DILLA UNIVERSITY COLLEGE OF MEDICINE AND
HEALTH SCIENCE; SCHOOL OF PUBLIC HEALTH
Prevalence and Associated Factors of Stunting Among Children
Under The Age of Five Years In Wonago District, Gede’o Zone,
Southern Ethiopia, 2018
By: Asres Mengesha Biftu (BSc)
A thesis submitted for partial fulfillment of Degree of Masters of Public
health, Reproductive health (MPH/RH) to the School of Public health, Dilla
University.
January, 2020
Dilla
Declaration
I, the undersigned declare that this thesis is the result of my original work and has not been
presented elsewhere for any degree, and that all sources of materials used for the thesis have
been fully acknowledged.
Name: Asres Mengesha Biftu
Signature: ___________________ Date of submission: _________________________
Name of the institution: Dilla university college of health sciences and medicine, department of
reproductive health
This thesis has been submitted with my approval after final defence as an internal examiner.
Name and signature of internal examiner:
Mr. Solomon Hailemariam (MPH/Epidemiology, Assistant Professor)
Signature_______________________
i
Acknowledgments
First and foremost, I would like to forward my genuine thanks to Almighty God, for making me
become successful in every dimension, particularly in this academic study.
My sincere gratitude goes to my advisors Mrs. Samrawit Hailu (PhD fellow) and Mrs. Mahlet
Birhane (MSc) for their unreserved guidance throughout my work so far. Their immediate follow
up and incisive comments inculcated me with enthusiasm for further research work. I consider it
an honor to have them as an advisor.
I am heartily thankful to Dilla University, School of public health and department of
reproductive health for their effort and coordination for the effectiveness of this study.
I would also like to acknowledge NORHED project for funding this study.
My deepest gratitude also goes to my family members and my immediate colleague Ato Tariku
Demissie, who never let me alone throughout my study period.
I would also like to thank Gede’o zone health department, Wonago woreda health office, leaders
of selected kebeles and all the study participants of this study for their cooperation and genuine
response, without genuine response of whom this research paper would not have assumed this
form.
The last but not least, I forward my thanks to data collectors, supervisors, health extension
workers and their volunteers for their kind help during identification of eligible households.
ii
Table of contents
Declaration ....................................................................................................................................... i
Acknowledgments........................................................................................................................... ii
List of tables ................................................................................................................................... vi
List of figures ................................................................................................................................ vii
Abbreviations and acronyms........................................................................................................ viii
Abstract .......................................................................................................................................... ix
Chapter one: Introduction ............................................................................................................... 1
Background ................................................................................................................................. 1
Statement of the problem ............................................................................................................ 3
Significance of the study............................................................................................................. 5
Objectives ................................................................................................................................... 6
Chapter two: Literature review ....................................................................................................... 7
Magnitude of stunting among children under the age of five years ........................................... 7
Factors associated with stunting among children under the age of five years House hold factors
related with under-five stunting .................................................................................................. 8
Maternal, child and nutrition related factors associated with stunting ................................... 8
Environmental factors associated with under-five stunting .................................................. 10
Conceptual framework .............................................................................................................. 12
Chapter three: Methods and materials .......................................................................................... 13
Study Area ................................................................................................................................ 13
Map of the study area ............................................................................................................ 14
Study Design ............................................................................................................................. 15
Study period .............................................................................................................................. 15
Population ................................................................................................................................. 15
iii
Source Population ................................................................................................................. 15
Study Population ................................................................................................................... 15
Sampling unit ............................................................................................................................ 15
Inclusion and Exclusion Criteria ............................................................................................... 15
Inclusion Criteria .................................................................................................................. 15
Exclusion Criteria ................................................................................................................. 15
Sample Size Determination....................................................................................................... 16
Sampling Procedures ................................................................................................................ 18
A schematic presentation of sampling procedure ................................................................. 19
Study Variables ......................................................................................................................... 20
Dependent Variable .............................................................................................................. 20
Independent Variables .......................................................................................................... 20
Data collection tools and techniques......................................................................................... 20
Data quality control................................................................................................................... 21
Data Analysis ............................................................................................................................ 22
Ethical Considerations .............................................................................................................. 23
Chapter four: Results .................................................................................................................... 25
Socio-demographic characteristics ........................................................................................... 25
Child factors .............................................................................................................................. 28
Maternal factors ........................................................................................................................ 30
Feeding and dietary characteristics ........................................................................................... 30
Personal hygiene and environmental sanitation characteristics ................................................ 32
Nutritional status of children aged below five years ................................................................ 34
Determinants of the stunting among children under the age of five years ............................... 35
Chapter five: Discussion ............................................................................................................... 38
iv
Chapter six: Strengths and limitations .......................................................................................... 41
Strengths ................................................................................................................................... 41
Limitations ................................................................................................................................ 41
Chapter seven: Conclusion and recommendations ....................................................................... 42
Conclusion ................................................................................................................................ 42
Recommendations ..................................................................................................................... 42
Chapter Eight: References ......................................................................................................... 44
Annexes......................................................................................................................................... 52
English questionnaire ................................................................................................................ 52
የአማርኛ ቃለ-መጠይቅ ................................................................................................................ 60
Qortuma Gede’uffat .................................................................................................................. 69
v
List of tables
Table 1 Calculated sample sizes for the second objective during the study of prevalence and
associated factors of stunting among children under the age of five years in Wonago district,
2018............................................................................................................................................... 17
Table 2 Socio-demographic and household characteristics of the respondents in Wonago district,
Gede’o Zone, southern Ethiopia, 2018 ......................................................................................... 25
Table 3 Child factors of under five children in Wonago district, Gede’o Zone, southern Ethiopia,
2018............................................................................................................................................... 28
Table 4 Maternal factors in wonago district, Gede’o Zone, southern Ethiopia, 2018 .................. 30
Table 5 Feeding and dietary characteristics of underfive children and household members in
Wonago district, Gede’o Zone, southern Ethiopia, 2018.............................................................. 31
Table 6 Personal hygiene and environmental sanitation characteristics among under five children
of wonago district, Gede’o Zone, southern Ethiopia, 2018 .......................................................... 32
Table 7 Factors associated with stunting among under-five children of Wonago district,
December/2018 ............................................................................................................................. 37
vi
List of figures
Figure 1 Conceptual framework showing associated factors of stunting among children under the
age of five years. Adapted from the study done in India and modified according to the context of
the study area. ............................................................................................................................... 12
Figure 2 Map of Wonago district ................................................................................................. 14
Figure 3 Schematic presentation of sampling procedure, Wonago district, southern Ethiopia,
2018............................................................................................................................................... 19
Figure 4 Bar chart showing prevalence of stunting among children under the age of five years in
Wonago district, Southern Ethiopia, 2018 .................................................................................... 34
vii
Abbreviations and acronyms
EDHS: Ethiopian Demographic health survey
DURH: Dilla University Referral Hospital
ERB: Ethical Review Board
FGDs: Focus Group Discussions
GDP: Gross Domestic Product
GTP: Growth and Transformation Plan
HFA: Height For Age
HEP: Health Extension Programme
HSTP: Health Sector Transformation Plan
MUAC: Mid Upper Arm Circumference of the Child
NCHS: National Center for Health Statistics
NORHED: Norwegian Programme for Capacity Development in Higher Education and Research
for Development
SD: Standard Deviation
UNICEF: United Nations Children’s Emergency Fund
WFA: Weight For Age
WFH: Weight For Height
WFP: World Food Programme
WHO: World Health Organization
viii
Abstract
Background: The joint work of the United Nations Children’s Emergency Fund, World Health
Organization and World bank (2018) on child malnutrition states that stunting affected an
estimated 150.8 million children under the age of five years globally in 2017. According to
Ethiopia Mini Demographic Health survey (EMDHS) 2019, about 37% of children under the age
of five years are stunted. So, identifying prevalence and associated factors of stunting in children
under the age of five years is central in developing childhood nutritional problem intervention
strategies.
Objective: To assess the prevalence and associated factors of stunting among children under the
age of five years in Wonago district, Gede’o Zone, Southern Ethiopia, 2018.
Methods: A community based cross-sectional study was conducted among 615 randomly
selected under five children paired with their caregivers in 7 kebeles of Wonago district. The
survey was conducted from December 1/2018-December 30/2018 using structured pretested
questionnaire and tools of anthropometric measurement. Data were coded and entered to EpiData
version 3.1, then it was exported to SPSS version 20 for cleaning and analysis. The prevalence of
stunting among children under the age of five years was analyzed by ENA for SMART 2011
software and the report was made using WHO Standard cut off point below -2 SD using z-score.
All variables with p value of < 0.25 during bivariate logistic regression analysis were entered to a
multivariate analysis to identify variables associated with the outcome variable at p value < 0.05
with 95% CI.
Result: Prevalence of stunting among children under the age of five years was 37.7%. Family
size of less than five members, being younger than 11 months old and rich wealth status of the
household has protective effect against the risk of stunting. Unsafe water source, presence of two
or more underfive children in the household, poor access to diversified diet and unsecured
household food security status increases the risk of stunting.
Conclusion: According to WHO global data base, the prevalence of stunting identified by this
study is high among children under the age of five years in Wonago district. Age of the child,
family size, number of underfive children in the household, wealth status of the household,
source of the drinking water, access to diversified diet and household food security status are
major factors associated with stunting among children under the age of five years in this study
area. Thus, to reduce childhood chronic nutritional problem in this district, due emphasis should
be given on intervening these factors.
Key
words:
Stunting,
under
five
children,
ix
Wonago
district,
Gede’o
zone
Chapter one: Introduction
Background
Stunting indicates a failure to achieve one’s genetic potential for height and thought to be
the result of chronic under nutrition originating in infancy [1, 2]. It is the outcome of inadequate
nutrition during this critical developmental phase of life. Because this phase does not reoccur
later in life, reversing or treating the developmental consequences of early childhood under
nutrition later in childhood is almost impossible [3].
Stunting is associated with an elevated risk of child mortality, increased susceptibility to
infection and poor cognitive and psychomotor development. The long-term consequences of
stunting include deficits in school achievement, reduced work capacity and adverse pregnancy
outcomes. Worldwide, stunting affects nearly one-third of children under 5 years of age, with the
prevalence being higher in low-resource countries in sub-Saharan Africa and South Asia [4, 5].
Stunting in young children is the result of multiple circumstances and determinants, including
antenatal, intra-uterine and postnatal malnutrition, more commonly due to inadequate or
inappropriate nutrition and the impact of infectious disease [6, 7].
Globally, it is estimated that under nutrition is responsible, directly or indirectly, for at least 35%
of deaths in children less than five years of age. Stunting affects close to 195 million children
under five years of age in the developing world [8]. Worldwide, one in four children, one-third
of children under 5 in low-income and middle-income countries, and also in Ethiopia, more
than 2 out of every 5 children are estimated to be stunted [9-11]. Ethiopia is the secondmost populated country in Africa with 15.4% under five children [12]. These children suffer
disproportionately from the poor health and nutritional situation in the country. Malnutrition is
the underlying cause of 57% of child death in Ethiopia [13] with some of the highest rate of
stunting and underweight in the World [14].
According to the latest Ethiopian mini demographic health survey, EDMHS 2019, in Ethiopia
37% of children under the age of five years were stunted, and 12% were severely stunted. The
survey also revealed that in Southern Nations Nationalities and People region of Ethiopia the
1
percentage of under five children who were stunted, and severely stunted was 36.3% and 12.4%
respectively [15].
The period from birth to two years of age is particularly important because of the rapid growth
and brain development that occurs during this time. The period is often marked by growth
faltering, micronutrient deficiencies and common childhood illnesses [17]. Data exists in
Ethiopia that show the problem of malnutrition beginning early in life, primarily during the first
12 months when growth faltering takes hold due to sub-optimal infant feeding practices. Stunted
infants grow to be stunted children and stunted adults [18].
Appropriate weaning and complementary feeding behaviors, nutritional interventions, and
disease control and treatment programs are strategies to prevent stunting. However, their
effectiveness also depends on counteracting the environmental and socio-economic
circumstances that allow infection and sub-optimal nutrition to persist [6, 19]. Infant-feeding
practices constitute a major component of child caring practices apart from socio-cultural,
economic and demographic factors. Somehow, these practices constitute one of the most
neglected determinants of young child malnutrition in spite of their important role in growth
pattern of children [20].
In order to effectively accomplish the goals of accelerated stunting reduction, identifying the
potential determinants of chronic under nutrition is a vital step to reduce the burden of stunting.
Despite many studies conducted at national and regional levels, the prevalence and risk factors at
sub-regional or community level have been insufficiently emphasized; particularly at Gede’o
zone, which makes interventions difficult in such circumstances. Thus, it is important to have
detailed and concrete data that can fill these gaps and would add a value that directs policy
makers to draw appropriate intervention measures to improve and flourish the health of future
generation. Therefore, this study investigated the current revalence and key factors contributing
to stunting among children under five years of age in Wonago district, Gede’o zone, southern
Ethiopia.
2
Statement of the problem
Worldwide, an estimated 171 million children do not have the opportunity to reach their
full potential because of poor nutrition in the earliest months of life. Globally, 165 million
children are stunted. More than one third of children in Asia are stunted, which accounts for
almost 100 million of the global total. In Africa, almost two in five children are stunted that is a
total of 60 million children [9, 21].
Under nutrition, consisting of fetal growth restriction, stunting, wasting, and deficiencies of
vitamin A and zinc, along with sub optimum breastfeeding, underlies nearly 3·1 million deaths
of children younger than 5 years annually worldwide, representing about 45% of all deaths in
this group [22]. Prevalence of stunting among children younger than 5 years has decreased
during the past two decades, but is higher in South Asia and Sub-Saharan Africa than elsewhere
(W). In Africa, this has seen an overall reduction of just 2% in 20 years from 40.3% in 1990 to
38.2% in 2010 [7, 21].
A Cost of Hunger in Ethiopia reports that 16% of all grade repetitions in primary school are
associated to the higher incidence of repetition that is experienced by stunted children. In
addition to this 67% of the working age population in Ethiopia is currently stunted with on
average, lower school levels than those who did not experience growth retardation by 1.1 years
of lower schooling. As industries continue to develop increasing number of people participate in
skilled employment, this loss in human capital will be reflected in a reduced productive capacity
of the population [11].
Although Ethiopia has already achieved a remarkable progress in reducing under-five mortality
in the last decades. Under nutrition among children is still a common problem in this country
[12, 23]. Under nutrition can best be described in the country as a long term year round
phenomenon due to chronic inadequacies in food combined with high levels of illness in
under-five children. It is the underlying cause of 57 % of child deaths. Under nutrition is
currently the most wide spread and serious health problem of children [12].
Even though, the government health sector development plan IV (2010/11-2014/15) continues
to improve the nutritional status of mothers and Children through different programmes;
3
such as Enhanced Outreach Strategy (EOS) with Targeted Supplementary Food (TSF) and
Transitioning of EOS into the Health Extension Programmed (HEP), Health Facility Nutrition
Services,
Community
Based
Nutrition
(CBN),
and Micronutrient
Interventions
and
Essential Nutrition Actions/Integrated Infant and Young Feeding Counseling Services;
under nutrition among children is still a common problem in Ethiopia [12, 24, 39]. Nevertheless,
there has been a substantial decline in the proportion of children stunted in the last 15 years
according to Ethiopian Mini Demographic and Health Survey 2014 (EMDHS) report [39].
Stunting continued to be one of the most important public health problems in Ethiopia. In recent
years Ethiopia has only had limited success in reducing the prevalence of stunting with annual
reduction of 1.3% over the past eleven years from 58% in 2000 to 44% in 2011. In 2012 and in
Southern region of Ethiopia (SNNPR) 41% of under five children were stunted. In SNNPR only
2.5% of children 6-23 months of age fed minimum acceptable diet according to the IYCF
recommendations [12, 25].
