Concurrent anemia and stunting (CAS)
|
Defined when a child was both anemic and stunted. Anemia status was measured by hemoglobin level < 11 g/dL and categorized as anemic and non-anemic [3]. Stunting was measured by length-for-age < − 2 z-score and categorized as stunted and non-stunted.
|
Basic (distal) factors
|
Residence place
|
Categorized as urban and rural.
|
Region
|
Categorized as mainly agrarian and mainly pastoral.
|
Household wealth category
|
First, household wealth index was developed by principal component analysis, using asset variables collected during the survey [19]. Then, the index was used to rank the households into low, middle and high wealth categories.
|
Caregiver’s education status
|
Categorized as illiterate/none, primary, and secondary and above.
|
Underlying (intermediate) factors
|
Water source
|
Categorized as improved and unimproved.
|
Toilet facility
|
Categorized as improved and unimproved.
|
Proximal (immediate) factors
|
Child sex
|
Categorized as boy and girl.
|
Child age
|
Categorized into < 12 and 12–23 months of age.
|
Birth size
|
Assessed by the subjective reporting of the mother about the size of the child at birth and categorized as large, average and small. Birth size was used as a proxy measure of birth weight.
|
History of infection
|
Assessed by whether the child had fever, diarrhea, or cough in the last two weeks preceding the survey. Categorized as yes and no.
|
Breastfeeding duration
|
Categorized as < 12 and 12–23 months.
|
Early breastfeeding initiation
|
Assessed by initiation of breastfeeding within the first hour after birth. Categorized as yes and no.
|
Deworming tablet use
|
Assessed by whether the child received deworming table within the previous 6 months. Categorized as yes and no.
|
Vitamin A supplement use
|
Assessed by whether the child received vitamin A supplement within in the previous 6 months. Categorized as yes and no.
|
Iron supplement use
|
Assessed by whether the child received iron supplement within the previous 7 days. Categorized as yes and no.
|
Complementary food groups
|
During the survey, caregivers were asked to recall the type of food the child was fed in the 24 h (one day) prior to the survey. The frequency of feeding during the same period was also assessed. The data were collected by trained interviewers, following the 5-Step Multiple-Pass Method. Using the WHO/UNICEF [39] and the DHS guidelines [19] for the assessment of infant and young child feeding practices, the food items were further categorized into 7 food groups: (1) meat, (2) egg, (3) milk, (4) grains, roots, and tubers, (5) legumes and nuts, (6) vitamin-A rich fruits and vegetables (VARFV), and (7) other fruits and vegetables (OFV). Using the 7 food groups above and following the WHO/UNICEF [39] and the DHS guidelines [19], dietary diversity and meal frequency indexes were determined for each child. The diversity and frequency indexes were used to determine whether the child met the WHO/UNICEF recommendations for dietary diversity and meal frequency.
|
Minimum dietary diversity (MDD)
|
Assessed by whether the child received ≥4 complementary food items from the 7 food groups within the previous 24 h. Categorized as yes and no [39].
|
Minimum meal frequency (MMF)
|
Assessed by whether the child was fed with complementary food ≥3 times if on breastfeeding, or ≥ 4 times if not on breastfeeding, within the previous 24 h. Categorized as yes and no [39].
|