SAMARA UNIVERSITY COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

ASSESMENT OF NUTRATIONAL STATUS AND ASSOCIATED FACTORS

IN CHILDREN:A COMPARATIVE STUDY BETWEEN SCHOOL FEDDING
AND NON SCHOOL FEEDING PROGRAMME IN AMIBERA DISTRICT
AFAR REGION, ETHIOPIA, 2018

BY

HABIB MOHAMMED (B.SC)

Advisor Main-Advisor: Dr SELAMAWIT ASFAW BEYENE

Co-Advisor: ABEL GEBRE(MPH)

A Thesis Paper Submitted to Samara University, College of Health Sciences, and

Department of Public Health in Partial Fulfillment of the Requirements for Masters
of Public Health (MPH).

September 2018

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Name of investigator HABIB MOHAMMED

Name of advisor Dr SELAMAWIT ASFAW BEYENE

Name of CO-advisor ABEL GEBRE

Title of the research project ASSESMENT OF NUTRATIONAL STATUS AND

ASSOCIATED FACTORS IN CHILDREN:A
COMPARATIVE STUDY BETWEEN SCHOOL
FEDDING AND NON SCHOOL FEEDING
PROGRAMME IN AMIBERA DISTRICT AFAR
REGION, ETHIOPIA, 2018

Duration of the project From January 2018 to June 2018 G.C

Study area Afar, zone 3 Amibara Woreda district

Total cost of the project 28250 ETB birr

Address of investigator Mobile No:0925228765

Email: hbbmohammed5@gmail.com

Address of C0-Advisor Mobile No: 0913596094

Email:abelge-bre21@gmail.com

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 ACKNOWLEDGEMENTS

I would like to thank my Almighty God for his blessings, protection and care, without him this work could
not have been effectively to be accomplishing. My special thank gratitude is expressed to my supervisor,
Dr Selamawit Asfaw and Abel Gebre, for his guidance and tireless efforts, supports and ideas throughout
my work, from the selection of Title up to thesis development. I thank for his constructive criticism and
contributions which make my proposal the way it appears.

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Table of Content

Contents
Table of Content .................................................................................................................................... iv

List of Table ......................................................................................................................................... vii

List of Figure........................................................................................................................................ viii

Acronyms and Abbreviation .................................................................................................................. ix

Abstract ................................................................................................................................................... x

1. INTRODUCTION .......................................................................................................................... 1

1.1 Background ..................................................................................................................................... 1

1.2 Statement of the Problem ................................................................................................................ 3

1.3 Significance of the study ......................................................................................................... 4

1.4 Literature Review.................................................................................................................... 5

1.4.1 Nutritional status of school age children on school feeding and non-school feeding program
5

1.4.2 Associated factor of nutritional status ............................................................................. 8

2. Objectives ..................................................................................................................................... 13

2.1 General objective .................................................................................................................. 13

2.2 Specific objectives ................................................................................................................ 13

3. Methods and Materials .................................................................................................................. 14

3.1 Study area and period............................................................................................................ 14

3.2 Study Design ......................................................................................................................... 14

3.3 Source Population ................................................................................................................. 15

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 3.4 Study Population ................................................................................................................... 15

3.5 Sample Unit .......................................................................................................................... 15

3.6 Inclusion and Exclusion criteria............................................................................................ 15

3.6.1 Inclusion criteria: .......................................................................................................... 15

3.6.2 Exclusion criteria: ......................................................................................................... 15

3.7 Sample Size........................................................................................................................... 15

3.8 Sampling Procedures ............................................................................................................ 16

3.9 Study Variables ..................................................................................................................... 18

3.9.1 Dependent variable ....................................................................................................... 18

3.9.2 Independent variables ................................................................................................... 18

3.10 Operational Definition .......................................................................................................... 18

3.11 Data collection procedure ..................................................................................................... 18