Stunting and its consequences should be prevented by ensuring access to appropriate
nutrition during the first 1,000 days of life [3]. Improvement of exclusive breastfeeding
practices, adequate and timely complementary feeding, along with continued breastfeeding
for up to two years or beyond, could save annually the lives of 1.5 million children under
five years of age [26]. Growth failure during intrauterine life and poor nutrition in the first
two years of life, have critical consequences throughout the life-course. Appropriate
breastfeeding and complementary feeding practices not only play a significant role in improving
the health and nutrition of young children, they also confer significant long-term benefits
during adolescence and adulthood [5].
To this end, chronic malnutrition problem is still a major concern in Ethiopia in general and
the study area in particular; no study was conducted before about chronic malnutrition status and
related factors among under-five children; and various associated factors were not clearly
known in the study area. Therefore, this study is aimed to determine factors associated with the
nutritional status of the children of under-five age group.
4
Significance of the study
Stunting reflects the cumulative effects of socio-economic, environmental, health, and nutritional
conditions. Stunting is directly associated with many of the Sustainable Development
Goals (SDGs), particularly SDG 1 (No poverty) and SDG 2 (Zero hunger). So, properly
addressing stunting helps for the success of achieving these goals. In Ethiopia stunting continued
to be one of the most important public health problems with severity that defined as " high"
stunting prevalence according to WHO criterion, 30-39% [27].
Factors that contribute to stunting are many and varied, so multifaceted strategies are required to
combat it. It is therefore important to determine its causative factors before appropriate
intervention can be implemented. This study will include the most important factors that are
demographic and socio-economic, environmental, health care and infant and young child feeding
factors of stunting. But, there is no published study conducted on this topic in the study
area, therefore, it is essential to assess the current prevalence of stunting and associated factors
among under five children in study area. Thus, this study attempts to formulate an actual figure
of magnitude of undernutrition among children under the age of five years in the district and
establishes the possible presence of the key contributing factors to their nutritional, so that
nutritional intervention can be better designed.
The result of this study would be utilized as a key focusing area in counseling or health
education session on healthy diet to improve nutritional status of under five children in this study
area. Furthermore, the study findings would be a guide to responsible bodies such as, nutrition
program managers and implementers; and for the better formulation of intervention activities
focusing in preventing child nutritional problem. It will also serve as a base line for further
studies.
5
Objectives
General objective: To assess the prevalence and associated factors of stunting among
under five children of Wonago district, Gede’o Zone, Southern Ethiopia, 2018.
Specific objectives
To measure prevalence of stunting among under five children of Wonago district, Gede’o
Zone, Southern Ethiopia.
To identify factors associated with stunting among under five children of Wonago
district, Gede’o Zone, Southern Ethiopia.
6
Chapter two: Literature review
Magnitude of stunting among children under the age of five years
The World Health Organization (2013) estimates that there are 178 million children that are
malnourished across the globe, and at any given moment, 20 million are suffering from the most
severe form of malnutrition. Malnutrition contributes to between 3.5 and 5 million annual deaths
among under-five children [29]. United Nations Children’s Emergency Fund (UNICEF) 2011
data shows that, one in four under-five children were stunted globally and this burden is
high in developing countries and about 80% of the worlds’ stunted children lives in 14
developing countries [30].
According to the recent estimates of the joint work of the UNICEF, WHO and world bank
(2018) on child malnutrition, stunting affected an estimated 22.2 percent or 150.8 million
children under the age of five years globally in 2017. Malnutrition rates remain alarming:
stunting is declining too slowly. The joint estimates, published in May 2018, cover indicators of
stunting, wasting, severe wasting and overweight among children under five, and reveal
insufficient progress to reach the World Health Assembly targets set for 2025 and the
Sustainable Development Goals set for 2030 [31].
Ethiopia has one of the highest rates of malnutrition in Sub-Saharan Africa, and faces acute and
chronic malnutrition and micronutrient deficiencies. Nutrition deficiencies during the first
critical 1,000 days (pregnancy to 2 years) put a child at risk of being stunted. This affects 40% of
children in Ethiopia [39].
As indicated by the recent Ethiopia Mini Demographic Health Survey of 2019, about 37 percent
of under 5 children are stunted (below -2 SD), and 12 percent of them are severely stunted
(below -3 SD) [15].
A community based cross Sectional study conducted in Lasta woreda, North East Ethiopia, the
proportion of moderate and severe stunting among under five children was 31.7% and 18.0%
respectively [32]. This finding is corresponding to a finding from studies done in Kenya (44.9%)
Uganda (41.6%), Malaysia (41.1%) and Bangladesh (41%) shows low prevalence of stunting
7
among under five children [33, 34, 35, 36]. This finding is in line with studies done in Dollo Ado
District of Somali region (47.7%) [37], Afar (46%) also finding in Tigray region [39].
A cross sectional study conducted in Sidama zone found that magnitude of stunting in Hawassa
University technology villages: Shamina Garmama, Doyo Chale and Tankaka Umbullo kebeles
at Hawassa Zuria woreda was 26.60%, in which the same study reported that this prevalence is
the lowest of the previous reports in Boricha woreda of Sidama zone (37.2%) [38].
Factors associated with stunting among children under the age of five years
House hold factors related with under-five stunting
A community based cross sectional study conducted in Hawassa town, southern Ethiopia suggest
that low monthly income (less than 500 ETB) is significantly associated with stunting among
under five children. This study also reported that under five children whose family size was 5 or
above were 3.13 times more stunted than families with less than 5 members [38]. This
finding was also consistent with the finding of other studies conducted in Somali region,
Ethiopia [37], Oromia region, West Ethiopia [42], Gambit, Ethiopia [43], Iran [44], Nigeria
[45], north Sudan [46] and Zimbabwe [47].
Maternal, child and nutrition related factors associated with stunting
A cross-sectional study conducted among children aged six to fifty nine months in Hawassa town
children’s individual factors were also found to be independently associated with under nutrition
among under five children. Sex of the child, number of under five children in household, birth
interval being less than two years, avaccination and history of diarrheal disease were found to be
significantly associated with stunting of under five children. Presence of diarrheal morbidity in
the last one year prior to data collection period was significantly associated with stunting of
under five children [48]. The finding of this study is consistent with the findings of different
studies conducted in different developing countries [49, 50, 51, 52].
A study conducted in children aged 6–59 months in Bule Hora district, south Ethiopia suggests
that presence of diarrhea in the past 2 weeks prior to the survey was significantly associated with
stunting. Children who had diarrhea in the past 2 weeks prior to the survey were 2.5 times more
8
likely to be stunted than children who had no diarrhea [53]. The results of this study are in
agreement with results of studies conducted in Ethiopia and Vietnam [54, 55].
Under five children who did not fed colostrum’s had about 5 times higher chance to be stunted
than their counterparts. Under five children who aged above 24 months were about 4 times more
likely to be stunted than below 12 months old ones [38].
In the study of Hawassa town, parental socio demographic variables are found to be
independently associated with under five children’s under nutrition. Maternal age was
significantly associated with under five children’s undernutrition as children born to mothers
aged 35 years and above were more likely to be stunted as compared to those who born to
mothers aged less than 35 years [48].
A study conducted in Wolaita zone, Southern Ethiopia indicated that maternal educational status
was significantly associated with chronic malnutrition among under five children [56]. Children
who had uneducated mothers were 5.7 times more likely to be stunted than those
mothers who had diploma and above. This finding corroborates the finding of other similar
studies conducted in different parts of the world [17, 37, 42, 57, 58]. The reason for the
association is explained that mother’s
management
of limited
education
is
associated
with
more
efficient
household resources, greater utilization of available health care
services, better health promoting behaviors, lower fertility as well as child centered caring
practices.
Concerning association between mothers’ marital status and under-five children nutrition,
findings from a study conducted in Gurage zone southern Ethiopia reveal that child's stunting is
significantly associated with marital status of the mother [85]. The likelihood of stunting were
4.27 times higher among divorced/widowed compared to married mothers. This finding
corroborates to the finding from a study cionducted in Uganda [29].
Children who did not exclusively breast fed were found to be at increased risk of stunting. Those
ninfants who did not breast-feeding exclusively were 2 times more likely to be stunted compared
with breast-fed exclusively [17]. This finding is consistent with similar studies conducted in
developing countries including Ethiopia show that infants who are not breastfed are 6 to
9
10 times more likely to die in the first months of life than infants who arebreastfed [86,
87,88]. The other studies also strongly recommended that the optimal nutrition of children
under two years of age, it is considered important that they be exclusively breastfed for the
first 6 months before being given complementary food [89].
Mother’s age is significantly associated with stunting of under five children. Under five children
who had mother with age less than 21 years old age were 2.11 times more exposed to stunting
than their counter parts [38].
A study conducted in Gurage zone southern Ethiopia also reveals that child age, number of
children residing in the household, and breast feeding duration were associated with stunting
among under five children. Children whose age were between 24 to 35 months were 3.13
times more likely to develop stunting than children whose agewere between 48 to 59
months. Those children residing together with three under five children were 4.52 times more
likely to develop stunting than single child in the household. Those children who fed breast
for less than two years were 5.32 times more likely to develop stunting compared to those who
fed two or more years [85]. This finding is consistent with a finding of study conducted in
Hossana town, southern Ethiopia, except the association between number of under five children
who are residing in household and stunting among under five children [90].
The result from pooled meta-analysis study also shown that maternal-related factors, such as
maternal autonomy, maternal employment and maternal education are important determinants of
early childhood stunting [59].
Environmental factors associated with under-five stunting
A study conducted in east Wollega zone of Western Ethiopia reports that using safe water has
significant association with under five children’s nutritional status. Children who are drinking
boiled water had significantly reduced odds of being stunted compared to drinking water
without boiling [17]. The possible reason might be due to that access to clean water reduces the
chance of exposure of the child to water borne diseases like diarrhea. The finding of this study is
consistent with another study conducted by Christiaensen, L. And H. Alderman [60].
10
From the reviewed literature, there seems to be a consensus that stunting among under-five
children is greater among large family size, poor wealth status, and boys than girls, older
children, being first child, illiterate mother, whose mothers were less than 20 years at the time of
birth [29, 32].
As already observed from different reviewed literature above, nutritional status of under five
children is influenced by numerous factors. But no studies have been strived to seek the real
picture of magnitude and examined the significant factors which are responsible for stunting
among children under the age five yeras in this particular study area. Therefore, having this in
mind is that a need to work out on this significant research gap is arisen.
11
Conceptual framework
Different factors affecting nutritional status of children below the age of five years are
summarized conceptually according to the context of the study area and span of this study as
follows.
Figure 1 Conceptual framework showing associated factors of stunting among children under the
age of five years. Adapted from the study done in India and modified according to the context of
the study area [61].
12
Chapter three: Methods and materials
Study Area
The study was conducted in wonago district, Gede’o zone, Southern Ethiopia. The study district
is located at about 374 kilometers south of Addis Ababa and 100 kilometers South of Hawassa,
capital of Southern Nations, Nationalities and Peoples’ Regional State and 14 kilometers South
of Dilla, which is the capital of Gede’o zone [62]. The district is found at an elevation of 15702070 above sea level [63]. The district is located between a latitude of 38° 14’N–38° 24’N and
longitude of 6° 20’E – 6° 32’E and has an approximate area of 248 km2 (25,680 hectare). the
mean annual average temperature of the district is 20.65 0c [64]. Based on the Gede’o zone
statistics office report of 2011 E.C. wonago district has 156,274 total population and households
of 31,893 and a total underfive years children of 24,394 [65]. According to Wonago district
health office report of Ethiopian fiscal year 2010 Wonago district has 21 kebeles (smallest
administrative units), with 6 health centers, 20 health posts and 2 private clinics [66].
13
Map of the study area
Figure 2 Map of Wonago district (Source: a study done in Wonago district [64])
14
Study Design
A community based cross sectional study
Study period
A study was conducted from December 1 to December 30/2018.
Population
Source Population
All under five children and their caretakers in Wonago district.
Study Population
Selected children aged below five years with their caretakers in selected kebeles of Wonago
district.
Sampling unit
Households with under five children
Inclusion and Exclusion Criteria
Inclusion Criteria
Households with at least one under five child
Under five children from families who have lived at least six months in Wonago
district.
Exclusion Criteria
Under five children who were critically ill
15
Sample Size Determination
Sample size for the first objective was calculated manipulating values of the required
parameters in single population proportion formula of Open Epi version 303 software.
The required sample size was calculated by considering the following assumptions.
𝑛=
𝑍 2 ∗ 𝑝∗(1−𝑝)
𝑑2
=
(1.96)2 ∗ 0.266∗(1−0.266)
(0.05)2
≈ 300;
Where:
n = required sample size
Z = critical value for normal distribution at 95% confidence level (1.96)
P = 26.6% of children under the age of five years are stunted (38).
d = 0.05 (5% proportion of tolerable sampling error between the sample and the
population).
As a multistage sampling technique was employed to identify study subjects, a design
effect of 2 was used. Adding 10% of the total sample size to compensate for nonresponse rate, the final sample size was 660.
Sample size for the second objective was calculated using statcalc of EPI info version
7.2.2.6 software. Values of factors associated with stunting were adopted from
different reviewed literatures [32, 38, 40, 67, 68]. Among different calculated sample
sizes for the second objectives, we got larger second sample size of 414 which is
obtained by considering vaccination factor. Among the calculated sample sizes for
both objectives, the largest was taken to retain representativeness of the first one
(n=660). (Table 1)
16
Table 1 Calculated sample sizes for the second objective during the study of prevalence and
associated factors of stunting among children under the age of five years in Wonago
district, 2018
Variable
% outcome in
unexposed group
CI
AOR Power n for both
groups
n
Age of the child
11.9
95%
3.97
80%
122
269
Family size
15.47
95%
3.13
80%
154
339
Birth interval
16.07
95%
2.89
80%
176
388
Vaccination
26.78
95%
2.47
80%
188
414
Maternal education
14.7
95%
4.02
80%
104
229
ANC follow up
51
95%
.29
80%
108
238
Diarrhea in the last 2wks. 43.4
95%
2.5
80%
172
379
Age at complementary
feeding
95%
3.3
80%
180
396
10.6
17
Sampling Procedures
A multi-stage sampling was employed to get study participants. At first stage of sampling, from
a total twenty one kebeles that are found in the district, seven kebeles were selected by using
simple random sampling considering one third of representativeness. In the second stage, a total
of 5,221 households which have at least one child below five years of age paired with their
caretakers was obtained from the health post family folder of the selected kebeles with the help
of health extension workers and their volunteers. Here is the list of randomly selected seven
kebeles with their corresponding number of households which have at least one child under the
age of five years paired with their caretakers (Tutufela=714, Hasse=449, Tokicha=369,
Jemjemo=815, Mokonisa=1344, Gelelcho=682 and Debota=848). The number of eligible
household was allocated
by using population proportional allocation technique based on
households with under five children they have (Tutufela=90, Hasse=57, Tokicha=47,
Jemjemo=103, Mokonisa=170, Gelelcho=86, Debota=107). For household with more than one
eligible child, one child was selected by using lottery method.
Where two or more eligible children were found in the same household, the youngest one was
selected in order to minimize recall bias. When the eligible households were closed during data
collection, they were revisited and if they were found still closed at second visit, they were
considered as non-respondents.
18
A schematic presentation of sampling procedure
Figure 3 Schematic presentation of sampling procedure, Wonago district, southern Ethiopia,
2018
19
Study Variables
Dependent Variable
Stunting
Independent Variables
Socio demographic and household factors: Family size, number of under five children in the
household, wealth status, age of the caretaker, sex of the caretaker, marital status of the
caretaker, occupation of the caretaker, educational status of the caretaker, head of the household
and residence.
