Prevalence and factors associated with undernutrition and anaemia among school children in Durbete Town, northwest Ethiopia

A total of 384 children enrolled in Abchikele and Ayalew Mekonnen Elementary Schools
were examined and 32.3 % of them were found undernourished (27.1 % were underweight
and 11.2 % were stunted) and 10.7 % were anaemic. Male and older age children were
at risk of being stunted and those who did not wash their hands before eating were
at risk of being underweight. The chance of being anaemic was higher in children who
were infected with hookworm compared to those who were not infected with helminths.
However, the prevalence of undernutrition and anaemia were similar between children
with different socio-economic status and those who were infected with intestinal helminth
and those were not infected.

The prevalence of undernutrition (underweight and/or stunting) in the current study
was similar to a recent report among school-age children in Addis Ababa (30.9 %) 17]. The prevalence of underweight found out in the current study is also comparable
with the prevalence documented in other regions of Ethiopia 18], 19]. However, some studies documented a higher prevalence of stunting (19.6 to 29.3 %)
17]–20] and undernutrition (underweight and/or stunting) (42 to 46.7 %) 17], 19], 20] among school-age children in different places of the country. These differences could
be due to variations in the factors predisposing to underweight and stunting in the
different regions of Ethiopia. Stunting is chronic and associated with long term factors;
howevere, being underweight is due to current and acute or chronic inadequate nutrition.

The prevalence of anaemia among school-age children in the current study is mild.
However, a relatively high prevalence of anaemia (27.6 to 37.6 %) was observed among
school-age children in a different regions of Ethiopia 21]–23]. The etiologic agents of anaemia are different and could vary from place to place
16]. This may contribute to the differences in the prevalence of anaemia among school-age
children in different regions of the country.

Male children of ages 10 to 14 years were at higher risk of being stunted. Similar
previous studies also reported a higher prevalence of stunting in males than in females
18], 24]–27] and in children of ages 10 to 14 years compared to those of ages 5 to 9 years 28]–30]. These sex and age biases in the prevalence of stunting in the area could be related
to community specific cultures. In the region, male children are usually more mobile
and undertake different playing activities (e.g. sport) that make them loss grater
energy from their body. On the other hand, females are usually give more attention
to their personal hygiene than males, are less mobile in their behavior and stay at
home, have more access to different food staff. As a result, females will be less
vulnerable to undernutrition compared to males. Particularly, the physical activities
are frequently practiced by older age children. On the other hand, the habit of not
washing hands before eating among children was associated with a greater prevalence
of underweight rather than stunting. Unlike stunting, which shows cumulative effects
starting from a past period, being underweight is acute, indicating current nutritional
status of children. Not washing hands before eating may cause acute bacterial or parasitic
infection that would lead to diarrhea or mal-absorption problems and acute undernutrition.

Hookworm infection was independently associated with an increased risk of anaemia,
as previously reported by many studies 31], 32]. However, the number of children infected with A. lumbrcoides and T. trichiura alone were too small to make valid statistical tests regarding the impact of these
infections on anaemia and undernutrition. On the other hand, Soil Transmitted Helminths
infection in general was not associated with undernutrition. This is in contrast to
some previous studies 32]–34]. The intensity of the majority of infections in the current study was light. As a
result, the infections may not have significant impact on the nutritional status of
the children.

Although previous studies linked low education status of mothers/fathers, drinking
unprotected water, defecating in open fields, living in rural area and not wearing
of shoes with undernutrition 35]–39] and anaemia 40]–42], similar associations were not observed in the present study. Other studies also
reported that the aforementioned socio-economic factors do not increase the risk of
undernutrition or anaemia 43], 44]. Different communities have different lifestyles, cultures, religions and environmental
conditions. As a result, risk factors of undernutrition and anaemia may not be similar
in all areas.

The use of single Kato Katz slide was a limitation in the present study because it
might have underestimated the prevalence and intensity of infection in the study population.
In addition, the cross-sectional nature of the study design hampers making conclusive
conclusions regarding the impact of the socio economic factors and intestinal helminth
infection on anaemia and undernutrition. Further community based longitudinal studies
would be helpful to evaluate whether Soil Transmitted Helminths infection and poor
socioeconomic, low education, poor sanitation status could lead to undernutrition
and anaemia in children and adult among the communities in Durbete Town, North west
Ethiopia.