3.11.1 Data collection tool, technique and procedure .............................................................. 18

3.12 Anthropometric measurements ............................................................................................. 19

3.12.1 Height ............................................................................................................................ 19

3.12.2 Weight ........................................................................................................................... 19

3.12.3 Dietary diversity............................................................................................................ 20

3.13 Data quality control issues .................................................................................................... 20

3.14 Data management and analysis ............................................................................................. 21

3.15 Research Ethics ..................................................................................................................... 21

3.16 Dissemination of Results .............................................................................................................. 22

4. Result ............................................................................................................................................ 23

4.1 Participant’s socio-demographic characteristics ................................................................... 23

4.2 Respondent’s parent/care giver socio -economic status. ............................................... 25

4.3 Dietary history of the participants ......................................................................................... 26

4.4 Participants Incidence of ill health ........................................................................................ 28

4.5 Participants Sanitation and hygiene ...................................................................................... 29

4.6 Participants School performance .......................................................................................... 29

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 4.7 Nutritional status of all the school age children .................................................................... 31

4.7.1 Nutritional status for the School feeding group ............................................................ 31

4.7.2 Nutritional status for the non feeding group ................................................................. 32

4.8 Factors associated with nutritional status.............................................................................. 33

4.8.1 Factors associated with wasting .................................................................................... 33

4.8.2 Factors associated with stunting.................................................................................... 36

5. Discussion ..................................................................................................................................... 40

5.1 Nutritional Status of children ................................................................................................ 40

5.2 Difference in Nutritional status of children in the school feeding program and non school feeding
program ............................................................................................................................................. 40

5.3 Factors associated with nutritional status (BAZ, HAZ) ........................................................ 41

5.3.1 Factors associated with low BMI for age (BAZ) .......................................................... 41

5.3.2 Factors associated with low HAZ for age (HAZ) ......................................................... 42

5.4 Strengths and Limitations of the Study ................................................................................. 44

5.4.1 Strength of the Study..................................................................................................... 44

5.4.2 Limitation of the Study ................................................................................................. 44

6. Conclusion and Recommendation ................................................................................................ 46

6.1 Conclusion ............................................................................................................................ 46

6.2 Recommendation .................................................................................................................. 46

7. References ..................................................................................................................................... 48

ANNEX 1 Consent form ....................................................................................................................... 54

ANNEX 2 Questionnaires (English Version) ....................................................................................... 56

ANNEX 3 Questionnaires (Afar Version) ............................................................................................ 62

ANNEX 4 Advisor’s Approval Sheet ................................................................................................... 66

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List of Table
Table 1 Socio demographic characteristics of students both SFP and NSFP of Amibara District Elementary
schools ......................................................................................................................................................... 24
Table 2 socio economic status of parents of both SFP and NSFP Amibara Woreda elementary school
children ,Jan,2018(n=679) ........................................................................................................................... 26
Table 3: Feeding Characteristics,Health and Sanitation Practices of the respondent of both SFP and NSFP
Amibara Woreda elementary school Children,Jan,2018(n=679) ................................................................. 29
Table 4 :Anthropometric measurement of the all study sample .................................................................. 31
Table 5: Multivariate Results for socio Demographic and feeding factors associated with wasting in SFP 34
Table 6:multivariate results for socio demographic,health history and feeding factors associated with
wasting in NSFP .......................................................................................................................................... 35
Table 7:Multivartate Results for household asset and feeding factors associated with stunting in SFP ..... 37
Table 8: multivariate results for Environmental and feeding factors with stunting in NSFP ...................... 38

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List of Figure

Figure 1 conceptual framework of nutritional assessment and associated factors among primary school
children in school feeding program adopted from different litratures(65,75,76,77).................................... 12
Figure 2 Map of the study Area Amibara Wored ........................................................................................ 14
Figure 3 Schematic Presentation of sampling procedure ............................................................................. 17
Figure 4: 7 Food Groups consumed by children in the past 24 Hours ......................................................... 28
Figure 5: DDS .............................................................................................................................................. 28
Figure 6:prevalence of malnutrition for the school feeding group.............................................................. 31
Figure 7: Prevalence of malnutrition for non school feeding group ............................................................ 32

