Risk Factors and Spatial Distributions of Underweight Among Children Under-Five in Urban and Rural Communities in Tigray, Northern Ethiopia: Using Ordinal Logistic Regression Analysis

Background: Despite the implementation of high-impact interventions, both acute and chronic childhood malnutrition has continued to be a critical public health concerns in Ethiopia. The present study was conducted to assess the spatial distributions of underweight and associated factors among 6-59 month old children in 18 urban and 34 rural areas of Tigray, Northern Ethiopia. Methods: A cross-sectional survey was conducted on 11,004 households from June to July 2019. Nutritional status of 11,004 children was evaluated by calculating weight-for-age anthropometric index and categorized into three groups namely severely underweight (< -3.0 z scores), moderately underweight (-3.0 to -2.01 z scores) and normal (>= -2.0 z scores). An ordinal logistic regression model was used to determine predictors of underweight. Odds ratio with 95% confidence interval (CI) was used to assess the strength of the association between independent variables and underweight. Spatial clustering of underweight was determined using SATSCAN and GIS softwares. Results: The overall prevalence of underweight was found to be 21.16% (95% CI = 19.54-22.86%). Of these 25.65% (95% CI = 22.20- 29.21%) and 74.35% (95% CI = 72.34-76.46%) were severely and moderately underweight, respectively. Children whose mothers lived in rural areas (AOR = 1.28, 95% CI = 1.11-1.49), severe households food insecurity (AOR = 1.29, 95% CI = 1.07-1.54), had fever (AOR = 1.29, 95% CI = 1.11-1.48), had diarrhea (AOR = 1.27, 95% CI = 1.08-1.49), had cough (AOR = 1.17, 95% CI = 1.02-1.34) and male (AOR = 1.28, 95% CI = 1.17-1.40) were more likely to be underweight. Moreover, children whose mothers had college or above education were less likely to be underweight than children whose mothers had no education (AOR = 0.48, 95% CI = 0.37-0.62). Conclusion: The burden of underweight among under-five children from Tigray was unacceptably high. In order to reduce the burden of underweight in the region, improving household level food insecurity, prevention of common childhood illnesses, maternal education and age appropriate feeding are recommended.