Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

Mesfin Wudu Kassaw; Aschalew Afework Bitew; Alemayehu Digssie Gebremariam; Netsanet Fentahun; Murat Açık; Tadesse Awoke Ayele

doi:10.1155/2020/2169847

Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

J Nutr Metab. 2020 Dec 12:2020:2169847. doi: 10.1155/2020/2169847. eCollection 2020.

Authors

Mesfin Wudu Kassaw¹, Aschalew Afework Bitew², Alemayehu Digssie Gebremariam³, Netsanet Fentahun⁴, Murat Açık⁵, Tadesse Awoke Ayele⁶

Affiliations

¹ Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
² Department of Public Health, College of Health Science, GAMBY Medical College, Bahir Dar, Ethiopia.
³ Department of Public Health, College of Health Science, Debre Tabore University, Debre Tabore, Ethiopia.
⁴ Department of Nutrition and Dietetics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
⁵ Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
⁶ Department of Public Health, College of Health Science, University of Gondar, Gondar, Ethiopia.

Abstract

Background: Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies' qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger's test, and Begg's test were used to assess publication bias. The I ² statistic, forest plot, and Cochran's Q-test were used to deal with heterogeneity.

Results: In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I ² = 97.6%, p < 0.001, Q = 1461.93). However, no publication bias was detected (Egger's test p=0.26 and Begg's test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I ² = 63.8%, p < 0.001, Q = 44.21 and I ² = 78.3%, p < 0.001, Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg's test, p > 0.05).

Conclusions: The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.