 6–59 months old children in Berahle, Afar, North East Ethiopia: a case control study 2016. BMC Res Notes BMC Res Notes. 2019;12:753. https://doi.org/10.1186/s13104-019-4805-z . Tosheno D, et al. ,. Risk Factors of Underweight in Children Aged 6–59 Months in Ethiopia. Hindawi J Nutr Metabolism Volume 2017 Article ID. 2017;6368746:8. pages https://doi.org/10.1155/2017/6368746 . Khan GN, Turab A, Khan MI, et al. Prevalence and associated factors of malnutrition among children under-five years in Sindh, Pakistan: a cross-sectional study. BMC Nutr. 2016;2:69. ttps://doi.org/10.1186/s40795-016-0112-4 . Austin P, Ntenda M, Chuang YC. Analysis of individual-level and community-level effects on childhood undernutrition in Malawi. Pediatrics & Neonatology Volume. August 2018;59(4):380–9. Demilew YM. Factors associated with mothers’ knowledge on infant and young child feeding recommendation in slum areas of Bahir Dar City, Ethiopia: cross sectional study. BMC Res Notes. 2017;10:191. https://doi.org/10.1186/s13104-017-2510-3 . WHO. (2018). Guideline: counselling of women to improve breastfeeding practices. Available at: https://apps.who.int/iris/bitstream/handle/10665/280133/9789241550468-eng.pdf?ua=1 . Batal M, Boulghourjian C, Akik C (‎2010)‎. Complementary feeding patterns in a developing country: a cross-sectional study across Lebanon. EMHJ - Eastern Mediterranean Health Journal, 16 (‎2)‎, 180–186 , 2010 https://apps.who.int/iris/handle/10665/117840 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2065097","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":144579460,"identity":"e5c02d4f-414b-48d7-98ef-f0c665506588","order_by":0,"name":"Francis Eriga","email":"","orcid":"","institution":"Clarke International University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Francis","middleName":"","lastName":"Eriga","suffix":""},{"id":144579461,"identity":"11545122-f1a4-4bdf-a349-49a102684c53","order_by":1,"name":"Godfrey Gulom","email":"","orcid":"","institution":"Clarke International University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Godfrey","middleName":"","lastName":"Gulom","suffix":""},{"id":144579462,"identity":"e153aa00-7dbe-4e27-a543-465916722a39","order_by":2,"name":"John Bosco Alege","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACxgbmBiBlw8BGghZGkJY0ErSANAGJwyRoYG4/2PjwS8V5eT6JBMYPPxgO2zUQtKMnsdlY5sxtwzaJBGbJHobDyYS1NCS2SUu23U5gk0hgkAa6MJmgwxj7H7b/lvx3DqSF+TdxWmYktjF+bDgA0sIGssWOCC0Pm6UZjiUbtvE8bLPsMUhPIKjFsD/54McfNXby8u3Jh2/8qLC2J6ylARjQPBALgUwDhsQGQlrkQWp/IAkQtmUUjIJRMApGHAAAfTE6gNZhNYQAAAAASUVORK5CYII=","orcid":"","institution":"Clarke International University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"John","middleName":"Bosco","lastName":"Alege","suffix":""}],"badges":[],"createdAt":"2022-09-14 13:14:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2065097/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2065097/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27941090,"identity":"7f396481-95b4-4cad-8683-e5ceb60cfbbf","added_by":"auto","created_at":"2022-10-18 15:55:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10557,"visible":true,"origin":"","legend":"\u003cp\u003eAccording to the result presented in (figure 1), 112(29%) of the children were underweight while 278(71%) had normal body weight children. Among the underweight children, 32.6% were boys as compared to girls 24.9%. In addition, the study found that 21.8% of the boys had moderate underweight unlike 10.9% who were severely underweight. Regarding girls, 18.3% were moderately underweight as compared to the 6.6% who were severely underweight (\u003cem\u003eFor further details see table 1 below\u003c/em\u003e)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2065097/v1/e4c51dd2add9c27e6df2dcb0.png"},{"id":41496819,"identity":"3d60ca8e-5f29-4a8c-9b82-e8ace3ba360c","added_by":"auto","created_at":"2023-08-13 21:22:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":796907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2065097/v1/83c64888-89e8-4d60-a415-8e29bd01c3c3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of under-weight among children less than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAccording to the Global Nutrition report (2018), malnutrition remains a severe problem, especially under nutrition, which is one of the major causes of child mortality globally. Besides, it seems that the world is not on track to achieve the target of reducing malnutrition by 40%, as a result, it remains unacceptably high across all regions of the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the Global burden of diseases, approximately 200 deaths per 100,000 in children less than five years are due to childhood under nutrition, equivalent of 21% total deaths in this age bracket [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In South East Asia, under nutrition continues to be an alarming public health concern especially in Pakistan, Bangladesh, and India [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Pakistan, under nutrition is responsible for 428 deaths per 100,000 in children less than five years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Besides, A Save the Children report (2012) in the UK revealed that 96% of the children less than two years do not receive the adequate diet recommended [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similarly, Indonesia has been ranked the fifth highest of stunted children globally, as a result, one in every three children are stunted implying 9.7\u0026nbsp;million children under five are malnourished [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the same report, about three million under-five children are wasted and two in every three children below two years of age are anemic. There is no clear data for monitoring progress on the target of reducing the incidence of low birth weight (LBW) by 30%. In the WHO African Region, 26 of the member countries with data have LBW rates in excess of 10%. This seemingly may need an underestimation of the LBW burden. This is because population groups with high socioeconomic status are more likely to deliver in maternity facilities under the care of skilled birth attendants where birth weight is measured, compared to groups with lower socioeconomic status who often deliver at home and are more likely to have babies with low birth weight [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong most Sub-Saharan African countries, the prevalence of wasting among children below five years of age remained below the emergency threshold level, though at the poor nutritional threshold level of 6.5% for East Africa [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn another review, it was also observed that an estimated 60\u0026nbsp;million under-five children in developing countries were found to be stunted, out of which 11\u0026nbsp;million were Nigerian children. The severity of childhood malnutrition was observed to steadily increase from 11% in 2003 to 18% in 2013 for wasting; 24% in 2003 to 29% in 2013 for underweight, nevertheless, there was a decline from 42% in 2003 to 37% in 2013 for stunted children [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this review it was observed that high rates of mortality of malnourished children in Sub-Saharan Africa result from factors such as low intake of calories, high rates of Human Immuno Virus/Acquired Immunodeficiency Syndrome (HIV and AIDS), political instability, conflicts among groups and poor implementation of government policies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, Malnutrition in developing countries is accountable for about one in five of all disability-adjusted life years, and Nigeria was ranked