Geospatial Distributions of Stunting and Determinants among Under-Five Children in Tigray: Using Partial Proportional Odds Model

Background. Despite improvements globally, child stunting remains one of the serious public health problems in Ethiopia. This study aimed to assess the distribution and determinants of stunting among under-five children in Tigray, Ethiopia. Materials and Methods. A cross-sectional survey was conducted in Tigray from June to July 2019. A total of 11,004 under-five children were included in this study with a stratified two-stage random sampling. The geospatial distribution of stunting among under-five children was determined using GIS and SATSCAN software. A partial proportional odds model was fitted to assess the risk of the child's nutritional status, and an odds ratio with a 95% confidence interval was used to assess the strength of the association of the independent variables and the child's nutritional status. Results. The average age of the children was 26.0 (SD = 14.0) months. The overall prevalence of stunting was found to be 41.0%. Western, Southern, South Eastern, Eastern, and Central zones experience a high proportion of stunting. Children having mothers who did not plan their last pregnancy (AOR = 0.90, 95% CI: 0.819-0.995), living in rural areas, and children being male (AOR = 1.33, 95% CI: 1.226-1.433) were more likely to be stunted. The estimated odds of stunting increased significantly with child's age but decreased with the mother's age. Children having mothers with primary and secondary education were 13% (AOR = 0.87, 95% CI: 0.787-0.969) and 12% (AOR = 0.88, 95% CI: 0.777-0.998) less likely to be severely stunted than children having mothers with no education. Likewise, children having fathers with secondary and college or above education had 0.76 (AOR = 0.76, 95% CI: 0.672-0.858) and 0.62 (AOR = 0.62, 95% CI: 0.517-0.736) times lower risk of having severely stunting compared with the children having fathers with no education. Conclusion. The prevalence of stunting in 6-59-month-old children from Tigray was unacceptably high. Potential factors associated with child stunting were parental educational level, child sex, child age, maternal age, place of residence, and zone. Thus, improving parental education and avoidance of early marriage are recommended in order to reduce the prevalence of stunting. Moreover, place and zone-specific interventions should be also introduced to tackle differences in the burden of stunting among children aged 6-59 months from Tigray.