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Acronyms and Abbreviation

ABE Alternative Basic Education

BMI Body Mass Index

CSB Corn Soya Bean

FANTA Food and Nutrition Technical Assistance

FFE Food for Education

FMoE Federal Ministry of Education

HAZ Height for Age Z score

IDDS Individual Dietary Diversity Score

SAC School Age Children

SFP School Feeding Programme

SPSS Statistical Package for the Social Science

UNICEF United Nations Children’s Fund

WAZ Weight for age Z score

WFA Weight for Age

WFH Weight for height

WFP World Food Programme

WHZ Weight for height Z score

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 Abstract
Introduction: School age is the active growing phase of childhood. Primary school age is a dynamic
period of physical growth as well as the mental development of the child. Malnutrition is a major public
health concern affecting a significant number of school age children influencing their health, growth and
development, and academic school performance.

Objective: The objective of this study would to compare the nutritional status and associated factor in
the selected primary school children in the school feeding program beneficiary and non beneficiary
program, in Amibara District of Zone Three, Afar Regional State, Ethiopia in 2018.

Methods: A school based comparative cross sectional study design was conducted in the
randomly selected schools. Simple random sampling technique was used to select 679 subjects,
50.07% were from schools that implement the school feeding program and 49.9% were from
schools that do not implement the program. An anthropometric measurement of weight and height
was measured and analyzed by WHO Anthro-Plus 2007 software, Moreover, Epi-info version 7
used for the other data entry and SPSS version 16.0 was further analysis. Logistic regression
analyses were used to identify factors associated nutritional status of the school aged children. All
tests were two-sided and p < 0.05 was considered statistically significant in the final model.
Results: The prevalence of wasting among children in schools on the school feeding program
and non- school feeding program was 23.2%and 22.71% respectively. Between beneficiary and
non-beneficiary children, there were no statistically significant differences in stunting (31.5% vs.
26.3%) and thinness (23.2% vs. 22.71%) respectively. father’s and mother occupations, low
monthly income, large family size and Vitamin A were significantly associated with wasting.
Similarly, no farmland, age groups of 10-14 Years and family’s source of drinking water was
surface water were significantly associated with stunting.
Conclusion: Stunting and thinness were higher among children in schools on SFP than in
children in schools without SFP. Multi-sect oral nutrition intervention in the community and an
evaluation of the implementation of the school feeding programme is recommended for future
studies.

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 1. INTRODUCTION

1.1 Background
School age is the active growing phase of childhood. Primary school age is a dynamic period of
physical growth as well as the mental development of the child. Malnutrition is a major public
health concern affecting a significant number of school age children influencing their health,
growth and development, and academic school performance (1). Stunting (low height-for-age) is
acknowledged as the best indicator for child growth that indicates chronic under nutrition (2).
Children who are stunted have a reduced learning ability in school and poor scholastic
achievement (3).are more likely to repeat grades in school or drop out (4).and could increase the
risk that they do not complete primary education, Globally Under nutrition contributes to about 8
million children death worldwide (5). It is still a major public health problem in the developing
countries, especially in the Sub-Saharan Africa (6). Malnutrition among School age children in
rural areas of Africa and including Ethiopia has been linked to by poverty, morbidity, hygienic
practices, and family socioeconomic status, Factors such as walking long distances to school, lack
of morning meals and poor quality and quantity of meals consumed at home (6,7). study of
primary school children in pastoral and agro-pastoral communities, MiesoWoreda, Somali Region
reported by Abdulkadir et’ al (8) Stunting was significantly associated with place of residence,
sex, age, family size, source of drinking water, wealth tertiles and child food insecurity.
Meanwhile thinness was significantly associated with family size, the source of drinking water,
availability of latrine, household wealth tertiles, washing hands with soap after toilet, diarrheal
illness and child food insecurity. Malnutrition in school-aged children can result in delayed
maturation, deficiencies in muscular strength, work capacity, reduced bone density later in life
and school performance. Studies from different regions of Ethiopia showed that the prevalence of
stunting ranges from 9.8- 48.1% and wasting 23.3- 50% among school children Childhood under
nutrition imposes significant economic costs on individuals and nations, and that improving
children’s diets and nutrition can have positive effects on their academic performance and
behaviors at school as well as their long-term productivity as adults (9). Malnutrition and lowest
literacy rates, highest school dropout rates and furthest distance to schools were found in
emerging regions like Afar are a negative impact on the children’s educational achievement.
Hence the government has implemented a program to support those food insecure households
with food security and productive safety net programs. This in turn helps those children in food