amongst the ten countries with the highest prevalence of underweight, stunting and wasting in children below five years [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Uganda, the burden of childhood malnutrition is more prevalent in rural areas compared to the urban areas, 29% (2.2\u0026nbsp;million) of the children suffered from stunting [low height-for-age], Uganda Bureau of Statistics [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While in terms of economic loss yearly, Uganda loses 1.8 trillion shillings equivalent of 6% of the country's Gross Domestic Product (DGP) in treatment, management, and prevention of childhood malnutrition [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, childhood malnutrition is associated with premature deaths and consequential life-course perspective in economic development [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn South Sudan, malnutrition is a serious public health problem where approximately 200,000 children below five years are at risk of malnutrition [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As a result, South Sudan ranks 15th highest in the world in terms of mortality rates for children below five years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, one in every seventh South Sudanese child dies before their fifth birthday due to diarrheal diseases and the burden of malnutrition is substantial with its rate-exceeding the 15% threshold of WHO [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Besides, in 2014, the burden of moderate acute malnutrition increased by 44.7% from 123, 3832 to 675, 4003, and over 900,000 children were severely malnourished; hence, the burden is more in Jonglei, Upper Nile and Unity states [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In Torit State particularly Nimule boarder town, there is limited information on the burden of malnutrition especially underweight among children below two years of age.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cb\u003eStudy setting and design\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study used analytical cross-sectional study design to determine the proportion of children below 24months who are underweight in Nimule border town. The study also determined factors associated with underweight. The exposure and the outcome data was collected at the same point in time. This study was conducted in Nimule border town, Magwi County, Eastern Equatoria State, South Sudan. Nimule is located at border with the Republic of Uganda in Magwi County, Torit State [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eSample size, and sampling procedure\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe study targeted mothers and caretakers of children less than 24 months in Nimule border town, Magwi County, Eastern Equatoria, in South Sudan. All mothers and caretakers of children less than two years who had growth monitoring cards and voluntarily consented to participate in the study, and had spent at least three months in the study area were eligible to participate in the study.\u003c/p\u003e \u003cp\u003eThe researcher used Open Epi software for sample size estimation. The sample size of 390 was established on expected result estimation of about 50% positive (underweight) and 50% negative (normal weight) with 95% confidence that the true frequency lies between 45 and 55% since there is no previous estimate of Underweight among children less than 24 months in Nimule border town. Systematic sampling technique with random start method was used in order to provide equal opportunity for the participants to participate in the study. The systematic sampling technique was first used to obtain the interval which was conducted by dividing 1000 (study population) by 390 (sample size). Thereafter, table of random numbers were generated against the name of the mothers and caretakers through simple random techniques to identify the number where the interval will start and pick every 2 unit at regular intervals.\u003c/p\u003e \u003cp\u003eIn this study, data were obtained from both primary and secondary sources. This involved face to face interviews with the participants and child\u0026rsquo;s information were obtained from the growth monitoring cards.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection and quality control measures\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA researcher administered interview was used to collect data. In this method, the researcher conducted face to face interviews with the respondents so that those who were unable to read and write were easily helped. Besides, this method also reduced the chances of high non-response rate by the target population. Semi Structured questionnaires were used to obtain reliable data from study participants. This tool enabled the researcher to generate well-structured set of responses that were easily coded and statistically analyzed as well as generating in-depth knowledge, attitude and opinions from the respondents to compliment and strengthen the result that were generated from the study. This kind of questionnaire were easily answered by the study participants, and the different responses were easily compared. The research team ensured that data were checked daily for consistency and completeness. Questionnaires with missing data were discarded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasurements\u003c/b\u003e \u003c/p\u003e \u003cp\u003eUnderweight was categorized using the WHO growth chart for children and is defined as being \u0026lt;\u0026thinsp;\u0026minus;\u0026thinsp;2 SD from the median reference weight for age [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Weight were measured using electronic weighing scales (kg). Heights and lengths measurements were carried out using measurement boards (stadiometers in cm) while laying down given the fact that the children are less than 24 months or less than 85cm [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The child\u0026rsquo;s determinants like age was measured in months, child sex as male and female, Birth Interval was measured in months before the next child, immunization status verified from vaccination cards to establish whether immunized or not and child morbidity was measured by the periods or frequency of illness that the child experienced. While maternal factors like age was calculated in years, marital status was either single parent or married, Weight of the mother was determined by the body mass index, place of residence was either urban or peri-urban, education level was determined by asking whether the mother or caretaker completed primary, secondary, tertiary/university or none, and household income low or high was determine by the World Bank cut off point of 2 dollars a day per person.\u003c/p\u003e \u003cp\u003eThe nutritional practices like dietary practices was measured by the WHO defined minimum dietary diversity as the proportion of children aged (6\u0026ndash;23 months) who received foods from at least four out of seven food groups. The seven food groups used in defining children\u0026rsquo;s minimum dietary diversity indicator are: (i) grains, roots and tubers; (ii) legumes and nuts; (iii) dairy products; (iv) flesh foods (meat/fish/poultry) (v) eggs (vi) vitamin A rich fruits and vegetables; and (vii) other fruits and vegetables. Breastfeeding practices was on demand and the months of exclusive breastfeeding, age of complementary feeding was either before or after six months, age at weaning is calculated by months at weaning, and Hygiene practices was determined by asking about the sanitation facilities like use of latrine and hand washing facilities after latrine use.