Maternal undernutrition as proxy indicators of their offspring’s undernutrition: evidence from 2011 Ethiopia demographic and health survey

Farah et al. BMC Nutrition (2019) 5:17 https://doi.org/10.1186/s40795-019-0281-z RESEARCH ARTICLE Open Access Maternal undernutrition as proxy indicators of their offspring’s undernutrition: evidence from 2011 Ethiopia demographic and health survey Alinoor Mohamed Farah1*, Bilal Shikur Endris2 and Seifu Hagos Gebreyesus2 Abstract Background: The intergenerational continuity of undernutrition is influenced by shared genetic, household socioeconomic and cultural resources which will be associated with the mother and the child nutritional status, possibly to the same degree. Provided that this assumption is valid, maternal height and BMI could be a simple way of measuring nutritional status of their children. Methods: Data were obtained from the 2011 Ethiopia Demographic and Health Survey (EDHS 2011). An analytical sample of 8, 505 children whose mothers are not pregnant and live with their biological mothers was included. The bivariate associations between nutritional indices of the mother and the children were analyzed with Pearson correlation coefficients. The sensitivity, specificity, predictive values and area under Roc curves were calculated. Logistics regression for binary outcomes was also used to evaluate the predictors of child undernutrition. Results: Children who experienced stunting, underweight or wasting had mothers with lower mean BMI than those who did not (p < 0.001). Maternal and child nutritional status were positively correlated. The sensitivity of maternal underweight (defined by BMI < 18.5 kg/m2) as a predictor of child’s nutritional status (<− 2 z-scores) is low, failing to reach 50% for any of the child nutrition indices. In logistics regression, maternal BMI was associated with stunting, underweight and wasting (p < 0.001) while maternal height was only associated with stunting and underweight (p < 0.001). Conclusion: The sensitivity and specificity of maternal anthropometric indicators to identify growth deficits among children were too low to justify using maternal indicators as a replacement for child growth measurements. Keywords: Child, Maternal, DHS, Ethiopia, Undernutrition, BMI, Height Background Anthropometry is widely used tool to assess the nutritional status of children and to monitor their growth [1]. Further, the prevalence of undernutrition in children particularly those aged 6–59 month is used as an indicator for nutritional status of the entire population since they are more sensitive to nutrition related stress [2]. A number of anthropometric indicators have been used assessing nutritional status of children and they * Correspondence: 1 Department of Public Health, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia Full list of author information is available at the end of the article include; weight-for-height, weight-for-age and height for age, among others. Multicomponent indicators such as weight for age and height for age require age to be determined accurately since they are more sensitive to random errors in age than in anthropometry [3]. Therefore, in a setting where vital statistics are not recorded or exact ages are not known it will be difficult to assess accurately the nutrition status of children. Likewise, younger children are more difficult to deal with during weight and height measurements and result in error [4]. In other words, at least two persons are required to measure weight and height accurately: one to take measurements and other to record [5]. In situations © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Farah et al. BMC Nutrition (2019) 5:17 where there are no sufficient health workers it may be also difficult to undertake these measurements accurately. Considering the intergenerational continuity of undernutrition, maternal BMI and height which are independent of age and relatively easier to measure could be a simple way of measuring nutritional status of their children and as a result they can be potential proxy indicators for nutritional status of the entire population. Therefore, the current study is aimed to determine whether maternal BMI and height can be used to assess child undernutrition and to explore the predictors of child undernutrition by analyzing a heterogeneous study population from a nationally representative sample. Methods Study setting Ethiopia is a country with 94 million people, second largest among African countries and among the least urbanized countries in the world. The majority of the population resides in the highland areas [6]. The source of livelihood of the settled rural population is farming while the lowland areas are mostly inhabited by nomads, who depend mainly on livestock production and move from place to place in search of pasture and water. There are 11 administrative regions in Ethiopia (9 regional states and two administrative cities); Tigray, Afar, Amhara, Oromia, Somali, Benishangul-Gumuz, Southern Nations Nationalities and Peoples (SNNP), Gambella, Harari, Addis Ababa, and Dire Dawa. Regions are divided into zones, and zones, into administrative units called woredas. Each woreda is further subdivided into the lowest administrative unit, called kebele. More than 80% of the country’s total population lives in the regional states of Amhara, Oromiya, and SNNP. The 2011 EDHS is the third Demographic and Health Survey conducted in Ethiopia. It is intended to measure levels, patterns, and trends in demographic and health indicators. EDHS provides data on fertility, family planning, maternal and child health, childhood mortality, nutrition, malaria, HIV knowledge and behavior, and HIV prevalence [6]. Data source Secondary analysis was performed using data from the 2011 Ethiopian Demographic Health Survey (EDHS), which is a nationally representative cross-sectional household survey of women of reproductive age and children less than five years old in Ethiopia. The data have been weighted to cater for the different sample proportions [6]. The survey was conducted from September 2010 to January 2011 and included three structured questionnaires: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. Page 2 of 12 EDHS sample design and procedure A representative probability sample of 18,720 households was selected using a multistage stratified twostage cluster sampling design in which samples of households within clusters (enumeration areas) are (...truncated)