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insecure areas and vulnerable households secure access to education, where malnutrition no
longer affects their performance, and to ensure the achievement of universal access to education.
Climate variability in Ethiopia has increasingly been the source of droughts and floods. Impacts
of climate change could potentially limit progress, such as full education enrollment (10).

Ethiopia is one of the poor countries where hunger has been a major barrier to child education.
The country has historically experienced severe famines, often in drought affected rural areas.
Households in such areas usually find it difficult to feed the entire family since own production of
food falls short of the demand in the household. Consequently, even children need to engage in
some kind of activities to generate livelihood for their households. Thus, many primary
school age children in food insecure areas remain out of school (11). In order to mitigate
hunger and its subsequent effect on nutritional status and development of SAC, school feeding
programs (SFP) has been established. Globally, the World Food programme (WFP) has been very
instrumental in implementing school feeding programmes. School feeding programs (SFP) as an
intervention contribute to improving the nutritional status of SAC by eliminating hunger in the
short term known as Food for Education program (FFE), is one such intervention that aims to
address some of the nutrition and health problems of school-age children (12).

School feeding was introduced in Ethiopia in 1994 with technical and financial support from the
WFP with an initial pilot project covering 40 primary schools in selected zones of four
different regions (13).As of 2012, the total beneficiaries reached 649,188 in food insecure
areas of six regions with more than 1186 primary schools and alternative basic education
centers (ABE) assisted(14). Accordingly SFPs are expected “ to raise and maintain school
enrollment with a particular focus on meeting the demand side of education of chronic
food insecure andvulnerable children‟(15).

In Ethiopia the School Feeding Program Provide SF for each entitled child approximately 650
kcal (kilo calorie) per day in the form of Porridge. The food is prepared inside school
premises by community paid cooks and the ingredients often used are Corn Soya Blend (CSB)
mixed with a small amount of vegetable oil and salt, fortified with selected micronutrients (16).
In pastoral and semi-pastoral areas, a special focus has been given for girls through the “Girls
Initiative”, an initiative to support girls with monthly rations of 2 liters of vegetable oil, subject to
80 percent class attendance (17).

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 1.2 Statement of the Problem
In 2010 according to WHO, the global prevalence of malnutrition among school-age children (5-
14 years old) as indicated by the prevalence of stunting, was approximately 28% (171 million
children), with Eastern Africa suffering a higher rate of 45% (18). In Ethiopia, school age
children under nutrition continue to be a major public health problem (19). Local studies show in
Ethiopia also indicated that under nutrition is a major public health problem. In 2015, about 31%
of the school children were undernourished out of which 19.6% were stunted, 15.9% underweight
and 14.0% wasted (21,20). The determinants of nutritional status of school-age children is include
household factors such as social-economic, demographic as well as individual characteristics.
Higher prevalence of under nutrition among primary school children have been associated with
poor food intake either at home or at school, poverty, poor sanitation, low education status of
parents together with prevalence of diseases (7, ,22,23,24) and it is evident that a significant
percentage of school age children suffer from under nutrition and that if there will be no nutrition
intervention to address the problem among school age children, it is estimated that by 2020 one
billion of children will be mentally and physically impaired (20). Also, poor nutritional status
among school going children results to morbidity, mortality, poor cognitive development, poor
performance and poor attendance in schools (4).