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eData were doubled checked for completeness and coded before entry into EPI data and SSPS version 20 for analysis. ENA SMART was used to determine the prevalence of underweight. Descriptive data analysis was performed and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was performed with the Chi-squared and Fisher's exact test for categorical independent variables, and the Student's t-test for numerical variables. While multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%.\u003c/p\u003e \u003cp\u003eThe researcher conducted one day training for two research Assistants on how to conduct interviews, carry out measurements and also briefed them on research ethics, especially on how to seek for consent from study participants, and maintain confidentiality throughout the data collection process. The standardized translated questionnaires from English to Madi and local Arabic were then used for by the research assistants for data collection. Completed questionnaires were checked daily for accuracy, consistency and completeness. Pre-testing of at least 10% of the sample size questionnaires was conducted in the Dioceses of Torit primary Health Care center (PHCC) in Nimule boarder town prior to data collection.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEthical Issues\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e to conduct this study was obtained from Clarke International University Research Ethics Committee. The researcher also sought for Ethical Review and Clearance by the local MoH Authority. Administrative clearance was provided by Nimule Hospital Director, and Catholic Diocese of Torit Primary Health Care Center. More importantly, the study participants\u0026rsquo; consent from both adults and emancipated minors aged 14 to 17 were considered before interviewing them. Study respondents were assured of confidentiality as per the National guidelines for research involving humans as research participants (July, 2014).\u003c/p\u003e \u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003e4.2 Prevalence of underweight based on weight-for-age z-scores by sex\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAccording to the result presented in (Fig.\u0026nbsp;1) below, 112 (29%) of the children were underweight while 278(71%) had normal body weight.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrevalence of underweight based on weight-for-age z-scores by sex\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll n\u0026thinsp;=\u0026thinsp;390\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBoys n\u0026thinsp;=\u0026thinsp;193\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGirls n\u0026thinsp;=\u0026thinsp;197\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevalence of underweight\u003c/p\u003e\n\u003cp\u003e(\u0026lt;-2 z-score)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112(28.7% (24.5\u0026ndash;33.4 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62(32.6% (26.4\u0026ndash;39.5 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(50) 24.9%(19.4\u0026ndash;31.4 95% C.I.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevalence of moderate underweight\u003c/p\u003e\n\u003cp\u003e(\u0026lt;-2 z-score and \u0026gt;=-3 z-score)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78 (20.0% (16.3\u0026ndash;24.3 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42 (21.8% (16.5\u0026ndash;8.1 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (18.3% (13.5\u0026ndash;24.3 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevalence of severe underweight\u003c/p\u003e\n\u003cp\u003e(\u0026lt;-3 z-score)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (8.7% (6.3\u0026ndash;11.9 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (10.9%(7.2\u0026ndash;16.1 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(14) 6.6%(3.9\u0026ndash;11.0 95% C.I.)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of underweight by age, based on weight-for-age z-scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the underweight children, 32.6% were boys as compared to girls 24.9%. In addition, the study found that 21.8% of the boys had moderate underweight unlike 10.9% who were severely underweight. Regarding girls, 18.3% were moderately underweight as compared to the 6.6% who were severely underweight (see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e below)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrevalence of underweight by age, based on weight-for-age z-scores\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSevere underweight\u003c/p\u003e\n\u003cp\u003e(\u0026lt;-3 z-score)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eModerate underweight\u003c/p\u003e\n\u003cp\u003e(\u0026gt;= -3 and \u0026lt;-2 z-score)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(\u0026gt; = -2 z score)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOedema\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo.(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo.(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo.(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e266\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(5.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46(17.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e205(77.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(16.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(24.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74(59.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e390\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e35(9.0)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e76(19.5)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e279(71.7)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0(0.0)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe prevalence of underweight by age indicates that 15(5.6%) of the children aged 6 to 12 years were severely underweight as compared to the 20(16.1%) aged 13 to 24 months. while, 46(17.3%) of the children aged 6 to 12 months were moderately underweight unlike 30(24.2%) aged 13 to 24 months (\u003cem\u003eRefer to\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003eabove\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Child\u0026rsquo;s determinants associated with underweight\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eChild\u0026rsquo;s Determinants Associated with Underweight\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUnderweight No. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal weight\u003c/p\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex of the Child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.141\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62(55.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e131(47.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e193(49.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50(44.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e147(52.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e197(50.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of the child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.738\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6 to 12 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75(67.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e191(68.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e266(68.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e13 to 24 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37(33.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87(31.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124(31.