Child factors: Child age, sex of the child, birth order of the child, birth interval between
preceding and index child, vaccination status of the child and history of deworming.
Maternal factors: Utilization of family planning, antenatal care follow up and post natal visit.
Feeding and dietary factors: Duration of breast feeding, whether colostrums was given or not,
exclusive breast feeding, weaning period, frequency of feeding per day, access to diversified diet
and household food security status.
Personal hygiene and environmental sanitation factors: Hand washing habit, access to safe
water, latrine ownership and its type, waste disposal system.
Co morbidity: History of illnesses in the last two weeks.
Data collection tools and techniques
Standardized questionnaire which is adopted from EDHS 2011 and corresponding literatures was
pre-tested and administered to mothers/caregivers by interviewers during data collection. The
questionnaire was first contextualized and developed in English and then translated in to local
language (Gede’uffa). Then it was translated back to English to assure its consistency. Grade ten
completed individuals were recruited for data collection. Two health officers were recruited for
supervision.
Anthropometric data was collected using the standard procedure determined by WHO (2007),
using instruments such as wooden length board, a vertical wooden height board with detachable
sliding headpiece which was designed by UNICEF and MUAC measuring tape. Their age was
20
asked cautiously before measuring anthropometry in order not to include non eligible children.
Body length of under-two children was measured with bare foot by using a horizontal wooden
length board with the infant in recumbent position. However, height of children 24 months and
above was measured using a vertical wooden height board by placing the child on the measuring
board, and letting the child stand upright in the middle of board. Length/height was taken to the
nearest 1 cm.
Data quality control
Quality of data was assured by creating awareness and common understanding about data
collection tools before data collection. Intensive training was given for data collectors and
supervisors by principal investigator on how to use the questionnaire and on ethical
consideration protocols before data collection. Anthropometric measurements were also
demonstrated. Weight scale was checked against zero reading before and after weighing every
child. To ensure the accurate age of the child, every efforts has been made by tracing birth
certificates, immunization card and asking the memory of
special events in mother’s or
caretakers’ life. If two or more eligible children were found in the same household, the youngest
one was selected to minimize recall bias. Maternal factors were assessed by enquiring only the
biological mothers of the children, which could minimize potential recall biases associated with
the long memory of the study participants.
The Pretest was done at Tumata chiracha kebele of wonago district which is not selected for data
collection. The main objective of the pretest was field practice and to check for consistency of
questionnaires and other data collection tools. Before the survey, 5% of questionnaires (33 in
number) accompanied with child anthropometry measurement was conducted and assessed.
Some modification was made on ambiguous words, unclear instructions, question sequence, and
questionnaire taking too long time. The collected data was checked by principal investigator and
supervisors for completeness, accuracy and clarity on daily basis. If the data was not completed,
it was completed by visiting those household on another time with the close follow up of
investigator and supervisors. Double data entry and validation was carried out. Data clean up and
cross-checking was done before analysis.
21
Data Analysis
Data was coded and entered to Epidata version 3.1, then it was exported to SPSS version 20
software for cleaning and analysis. Anthropometric data was exported to Emergency nutrition
assessment (ENA) 2011 software and analyzed through it and again exported to Ms excel to have
meaningful consistency. Then analyzed data of anthropometry was exported back to SPSS data.
Principal component analysis (PCA) has been carried out by the reduction of variables involved
in the development of wealth status, access to diversified diet and household food security status.
Fifteen variables (12 binary and 3 categorical variables) were used to construct a single wealth
index variable with three categories (poor, medium and rich). A total of 12 food group items
assessing household food diversity level; and a total of 9 frequency of occurrence questions
among 18 household food insecurity access scale generic questions that appear to distinguish the
food secure from unsecured households were dimensionally reduced to a single access to
diversified diet variable and household food security variable respectively. Among the variables
that had been entered into the pool of PCA, components whose Eigen value loads greater than
one were extracted. Factor one has been considered to address involved components. Since, there
are no established cut-off points in terms of food groups to indicate adequate or inadequate
dietary diversity for the household and, can be analyzed in several ways [69], household access
to diversified diet would be measured based on factor analysis and the rank would be assigned
into two categories from lowest to highest values; so that 1 was given for poor access & 2 for
good access. Similarly, the household food security status would be analyzed by factor analysis:
and the rank would be assigned into two categories from highest to lowest values; so that 1 was
given for food unsecured households & 2 for food secured households.
Tools of descriptive statistics such as frequencies, proportion, means and SDs were used to
summarize descriptive statistics of the data using tables and graphs. Cross tabulation was
conducted to test independence between two variables and to identify between cells having less
than 5 expected counts and to choose between appropriate tests.
Crude odds ratio with 95% confidence interval was used to assess the association between
independent and dependent variables during bivariate analysis. Independent variables which had
association with the outcome variables during bivariate logistic regression and those with p value
22
of less than 0.25 were considered as candidate for multivariate logistic regression. Multivariate
binary logistic regression analysis was carried out to test the effect of each independent variable
on nutritional status of children below the age of five years, which is explained as stunting at p
value 0.05 with 95% CI. Graph was used for diagrammatic summarization of categorical
variables and tables were used for summarizing variables.
Ethical Considerations
Ethical clearance letter was obtained from ethical review Board of Dilla University. Formal
consent letter was written to Gede’o zone health department. Gede’o zone health department in
turn sent the letter to Wonago woreda health office and the letter was written to respective
kebeles from Woreda Health office with carbon copy to catchment health facilities. Significance
of the study was clarified for study participants. They were also informed that their participation
was purely voluntary and assured of the privacy and confidentiality of all information. It was
clarified that no personal identities (such as name and so on) would be revealed and published at
any document. Then oral informed consent was obtained from each mothers/caretakers.
Malnourished cases which were identified during the study period were advised to go to nearby
health facilities for treatment.
23
Operational definitions and definition of terms
Anthropometry: Height/length and MUAC measurements to be recorded for under five
children.
Stunting is a height for age below -2 Z score from the median of WHO reference population.
Severe stunting: is a height for age below -3 Z score from the median of WHO reference
population.
Prevalence of stunting: percentage of children who are stunted.
Family size: A total number of family members who are living in a certain household.
Weaning period: The age at which solid or liquid foods can be introduced to infants. Early, if
before first 6 months of life [8].
Safe water: Water which is either purified by boling or treated by chemicals like chlorine and
water guard or fetched from clean source i.e. public tap and pipe and stored in a material with
narrow opening and has a tightly closing cover.
Unsafe water: Water which is fetched from pond, river and spring and not purified as well.
Access to diversified diet: Ability to get food that includes all of the diversified food items to
meet all household member’s nutritional requirements. The access would be measured based on
the cutoff point during factor analysis; 1 for poor access & 2 for good access[70] .
Food security: Adequate physical, social or economic access to food. The household food
security status would be measured based on the cutoff point during factor analysis: 1 for food
unsecured households, and 2 for food secured households [70].
Wealth status: Variables assesing economic status of the household were enetered into the pool
of factor analysis and the rank would be assigned into three categories from lowest to highest
values; so that 1 was given for poor households, 2 for medium households & 3 for rich
households.
24
Chapter four: Results
Socio-demographic characteristics
A total of 615 children paired with 539 (87.6%) caretakers from rural and 76 (12.4%) from urban
setting were participated in the study, yielding a response rate of 93.2%. Majority of the
respondents, 487 (79.2%) were female, out of which 412 (67%) were biological mothers of the
under five children.
Greater proportion of the respondents, 434 (70.6 %) were Gede’o in ethnicity, 512 (83.3%) of
the respondents were protestant in religion, 336 (54.6%) were housewives in occupation and 245
(39.8%) attended primary education level.
The highest proportions of the households, 570 (92.7%) were headed by fathers. Above half
percent 382 (62.1%) of the households had family size of five or more and 346 (56.3%) had only
one under five child.
Analysis of wealth index of the respondents shown that, the number of poor and those in medium
level of economic status were almost proportional: 222 (36.1%) and 227 (36.9%) respectively.
(Table 2)
Table 2 Socio-demographic and household characteristics of the respondents in Wonago
district, Gede’o Zone, southern Ethiopia, 2018 (n=615)
Variables
Frequency
Percent (%)
Mother
412
67
Father
119
19.3
Other relatives
84
13.7
Urban
76
12.4
Rural
539
87.6
Male
128
20.8
Female
487
79.2
Caretaker’s relation with the child
Residence
Sex of caretaker
25
Ethnicity of caretaker
Gede’o
434
70.6
Oromo
87
14.1
Amhara
55
8.9
Others
39
6.3
Protestant
512
83.3
Orthodox
83
13.5
Muslim
16
2.6
Others*
4
0.7
Father
570
92.7
Mother
35
5.7
Others£
10
1.6
No formal education
161
26.2
Primary education
245
39.8
Secondary
117
19
Higher level
92
15
336
54.6
employee
32
5.2
Merchant
146
23.7
Daily laborer
44
7.2
Farming
30
4.9
Others¥
Age of the caretaker
27
4.4
<20
3
0.5
20-34
421
68.5
35-49
172
28
>49
19
3.1
Religion of the caretaker
Head of the household
Educational status of the caretaker
Occupation of the caretaker
Housewives
Government/ private
26
Marital status of the caretaker
Single
13
2.1
Married
565
91.9
Divorced
8
1.3
Widowed
29
4.7
<5
233
37.9
≥5
382
62.1
One
346
56.3
≥2
269
43.7
Poor
222
36.1
Medium
227
36.9
Rich
166
27
Family size
Number of under five children in the household
Wealth status of the family
* Catholic, traditional followers…
£ Grandparents,
27
other relatives
¥ Barbers,
carpenter..
Child factors
The mean age of children was 25.6 ±14.3 months and above half percent 327 (53.2%) of
underfive children were female. Birth order of 269 (43.7%) of the underfive children was first.
Birth interval was assessed only for children beyond first birth order (346) so that, there is 1 year
birth interval between 113 (32.6%) of underfive children and their preceding under five child and
similarly, it was 3 years between 113 (32.6%) of them. Out of the 162 children below or 12
months of age, 69 (42.6%) of them had received vaccination in line with their age. Among 525
children above or 9 months age, 219 (41.7%) were fully vaccinated. One hundred and fourteen
underfive children (18.5%) had history of comorbidities (Table 3).
Table 3 Child factors of under five children in Wonago district, Gede’o Zone, southern
Ethiopia, 2018 (n=615)
Variables
Frequency
Percent (%)
<6 months
72
11.7
6-11 months
74
12
12-24 moths
151
24.6
>24 months
318
51.7
Male
288
46.8
Female
327
53.2
First
269
43.7
Second
135
22
Third
109
17.7
Fourth or more
102
16.6
1 year
113
32.6
2 years
67
19.4
≥3 years
113
32.6
I don’t know
53
15.4
Age of the child
Sex of the child
Birth order of the child
Birth interval between index and preceding child (n=346)
28
Receive vaccination in line with his/her age (n=162)
No
55
33.9
Yes
69
42.6
I don’t know
38
23.5
No
134
25.5
Yes
219
41.7
I don’t know
172
32.8
No
139
43.7
Yes
122
38.4
I don’t know
57
17.9
No
501
81.5
Yes
114
18.5
Fully vaccinated (n=525)
Deworming (n=318)
Child experience comorbidities
29
Maternal factors
Out of the total 412 biological mothers of underfive children participated in this study, 117
(28.4%) mothers did not have ANC visit, 133 (32.3%) mothers attended PNC and 123 (29.9%)
utilized family planning. (Table 4)
Table 4 Maternal factors in wonago district, Gede’o Zone, southern Ethiopia, 2018 (n=412)
Variables
Frequency
Percent (%)
No follow up
117
28.4
1-3 times
147
35.7
Four or more times
148
35.9
No
279
67.7
Yes
133
32.3
No
289
70.1
Yes
123
29.9
Number of ANC during pregnancy of index child
Attended PNC after birth of index child
Utilized family planning before pregnancy of index
child
Feeding and dietary characteristics
Out of 412 underfive children from biologic mothers who are assessed for colostrum status,
above half percent, 316 (76.7%) had fed colostrum. Out of 346 under five children assessed for
breast feeding duration (≥24 months children), majority 177 (51.2%) fed breast milk for less than
two years as opposed to 169 (48.8%) of them who fed for greater than or two years. Concerning
initiation of supplementary food, 217 (35.3%) of underfive children got supplementary feeding
right at six months while 127 (20.7%) of them got it before six months and 69 (11.2%) of them
got it after six months of life. Of 543 under five children to be assessed for initiating
supplementary food at right age, around half of them 304 (56%) had fed three or more time per
30
day. Access to diversified diet and food security status of beyond half of households in this study
area were found to be good (55.6%) and secured (60.2%) respectively. (Table 5)
Table 5 Feeding and dietary characteristics of underfive children and household members
in Wonago district, Gede’o Zone, southern Ethiopia, 2018 (n=615)
Variables
Frequency
Percent (%)
Given to the child
316
76.7
Withdrawn
96
23.3
< 24 months
177
51.2
≥ 24 months
169
48.8
Not given b/se child is <6 months age
46
7.5
Started regardless of its <6 months age
26
4.2
Before 6 months
127
20.7
Right at 6 months
217
35.3
After 6 months
69
11.2
I don’t know
130
21.1
≤3 times
129
23.8
>3 times
304
56
I don’t know
110
20.2
Poor
273
44.4
Good
342
55.6
Food unsecured
245
39.8
Food secured
370
60.2
What was done to the colostrum (n=412)
Duration of breast feeding (n=346)
When was the complementary feeding initiated
Frequency of child feeding per day (n=543)
Access to diversified diet
Household food security status
31
Personal hygiene and environmental sanitation characteristics
Main source of drinking water for majority of the respondents was public tap 277 (45%).
Majority of the respondents 479 (77.9%) do not treat water, 461 (75%) wash their hand before
feeding child, 580 (94.3%) of the respondents had latrine out of which, 544 (88.5%) was pit
latrine. Regarding disposal mechanism of domestic wastes, 279 (45.4%) of the respondents
disposed domestic waster at open field. (Table 6)
Table 6 Personal hygiene and environmental sanitation characteristics among under five
children of wonago district, Gede’o Zone, southern Ethiopia, 2018 (n=615)
Variables
Frequency
Percent (%)
River
19
3.1
Pond
51
8.3
Spring
222
36.1
Private pipe
22
3.6
Well
24
3.9
Public tap
277
45
Water on premises
73
11.9
Less than 30 minutes
356
57.9
Gereater or equal to 30 minutes
186
30.2
No
479
77.9
Yes
136
22.1
Pot
64
10.4
Jerry can
366
59.5
Bucket
163
26.5
Others
22
3.6
No
154
25
Yes
461
75
Main source of drinking water
Distance to drinking water
Treat water before drinking
What type of equipment do you use to store water?
Wash hand before feeding child
32
Have latrine
No
35
5.7
Yes
580
94.3
Pit latrine
544
93.8
Ventilated improved latrine
28
4.8
Flush toilet
8
1.4
No
564
91.7
Yes
51
8.3
No
580
94.3
Yes
35
5.7
At open field
279
45.4
At pit
117
19
By municipality
73
11.9
By composting
69
11.2
By burning
77
12.5
Type of latrine (n=580)
Wash hand after latrine
Share latrine with other household
Disposal mechanism of domestic wastes
33
Nutritional status of children aged below five years
This study revealed that, the prevalence of stunting among children under the age of five years in
this study area was 37.7%. The proportion of severely stunted under five children was 12.5%.
