ALBERT

Description: Background The prevalence of under-five children’s undernutrition in Ethiopia is among the highest in the world. This study aimed at exploring the prevalence and risk factors of the composite index for anthropometric failure (CIAF) of under-five children in Ethiopia by incorporating the zonal (district) effects. Methods The data was drawn from Ethiopian Demographic and Health Surveys (EDHSs), a population-based cross-sectional study of 29,599 under-five year children from 72 Zones in the years 2000, 2005, 2011, and 2016. Fixed effect variables related to child and maternal-household were included in the model. We adopted a generalized mixed model with CIAF as outcome variable and Zones as random effects. Results The prevalence of CIAF in Ethiopia was 53.78% with the highest prevalence of 61.30% in 2000 and the lowest prevalence of 46.58% in 2016. The model result revealed that being a female child, absence of comorbidity, singleton births, and the first order of birth showed significantly lower CIAF prevalence than their counterparts. Among the household characteristics, children from mothers of underweight body mass index, uneducated parents, poor household sanitation, and rural residents were more likely to be undernourished than their counterparts. Based on the best linear unbiased prediction for the zonal-level random effect, significant variations of CIAF among zones were observed. Conclusion The generalized linear mixed-effects model results identified gender of the child, size of child at birth, dietary diversity, birth type, place of residence, age of the child, parental level of education, wealth index, sanitation facilities, and media exposure as main drivers of CIAF. Disparities of CIAF were observed between and within the Ethiopian administrative Zones over time.