Even though different strategies, policies and nutrition programs were tried to solve the
malnutrition related problems both at global and national levels, under nutrition among school
children is still a public health problem. On the other hand, the interventions and evidences were
merely focusing on the nutritional status of under-five children (25, 26,)as well as due to little
attention given to know the magnitude of stunting and wasting among school age children and
insufficient documented information on the nutritional status of school children, understudied,
(27) the children might by far the most commonly affected group (28).

The School feeding programs (SFPs) intend to alleviate short-term hunger, improve nutrition and
cognition of children, and transfer income to families. However the effects of SFP on nutritional
status outcomes of school children remain debatable. Some studies have failed to witness the
significant effect of SFP on class attendance rate (29). Especially The food provided is not
designed to address specific energy and nutrient needs at this age. Nutrition needed in order to
overcome the problem that the students are facing such as hunger and wasting, stunting was not
analyzed.

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Most of literature on the impact of school feeding program me has shown varied outcomes, For
instance, impact on school enrolment and attendance has been conclusive (12,30). However,
nutritional status of school-aged children receiving school-fed children has been inconclusive
(13, 31, 32, 33).The basis of this study was to identify the nutritional status of school children and
the risk factors as well as their relative contribution to the malnutrition school feeding beneficiary
and none beneficiary, as well as the end users governmental and non-governmental organizations
will be take intervention measures and set appropriate plans to tackle the existing nutrition and
health problems. Moreover the study would be expected to provide information to fill the gap
concerning severity of school children malnutrition both in the regional and country. Therefore,
the study was investigating on to assessment the nutritional status and Associated Factor of school
feeding children beneficiary students in the selected primary school Amibara district of Zone
Three Afar Regional State, Ethiopia in 2018.

1.3 Significance of the study

Since poor nutrition is associated with physical and mental retardation among school children and
that rapid growth mostly occurs at this age; it is important to know and address nutritional status
among school children age (7-14 years) and its associated factors. Afar Region has no information
on nutritional status of school age group and unknown is whether the intervention resulted in
significant changes in nutritional status when compared with other non school feeding children
that intervention school children, therefore this study aim serves as an input in the government,
non government school feeding program for policy makers, and international organization in
relation to school feeding program and non school feeding program students. Besides, it provides
a base line for regional & national researchers, international NGOs and donors to make further
researches in pastoralist areas in accordance school children nutritional status with school feeding
program. Furthermore, the study will contribute to the works that have been done in pastoralist
areas regarding the school children nutritional intervention on specifically in Ethiopia as well as
in Afar region, by provides the gap and use the findings in strategic planning for those who are
planning to give school feeding program. At last but not least, it contributes for better
understanding about school feeding program on school children nutritional status to the
community, donors and local governments and will enable to have a baseline to design school
feeding program related strategy, framework and projects.

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 1.4 Literature Review

1.4.1 Nutritional status of school age children on school feeding and non-school
feeding program
School age is the active growing phase of childhood it is a dynamic period of physical growth as
well as of mental development of the child (19). It is a period of rapid growth in human
development when nutritional demand is increased and dietary habit is established. It is also the
prime time to build up body stores of nutrients in preparation for rapid growth of adolescence.
Nutrition plays a vital role, as inadequate nutrition during childhood may lead to malnutrition,
growth retardation, reduced work capacity and poor mental and social development (34).
Pervasive Under nutrition is still a worldwide problem as it is reported to be high in different
countries. For example in India, child malnutrition among school going children is responsible for
22% of the countries burden of disease (35).