Prevalence of stunting
100
90
80
Percentage
70
60
Stunting
50
Severe stunting
37.7
40
30
20
12.5
10
0
Nutrional status
Figure 4 Bar chart showing prevalence of stunting among children under the age of five
years in Wonago district, Southern Ethiopia, 2018
34
Determinants of the stunting among children under the age of five years
Bivariate analysis
Factors associated with stunting in the bivariate analysis includes age of the child, family size,
number of underfive children in the household, sex of the caretaker, educational status of the
catetaker, occupational status of the caretaker, head of the household, wealth status, birth order,
antenatal care follow up, age of the child during initiation of the complementary feeding,
frequency of complementary feeding, status of colostrum, child fully vaccinated status, child
morbidity, source of drinking water, hand washing practice after latrine, waste disposal method,
access to diversified diet and household food security status.
Multivariate analysis
According to the result of this study, the peak age range for stunting was 36-47 months, and then
the decline for the higher age between 48-59 months was exhibited. There is 96.6% reduced odds
of being stunted for children whose age is less than six months than children whose age is above
24 months (AOR=0.034, 95% CI: 0.005, 0.24) and children who are in age category of 6-11
month have 82.6% reduced odds of stunting than children whose age is above 24 months
(AOR=0.174, 95% CI: 0.075, 0.4).
Odds of getting stunted among under five children who are living in a household with a family
member of less than five is less likely by 41% than under five children who are living in a
household with a member of five or more (AOR=0.59, 95% CI: 0.37, 0.97). There is 72%
increased risk of being stunted for underfive children who are living in household with two or
more children than those who are living as the only one under-five child in a household
(AOR=1.72, 95% CI: 1.07, 2.77).
Odds of stunting among under five children who are living in a household with a wealth status of
rich is less by 54% than under five children who are living in household with poor wealth status
(AOR=0.46, 95% CI: 0.266, 0.79).
The likelihood of being stunted among underfive children who are are getting drinking water
from a river is 5.1 times higher than those under five children whose drinking water source is a
35
public tap (AOR=5.11, 95% CI: 1.6, 16.4) and for those who are getting from pond is 6.24 times
higher than those underfive children whose drinking water source is a public tap (AOR=6.24,
95% CI: 2.45, 16), while for those underfive children who are getting water from the spring is
almost 2.1 times higher than those underfive children whose drinking water source is a public tap
(AOR=2.08, 95% CI: 1.15, 3.75).
Under five children who are living in household which had poor access to diversified diet is 82%
more likely to get stunted than those under five children who are living in household which had
good access to diversified diet (AOR=1.82; 95% CI 1.17, 2.83).
Under five children who are dwelling in a food unsecured household have 83% increased odds
of stunting than under five children who are living in a food secured household (AOR =1.83;
95% CI: 1.13, 2.96). (Table 7)
36
Table 7 Factors associated with stunting among under-five children of Wonago district,
December/2018 (n=615)
Variables
Category
Stunting
OR (95% CI)
Yes
No
Number (%)
Number (%)
<6 months
3 (4.2%)
69 (95.8%)
.05 (.016, .76)***
.034 (.005, .24)**
6-11 months
18 (24.3%)
56 (75.7%)
.38 (.21, .67)**
.174 (.075, .40)***
12-24 months
65 (43.0%)
86 (57.0%)
.89 (.603, 1.32)
.76 (.47, 1.22)
>24 months
146 (45.9%)
172 (54.1%)
1
1
<5 members
82 (35.2%)
151 (64.8%)
.65 (.45, .94)*
.59 (.37, .97)*
≥5 members
150 (39.3%)
232 (60.7%)
1
1
1
135 (39%)
211 (61%)
1
1
≥2
172 (63.9%)
97 (36.1%)
1.53 (1.36, 1.87)**
1.72 (1.07, 2.77)*
Poor
99 (44.6%)
123 (55.4%)
1
1
Medium
81 (35.7%)
146 (64.3%)
.805 (.62, 1.05)
.89 (.5, 1.58)
Rich
52 (31.3%)
114 (68.7%)
.56 (.42, .73)***
.46 (.266, .79)**
River water
11 (57.9%)
8 (42.1%)
6.18 (1.5, 25.5)*
5.11 (1.6, 16.4)**
Pond
28 (54.9%)
23 (45.1%)
5.5 (1.63, 18.5)**
6.24 (2.45, 16)***
Spring
85 (38.3%)
137 (61.7%)
2.27 (1.75, 6.91)*
2.08 (1.15, 3.75)*
Private pipe
8 (18.2%)
14 (81.8%)
3.8 (.99, 14.6)
.47 (.124, 1.77)
Well
11 (45.8%)
13 (54.2%)
2.79 (.91, 8.53)
2.18 (.72, 6.6)
Public tap
93 (33.6%)
184 (66.4%)
1
1
Access to
Poor
142 (52.0%)
131 (48.0%)
3.0 (2.16, 4.3)***
1.82 (1.17, 2.83)**
diversified diet
Good
90 (26.3%)
252 (73.7%)
1
1
Household food
Food unsecured
111 (45.3%)
134 (54.7%)
1.7 (1.22, 2.37)**
1.83 (1.13, 2.96)*
Food secured
121 (32.7%)
249 (67.3%)
1
1
Age of the child
Family size
Number of
underfive children
in household
Wealth status
Source of drinking
Crude
Adjusted
water
security
*P<0.05, **P<0.01, and ***P<0.001 *Others: rotto, tankers
37
Chapter five: Discussion
This study revealed that the prevalence of stunting among children under the of five years in this
study area was 37. This study identified seven variables such as age of the child, family size,
number of underfive children in the household, wealth status of the household, source of the
drinking water, access to diversified diet and household food security status as major
determinants of stunting among children under the age five years in this study area.
The prevalence of stunting identified by this study, 37.7% (95% CI=33.8%-41.5%) is in close
proximity with the national and SNNPR prevalence of stunting among under fives reported by
EMDHS 2019, 37% and 36.3% respectively (39); and with corresponding study conducted in
somale region (33.4%), Kenya (39%) Padanpur (37.7%) and Bench maji zone (35.4%) [37, 79,
83, 84]. This similarity may be due to similarity in study setting and age category. However, this
prevalence of stunting was lower than finding of the identical study conducted in Bule Hora
district, south Ethiopia (47.6%) , Wondo genet (50.3%), Haramaya district (45.8%), Wolaita
sodo (90.3%), Hidabu abote district (47.6%), Shire Indaselassie (56.6%), Lasta woreda ( 49.7%),
Nepal (47%), Nigeria (47.6%) and India (43%) respectively [71, 72, 67, 73, 28, 68, 32, 74, 75,
76]. The difference may be due to the difference in study segment, study period, socio economic
characteristics, health service delivery and study area. The prevalence of stunting in this study
was higher than finding of the similar study conducted in Sidama zone, Ethiopia (26.6%), Kenya
(21.5%), other study in Kenya Busia district (13.3%) and China (8.1%) [38, 77, 78, 82].
Variation in prevalence might be due to the difference in sample size, methodological difference,
or due to difference in socioeconomic background of the study participants.
Some of the determinants identified by this study are alike to those identified by a study
conducted at public health facilities of Gede’o zone, Southern Ethiopia [80]. As to the finding of
this study, there was significantly reduced odds of being stunted for children who aged less than
six months and for those who aged 6-11 month than those who aged above 24 months. This
finding is in line with the identical study conducted in Lasta woreda, northern Ethiopia, Wolaita
sodo, Somale region, Kenya busia district, Nigeria, Nepal, China and India [32, 73, 37, 78 , 75,
74, 82, 76]. Starting from this, it can be asserted that, the potential of stunting is serious among
those children below 36 months of age. This implies that, underfive children in age category
38
where they can take food independently is the critical age at which they are likely to be more and
irreversibly stunted [84]. This age group is also susceptible for diarrheal disease, intestinal
parasites and others acute infections as well: this is perhaps why they are more likely to be
stunted.
This study also revealed that, family size was associated with stunting among under five
children. The odds of getting stunted was less likely among under five children who are living in
household with a family member of less than five. This is consistent with the results of a study
done in Wolaita sodo, Bule Hora district, south Ethiopia, Haramaya district, Somali region, Lasta
woreda, northern Ethiopia, Shire Indaselassie, Kenya busia district and India [73, 71, 67, 37, 32,
68, 78, 76]. Again, the tendency of being stunted among underfive children from the household
with two or more under five children was higher than under five children from household with
only one under five child. This finding supports findings from studies conducted in Bench maji
zone, Haramaya district, somale region and Kenya busia district [Error! Reference source not
ound., 67, 37, 78]. This might be due to the fact that, food and healthcare accessibility decrease
with higher family size especially in low income families. Other possible explanation might be
that, mothers belonging to households with much higher family, especially children do not have
time to care for their children properly.
According to the finding of this study, odds of stunting among under five children from rich
family was less likely than those from poor. This is in agreement with finding from studies
conducted in Lasta woreda, northern Ethiopia, somale region, Nigeria and India [32, 37, 75, 76].
The possible reason for this could be that, families with low economic status experience more
economic stress, hence they are more likely to suffer from food insecurity. Particularly, poor
families cannot fulfill the nutritional requirements of the children.
As to the finding of this study, the likelihood of being stunted for underfive children whose
households use unsafe drinking water was significantly higher than those underfive children
whose household uses safe drinking water. The finding of this study is in agreement with studies
conducted in Bench maji zone, Wolaita sodo, Somale region, Shire Indaselassie, India, Bule
Hora district, south Ethiopia, Haramaya district and Kenya busia district [84, 73, 37, 68, 76, 71,
67, 78]. The reason for this is likely that, under five children that drink water from unsafe source
39
are likely to be undernourished secondary to infections like diarrheal diseases and other
comorbidities.
Under five children who are living in a household which had poor access to diversified diet and
under five children who are dwelling in a food unsecured household were more likely to get
stunted than their counterparts. Finding of this study is in line with studies conducted in Lasta
woreda, northern Ethiopia, vihiga county, Kenya Somale region and India [32, 77, 37, 76]. The
possible reason for this is straightforward that, around 73% of the families of underfive children
in this study area were poor and medium in socio economic status that immediate causes for
under nutrition- food accessibility and food security was poor with their household.
This study has accomplished its objectives to assess the prevalence and factors associated of
stunting among children under the age of five years in Wonago District, South Ethiopia. On top
of strengths of the study, however, there are some of the limitations that we have not explored all
significant factors which are supposed to contribute for stunting. Firstly, since it was a crosssectional design, it was difficult to examine any potential temporal relationships. Secondly, there
might be potential recall bias among respondents answering questions relating to events
happening in the past, such as the child’s history of illness and breastfeeding patterns
immediately after birth and others. In addition to these, information on some important
confounding variables such as parasitic infection, HIV/AIDS status, mother’s pre-pregnancy
weight, maternal body mass index (BMI), the child’s birth weight and the daily caloric intake
were not collected.
40
Chapter six: Strengths and limitations
Strengths

As long as the study is cross-sectional in design, it may reflect the actual prevalence of
stunting among children under the age of five years in the study area.

Maternal factors were assessed by enquiring only the biological mothers of the children,
which could minimize potential recall biases associated with the long memory of the
study participants.
Limitations

Drawback related to the nature of study design; it neither represents seasonal variation of
nutritional outcomes nor establishes causal relationship.

Some measurements may not be accurate due to subjective responses and recall biases
from answers based on the memories of the mothers or the caretakers.
41
Chapter seven: Conclusion and recommendations
Conclusion
According to WHO global data base, the prevalence of stunting identified by this study is high
among children under the age of five years in Wonago district [81]. This study revealed that age
of the child, family size, number of underfive children in the household, wealth status of the
household, source of the drinking water, access to diversified diet and household food security
status are major factors associated with stunting among children under the age of five years in
this study area. Family size of less than five members, being younger than 11 months old and
rich wealth status of the household has protective effect against the risk of stunting. Unsafe water
source, presence of two or more underfive children in the household, poor access to diversified
diet and unsecured household food security status increases the risk of stunting. Thus, to reduce
childhood chronic nutritional problem in this district, due emphasis should be given on
intervening these factors.
Recommendations
Based on the findings of the study, the following recommendations are made:
For the community members
As observed in this study, utilizing water from unsafe sources has a greater risk to stunting
among underfive children; so please try your best to boil or treat water before usage and keep
drinking water in hygienic way; as in equipments with tight closing and narrow opening like
jerrycan.
For the health extension workers
Since prevalence of stunting among under ifve children is high in this district which might
probably results from the lack of adequate knowledge on how to have diversified diet from items
of the cultivated backyard, you should provide nutrition counseling and prepare sessions like
cooking demonstration for improving food fortification and diversification.
42
As long as underfive children who are living in household with two or more children are more
prone to stunting than their counterparts, you should strongly work on counseling for family
planning usage and antenatal follow up of the mothers during pregnancy.
For Woreda health office and Zonal health department
Community based nutrition program targeting under five children would be established to tackle
the problems of stunting, poor hygiene and other health related challenges at community level.
Nutrition surveillance programs like community health days (CHDs) needs to be regularly done.
Supportive supervision on the ongoing therapeutic and targeted supplementary feeding programs
should be strengthened.
For water sector
As far as underfive children living in household which is getting a potable water from unsafe
water source is more prone to stunting, you should work on improvement and expansion of safe
water sources as well as enormous distribution of water treating chemicals.
For local administrators
You should make a room for different governmental and NGOs which focuses on nutrition
programs, which might in the long run minimize prevalence of the stunting among under five
children in this district.
Efforts would be made to provide skill training and startup capital for the poor parents/guardians
(ye deha-deha) so that they will be economically capable to fulfill the basic needs for under five
children in the community.
For policy makers
The under five children nutrition issues would better be central in all nutrition programs planning
to save future generation and requires great attention to be paid at all levels.
For potential researchers
Further study should be carried out to explore additional factors that might not be included in this
study.
43
Chapter Eight: References
1. Golden M. H. Proposed recommended nutrient densities for moderately malnourished
children. Food Nutrition Bulletin, 2009
2. Casapia M, Joseph SA, Nunez C, Rahme E, Gyorkos TW. Parasite risk factors for
stunting in grade 5 students in a community of extreme poverty in Peru. Int J Parasitol,
2006.
3. Martin W. Bloem, Saskia de Pee, Le Thi Hop, Nguyen Cong Khan, Arnaud Laillou,
et.al. Key strategies to further reduce stunting in Southeast Asia: Lessons from the
ASEAN countries workshop. Food and Nutrition Bulletin. 2013
4. Rah JH, Akhter N, Semba RD, de Pee S, Bloem MW, et al. Low dietary diversity is a
predictor of child stunting in rural Bangladesh. Eur J Clin Nutr, 2010
5. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, et al. Maternal and child
undernutrition: consequences for adult health and human capital. Lancet 371: 2008.
6. Willey BA, Cameron N, Norris SA, Pettifor
JM,
Griffiths
PL
Socioeconomic
predictors of stunting in preschool children--a population-based study from Johannesburg
and Soweto. S Afr Med J 99: 2009.
7. M. de Onis, Blössner M, Borghi E, 'Prevalence of stunting among pre-school
children
1990-2020',
Growth Assessment and Surveillance Unit, Public Health
Nutrition, 2012
8. WHO, Global Data Bank on Infant and Young Child Feeding, World Health Statistics.
Geneva, World Health Organization. 2010.
9. United Nations Children’s Fund, World Health Organization & The World Ban.
UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. UNICEF N Y WHO
Geneva World Bank Wash DC. 2012
10. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and
child undernutrition: global and regional exposures and health consequences. Lancet.
2008
11. The Cost of Hunger in Ethiopia; Implications for the Growth and Transformation of
Ethiopia.
The Social and Economic Impact of Child Undernutrition in Ethiopia
44
Summary Report. Federal Ministry of Health (FMoH) and the Ethiopian Health and
Nutrtion Research Institute (EHNRI).