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBirth interval\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.196\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFirst birth\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41(36.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e88(31.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e129(33.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLess than 12 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42(37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e108(38.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e150(38.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e12 months 24 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21(18.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42(63.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63(16.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e25 months and above\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8(7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40(14.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48(12.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChild ever suffered disease past six months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.990\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e108(96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e268(96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e376(96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4(3.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(3.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14(3.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChild received recommended Immunization\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.566\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e83(74.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e198(71.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e281(72.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29(25.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80(28.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e109(27.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003eSource primary field data 2019\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003eThe frequency distribution of the child determinants presented in (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003eabove\u003c/em\u003e) indicated that 193 (49.5%) of the respondents had baby boys while 197(50.5%) had baby girls. Regarding birth interval, 150(38.5%) of the respondents had spaced their children less than 12 months while 48(12.3%) were spaced 25 months and above. In addition, almost all 376(96.4%) of the children had suffered from any disease in the past six months. 204 (52.3%) of the children had suffered from diarrhea, 31(7.9%) acute respiratory infection, 35(9.0%) upper respiratory infection, 256(65.6%) malaria and 52(13.3%) suffered from other diseases. Besides, 281(72.1%) of the had received recommended immunization services as compared to the 109 (27.9%). The study established that all the children had received polio and BCG vaccines. Meanwhile, 387(99.2%) of the children were given hepatitis B vaccine, 282(72.3%) measles, 385(98.7%) DPT and 382(97.9%) had whooping cough.\u003c/p\u003e\n\u003cp\u003eThe child\u0026rsquo;s determinants were analyzed to assess their association with underweight in Nimule border town, South Sudan. However, the study finding indicated that none of the child\u0026rsquo;s determinants had any significant effect on underweight. (\u003cem\u003eRefer to\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003eabove\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003e3.2 Maternal factors associated with underweight\u003c/strong\u003e\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMaternal factors associated with under weight\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUnderweight\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal weight\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo. (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo. (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo. (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of the mothers/caretakers\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e15 to 24\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55(49.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160(57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e215(55.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e25 and above\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57(50.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118(42.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e175(44.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.200\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100(89.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e259(93.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e359(92.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDivorced/separated\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(10.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(6.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(7.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.104\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRural\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76(67.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164(59.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e240(61.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36(32.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114(41.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150(38.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHighest level of education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40(35.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88(31.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e128(32.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50(44.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91(32.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e141(36.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTertiary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(13.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53(19.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68(17.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNon-formal Education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(6.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46(16.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53(13.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonthly household income\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLess or equals 4900\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(20.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131(47.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e154(39.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5000 to 10000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(27.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93(33.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124(31.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAbove 10000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58(51.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54(19.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112(28.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s BMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.613\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnderweight\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(8.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(7.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e200(71.