In Bangladesh, under nutrition is a problem affecting many parts of the country and it is the main
cause of morbidity and mortality among children whereby a very high (43%) proportion of the
children were stunted while 20% were wasted (36). Stunting, wasting, and underweight are
significant public health problems affecting school children worldwide.

According to Vipul (37) reported that wasting and stunting among school children was 12% and
13% respectively. It was reported further that 27% of males and 25% were under nourished, and
that high magnitude of wasting signifies the prevalence of chronic and acute chronic types of
under nutrition (37).

According to Adeladza, (38) about 39.5% of school age children were found wasted and 51%
were stunted. In the study school children aged 5-7 years were found to be most affected, and that
under nutrition was associated with poor caregivers’ level of education and consumption of less
than three meals per day. In this regard, the study recommended for the efforts to be directed
towards education of caregivers and an increase of frequency of meals intake per day in order to
have positive impacts on nutritional status of school children in this area.

According to Ministry of Education, school-age children in Ethiopia are affected by a wide range
of health- and nutrition-related problems that constrain their ability to thrive and benefit from
education. According to a study by the Ethiopian Ministry of Economic Development and
Cooperation, 50% of the Ethiopian population are living below the food poverty line and cannot
meet their daily minimum nutritional requirement. As such, children are particularly vulnerable to

5
malnutrition because of low dietary intakes, inequitable distribution of food with in the
household, improper food storage and preparation and infectious diseases. The nutritional status
of an individual is often the result of many inter- related factors (39).In Ethiopia, little is known
about the magnitude of undernutrition in this older children, studies conducted in Addis
Ababa indicated 31% of school age children were undernourished (20).

Another cross sectional study showed the prevalent of under nutrition among school age
children in South West Ethiopia, 40.2% and 28.2% of children were stunted and underweight
respectively(40). Also revealed Study conducted School-Aged Children of Fogera District,
Northwest Ethiopia, revealed high under nutrition found with the prevalence of wasting at 37.2%
and stunting at 30.7% among in Rural Primary School Children (41).

A Cross-Sectional Study conducted School-Aged Children Felling Hunger at School Were at a

Higher Risk for Thinness in Kersa District, Eastern Ethiopia: Thinness affected 11.6% (95% CI
10.1-13.1) of schoolchildren; of these 1.9% had severe low BMI for age (< -3 SD of BMI for age
z-score) (42). Due to This burden particular study conductor school age children suggests school
interventions. Adequate nutritional status has positive impacts on cognitive development and
learning capabilities among school children. Various studies have provided enough evidence of
the importance of proper nutrition on the cognitive development of an individual, and which also
affects one’s education achievements. According to Zenebeet”al the study was conducted School-
based comparative cross-sectional in Sidama Zone, Boricha district, Southern Ethiopia, the SFP
has improved the dietary diversity as well as the mean BMI-for-age z-score and the mean HAZ of
the beneficiary students was significantly increased as compared with that of the non-
beneficiaries.(43).

The study reveals that “since child nutrition, child health and schooling reflect household
preferences in human capital investments in the child; they might be correlated without any direct
causal relationship between them‟ (44).

Another study also shows that school feeding programs can improve health by reducing morbidity
and illness and hence attract children to school (45). However there are conflicting arguments as
the supplement of food not sufficient to improve the children nutrition’s status rather crucial to
alleviate short term hunger. An evaluation of the impact of the Bangladesh SFP reported that even
poor household was not replacing the snacks children ate at school with home foods (46). This
may be a result of the snack provided and not a meal. SFP meals can increase dietary intake of
children by 30 to 95% (46). It can also increase nutrient intakes, Study among 320 Kenyan

6
primary pupils, it was observed that participants had a higher intake of energy (2089 ± 12.41 kcal
vs. 1841 ± 15.68 kcal) and protein than non-participants (47). In Ghana, Martens(48).Observed
that GSFP increased the dietary diversity scores (DDS) of the participating children by 1.0 ± 0.8.
Nutritional Status although earlier malnutrition cannot be reversed by school Feeding (49), there
is evidence to suggest that meals provided in school improve nutritional status. Evaluating the
impact of school feeding on nutritional status of school children, it was reported that Body Mass
Index increased by 0.62points of participants than controls (46).