12. Ethiopia Demographic and Health Survey 2011. Central Statistical Agency Addis
Ababa, Ethiopia ICF International Calverton, Maryland, USA; 2012
13. Save the Childern Uk Ethiopia. National Nutrtion Stratagy: Review and Analysis
of progress and Gaps, one year on. London: Save the Childern Uk; 2009
14. Eliyas Musbah, Amare Worku, Influence of Maternal Education on Child Stunting in
SNNPR, Ethiopia, 2016
15. Central Statistical Agency Addis Ababa, Ethiopia mini demographic and health survey
2019
16. Agedew E, Demissie M, Misker D. Early initiation of complementary feeding and
associated factors among young children, in Kamba Woreda, South West Ethiopia. J
Nutr Food Sci 2014
17. Tsedeke Wolde, Emiru Adeba and Alemu Sufa, Prevalence of Chronic Malnutrition
(Stunting) and Determinant Factors among Children Aged 0-23 Months in Western
Ethiopia: A Cross-Sectional Study, 2014
18. Kimani-Murage EW, Madise NJ, Fotso JC, Kyobutungi C, Mutua MK, et al. Patterns and
determinants of breastfeeding and complementary feeding practices in urban informal
settlements, Nairobi Kenya. BMC Public Health 11: 2011
19. Ruel MT, Menon P Child feeding practices are associated with child nutritional
status in Latin America: innovative uses of the demographic and health surveys. J Nutr
132: 2002.
20. Kumar D, Goel NK, Mittal PC, Misra P Influence of infant-feeding practices on
nutritional status of under-five children. Indian J Pediatr 73: 2006
21. UNICEF, The state of world’s children: Children in an Urban. New York: World
United Nations Children's Fund, 2012
22. Liu L, Johnson HL, Cousens S, et al, for the Child Health Epidemiology
Reference Group of WHO and UNICEF. Global, regional, and national causes of
child mortality: an updated systematic analysis for 2010 with time trends since
2000. Lancet 2012
45
23. Taylor L. From food crisis to nutrition: challenges and possibilities in Ethiopia’s
nutrition sector. Analysing Nutrition Governance: Ethiopia Country Report; 2012
24. Tadiwos Zewdie, Deginet Abebaw, Determinants of Child Malnutrition: Empirical
Evidence from Kombolcha District of Eastern Hararghe Zone, Ethiopia, 2013
25. Jessica Fanzo. The Nutrition Challenge in Sub-Saharan Africa. Rome: United
Nation Development Programme (UNDP). 2012.
26. Jones G et.al. How many child deaths can we prevent this year? Lancet 2004
27. World Bank. Lesson from a review of interventions to reduce child malnutrition
in developing countries: what can we learn from nutrition impact evaluation?.
Washington, D.C. : The World Bank,2010
28. Mengistu K, Alemu K, Bikes Destaw, Prevalence of Malnutrition and Associated Factors
Among Children Aged 6-59 Months at Hidabu Abote District, North Shewa, Oromia
Regional State,. J Nutrition Disorders Therapy. 2013
29. Habaasa Gilbert, Determinants of Malnutrition among Under-Five Children in Nakaseke
and Nakasongola Districts, Uganda, 2014
30. African Union Status report on maternal newborn and child health. 2012
31. Levels and trends in child malnutrition. UNICEF/WHO/World Bank Group joint
malnutrition estimates. Key findings of the 2017 edition. New York/Geneva/Washington
DC: The United Nations Children’s Fund, the World Health Organization and the World
Bank Group; 2018
32. Birhanu A, Mekonen S, Atenafu A, and Abebaw D Stunting and Associated Factors
among Children Aged 6-59 Months in Lasta Woreda, North East Ethiopia,: A
Community Based Cross Sectional Study Design, 2017
33. Magaju P. Factors Associated With The Prevalence Of Under-Nutrition In PreSchool Children In Matisi Peri-Urban Location, Trans-Nzoia District, Kenya. Journal
of Biology, Agriculture and Healthcare. 2013
34. Turyashemererwa FM, Kikafunda JK, and E Agaba. Prevalence of Early Childhood
Malnutrition And Influencing Factors In Peri Urban Areas Of Kabarole District,
Western Uganda. African Journal of Food Agriculture Nutrition and Development. 2009
35. Tumwine Jk, Kikafunda, M. Owor. Socio-Economic Risk Factors for Severe Protein
Energy Malnutrition among Children in Mulago Hospital, Kampala. 2007
46
36. Ahangir Alom M, Abdul Quddus. Mai. Nutritional Status of Under-Five Children in
Bangladesh: A Multilevel Analysis. Journal of Biosocial Science. 2012
37. Demissie S, Worku A. Magnitude and factors associated with malnutrition in children 659 months of age in pastoral community of Dollo Ado district, Somali region, Ethiopia
Science Journal of Public Health. 2013
38. Beruk Berhanu Desalegn, Stunting and Its Associated Factors in Under Five Years Old
Children: The Case of Hawassa University Technology Villages, Southern Ethiopia, 2016
39. Ethiopia Mini Demographic and Health survey (EMDHS), CSA 2014
40. Lamirot Abera, Tariku Dejene and Tariku Laelago, Prevalence of malnutrition and
associated factors in children aged 6–59 months among rural dwellers of Damot gale
district, south Ethiopia: community based cross sectional study, 2017
41. Semba RD1, de Pee S, Sun K, Sari M, Akhter N, et al.
Effect of parental formal
education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional
study. Lancet 371: 2008
42. Ayana AB, Hailemariam TW, Melke AS Determinants of acute malnutrition among
children aged 6-59 months in Public 4 Hospitals, Oromia region, West Ethiopia: A
case-control study. BMC Nutr 1: 34, 2015
43. Edris M Assessment of Nutritional Status of Preschool Children of Gumbrit, North West
Ethiopia. Ethiop J Health Dev 21: 125-129, 2007
44. Sharghi A, Kamran A, Faridan M Evaluating risk factors for protein-energy malnutrition
in children under the age of six years: a casecontrol study from Iran. Int J Gen Med 4:
607-611, 2011
45. Odunayo SI, Oyewole AO Risk factors for malnutrition among rural Nigerian children.
Asia Pac J Clin Nutr 15: 491-495, 2006
46. Coulter JB, Omer MI, Suliman GI, Moody JB, Macfarlane SB, et al. Protein-energy
malnutrition in Northern Sudan: prevalence, socioeconomic factors, and family
background. Ann Trop Paediatr 8: 96-102, 1988
47. Radebe BZ, Brady P, Siziya S, Todd H
Maternal risk factors for childhood
malnutrition in the Mazowe District of Zimbabwe. Cent Afr J Med 42: 240-244, 1996
47
48. Hiwot Darsene, Ayele Geleto, Abebaw Gebeyehu, and Solomon Meseret, Magnitude and
predictors of undernutrition, among children aged six to fifty nine months in Ethiopia: a
cross sectional study, 2017
49. Wamani H, Astrom A, Peterson S. Prevalence and determinants of stunting and
overweight in 3-year old black. S Afr Child J Public Health Nutr. 2007
50. Amita P. Factors associated with nutritional status of the under five children. Asian J
Med Sci. 2010
51. Nguyen N. Nutritional Status and Determinants of Malnutrition in Children Under Three
Years of Age. Pak J Nutr. 2009
52. Deribew A, Alemseged F, Tessema F, Sena L, Birhanu Z, Sudhakar M, et al. Biadgilign:
malaria and under-nutrition: a community based study among under-five children at risk
of malaria, south-west Ethiopia. PLoS One. 2010
53. Mandefro Asfaw, Mekitie Wondaferash, Mohammed Taha and Lamessa Dube
Prevalence of undernutrition and associated factors among children aged between six to
fifty nine months in Bule Hora district, South Ethiopia, 2015
54. Teshome B, Kogi-Makau W, Getahun Z, Taye G. Magnitude and determinants of
stunting in children underfive years of age in food surplus region of Ethiopia: the case of
west gojam zone. Ethiop J Health Dev. 2009
55. Hien N, Hoa N. Nutritional status and determinants of malnutrition in children under
three years of Age in Nghean. Vietnam Pak J Nutr. 2009
56. Dereje Desalegn, Gudina Egata (Phd), and Yoseph Halala, Prevalence of stunting and
associated factors among children aged 6 to 59 months in Areka town, Wolaita Zone,
Southern Ethiopia, 2016
57. Paudel R1, Pradhan B, Wagle RR, Pahari DP, Onta SR Risk factors for stunting among
children: a community based case control study in Nepal. Kathmandu Univ Med J
(KUMJ); 2012
58. Wamani H1, Astrøm AN, Peterson S, Tumwine JK, Tylleskar T Predictors of poor
anthropometric status among children under 2 years of age in rural Uganda. Public Health
Nutr 9: 2006
59. Review of Maternal Effects on Early Childhood Stunting, Thokozani Phiri, University of
Waterloo, 2014
48
60. Christiaensen, l. And h. Alderman Child malnutrition in Ethiopia: can maternal
knowledge augment the role of income? In: Economic Development and Cultural
Change, 2004
61. Priyanka Chakraborty, Determinants of nutritional status in children under 5 years in
India: a multilevel approach, 2011
62. Takele Bekele Bayu, The Expansion of cash cropping; Implications on Gender Division
of Roles: A Case Study from Gede'o Community Southern Nation Nationalities and
Peoples Region, Ethiopia, 2017
63. Wonago woreda agricultural and Rural Development Office, Women and their
contribution to the livestock sector, 2015
64. Fisseha Mesfin, An ethnobotanical study of medicinal plants in wonago woreda,SNNPR,
Ethiopia, 2007
65. Socio-Economic and Geo- Spatial Data Analysis and Dissemination Core process,
Bureau of finance and economic development (BoFED), 2017
66. Wonago Woreda Health office 2010 EFY, Woreda base plan achievement report,
unpublished, 2018
67. Hiwot Yisak, Tesfaye Gobena and Firehiwot Mesfin, Prevalence and risk factors for
under nutrition among children under five at Haramaya district, Eastern Ethiopia, 2015
68. Gezae Berhane a, Nigatu Regassa Nutritional status of children under five years of age in
Shire Indaselassie, North Ethiopia: Examining the prevalence and risk factors, 2014
69. Gina Kennedy, Terri Ballard and Marie Claude Dop, Guidelines for Measuring
Household and Individual Dietary Diversity, 2013
70. Andnet Tadesse Wete, Tadesse Alemu Zerfu & Adane Tesfaye Anbese, Magnitude and
associated factors of wasting among under five orphans in Dilla town, southern Ethiopia:
2018: a cross-sectional study, 2019
71. Mandefro Asfaw, Mekitie Wondaferash, Mohammed Taha and Lamessa Dube
Prevalence of undernutrition and associated factors among children aged between six to
fifty nine months in Bule Hora district, South Ethiopia, 2015
72. Yadessa Tegene Woldie Tefera Belachew Dejene Hailu Tesfalem Teshome Hordofa
Gutema, prevalence of stunting and associated factors among under five children in
wondo genet woreda, sidama zone, southern Ethiopia, 2015
49
73. Chala W Diro Amegnew Walle Rodas Wondwossen Amare Molla, Prevalence of
Malnutrition and Associated Factors Among Under-Five Children Visiting Wolaita Sodo
University Hospital, Wolaita sodo, Ethiopia, 2016
74. Sanjeev Kumar Shah*, Sudeep Kumar Shetty, Devendra Raj Shingh, Jennifer Mathias,
Abinash Upadhyay and Ramanad Pandit, Prevalence of Undernutrition among Musahar
Children Aged Between 12 To 59 Months in Urban Siraha District, Nepal, 2016
75. Andy Emmanue, Nwachukwu O. Juliet, Oyedele E. Adetunji, Gotodok K. Hosea,
Kumzhi R. PartienceMalnutrition and Associated Factors among underfive in a Nigeria
Local Government Area, 2016
76. Indrapal Ishwarji Meshram Trends in the prevalence of undernutrition, nutrient & food
intake and predictors of undernutrition among under five year tribal children in India,
2012
77. Department of food science, nutrition and technology university of nairobi, Prevalence of
protein energy malnutrition and associated factors amongst children aged 6-59 months in
chavakali, vihiga county, Kenya 2014
78. Jela nakhabi phoebe prevalence of childhood malnutrition and associated factors
among children aged 6-59 months in busia district, Kenya, 2013
79. Mutua, n.m, onyango, d.a.o, wakoli, a. B., & mueni, h. N. Factors associated with
increase in undernutrition among Children aged 6-59 months in kamoriongo village,
nandi county, Kenya, 2015
80. Teshome Abuka, Dawit Jember and Desalegn Tsegaw, Determinants for Acute
Malnutrition among Under-Five Children at Public Health Facilities in Gede'o Zone,
Ethiopia: A Case-Control Study, 2017
81. WHO "global database on child growth & malnutrition", Geneva, 1997
82. YU Dong Mei, ZHAO Li Yun, YANGZhen Yu, CHANGSu Ying, YUWen Tao,
FANGHong Yun et.al, Comparison of Undernutrition Prevalence of Children under 5
Years in China between 2002 and 2013
83. Ruwali D Nutritional Status of Children Under Five Years of Age and Factors Associated
in Padampur VDC, Chitwan, 2013
84. Ermias Ayalew, The prevalence of stunting and associated factors among children age 659 months at mizan-aman town, Bench maji zone, SNNPR region, Ethiopia, 2015
50
85. Zeritu Dewana, Teshale Fikadu, Wolde Facha and Niguse Mekonnen, Prevalence and
Predictors of stunting among Children of Age between 24 to 59 Months in Butajira Town
and Surrounding District, Gurage Zone, Southern Ethiopia, 2017
86. UNICEF, Progress for children: a world fit for children. Statistical Review Number 6.
New York, UNICEF; 2007
87. Bahl R1, Frost C, Kirkwood BR, Edmond K, Martines J, et al. Infant feeding
patterns and risks of death and hospitalization in the first half of infancy: multicentre
cohort study. Bull World Health Organ; 2005
88. Melkamu Beyene Teferi, Hamid Yimam Hassen, Amanu Kebede, Emebet Adugnaw,
Gebrelibanos Gebrekrstos, Mebrahtom Guesh, Prevalence of Stunting and Associated
Factors among Children Aged 06-59 Months In Southwest Ethiopia: A Cross-Sectional
Study, 2016
89. Kuchenbecker J, Jordan I, Reinbott A, Herrmann J, Jeremias T, et al. Exclusive
breastfeeding and its effect on growth of Malawian infants: results from a crosssectional study. Paediatr Int Child Health; 2014
90. Beminet Moges, Amsalu Feleke, Solomon Meseret and Feleke Doyore, Magnitude of
Stunting and Associated Factors Among 6-59 Months Old Children in Hossana Town,
Southern Ethiopia, 2015.
51
Annexes
English questionnaire
Dilla University, School of Public health
A Questionnaire designed to assess prevalence and associated factors of stunting among under five children of
Wonago district, Gede’o Zone, Southern Ethiopia
Written consent
Part i: information sheet
Introduction
Greetings!
“Hello. My name is…………………………. I am assigned to collect data forAsres Mengesha, who is conducting a
study with the research title “prevalence and associated factors of stunting among under five children of Wonago
district, Gede’o Zone, Southern Ethiopia”. The aim of this study is to gather information regarding nutritional
status of under-five children in Wonago district. The data to be collected will be used only for academic purposes.
Dear participant, your response will be kept confidential and I kindly request you to participate voluntarily in this
study. The quality of this study depends up on your genuine response. I will assure you that the interview and child
assessment will not take more than 30 minutes of your time. I hope you will be kind enough to take some time out of
your busy schedule to answer to the following questions.
If there are things that require clarification, or if you think that your privacy is exposed, please don’t hesitate to ask
the principal investigator through the following address.