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e275(70.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOverweight/obese\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(24.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58(20.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85(21.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003eSource primary field data 2019\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e above presents maternal factors associated with underweight. Among the 390 respondents who participated in this study, 215 (55.1%) were aged between 15 to 24 years while 175 (44.9%) lie between 25 to 59 years with the mean of 1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.498. 359 (92.1%) of the participants were married, while 31(7.9%) were either divorced or separated. 240(61.5%) of the participants lived in peri-urban setting as compared to the 150(38.5) living in urban setting. The majority of participants have basic level of education with only 64 (17.4%) reached tertiary level, 141(36.2%) completed secondary level while 128(32.8%) ended in primary and the remaining 53(13.6%) had no formal education. The findings also indicated that only 112 (28.7%) of the entire participants had household income above 10,000 South Sudan Pounds. The analysis of maternal factors indicated that mother/caretaker\u0026rsquo;s education level had a significant association with underweight (P\u0026thinsp;=\u0026thinsp;0.011). Monthly household income has also shown a highly significant (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001) effect on the prevalence of underweight.\u003c/p\u003e\n\u003cp\u003eHowever, maternal/caretaker\u0026rsquo;s factors like age, marital status, residences, and BMI were not associated with underweight.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3 Nutritional practices associated with Underweight associated with underweight\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNutritional practices Associated with Underweight\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUnderweight\u003c/p\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal weight\u003c/p\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003eNo. (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFeeding the baby entirely on Family food?\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.812\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e107(95.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264(95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e371(95.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5(4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19(4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMethod of feeding the baby\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.584\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBreastfeeding exclusively\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7(6.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21(5.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMixed method feeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e101(90.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e248(89.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e349(89.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReplacement feeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3(2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(2.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(2.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo Milk substitutes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(3.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(2.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHealth education conducted on breastfeeding?\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.196\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79(70.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e177(63.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e256(65.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33(29.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101(36.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e134(34.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency of hand washing before breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAlways\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78(69.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100(36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e178(45.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIrregularly\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34(30.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e148(53.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e182(46.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDo not wash\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(10.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30(7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBreast Feeding duration\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.502\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBF\u0026thinsp;\u0026lt;\u0026thinsp;2 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64(56.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e158(56.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e221(56.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBF 2 years +\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49(43.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120(43.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e169(43.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e25 months and above\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16(14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(6.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34(8.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSafe versus unsafe water sources\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.575\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSafe water\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110(98.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e275(98.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e385(98.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eunsafe water\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(1.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5(1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of supplementing child's food(months)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eExclusive breastfeeding only\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4(3.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(11.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35(9.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBefore 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56(50.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(2.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64(16.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAt 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52(46.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e206(74.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e258(66.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAfter 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0(0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33(111.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33(8.