Study design and setting
A community-based cross-sectional study design was conducted from October 12 to November 12, 2022 at Itan Special Woreda, Gambella, Ethiopia.
data
The study population was all mothers/caregivers in the household who had children between 6 and 59 months of age and who had lived in the study area for at least 6 months prior to the time of data collection in the selected study area. and consent has been obtained. It also included those who participated.
RUTF therapy should not be administered to children younger than 6 months of age7. Height cutoffs are frequently used in SAM treatment programs to identify children who are likely to be younger than 6 months of age and are not suitable for treatment with RUTF. If there were multiple children aged 6–59 months in the same household, the youngest child was selected to avoid recall bias. Mothers/caregivers of children aged 6–59 months with other health problems who are in critical condition and who have not lived in the study area for at least 6 months before the survey Excluded.
During the study, the number of mothers/caregivers in households with children aged 6 to 59 months living in Itan Special Woreda was 8,685. Of the total number of children aged 6-59 months residing in 23 kebeles, there were 3,652 children. Selected 11 sample people residing in the Kebeles for less than 5 years were taken as the sampling frame. A multistage sampling technique is applied in this study. Initially, her 23 kebeles administrations in this district were divided into her two main subgroups. The first cluster contains 12 kebeles found on the main asphalt of the Baro River/Itan special woreda closest to the town, and the second cluster contains 11 kebeles found after the Baro River. It is. From the 12 kebeles found in front of the Baro River, 6 kebeles (BILJAKOK, PILUAL, BAZIEL, DRONG, WAAR, OKURA) were randomly selected for the study. Similarly, from the Elvish kebeles discovered after the Baro River, five kebeles (EBAGO, ADONG, ELIA, ALAHA, ADIMA) were randomly selected to account for heterogeneity.
In both clusters, the studies selected using simple random sampling included a total of 11 kebeles, and the sample size for each selected kebele was determined using pro-rata allocation.
use 8 Sample Size Determination Formula,The total sample size (n) of the study was determined as follows: \(n=\frac{{\text{N}}}{1+{\text{N}}({e)}^{2}}=\frac{3652}{1+3652({0.05)} ^{2}}=361\) where n = sample size, N = population size (N = 3652), e = sample size for precision (a 5% margin of error was used, considering the homogeneity of the study population).
Using this formula, the number of children under 5 years of age, 361, was determined from the 11 Kebeles filling out the questionnaire. However, due to concerns about missing data and nonresponse rates, the sample size was determined to be 397 in 10% increments. On the contrary, 9 We argue that it is prudent to oversample by 10–20% when there is a nonresponse rate. In other words, you can add 10-20% to the already calculated sample size to compensate for samples that cannot be contacted or are not properly filled.Ten.
Finally, based on the sampling frame obtained from the 2015 Itan Special Woreda Basin Population Health Office, 397 children under 5 years of age were sampled from 11 kebeles for structured interviews (see Table 1) .
For layer h (each year of the department), the number of samples is calculated by proportional division. This will give you a result like this:\(n_{hs} = \frac{{N_{hd} \times n}}{N}\) 11 These samples for each selected kebeles are then selected using simple random sampling.
Two types of equipment are used to collect the necessary data. One was a researcher-designed questionnaire, and the other was anthropometric measurements, including weight and age, from healthy children aged 6 to 59 months during the study period. A portable scale (Seca model 881) is used to measure the child’s weight. During the measurement, participants wore light clothing, and their weight was recorded to the nearest 0.1 kg.12. Children who were unable to step on the scale were weighed with their mother or caregiver, who then weighed alone, and the difference was used to obtain the child’s net weight. The child’s height will be measured using an appropriate height scale with minimal clothing. The headpiece is lowered until it touches the head. Height and length are measured by trained health extension workers.
Although a variety of methods have been commonly used to assess the nutritional status of children aged 6 to 59 months, including anthropometric, clinical, dietary, and biochemical measurements, anthropometric measurements (physical dimensions and body composition) are often used as surrogates to assess final nutritional status and nutritional status. Severity of malnutrition. A good general measure of the nutritional health of a population is the anthropometric index of weight-for-age. Additionally, weight-for-age was a composite index of weight-for-height and height-for-age. 13, 14, 15. The dependent variables were severely malnourished (< − 3.0 Z-score), moderately malnourished (− 3.0 to − 2.01 Z-score) and well-nourished (≥ − 2.00 Z-score).
Socioeconomic, demographic, and maternal and child health characteristics as independent variables that influence the severity of malnutrition in children aged 6–59 months include maternal education, maternal employment status, maternal marital status; It was the employment situation. Father’s economic status, father’s educational background, number of household members, region of residence, geographical region (kebele), child’s gender, child’s age, mother’s age at first birth, child birth interval, birth type, vitamin A drops, pregnancy status. administration of iron supplements/syrup, availability of toilet facilities, water supply source, diarrhea in the 2 weeks before the survey, and fever in the 2 weeks before the survey.
data analysis
After data collection, data were checked and entered by SPSS and analyzed using R version 3.4.0 and STATA 14.2 statistical software packages. In this study, the analysis focuses on three outcomes regarding the nutritional status of children aged 6–59 months. Whether severely undernourished, moderately undernourished, or undernourished. Two logistic regression models were run separately. First, we used an ordinal logistic regression model to identify the determinants of malnutrition in children aged 6–59 months and to predict the probability of malnutrition in children aged 6–59 months. Finally, we use a multilevel ordinal logistic regression model to assess the impact of determinants between different kebele levels on the prevalence of malnutrition. All inferences were made at a 5% significance level.
ethical considerations
All procedures are performed in accordance with relevant regulations and journal standards. Ethics clearance approval letter was obtained from Gambella University Institutional Review Board Research Department Ethics Approval Committee (reference number: 258/GmU/2014, deadline: November 15, 2014). Data collected from structured questionnaires were generated by anthropometric measurements including weight and age from healthy children aged 6–59 months during the study period by researchers and health care workers. This study was conducted with individual informed consent obtained from all subjects and their literate legal guardians. All methods were performed in accordance with the Declaration of Helsinki.