Address of the principal investigator
Asres Mengesha
Mobile: +251912378751 or e-mail asresmen@gmail.com
Do I have your permission to continue?”
YES
NO
Signature of participant _________________ (Thumb print)
Date of the interview ______/____/_______
time start_________________
52
Households Identification
Questionnaire Code______ House no___________
Zone: Gede’o
District (Woreda):
Kebele______________
Part I. Questions to assess socio demographic and household characteristics
No
Questions
101
Number of under five children in this household
Responses
________________________
102
How many people currently live in this household?/Family
size
103
The respondent’s relation with the child
________________________
1.
Mother
2.
Father
3.
Brother/sister
4.
Grand parents
5.
Neighbour
6.
Other relative
1.
2.
1.
2.
Male
Female
Urban
Rural
104
Sex of the caretaker
105
Residence
106
Age of the caretaker (in years)
107
Educational status of the caretaker
1.
2.
3.
4.
_____________________
No formal education
Primary education (1-8)
Secondary education (9-12)
Higher level
108
Occupational status of the caretaker
1.
2.
3.
4.
5.
6.
Housewife
Farming
Merchant
Government or private employee
Daily laborer
Other(specify)_______________
109
Marital status of the caretaker
1.
Single
2.
Married
3.
Divorced
4.
Widowed
1.
2.
3.
1.
Father
Mother
Others (specify)_________________
Gede’o
110
Who is the head of your HH?
111
What is your ethnicity?
53
Skip
to
112
What is your religion?
201
Part II. Questions to assess wealth status
Do you have Electricity?
202
Do you have watch?
203
Do you have radio?
204
Do you have TV?
205
Do you have mobile?
206
Do you have refrigerator?
207
Do you have separate room for kitchen?
208
Do you have bicycle?
209
Do you have any land for agriculture?
2.
3.
4.
5.
1.
2.
3.
4.
5.
Oromo
Amhara
Gurage
Others (specify)_____________
Protestant
Orthodox
Muslim
Catholic
Other(specify)_______________
0.
1.
0.
1.
0.
1.
0.
1.
0.
1.
0.
1.
0.
1.
0.
1.
0.
1.
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
If no>>
211
210
211
How many/much of agricultural land do members of this
house hold own? (in local units) hectare/massa (Farming
land size)
Do you have livestock?
______________________________
0.
1.
No
Yes






0.
1.
1.
2.
3.
4.
Milk cow,oxen,bulls…..
Horses,donkeys,or mules…….
Goats………
Sheep……..
Chicken……….
Beehives………..
No
Yes
Thatch/Leaf
Corrugated Iron
Cement/Concrete
Other
1.Earth/Dung
2. Ceramic Tiles
3. Cement
4. Other……………………………
If no>>
213
212
How many of the following animals does this house hold
own?
213
Do you have any account of bank or credit association?
214
Main material of the roof
215
Main material of the floor
54
216
Main material for the wall of your house
1.wood with mud
2. wood with mud & cement
3. bricks
4. Others…………..
Part III. Questions to assess maternal, child, co-morbidity, feeding and dietary characteristics
Date (month) of birth of the child ( (if possible verify with
(DD/MM/YY)
the available documents)
_____/_____/_______
301
302
Age of the child (in months)
Sex of the child
303
Birth order of the index child
1.
2.
_________________
Male
Female
1.First
2. Second
3. Third
4. Fourth and above
304
Birth interval between the indexed child and preceding one/
Gap between the indexed and preceding child
305
308
ONLY FOR THE MOTHER OF A CHILD, How many
times did you visit antenatal care in the health
institution when you are pregnant of this child?
ONLY FOR THE MOTHER OF A CHILD, Did you attend
post-natal care of the index child?
ONLY FOR THE MOTHER OF A CHILD, Did you use
family planning before the pregnancy of this child?
Did the child breast feed?
309
310
For how long did the child breast feed?
At what age did you start to give food in addition to breast
306
307
milk?
311
312
313
ONLY FOR THE ELIGIBLE CHILDREN (≥6 months),
How many times per day could you feed your child?
(CF frequency in 24 hours)
ONLY FOR THE BIOLOGIC MOTHER OF CHILD,
Colostrum
ONLY FOR THE ELIGIBLE CHILDREN (≤12 months)
Did the child receive vaccination in line with his age?
______________ (years)
1.
2.
3.
0.
1.
0.
1.
2.
1.
2.
3.
4.
1.
2.
No follow up
1-3 times
Four times or more
0. No
1. Yes
No
Yes
No
Yes
I don’t know
__________________ (months)
Not given yet, because his/her age is
less that 6 month
Before 6 month
At 6 month
After 6 month
For 3 or less times
For more than 3 times
1.
2.
0.
1.
2.
Given to the child
Squeezed and thrown
No
Yes
I don’t know
0.
1.
2.
0.
1.
2.
0.
1.
No
Yes
I don’t know
No
Yes
I don’t know
No
Yes
(assure this with the immunization card, if available)
314
315
316
ONLY FOR THE ELIGIBLE CHILDREN (≥9 months),
Did the child fully supplemented with measles and
Vitamin A (observe routine EPI card, if available)
ONLY FOR THE ELIGIBLE CHILDREN ((>24 months),
Did the child dewormed with in the last 6 month?
Did the child suffered from the illnesses like diarrhea and
other diseases in the last two weeks?/Morbidity
55
If No,
»309
401
status
2. I don’t know
Part IV. Questions to assess personal hygiene and environmental sanitation characteristics
1. River water
2. Pond
What is the main source of your drinking water?
3. Spring
4. Private pipe water
5. Public tap
402
How long does it take to go to water source, get water, and
come back? (In minutes)
_____________________________
403
0.
1.
Do you do anything to the water to make it safer to drink?
404
What do you usually do to make the water safer to drink at
your home?
405
406
What type of equipment do you use for water storage?
1.boiling
2. adding chemicals like aquatab/ water guard/
PUR/bishangari
3. others
1. Pot
Do you wash your hands with soap and water whenever you
feed a child?
407
Do you have latrine?
408
What kind of latrine facility do members of your household
usually use?
409
Do you share this latrine facility with other households?
410
Do you wash your hand after latrine? (check whether they
have hand washing facility after latrine)
411
How do you dispose of domestic waste materials?/method of
waste disposal
501
Part V Questions to assess household access to diversified diet
Did you or anyone in your household eat any flat bread,
biscuits, or any other foods made from cereal (maize,
sorghum, millet, wheat, barely or teffe) yesterday?
56
No
Yes
2.
Jeri Can
3.
Bucket
4.
Other (specify) _________
0.
1.
No
Yes
0.
1.
1.
2.
3.
4.
No
Yes
Pit latrine
Ventilated improved latrine (VIP)
Flush toilet
Others………………………….
0.
1.
No
Yes
0.
1.
No
Yes
1.
2.
3.
4.
5.
Openly at the field
At pit
By Municipality
By composting
By burning
0.
1.
No
Yes
If no >>
405
If No,
»411
502
Did you or anyone in your household eat any pumpkin,
carrots, orange, flesh, sweet potatoes, potato, onion, white
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
0.
1.
No
Yes
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
0.
1.
No
Yes
yam, cassava, kocho and other foods made from roots
yesterday?
503
Did you or anyone in your household eat any dark green
leafy vegetables (kale, chard, cabbage) and other vegetables
(tomato, onion) yesterday?
504
Did you or anyone in your household eat any fruits like ripe
mango, papaya, banana, avocado and lemon and orange…)
and other fruits yesterday?
505
Did you or anyone in your household eat any flesh meat
(beef, lamb, goat, chicken) and any organ meat (liver,
kidney, heart) yesterday?
506
Did you or anyone in your household eat egg yesterday?
507
Did you or anyone in your household eat any fresh or dried
fish yesterday?
508
Did you or anyone in your household eat any food made
from beans like kidney beans, haricot beans, field peas, cow
peas, chick peas, nuts, lentils or others yesterday?
509
Did you or anyone in your household drink milk and milk
products yesterday? (milk, cheese, yogurt or other milk
products)
510
Did you or anyone in your household eat any food with oil,
fat or butter yesterday?
511
Did you or anyone in your household eat any sugar or honey,
sweet/soft drink yesterday?
512
Did you or anyone in your household eat any spices (black
pepper, salt), condiments (soy sauce, hot sauce), and coffee,
tea yesterday?
Part VI Questions to assess household food security status
601
Did you worry that your household would not have enough
food in the last 30 days?
57
If no,
»Q.603
602
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
603
Were you or any household member not able to eat the kinds
of food you preferred because of lack of resources in the last
0.
1.
No
Yes
If no,
»Q.605
30 days?
604
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
605
Did you or any household member eat just a few kinds of
food day after day due to lack of resources in the last 30
0.
1.
No
Yes
If no,
»Q.607
days?
606
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
607
Did you or any household member eat food that you
preferred not to eat because of lack of resources to obtain
0.
1.
No
Yes
If no,
»Q.609
other types of food in the last 30 days?
608
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
609
Did you or any household member eat a smaller meal than
you felt you needed because there was not enough food in
0.
1.
No
Yes
If no,
»Q.611
the last 30 days?
610
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
611
Did you or any household member eat fewer meals in a day
because there was not enough food in the last 30 days?
58
0.
1.
No
Yes
If no, »
Q.613
612
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
613
Was there ever no food at all in your household because
0.
1.
there were not enough resources to get more in the last 30
No
Yes
If no,
»Q.615
days?
614
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
615
Did you or any household member go to sleep at night
0.
1.
hungry because there was not enough food in the last 30
No
Yes
If no,
»Q.617
days?
616
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
617
Did you or any household member go a whole day without
0.
1.
eating anything because there was not enough food in the
No
Yes
last 30 days?
618
If yes, how frequent? (Rarely=1-2 days, sometimes=3-10
days, often=>10 days)
1.rarely
2.sometimes
3.often
Part VII. Child anthropometry
701
702
Age of the child______________________
What is the height/length of the child? (in cm)
What is the MUAC of the child? (in cm)
Time at the end of the interview
Name of data collector……………………………………….
____________________
____________________
____________________
Sign………………………….
THANK YOU FOR YOUR PARTICIPATION!!!
59
If no,
»Q.701
የአማርኛ ቃለ-መጠይቅ
ዲላ ዩኒቨርስቲ፣ የህብረተሰብ ጤና ት/ቤት
በደቡብ ኢትዮጵያ፣ ጌዴኦ ዞን፣ ናጎ ወረዳ ከአምስት ዓመት በታች የሚገኙ በቂ ምግብ ያላገኙ ህፃናት ብዛት
(መቀንጨር) እና ተያያዥ ምክንያቶችን ለመገምገም የተዘጋጀ ቃለ-መጠይቅ
ፈቃድ መጠየቂያ
ስሜ..........................................................................ይባላል፤ እኔ “በደቡብ ኢትዮጵያ፣ ጌዴኦ ዞን፣ ወናጎ ወረዳ ከአምስት
ዓመት በታች የሚገኙ በቂ ምግብ ያላገኙ ህፃናት ብዛት (መቀንጨር) እና ተያያዥ ምክንያቶችን መገምገም” በሚል
ርዕስ ጥናት ለሚያካሄዱት ለአቶ አስረስ መንገሻ መረጃ እየሰበሰብኩ እገኛለሁ፡፡ የዚህ ጥናት ዓላማ በወናጎ ወረዳ የሚኖሩ
ከአምስት ዓመት በታች የሚገኙ በቂ ምግብ ያላገኙ ህፃናት ብዛት እና ተያያዥ ምክንያቶችን መገምገም ነው፡፡ የተሰበሰበው
መረጃ ለትምህርታዊ ጉዳይ ብቻ ይውላል፡፡ ውድ የጥናታችን ተሳታፊ! እርስዎ የሚሰጡን ምላሽ ሁሉ ሚስጥራዊነቱ የተጠበቀ
ስለሆነ በጥናቱ እንዲሳተፉ ቀና ትብብርዎን በትህትና እንጠይቃለን፡፡ የዚህ ጥናት ውጤት ጥራት የሚለካው በሚሰጡን
እውነተኛ ምላሸ ነው፡፡ ለርስዎ የሚቀርብ ጥያቄና የልጅዎ የምግብ ሁኔታ ግምገማ በሰላሳ ደቂቃ ውስጥ እንደሚጠናቀቅ
አረጋግጥልዎታለሁ፡፡ ካሎት ጠባብ ጊዜ ውስጥ የሚከተሉትን ጥያቄዎች ለመመለስ ፈቃደኛ እንደሚሆኑ ተስፋ አደርጋለሁ፡፡
ማንኛውም ሰፊ ገለጻ የሚያስፈልጋቸው ነገሮች ካሉ ወይም መብቴ ተነክቷል ብለው ካሰቡ ዋና ተመራማሪውን በአካልም ሆነ
በሚከተለው አድራሻው ማግኘት ይችላሉ፡፡
የዋና ተመራማሪው አድራሻ ፡
አስረስ መንገሻ
ስልክ +251912378751 ወይም ኢ_ሜይል asresmen@gmail.com
ለመቀጠል ፈቃደኛ ነዎት? አዎ
አይደለም
የተሳታፊ
ፊረማ_____________________
ቀን______/______/_____________________
ቃለ-መጠየቅ
የአባወራ/እማወራ መለያ
የቃለ-መጠይቅ ኮድ__________________የቤት ቁጥር___________________
ዞን፣ ጌዴኦ
ወረዳ፣ ወናጎ
60
የተጀመረበት
ሰዓት_______________
ቀበሌ______________________
ክፍል 1. ማህበረሰባዊ እና የቤተሰብ ሁኔታ ለመገምገም የተዘጋጀ መጠይቅ
ተ.ቁ
ጥያቄ
ምላሽ
101
በዚህ ቤት ውስጥ ስንት ከ 5 ዓመት በታች ህፃናት ይኖራሉ?
_________________________
102
በዚህ ቤት ውስጥ ስንት ሰዎች ይኖራሉ?
__________________________
103
ምላሽ ሰጪ፣ ከህፃኑ ጋር ያለው/ላት ዝምድና
104
የሀፃኑ ተንከባካቢ ጾታ
1.
2.
3.
4.
5.
6.
1.
2.
እናት
አባት
ወንድም/እሂት
አያት
ጎረቤት
ሌላ ዘመድ
ወንድ
ሴት
105
መኖሪያዎ የት ነው?
1.
2.
ከተማ
ገጠር
106
የአባት/የእናት/ የሀፃኑ ተንከባካቢ እድሜ
_________________________
107
የአባት/የእናት/ የሀፃኑ ተንከባካቢ ትምህርት ደረጃ
108
የአባት/የእናት/ የሀፃኑ ተንከባካቢ የስራ ድርሻ
109
የአባት/የእናት/ የሀፃኑ ተንከባካቢ የጋብቻ ሁኔታ
110
የቤተሰብ አስተዳዳሪ ማነው?
1.
2.
3.
4.
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
1.
2.
3.
61
ያልተማረ
1ኛ ደረጃ (1-8)
2ኛ ደረጃ (9-12)
ከፍተኛ ትምህርት
የቤት እመቤት
ግብርና
ነጋዴ
የግል/የመንግስት ሰራተኛ
የቀን ሰራተኛ
ሌላ (ይጠቀስ)___________________
ያላገባ/ች
ያገባ/ች/አብረው የሚኖሩ
የፈታ/ች
ባል/ ምስት የሞተባት/የሞተችበት
አባት
እናት
ሌላ
ወደ
ተ.ቁ___ዝ
ለል
111
ብሄር
112
ሃይማኖት
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
ጌዴኦ
ኦሮሞ
አማራ
ጉራጌ
ሌላ (ይጠቀስ)__________________
ፕሮቴስታንት
ኦርቶዶክስ
ሙስሊም
ካቶሊክ
ሌላ (ይጠቀስ)__________________
0.