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003eSource primary field data 2019\u003c/em\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e above presents data on nutritional practices Associated with underweight in this study. The study established that the majority of the respondents 371(95.1%) fed their children on entirely family food while 19(4.9%) did not. However, 44(11.3%) of the children were fed more than three times a day while less than half 156(40.0%) of them were fed twice a day. Regarding breastfeeding practices, 21(5.4%) of the children were exclusively breastfed while 349(89.5%) had both breast milk and milk substitutes. Besides, more than half 256(65.6%) of the respondents were encouraged by staffs to look for signs of breastfeeding. Yet, 171(43.8%) of the respondents were advised every time to see whether the baby seemed hungry as compared to 12(3.1%) were advised to breastfeed two to three times a day. 317(81.3%) of the respondents agreed that they have given anything other than breast milk to their baby. The study also revealed that 35(9.0%) of the mothers practiced exclusive feeding only despite their children being six months and above, 64(16.4%) of the children were started on food supplements before six months, 258(66.2%) started their children as recommended by WHO at 6 months while 33(8.5%) where started after six months.\u003c/p\u003e\n\u003cp\u003eWhile according to the bivariate analysis, nutrition practices associated with underweight, frequency of hand washing before breastfeeding and age of supplementing has shown a highly significant (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001) association on underweight.\u003c/p\u003e\n\u003cp\u003eIn this study, out of the 9 participants who admitted to have not initiated complementary feeding at 6 months as recommended by WHO, 4 of them acknowledged \u0026ldquo;\u003cem\u003ethat in South Sudan the price of food items is very high, while the rest attributed this to lack of enough money to purchase food items\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConversely, nutritional practices such as feeding the baby entirely on family food, method of feeding the baby, health education conducted on breastfeeding, breast feeding duration and source of drinking water were not associated with underweight.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003e3.4 Multivariate Analysis of Significance Factors associated with underweight\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003emodel summary of factors associated with underweight in children 24 months\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"9\" align=\"left\"\u003e\n\u003cp\u003eBinary logistic regression analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnadjusted\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdjusted\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003euOR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents highest level of education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-formal education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.14\u0026ndash;0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u0026ndash;1.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.095\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.12\u0026ndash;0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u0026ndash;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.091\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTertiary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.20-1-43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u0026ndash;2.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.671\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents monthly household income\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMin to 4900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5000 to 10000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.21\u0026ndash;0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.10\u0026ndash;0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbove 10000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.06\u0026ndash;0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u0026ndash;0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency of hand washing before breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlways\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIrregularly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2.11\u0026ndash;5.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.14\u0026ndash;4.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDo not wash\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of supplementing your child\u0026rsquo;s food\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExclusive breastfeeding only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.01\u0026ndash;0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.02\u0026ndash;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 Months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0. 17-1.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.15\u0026ndash;1.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.216\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbove 6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e above presents the model summary of factors associated with underweight in children under 24 months. Mothers/caretakers with primary (aOR, 0.38; 95% CI, 0.12\u0026ndash;1.18; P\u0026thinsp;=\u0026thinsp;0.095) and secondary (aOR, 0.37; 95% CI, 0.12\u0026ndash;1.17; P\u0026thinsp;=\u0026thinsp;0.091) levels of education had reduced odds of underweight compared to those with no formal education. However, tertiary level of education was not associated with reduced odds of underweight (aOR, 0.76; 95% CI, 0.21\u0026ndash;2.74; p\u0026thinsp;=\u0026thinsp;0.671).\u003c/p\u003e\n\u003cp\u003eIn regards to monthly household income, participants with household incomes that ranged from 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10\u0026ndash;0.68; P\u0026thinsp;=\u0026thinsp;0.006) and those with incomes above 10,000 (aOR, 0.11; 95% CI, 0.04\u0026ndash;0.28; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) South Sudanese pounds compared with those with incomes less than 5000 South Sudanese pounds had reduced odds of underweight.\u003c/p\u003e\n\u003cp\u003eParticipants who irregularly wash their hands before breast-feeding their children below 2 years had increase odds of underweight compared to those who always wash their hands. However, there was no different between participants who always washed hands before breastfeeding their children and those who do not wash their hands. Participants who began supplementary feeding before six months of age (aOR; 0.01; 95% CI, 0.02\u0026ndash;0.05; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and those who started at 6 months (aOR, 0.48; 95% CI, 0.15\u0026ndash;1.54; P\u0026thinsp;=\u0026thinsp;0.216), had reduce likelihood of underweight compared to those who exclusively breastfed their children. Conversely, there was no association between participants who started supplementary feeding after six months and those who exclusively breastfed their children.