Clustering and determinants of acute undernutrition among under-five children in urban and rural communities of Tigray in Ethiopia

Background Undernutrition is one of the major public health problems and an important health indicator for under-five children in many developing countries. It causes the death of 3.5 million children under-five years old per year in the world and nearly 45 mil- lion are acute malnutrition globally. Objective The objective of the study was to assess the distributions and determinants of acute undernutrition among under-five children in all urban and rural areas of Tigray. Methods A cross-sectional study design was employed in 18 urban and 34 rural areas of Tigray, northern Ethiopia. A sample of 11,004 children aged 6-59 months was included in this study. Child nutrition status was developed by calculating weight-for-height z score and categorized into three groups as severely undernourished, moderately undernourished, and nourished. Spatial clustering of child undernutrition was determined using SATSCAN and GIS softwares. An ordinal logistic regression model (proportional odds model) was fitted to assess the risk of child nutritional status and odds ratio with 95% confidence interval was used to assess the presence of associations. Results The prevalence of acute undernutrition in the rural and urban areas was 9.3% and 7.8%, respectively. High burden of acute undernutrition is concentrated mainly in the central, northwestern, south, and southeast zones of Tigray. Conclusions proportional odds model showed that child sex, mother’s education, fever in the last two weeks, timing of child put to the breast after birth, cough in the last two weeks, and regular ANC visits were the significant predictors of child acute undernutrition. The prevalence of acute undernutrition among under-five children in Tigray was high and concentrated mainly in the central, northwestern, south, and southeast zones of the region.