1.
የለም
አዎ
0.
1.
የለም
አዎ
ክፍል 2. የእኮኖሚ ሁኔታ ለመገምገም የተዘጋጀ መጠይቅ
201
ኤሌክትርክ ቤትዎ ውስጥ አለ?
የግድግዳ ሰዓት ቤትዎ ውስጥ አለ?
202
203
ሬድዮ ቤትዎ ውስጥ አለ?
0.
1.
የለም
አዎ
204
ቴሌቭዥን ቤትዎ ውስጥ አለ?
0.
1.
የለም
አዎ
205
ስልክ/ሞባይል ቤትዎ ውስጥ አለ?
0.
1.
የለም
አዎ
206
ፍሪጅ ቤትዎ ውስጥ አለ?
0.
1.
የለም
አዎ
207
ኩሺናዎትና ዋና ቤትዎት ለየብቻ ነው?
0.
1.
የለም
አዎ
208
ብስክሌት አለዎት?
0.
1.
የለም
አዎ
209
የእርሻ መሬትአላችሁ?
0.
1.
የለም
አዎ
210
ስንት/ ምን ያህል የግብርና እርሻ አላችሁ? በሄክታር/በማሳ
211
እዚህ ቤት የከብት መንጋ/ የወተት፣የእንቁላልና የስጋ ከብት አለ
ወይ?
0.
1.
የለም
አዎ
ይህ ቤተሰብ ከሚከተሉት ምን ያህል እንስሶች አሏቸው?



212
62
የወተትላም፣በሬ፣ኮርማ........
ፈረስ፣አህያ፣በቅሎ…….
ፍየል………
213
የባንክ ቁጠባ/ የብድር ማህበር አካውንት አላችሁ?
የቤትዎ ጣሪያ የተሰራው ከምንድን ነው?
214
215
የቤትዎ ወለል የተሰራው ከምንድን ነው?
216
የቤትዎ ግድግዳ የተሰራው ክአሸዋ ግርፍ/ ክብሎኬት/ ክእንጬት
ነው?
0.
1.
 በግ……..
 ጫጩት……….
 የንብ ቀፎ………..
የለም
አዎ
1.
2.
3.
4.
1.
2.
3.
4.
1.
2.
3.
4.
ከሰንበለጥ/ከጭቃ
ከቆርቆሮ ኪዳን
ከሲሚንቶ
ከሌላ
ከአፈር
ከሴራምክ
ከሲሚንቶ
ከሌላ
ከእንጨትና ጭቃ
ከአሸዋ ግርፍ
ከብሎኬት
ከሌላ
ክፍል 3. የህፃኑ፣የእናትየው፣ የህፃኑን አመጋገብ እና ጤንነት ሁኔታ ለመገምገም የተዘጋጀ መጠይቅ
ህጻኑ የተወለደበት ቀን (ወር) (የሚታዩ ዶክመንቶች ካሉ አመሳክር)
ቀን/ወር/ዓ.ም
_________/______/______
301
የሀፃኑ እድሜ(በወር)
_________________ወር
302
የሀፃኑ ጾታ
1.
2.
የህጻኑ የወሊድ ተራ
303
304
በዚህ ህጻንና ቀድሞት በተወለደው ህጻን ያለው የመወለድ እድሜ
ልዩነት
305
ለህጻኑ እናት ብቻ የዚህ ህጻን ነብሰጡር ኢያለሽ ስንት ቅድመወሊድ ክትትል አድርገሽ ነበር?
306
ወንድ
ሴት
1.1ኛ
2. 2ኛ
3. 3ኛ
4. 4ኛ
________________ዓመት
ለህጻኑ እናት ብቻ ለዚህ ህጻን ድህረ_ወሊድ ክትትል አድርገሽ
ነበር?
0.
1.
2.
0.
1.
ቅድመ-ወሊድ ክትትል አልነበረም
1-3 ጊዜ
4ጊዜና ከዚያ በላይ
አይደለም
አዎ
307
ለህጻኑ እናት ብቻ ከዚህ ልጅ እርግዝና በፊት የቤተሰብ ምጣኔ
ተጠቅመሽ ነበር?
0.
1.
አይደለም
አዎ
308
ህጻኑ ጡት ጠብቶ ነበር?
0.
1.
አይደለም
አዎ
63
አይደለም
2.
ከሆነ » ቁ.
አላዉቅም
309
309
310
ጡት የጠባበት ጊዜ ርዝማኔ
ተጨማሪ ምግብ በጀመረበት ወቅት የህፃኑ እድሜ
311
312
ለተመረጡ ህጻናት ብቻ (6 ወር እና ከዚያ በላይ ለሆኑት ብቻ)
ልጅዎን በቀን ስንት ጊዜ ይመግባሉ?
(ለህጻኑ እናት ብቻ) እንገር......................
313
ህፃኗ/ኑ ለዕድሜዋ/ዉ ተገቢዉን ክትባት ወስዳለች/ዷል?
______________________ወር
1. ከ6 ወር በታች ስለሆነ እስካሁን አልተሰጠውም
2. ከ 6 ወር በፊት
3. በ 6 ወር
4. ከ 6 ወር በኋላ
1. 3 ጊዜና ከዚያ በታች
2. ከ 3 ጊዜ በላይ
1. ለህፃኑ ተሰጥቷል
2. ተጨምቆ ተጥሏል
0. አይደለም
1. አዎ
2. አላዉቅም
ለተመረጡ ህጻናት ብቻ (12 ወር እና ከዚያ በታች ለሆኑት
ብቻ)
314
315
ለተመረጡ ህጻናት ብቻ (9 ወር እና ከዚያ በላይ ለሆኑት ብቻ)
ህጻኑ የኩፍኝ ክትባት እና ቫይታሚን ኤ ተከትቧል (ካርድ ካለ
ይመልከቱ)
ህፃኗ/ኑ ባለፉት 6 ወራት የአንጀት ጥገኛ ትላትል መድኃኒት ወስዶ/ዳ
ነበር? ለተመረጡ ህጻናት ብቻ (ከ24 ወር በላይ ለሆኑት ብቻ)
316
ባለፉት 2 ሳምንታት ህፃኑ ተቅማጥ ወይም ሌላ ህሜም ታሞ ነበር?
0.
1.
2.
0.
1.
2.
0.
1.
2.
አይደለም
አዎ
አላዉቅም
አይደለም
አዎ
አላዉቅም
አይደለም
አዎ
አላዉቅም
ክፍል 4. የግልና የአካባቢ ንጽህና ሁኔታ ለመገምገም የተዘጋጀ መጠይቅ
401
የመጠጥ ውሃ ከየት ነው የሚቀዱት?
402
ዉሃ ቀድቶ ለመመለስ ምን ያህል ሰዓት ይፈጃል? (በደቂቃ)
403
የመጠጥ ውሃ አክማችሁ ነው የምትጠቀሙት?
404
ምን አይነት የህክምና ዘዴ ነው የምትጠቀሙት?
405
የተቀዳውን ውኋ በምንድነው የምታጠራቅሙት
1.
2.
3.
4.
5.
ከወራጅ ወንዝ
ከኩሬ
ከምንጭ
ከግል ምንጭ
ከህዝብ የጋራ ቧንቧ
0.
1.
አይደለም
አዎ
1.ማፍላት
2.
ኬሚካል
መጨመር
አጋር/ብሻንጋሪ/PUR)
3. ሌላ_______
1. በማሰሮ
2. በጀሪካን
3. በባልዲ
64
(አኳታብ/
ዉሃ
406
ልጅዎን ከመመገብዎ በፊት እጅዎን ይታጠባሉ?
4.
0.
1.
407
መጸዳጃ ቤት አላችሁ ወይ?
0.
1.
ሌላ (ግለጽ)__________________
አይደለም
አዎ
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
411
0.
1.
ክዳን የለለው ጉድጓድ
ዝንቦችን መከሊከሌ እንዲቺል ተደርጎ
የተሰራ
3. ውሃ የሚፈስበት
4. ሌላ_________________________
አይደለም
አዎ
0.
1.
አይደለም
አዎ
1.
2.
408
ምን ዓይነት መጸዳጃ ቤት ነው የምትጠቀሙት?
409
ይህን መጸዳጃ ቤት ከሌላ ቤተሰብ ጋር ትጋሩታላችሁ?
410
ከሽንት ቤት መልስ እጅዎን ይታጠባሉ? (የመታጠቢያ ገንዳ መኖር
አለመኖሩን አረጋግጥ)
411
ቆሻሻን እንዴት ያስወግዳሉ?
501
ከቤተሰበችሁ ውስጥ ትናንት ዳቦ(ቂጣ)፣ ከበቆሎ፣ ከማሽላ፣
1. በሜዳ ላይ በመበተን
2. በግል ጉድጓድ
3. በማዘጋጃ ቤት አማካኝነት
4. ማዳበሪያ በመስራት
5. በማቃጠል
ክፍል 5 ፡ የተመጣጠነ የቤተሰብ ምግብ አቅርቦት ለመገምገም የተዘጋጀ መጠይቅ
ከዳጉሳ፣ ከስንዴ፣ ከገብስ ወይም ከጤፍ የተሠራ ምግብ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
በልታለች/ቷል?
502
ከቤተሰበችሁ ውስጥ ትናንት ከአትክልቶች፣ ዱባ፣ ካሮት፣ ቢጫ
ስኩር ድንች፣ ብርትኳናማ ድንች፣ ከድቡልቡል ድንች፣ ከስኳር
ድንች፣ ከሽንኩርት፣ ከሀረግ ቦዬ፤ ከእንሰትና ከሌሎች ስራስሮች
የተሠራ ምግብ በልታለች/ቷል?
503
ከቤተሰበችሁ ውስጥ ትናንት ከአረንጓዴ አትክሌቶች የተሠራ
ለምሳሌ ጎመን፣ ቆስጣና ጥቅልል ጎመን ቲማቲም ሽንኩርት
የተሠምግብ በልታለች/ቷል?
504
ከቤተሰበችሁ ውስጥ ትናንት ከፍራፍሬ ለምሳለ ማንጎ፣ ፓፓያ፣
65
ዘይቶን አቮካዶ፣ ሎሚ በልታለች/ቷል?
505
ከቤተሰበችሁ ውስጥ ትናንት ከስጋ ዉጤቶች ለምሳሌ የበሬ ስጋ፣
የበግና የፍየል ስጋ፣ የዶሮ ስጋ እና ከሆድ ዉስጥ ስጋ ምሳሌ ጉበት፣
0.
1.
አይደለም
አዎ
0.
1.
0.
1.
አይደለም
አዎ
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
0.
1.
አይደለም
አዎ
ኩላልት፣ ልብ በልታለች/ቷል?
506
ከቤተሰበችሁ ውስጥ ትናንት ዕንቁላል በልታለች/ቷል?
507
ከቤተሰበችሁ ውስጥ ትናንት ጥሬ ወይም የበሰለ ዓሣ
በልታለች/ቷል?
508
ከቤተሰበችሁ ውስጥ ትናንት ቦሎቄ፣ ከባቄላ፣ ከአተር፣ ከአኩሪ
አተር፣ ከሽምብራ እና ከመሳሰሉት በልታለች/ቷል?
509
ከቤተሰበችሁ ውስጥ ትናንት ወተትና የወተት ወጤቶች ለምሳሌ
አይብ፣ እርጎ፣ በልታለች/ቷል?
510
ከቤተሰበችሁ ውስጥ ትናንት በዘይት/በቅቤ የተሰራ ምግብ/ሌሎች
ቅባት ነገሮችን በልታለች/ቷል?
511
ከቤተሰበችሁ ውስጥ ትናንት ከጣፋጭ ነገሮች ለምሳሌ ስኳር፣ ማር
ሸንኮራ አገዳ፣ ለስላሳ መጠጦችን ወስዳለች/ዷል?
512
ከቤተሰበችሁ ውስጥ ትናንት ቅመማ-ቅመም፣ ቡና፣
ወስዳለች/ዷል?
ክፍል 6 የቤተሰብ የምግብ ዋስትና ለመገምገም የተዘጋጁ ጥያቄዎች
601
ባለፉት 30 ቀናት ቤታችን በቂ ምግብ የለም ብለው ተጨንቀው
ያውቃሉ?
አይደለም
ከሆነ » ቁ.
603
602
603
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት እርስዎና የቤተሰብዎ
0.
1.
ኣባል የሚፈልጉትን የምግብ አይነት ያልበሉበት ጊዜ አለ?
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
605
66
604
605
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት እርስዎና የቤተሰብዎ
0.
1.
ኣባል ትንሽ ምግብ የበሉበት ጊዜ አለ?
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
607
606
607
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት እርስዎና የቤተሰብዎ
0.
1.
ኣባል የማይፈልጉትን የምግብ አይነት የበሉበት ጊዜ አለ?
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
609
608
609
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት እርስዎና የቤተሰብዎ
0.
1.
ኣባል መአድ ላይ ምግብ ያነሰበት ጊዜ ነበር?
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
611
610
611
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት እርስዎና የቤተሰብዎ
0.
1.
አባል ትንሽ ምግብ የበላችሁበት ቀን ነበር?
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
613
612
613
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት ገቢዎ በማነሱ ምክንያት ቤታችሁ ውስጥ ፈፅሞ
ምግብ ያልነበረበት ጊዜ ነበር?
0.
1.
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
615
67
614
615
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት በቂ ምግብ ባለመኖሩ እርስዎና የቤተሰብዎ አባል
የተራበበት ጊዜ ነበር?
0.
1.
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
617
616
617
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ባለፉት 30 ቀናት በቂ ምግብ ባለመኖሩ እርስዎና የቤተሰብዎ አባል
ሙለ ቀን ምግብ ያልበሉበት ጊዜ ነበር?
0.
1.
አይደለም
አዎ
አይደለም
ከሆነ » ቁ.
701
618
መልሶ አዎ ከሆነ ፣ምን ያህሌ ጊዜ? አልፎ አልፎ (በወር1 ወይም 2
1.
አልፎ አልፎ
ጊዜ ፤የተወሰነ ጊዜ (በወር ከ 3 እስከ 10 ጊዜ) ፤ አብዛኛው ጊዜ (በወር
2.
የተወሰነ ጊዜ
ከ10 ጊዜ በላይ)
3.
አብዛኛው ጊዜ
ክፍል 7. የህፃኑ ርዝመት (አንትሮፖሜትሪ) ሁኔታ
701
የህጻኑ ርዝመት/ ቁመት (በሴ.ሜ)
_______________________ሴ ሜ
702
የላይኛው ክንድ እኩሌታ (በሴ.ሜ))
______________________ሴ ሜ
ቃለ-መጠይቁ የተጠናቀቀበት ሰዓት
የመረጃ ሰብሳቢ ስም.......................................................
ፊርማ.............................................
ቃለ-መጠይቁን ጨርሰናል: ስለትብብርዎ ከልብ እናመሰግናለን!!!