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study the prevalence of underweight was 28.7% with more boys presenting with underweight compared to girls. A community based cross-sectional study conducted in Western Ethiopia established a much lower prevalence of underweight among under-two children of 8.9%. The study further indicated that the prevalence of underweight among children under the age of one year was 15.1%. Males (9.7%) and were more malnourished than females (8.2%), which is similar to findings from this study. As compared with children in the age group less than six months, the risk of underweight was about 2.6 times higher for children in age groups over one year [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the contrary, a cross-sectional study conducted in South India among 500 participants observed that females were actually found to be more underweight (27.95%) compared to the males 20.29% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These contrasting findings between this study and that in India could be due to some cultural inclination of the communities where these studies were conducted. The cultural preference of a particular gender (girls or boys) on the basis of being sources of wealth or heir to succeed the father means, little attention maybe given to any gender that is not of preference especially in regards to duration of breastfeeding. The need to conceive a baby girl or boy might compel the mother into early cessation of breastfeeding which in turn exposes the child to underweight. Therefore, this study finding is not a surprise because in South Sudan, the girl child is valued more compared to the boy child.\u003c/p\u003e \u003cp\u003eThis study also revealed that Underweight was higher in children less than one year compared to those above one year. This is in agreement with findings from a cross-sectional study conducted among 500 participants in rural area of South India which indicated that the prevalence of underweight was higher in children\u0026thinsp;\u0026lt;\u0026thinsp;1 year of age (37.2%) compared with other age groups [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This could be because children above one year have other sources food to feed on apart from the breast milk compared to less than one-year children who mostly depends on breast milk.\u003c/p\u003e \u003cp\u003eThis study showed that increase in mothers/caretaker\u0026rsquo;s level of education was protective against underweight. These findings are consistent with findings from two other similar studies; a cross sectional study, and a case\u0026ndash;control conducted in Ethiopia, were in both studies; age of the child and education status of the mother were statistically significant predictors of underweight [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilarly, a community based cross-sectional study conducted in Ethiopia among 384 participants also showed that for any unit increase in maternal education (diploma and higher), the odds of their children getting underweight reduces by 81% more than those whose level of education is below diploma level [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This could be due to their positive health seeking behaviour because participants who attained at least some formal level of education have a higher chance of being well informed about the ways to provide care to their children, show positive practices with regard to hygiene, breast feeding and empowered decision making in health compared to those who never had any formal education.\u003c/p\u003e \u003cp\u003eAdditionally, this study established that households with higher income of at least 5,000 South Sudanese Pounds was associated with reduced likelihood of underweight. A study conducted in Pakistan, revealed a significant association between household wealth and underweight, thus, more cases of underweight were reported in the poorest households compared to those in the wealthiest household [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, findings from this study are consistent with several studies conducted in various countries in Sub-Saharan Africa. For instance, in Malawi, results from analysis of individual-level and community-level effects on childhood undernutrition established that children in communities with a low and medium income had higher chances of being undernourished compared to those from households with low-income levels [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consistency in these findings could be because mothers who have reasonable amount of money are able to afford nutritious foods and provide a balance diet for their children compared to those who do not have any sources of income. Probably that explains why various studies have similar findings on the variable of levels of income or household wealth. This is also in line with opinions of 4/9 of the mothers who had not given any supplementary foods to their children even at 6 months. When asked to explain the reason for not supplementing, they testified \u003cem\u003e\u0026ldquo;in South Sudan everything including food items are bought from the market expensively which we cannot afford. A 21-year-old mother said my baby does not want to eat our family food. I wish to make something different like porridge and eggs for her but my husband and I cannot afford enough food for the family to eat even twice a day\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThis study had proven that mothers or care takers who irregularly wash hands before breastfeeding their children had increased odds of underweight. This finding is similar to those of another study conducted in Ethiopia among 480 participants where it established that Children of caregivers/mothers who did not practice hand washing after latrine use were found to be 6.7 times as likely to be underweight as their counterparts whose caregivers did wash their hands [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This could be because one of the major causes of diarrheal disease common in children 6 to 24 months old, happened as a result of bacterial contamination of complementary foods. Mothers or caretakers who irregularly washed before feeding their children are likely to contaminate the foods while preparing it or transmit infection through unclean utensils, such as cups, spoons and bowls, used for storing and serving young children's food.\u003c/p\u003e \u003cp\u003eThis study showed that introduction of supplementary feeding before six months of age and at six months was protective against underweight compared to those who exclusively breastfed at six months and those who were introduced complementary feedings after six months. This finding is consistent with the WHO recommendation which states that children should be introduced to supplementary feeding at six months. However, the practice of responsive feeding in WHO complementary guidelines means a child who expresses interest for food even before six months can receive supplementary feeding. This is because at 6 months, the child\u0026rsquo;s requirements for energy and nutrients starts to exceed what is provided by breast milk [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. On the contrary, a cross sectional study conducted across Lebanon among 1000 participants, indicated no risk\u0026ensp;of\u0026ensp;diarrhoeal\u0026ensp;diseases\u0026ensp;associated\u0026ensp;with\u0026ensp;the\u0026ensp;early\u0026ensp;introduction\u0026ensp;of\u0026ensp;nonmilk\u0026ensp;supplements, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, this study showed that the prevalence of underweight in children less than 24 months in Nimule town council is high (28.7%). This result falls within WHO underweight high prevalence cut-off values (20\u0026ndash;29%) for public health significance. As the mothers or caretaker\u0026rsquo;s level of education reduces the chances of their children becoming underweight. Monthly household income of at least 5,000 South Sudanese pounds was associated with reduced likelihood of underweight in children. Mothers or caretakers who irregularly washed hands before breastfeeding their children had increased odds of underweight and the introduction of supplementary feeding before six months of age and at six months was protective against children being underweight.