Joint statistical analysis of household food insecurity and child stunting in Hawassa Zuria district, Sidama region, Ethiopia.

BACKGROUND: Malnutrition and food insecurity remain major public health issues in Ethiopia. Although several studies in the Sidama region have explored their association, few have jointly analyzed these outcomes using an integrated statistical framework. Identifying shared and unique predictors is crucial for developing context-specific prevention strategies. METHODS: A cross-sectional study was conducted from November 2023 to February 18, 2024, involving 1,149 households with children under five years of age. Participants were selected using a multistage sampling technique. Data were collected through a pre-tested structured questionnaire administered by trained data collectors. Child nutritional status was assessed using height-for-age Z-scores (HAZ), where children with HAZ < - 2 SD were coded as stunted (1), and those with HAZ ≥ - 2 SD were coded as not stunted (0). The Household Food Insecurity Access Scale (HFIAS) was used to categorize households according to food access levels using its nine standard questions. Joint generalized linear mixed models were applied to identify predictors of both stunting and food insecurity and assess the correlation between them. Statistical significance was set at p < 0.05. RESULTS: Out of the total households surveyed with under-five children, 801 (78.2%; 95% CI: 75.2-83.7) were found to be food insecure, and 541 children (47.08%; 95% CI: 42.5-51.5) were stunted. The random effects in the joint generalized linear mixed model indicated significant variability across clusters (Kebeles), with variance estimates of 0.30 (p = 0.001) for food insecurity and 0.45 (p < 0.001) for stunting. A moderate positive correlation of 0.52 (p = 0.039) was observed between the two outcomes. Significant predictors for both stunting and food insecurity included: employment status, father's age, number of under-five children in the household, mother's age at first birth, succeeding birth interval, household wealth index, husband's occupation, parental education levels, dietary diversity score, and meal frequency per day. CONCLUSIONS: This study revealed a high prevalence of stunting and food insecurity among households with under-five children in Hawassa Zuria district, Sidama region, Ethiopia. Household and child-level factors were significantly associated with these conditions. Integrated, multisectoral interventions should prioritize vulnerable households, focusing on dietary diversity, maternal and child health services, and sustainable food access. Policymakers should strengthen community-based programs to tackle both the immediate and underlying causes of child malnutrition and household food insecurity.