68
Qortuma Gede’uffat
Dillixxe Uuniversitexxe qorsiinxenna fayyuntetixxe sayinse’n,
Aradddiinxe fayyunteka Barachchot mine
Bita’ike Tophpha’n, Gede’iinxe Zoone’n, Wonaagoke Roga’n afendaaxxe onde wogganni butti’a hexxeexxe ooseka
Itatixxe xe’yake laakkossike koobbika jeeja (ciikka) towatatee’e qixxeessemeeka qortumuwwa
ASHSHAMA'A! - Anki summi………………………………………… hiyyemaan. Ani “Bita’ike Tophpha’n,
Gede’iinxe Zoone’n, Wonaagoke Roga’n afendaaxxe onde wogganni butti’a hexxeexxe ooseka Itatixxe xe’yake
laakkossike koobbika jeeja (ciikka) towachcho” hiyyendaaxe borronni qo’ne assate’n iima hedheeke Asiressii
Mangashakee tarja bukki assate’n hedhennen. Tenne qo’nek yaadi wonaagoke Roga’n afendaaxxe onde wogganni
butti’a hexxeexxe ooseka Itatixxe xe’yake laakkossike koobbika jeeja towatate kaddaan. Uutinaak tarj duuchchi
barachchotike yaad calli’a hosaaken.Fedheexxi ha’noxxi ayyunte tenne towachcho’n buqendeexxen. Ha’nok summi
heene bakka’ninna boreesseme ifa fulabaan. Rakko daddaaxxi yaanuwwanna hexxabaan. Ha’noxxi hordofiyyo tenne
qo’nexxe wo’ma gumma’anna ardiinxxe la’o’a yo’oke gargaarsa affe’en. Qortum 25-30 daqiiq qico’n turaan.
Tenne hundaayye'n shiqeeke qortumi’a hissichcho hissitinaashsha ha'noxxa eeyyunte shaqquntet qora’n ha’noxxe
hordofiyyo’a lumooshsha assee galateeffataannen.
Feetexxi ba’laxxi mari’achcho hasissaaxxi yaane yookin towachchotixxe yanna’n gelteexxi rakko hexxoole umo
qo’netike me’isanji edo shinqe yookin bilbilik haasosse yookin konnechchinni butta kuleemeeke loola isike’n afa
dandeessissaaxxe kaddeexxa ege’ninshaannen.
Umo qo’netika me’isanjo: Asres Mengesha
Bilbila +251-9 12378751, E-mail: asresmen@gmail.com
Fedhii uwweennen.
Gibeennen.
Qoremaakika beessisa________________ Barra (barra/agenjo/wogga) ___________
Min hado gargar hiissatika qortumuwwa
Qortumiinxxa koodde______________Miniinka laakkossa_____________________
Zoone: Gede’iinxe
Rogi: Wonaago
Loola: ___________________________
69
Kuta Mitte. Iikkoonoometikanna araddiinkanna minigiddika jeeja towatatika qortumuwwa
Laak
Qortuma
101
Mini giddo onde woggan butti’a hexxeexxe ooseka
laakoossa
102
Konne mini giddo minihadika laakoossa
103
Qoremeeki/xxi Annoti afeeka/xxa firunte
104
Hiissichcho
_________________
__________________
Anno kubbisaakika saala
1.
2.
3.
4.
5.
6.
1.
2.
Ama
Anna
Dayyo
Akka’yo
Olla’a
Wele fira
Labballo
Meyyaxxe
105
Habate hexxateki?
1.
2.
Qaachchake'n
Had giddo
106
Amatixxa/ anninixxa/ kubbisaakixxa wogga
107
Anninka/ amatika/ kubbisaakika barachchotik koobbi
________________
108
Anninka/ amatika/ kubbisaakika hujetikiu koobbi
70
1.
Baratebaake
2.
Taakkakea koobbo muuxe’eke (1-8)
3.
langaka koobbo muuxeeke (9-12)
4.
1.
2.
3.
4.
5.
6.
lumoke koobbixxa
Minixxe ama
Fichcha hucca
Daddala
Moottummatike/ifixxe beeroke hujallo
Barratixxa hucce galdaaxxe
Wele (ege’nish)___________
Q
_____ba
Sa’i
109
Aninka/ amatika/ kubbisaakika aadhe heerumatika
jeeja
110
Konnee mine galcha’eeki ayyete?
111
Gosa atixxi maachcho?
Adde atixxi maachcho?
112
1.
2.
3.
4.
1.
2.
3.
1.
2.
3.
4.
5.
Aadhebaake/ heerundebaaxxe
Aadheeke/heerundexxe (welti hedha’neera)
Tikkeexxe/ke
Miniink anni/ ama reyeexxe/rerte’exxe
Annake
Amate
Wele (ifis)_________________
Gede’o
Oromo
Amaara
Guraage
Wele (ifis)____________
1.
Pirootestaante
2.
Ortoodokise
3.
Muusiliime
4.
Kaatoolike
5.
Wele (ifis)____________
Kuta Lame. Ikkoonoometika jeeja towatatika qortumuwwa
201
Mini giddo korronte affine’e?
0.
1.
Waawwo’o
Eet
202
Mini giddo gimotixxa saate affine’e?
0.
1.
Waawwo’o
Eet
Mini giddo raadone affine’e?
0.
1.
Waawwo’o
Eet
Mini giddo televizhiine affine’e?
0.
1.
Waawwo’o
Eet
Mini giddo moobayile affine’e?
0.
1.
Waawwo’o
Eet
Mini giddo firiije affine’e?
0.
1.
Waawwo’o
Eet
203
204
205
71
206
Kushiinikinna galjetiki mini qofiqofittitee?
0.
1.
Waawwo’o
Eet
Sayikiliite affine’e?
0.
1.
Waawwo’o
Eet
Huccitinaaka fichcha affine’e?
0.
1.
Waawwo’o
Eet
207
208
209
____________________________________
210
Me’e fichcha affine’e? hektaaret/laakkossik
Waawwo’o
Eet
Hore affine’e?
0.
1.
Konneer giddinaa’n ha’nok min had me’e afe’e?
Adot saayya, qotiyyo________
211
212
Harre, gaange, fadhado__________
Re’e__________
Gedhebo __________
Lukko __________
Salcho __________
Baanketixxa buukke
akkawunte affine’e?
yookin
liqiiinxe
bukkixxa
0.
1.
Waawwo’o
Eet
1.
2.
3.
4.
Buuyyot/Dhoqqet/ shafik
Qorqoorotike hochchinni
Liishot
Welechchinni
213
Mine ha’nook giddo iimik mayik hujeme’eke?
214
72
Min giddo buttik mayik hujeme’eke?
215
Mine ha’nookixxi gimo mayik hujeme’eke?
216
1.
2.
3.
4.
Buttinik
Liishot
Seeramiket
welichchinni
1.
2.
3.
4.
Haqqetinna dhoqqet
Ashawaa girfe
Bilookkeette
welechchinni
kuta Sase: Annotika,amatikanna,annotixxe fayyunteka jeeja ittanni annotika itatika jeeja to’atatika qortumuwwa
BAR/AG/WOG___/___/______
Anno ilendexxa barra/agenjo ( Dandettottole
dhugichcha tarja kok)
_________________
301
Annotix wogga (Agenjik)
302
Saala
1.
2.
Labballo
Meyyaxxe
Tinni annuyyo meqqaba ilende?
1.
2.
3.
4.
Taakkaba
langaba
sakkaba
sholgaba
Tenne annoxxenna ise edixxixxe oddo’ni me’e
woggaxxe gargarunte hexxe?
_________wogga
303
304
305
ANNUYYOTIXXE AMUWWA CALLI’A. Tenne
annoke siilinni hexxetta wodda me’ele fayyunteti
mine’ni hordofa assiteetta’a?
306
ANNUYYOTIXXE AMUWWA CALLI’A. Tenne
anno ildetechchinni uduma ilat udumixxa hordofa
assiteetta’a?
307
ANNUYYOTIXXE AMUWWA CALLI’A, tenne
annuyyoke siil edi ga’ma ila qeerrisatixxa la’o
la’ooffatteetta’a?
73
0.
1.
2.
Hordofeennaba’a
1-3 le
4lenna okkonechchinni iimi’a
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
Waawwo’o
Eet
Annuyyo tinni ununa unu’niteema’a?
0.
1.
Hitteexxe yanna’a ununa unu’niteemma’a?
__________________agenjo
Waawwo
’o
kaddoole
, » 310
308
309
2.
3.
4.
1.
2.
6 agenjinni butti’a
uunebo’no
6 agenji edidarre
6ke agenjo’n
6 agenji uduma
3le yookin butti’a
3 yannan iimi’a
1.
2.
Annotee’e uwwenne
Miicee hunenne
0.
1.
2.
Waawwo’o
Eet
Moosh
0.
1.
2.
Waawwo’o
Eet
Moosh
0.
1.
2.
Waawwo’o
Eet
Moosh
0.
1.
2.
Waawwo’o
Eet
Moosh
1.
Ununini gadhi’a wele ita/ha’wa haano uutine?
310
311
FILENDEEXXE
ANNUYYO
CALLI’A
(6
agenjonna iimi’a hexxeexxe calli’a). Barrate’ni
me’ele ita annuyyotee’e uutaatta’a?
ANNOTIXXE
AMA
CALLI’A.
Taakkaxxa
ununikinaa’ni fuldammaxxa furdaxxa ado maassitette?
312
313
314
315
FILENDEEXXE ANNUYYO CALLI’A (12
agenjonna butti’a hexxeexxe calli’a) Annuyyo
wogga isexxixxa kittibaate adhdhiteemma’a?
FILENDEEXXE
ANNUYYO
CALLI’A
(9
agenjonna iimi’a hexxeexxe calli’a). Annuyyo
‘huffannatixxanna viitaamine “A” xxa kittibaate adhee
ege’nee? ( kaarde uud)
FILENDEEXXE ANNUYYO CALLI’A (24
agenjinni iimi’a hexxeexxe calli’a)Sa’eeke jaane
agenji giddo godob giddixxe corroqaxxa kiniine
adhdhiteemma’a?
Saxxeexxe lame torba giddo albaateti yookin wele
dhukkubinni abidendee egendee?
316
74
kaddemmaxxee’e
Kuta Shoole: Ifixxanna loolinxxa ca’unte qo’nisaaka qortumuwwa
1. Galaanakenaa’n
2. Baleessakenaa’n
3. Muummetenaa’n
4. Ifixxa muumme
5. Boonotike baanbinaa’n
_______________________________
401
Ha’watika wode’e habaa’ni ikkildina’ne?
402
Wode’e ikkile dagatee’e me’e daqiiqa adhaha?
403
Wode’e dhukkussiisatee’e la’offattinaachchi hedhee?
404
Wode’e dhukkussiisatee’e maachcho la’ooffattina?
0.
1.
Waawwo’o
Eet
1.
2.
Ikkilemeeka wode’e maachchoke’ni candina?
405
Annuyyo atixxa itisati edidarre anga atixxa bululiki
yookin saamuniki anshexxa’ette?
1.
2.
3.
4.
Gafa
Keemikaale (Wuha aggaare/akkua
taabe/ bishangaar/PUR) leba
3. Wele.........
Odolchote’n
Jarkaanake’n
Baaldete’n
Wele ( ifis)________________
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
406
407
Foole’iin mine affine’e
408
Foole’a ofo’lati uduma anga ha’nooxxa anshexxinaa? (
fooleiinke mini bira anga anshe’naaki wodi’i
hedheeshsha uud)
409
Maa bifake foole’iinke mine la’ooffattina’ne?
0.
1.
Waawwo’o
Eet
1.
Qo’iinka tuphanjo afebaaka foole’in
mine
Hafuur fulaaba afeeka foole’in mine
Wode’e harkiinsee’naa foole’a wodi’iki
welebaa’a adhite metaaxxe
Wele___________________________
________
2.
3.
4.
75
Waawwo
’o
kaddoole
, » 411
410
Konnee foole’in mine
la’ooffattina’nee?
wele
0.
1.
min hadinni welt
1.
2.
3.
4.
5.
Minika kodha haba hundina?
411
Waawwo’o
Eet
Fichchigiddo
Bale giddo
Qophpheessatike mine bukkasse huna
Aloossinee fichchi giddo hunnanno
Gumbanno
Kuta Onde: Mini hadixxa itatixxa wo’ma qo’nisaaka qortumuwwa
501
Konne minike haduwwi giddii’n bereqe badalakenaa’n,
sindetenaa’n, so’akenaa’n… hujenideexxe sagalenaa’n
iteek hedhemma’a?
502
Konne minike haduwwi giddii’n bereqe
baaqulakenaa’n, hiddichchuwwakenaa’n,
maxaaxeshshakenaa’n, bo’enakenaa’n… hujenideexxa
sagale iteek hedhemma’a?
503
Konne minike haduwwi giddii’n bereqe
shaanakenaa’n, shunkuritetenaa’n, timaanitimetenaa’n
hujenidexa sagale iteek hedhemma’a?
504
Konne minike haduwwi giddii’n bereqe firafirretenaa’n
hujendeexxa sagale iteek hedhemma’a?
505
Konne minike haduwwi giddii’n bereqe maluwik
hujenidexa sagale iteek hedhemma’a?
506
Konne minike haduwwi giddii’n bereqe quuphphe
iteek hedhemma’a?
507
Konne minike haduwwi giddii’n bereqe qulxu’me iteek
hedhemma’a?
508
Konne minike haduwwi giddii’n bereqe ataruwakenan,
baaqeluwakenaa’n… hujenidexa sagale iteek
hedhemma’a?
76
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
509
Konne minike haduwwi giddii’n bereqe ado ha’week
hedhemma’a?
510
Konne minike haduwwi giddii’n bereqe buuro/zayite
worreexxa midha iteek hedhemma’a?
511
Konne minike haduwwi giddii’n bereqe shaye/malebo
iteek hedhemma’a?
512
Konne minike haduwwi giddii’n bereqe qimamuwwa
lebendeexxa sagale iteek hedhemma’a?
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
0.
1.
Waawwo’o
Eet
KUTA Jaane: Mini hadixxe itaxxa wo’manna nageellunte qo’nisaaka qortumuwwa
601
Saxxeexxe 30 barra’n itatixxe gonphee’n yaaddee
egendete? konnen gico ( agenjoke’n 1-2 barra
qico’n), Sa’e sa’e (agenjoke’n 3-10 barra qico’n)
Yo’oxxa yanna (agenjoke’n 10 barra iimi ga’ma)
602
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
603
Saxxeexxe 30 barra’n mini giddo ittinaachcho
gophphinee egendinee?
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 603
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 605
604
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
605
Saxxeexxe 30 barra’n sagale gophematenaa’n
keexxeexxa shiixxochcho ittinee egendinee?
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 607
77
606
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
607
Saxxeexxe 30 barra’n hasssinebaaxxa sagale
ittinee egendinee?
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 609
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
608
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
609
Saxxeexxe 30 barra’n ita gophendee’naa hassinee
qici buttidarra ittinee egendinee?
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 611
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
610
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
611
Saxxeexxe 30 barra’n ita gophendee’naa barrate’n
shiixxochcho ittinee egendinee?
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 613
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
612
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
613
Saxxeexxe 30 barra’n indaachchi mine gophemee
ege’nee?
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 615
78
614
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
615
Saxxeexxe 30 barra’n sagale ittinebaang
diiphphinee egendinee?
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 617
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
616
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
617
Saxxeexxe 30 barra’n barra duuchcha indaachchi
gophemee’naa’a hossinee egendinee?
0.
1.
Waawwo’o
Eet
Waawwo’o
kaddoole,
» 701
618
1. konnen gico
2. Sa’e sa’e
3. Yo’oxxa yanna
Eet kaddoole, hittee qico? konnen gico (
agenjoke’n 1-2 barra qico’n), Sa’e sa’e
(agenjoke’n 3-10 barra qico’n) Yo’oxxa yanna
(agenjoke’n 10 barra iimi ga’ma)
Kuta Torbaane: Qeerrinniinka jeeja/Antiropoomeetire towatatika qortumuwwa
701
Annotiki
uurrichchi/qeerrinni
(saantimeetiret)
702
Annotixxe hirreki
saantimeetire?
furdinni
hittee
qico
________________cm
(MUAC)
me’e
________________cm
Tarja bukkassa muuxendeexxa saate
________________
Tarjabukkasseekika
summa______________________
Beesisa___________
Qortuma bireennen, fedhii uutettexxee lumooshsha assee galateeffatannon!!!!
79