\u003c/p\u003e \u003cp\u003eFindings from this study strengthens the evidence base for MoH Government of South Sudan and the development/Implementing partners to focus on nutrition in children below two years of age. There is need to strengthen the affirmative action efforts to empower the girls and women, through education for instance. Empowerment of girls through formal education is beneficial for maternal and child health outcomes immediately or later in their life. Importantly, empowerment of girls through formal education also increases their chances for jobs and hence improves their earning which is preventive against underweight. Alternatively, this study also recommends for multi sectorial approaches targeting women\u0026rsquo;s socioeconomic status by introducing income generating activities that could improve household food security. There is need to have access to safe and clean water and to educate households and community members on personal hygiene so as to cut down the fecal oral transmission of diseases among children. Finally, children should be introduced to supplementary feeding at six months as recommended by WHO. However, in line with IMCI guidelines also, when a child expresses interest in food, he/she can be introduced into supplementary feeding before six months since both are protective against underweight.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval to conduct this study was obtained from Clarke International University Research Ethics Committee. The Principal Investigator also sought for Ethical Review and Clearance by the National Ministry of Health IRB in South Sudan. Administrative clearance was provided by Nimule Hospital Director, and Catholic Diocese of Torit Primary Health Care Center (study sites). More importantly, the study participants. Importantly, voluntary and informed consent to participate in the study was obtained from the participants before the research assistants embarked on the interviews to collect data. Consent from both adults and emancipated minors aged 14 to 17 were considered before interviewing them. The study respondents were assured of confidentiality as per the National guidelines for research involving humans as research participants (July, 2014). \u0026nbsp;Similarly, the entire data management process including the interviewing of participants, were performed in accordance with\u0026nbsp;the relevant guidelines and regulations pertaining to research processes involving human subjects (for example- Declarations of Helsinki)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable for the above section\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset for this study are provided, it has been uploaded as a separate file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests in this study, findings and the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding Sources\u003c/p\u003e\n\u003cp\u003eNo funding from any institution was received for this study. This was a self-funded study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur first goes to the study participants for their time to participate in this study. Secondly, to the MoH South Sudan for allowing the stud to be conducted. Third, The Institute of Public Health and Management, Clarke International University, and lastly, The School of Public Health and Applied Human Sciences, Kenyatta University to which the authors are affiliated is acknowledged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEriga Francis conceptualized and designed the study, performed data analysis. John Bosco Alege provided overall technical research guidance from the onset of the concept up to writing of the manuscript. Eriga and Alege designed the methodology and wrote the draft manuscripts. Gulom Godfrey did the draft reviews and provided additional technical guidance that led to this final manuscript. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO 2018 Global Nutrition Report; Shining a light to spur action on nutrition. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/nutrition/globalnutritionreport/2018_Global_Nutrition_Report.pdf?ua=1\u003c/span\u003e\u003cspan address=\"https://www.who.int/nutrition/globalnutritionreport/2018_Global_Nutrition_Report.pdf?ua=1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD Compare. (2015). 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Complementary feeding patterns in a developing country: a cross-sectional study across Lebanon. \u003cem\u003eEMHJ - Eastern Mediterranean Health Journal, 16 (\u0026lrm;2)\u0026lrm;, 180\u0026ndash;186\u003c/em\u003e, 2010 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/117840\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/117840\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Birth, weight, low, children under 24 months, determinants","lastPublishedDoi":"10.21203/rs.3.rs-2065097/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2065097/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eUnderweight is a public health problem globally, and more severe in South Sudan with wide regional differences. In Nimule border town, which represents other border towns in South Sudan, data on underweight among children below two years is unavailable. Thus, this study set out to assess determinants of underweight among children less than 24 months in Nimule boarder town, Pageri County, Eastern Equatoria State, South Sudan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAn analytical cross-sectional study was conducted in Nimule boarder town targeting 390 children below two years. Systematic sampling and simple random sampling methods were used. Data were collected through a researcher-administered questionnaire with both open and closed ended questions. Data was entered in EpiData and then exported into Statistical Package for Social Sciences research (SPSS) version 20 for analysis. Descriptive data analysis was conducted and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was conducted with the Chi-squared and Fisher's exact tests for categorical independent variables, and the student’s t-test for numerical variables. Finally, multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOut of 390 participants, 112 (28.7%) were under weight. The study showed primary (aOR, 0.38; 95% CI, 0.12-1.18; P=0.095) and secondary (aOR, 0.37; 95% CI, 0.12-1.17; P=0.091 levels of education were associated with underweight but not tertiary level of education (aOR, 0.76; 95% CI, 0.21-2.74; p = 0.671). Household income of 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10-0.68; P =0.006) and above 10,000 (aOR, 0.11; 95% CI, 0.04-0.28; P\u0026lt;0.001) South Sudanese pounds, supplementary feeding before 6 months (aOR; 0.01; 95% CI, 0.02-0.05; P\u0026lt;0.001) were associated with underweight and irregular hand washing (aOR; 2.17; 95% CI, 1.14-4.11; P=0.018) was associated with increased odds of underweight.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This study established a high prevalence of underweight. Maternal levels of education particularly primary, secondary, higher household incomes in excess of 5,000 South Sudanese pounds were protective against underweight. While irregular hand washing was a risk factor for underweight.\u003c/p\u003e","manuscriptTitle":"Predictors of under-weight among children less than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-18 15:55:53","doi":"10.21203/rs.3.rs-2065097/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8280a912-81fa-414b-b336-99c92bc14866","owner":[],"postedDate":"October 18th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-13T21:14:11+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-18 15:55:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2065097","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2065097","identity":"rs-2065097","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}