Abstract
Introduction/Background: Child undernutrition is a major
public health problem globally. Stunting is linear growth
retardation among children under 3 years of age which results from
a range of multifaceted factors. Poor sanitation, hygiene and water
quality collectively constitute a household environment which can
predispose young children to the risk of developing environmental
enteropathy (EE). There is limited evidence documented from
research or programs on the effect of the household environment on
child nutritional outcomes.
Objective: The objective of this study is to assess the
relationship between the household WASH (water quality, sanitation
and hygiene) environment and stunting among children 6-36 months of
age from rural Ethiopia.
Method: Data were analyzed from the baseline survey of a
cross sectional observation study conducted by the Nutrition at
Center (N@C) project of CARE Ethiopia . This project is currently
working in the north east part of Ethiopia. A total 2123 children
age 0-36 months and their mothers or primary caregivers were
included in this survey. A logistic regression model was employed
to run the analysis. Both bivariate and multivariate regressions
were performed using IBM SPSS Statistics Version 20
and WHO Anthro version 3.2.2.
Results: About 55% children are stunted (HAZ <-2SD)
and have poor household WASH indicators. The latter are key
constituents of EE risk. A summative index of EE components was
used in the binary logistic regression. Results of logistic
regression indicates that households with a higher risk of EE [OR
1.273, p value= 0.007, CI (91.067-1.518)] are more likely to have
stunted children.
Conclusion: The household WASH environment constitutes a
risk of developing EE and mediates its effect on health and
nutrition outcomes. Improvement of household WASH environment along
with nutrition interventions can potentially prevent stunting among
young children.
Table of Contents
Table of Contents
Chapter I:
Introduction
Context of
project
Problem
Statement
Objectives
Chapter II: Literature
review
Global child
undernutrition
Child undernutrition in
Ethiopia
Determinants of
stunting
Figure 2.1: UNICEF Child
Undernutrition Framework
Household WASH environment and
risk of EE
Environmental
Enteropathy
EE's
Pathological Pathways
Diagnostic criteria of Environmental
Enteropathy (EE)
Reversibility of EE among
individuals
Association of EE with stunting among
children
Figure 2.2: Environmental
Enteropathy Pathological Pathway and Stunting
Socioeconomic status and EE
EE,
nutrition and WASH interventions
Key Study
Premise
Chapter III: Methodology,
variables and model development
Study area
location
Fig 3.1: Map of "Nutrition at
Center" Ethiopia project baseline and control
districts
Intervention district
characteristics
Survey
methodology
Sampling frame
Sample size
Table 3.1: Survey sample size
included in the analysis by age group
Study design
Selection of
participants
Survey tool
Enumerator
training
Data
collection
Data entry quality control
protocol
Data analysis
Statistical
model
Figure 3.1: Proposed
Theoretical Model
Variables and
measures
Table 3.2: Concepts and
measures on anthropometry and mother's literacy
Table 3.3: Concept and measures
on HH toilet facilities
Table 3.4: Concepts and
measures of child defecation
Table 3.5: Concept and measures
on handwashing at the three critical times
Table 3.6: Concept and measures
on soap and water availability at HH for
handwashing
Table3.7: Concepts and measures
on water quality
Table 3.8: Variable Final
Categories
CHAPTER IV:
RESULTS
Table 4.1: Characteristics of
study sample
Table 4.2: Final measures for
bivariate and multivariable analyses
Bivariate
analysis
Table 4.3: Final measures and
stunting - bivariate analysis
Multivariate
analysis
Table 4.4: Logistic
regression-1 results: Children stunted at (6-36) months of age
compared to those who are not
Table 4.5: Logistic
regression-2 results: Children stunted at (6-36) months of age
compared to those who are not
CHAPTER V: DISCUSSION AND
CONCLUSION
Policy
implications
Contribution
Limitations
Reference
Appendix-1
Table of content of survey
questionnaire
A. Household
identification and summary
B. Child
Information
C. Mother's
Information
D. Basic
information of household characteristics
E. Agriculture
production, access to food
F. Food
preservation and storage
G. Agriculture
Extension
I. Household
Hunger Scale
J. Women's Diet
Diversity Score
K. Maternal
health/pregnancy
L. Infant and
Young Child Feeding Practices (IYCF)
M. Responsive
Feeding
N. Childhood
illness
O. Drinking
water
P. Hand washing,
sanitation and disposal of child's feces
Q. Women's
Empowerment
Mobility
Community Social
Capital
Household
Decision-making
Gender Attitude and Belief:
Tolerance of Intimate Partner Violence
R. Community group
and Government safety net participation
S. Mother's
Anthropometry (Part I)
Z. Child's
Anthropometry (Part I)
S. Mother's Anemia (Hemoglobin)
Part II
Z. Child's Anemia (Hemoglobin)
Part II
About this Master's Thesis
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