A study among Kenyan primary 5 and 6 pupils in schools with or without SFP revealed that
participants were less likely to be undernourished (8.1% BAZ scores of participant’s verses
16.3% of non-participants and 30% stunted participants against 53.1% of non-participants (47).a
recent study by Danquah et al., (50), found 52.2% of primary 5 pupils who were participants and
nonparticipants of GSFP in Ashanti region to be stunted and 46.5% of them were underweight.
However in Ghana, unlike the Kenya study (47), SFP did not contribute to nutritional status of
participants (50).

Other recent study show (2018) in Denkyebour district of Ghana, the prevalence of wasting was
two times higher (9.3%) among children in schools on the SFP than in children in schools that do
not implement the SFP (4.6%) (51).

According to Bundy position it if food for education is one of the better investments in improving
nutrition (49). Despite new evidence indicating favorable externalities to siblings of students, and
the clear benefit in addressing hunger in schoolchildren, the answer there is no reliable evidence
to prove that nutrition interventions through food for education interventions are the most
effective, or provide the best ‘value for money’, on improving educational outcomes. However,
nutrition and health interventions for preschool and school-age children are often part of a
continuum of supportive programs of which food for education is just one component. Through a
life-cycle approach, from maternal and child health during fetal development and infancy, to early
child development, through pre-school and school, these combinations of interventions do serve a
purpose. There are compelling arguments that school health and nutrition programs should be
mainstreamed into education by making school health and nutrition an integral part of a sector-
wide education approach. Another studies show that food alone does not guarantee improved
nutritional status. For example, a study in Ethiopia found that differences in food availability and
access had limited effect on the differences observed in child nutritional status (52). This could be
because a child’s nutritional status is a function of not only the quality and quantity of the dietary

7
intake but also a function of morbidity, child caring and feeding practices, and household
variables such as income and parental education. Further, in developing countries, poor health
status of children is exacerbated by poor and inadequate: health facilities and services,
immunization, safe water and sanitation, and health education programs. Some reviews even
show that food-based interventions alone have little measurable impact on nutritional status,
morbidity or mortality levels except in crisis situations (53). Nevertheless, there is evidence from
school feeding program evaluations that some programs do improve children’s nutritional status.
For example, a randomized, controlled trial of giving breakfast to undernourished versus
adequately nourished children studied in Jamaica showed positive results: compared to the control
group, both height and weight improved significantly in the breakfast group (54). Studies have
shown improvements in IQ, immunity to illness, height and weight among school feeding
participants children (4). And also insufficient vitamin A intake suggested a risk for vitamin A
deficiency, which is involved in morbidity linked to diarrhea and measles, in growth retardation
(55). According to Buhl (56), wasting and stunting are important nutritional problems that persist
among School age children in developing countries including Sub-Saharan Africa. In a pre-
intervention baseline assessment of primary school children 6 to 9 years in Suba District in
Kenya, 30% of the total sample size surveyed was stunted (57). Also, in Nigeria, the national
prevalence of underweight has been reported to be 80% among primary school pupils
(FME/UNICEF), 2008 cited in Hassan et al (58), A study that assessed the nutritional status of
394 primary school children aged 7 to 11 years in Nigeria reported that about one half of the
children were underweight and 43% of them were stunted (58). Other studies have also reported
PEM among SAC, In Boirahmad rural areas, Iran, an assessment of 544 school age children
revealed that 15.7% of them were stunted,12.5% of them were underweight and 3.6% were
wasted (59).Moreover, in Ethiopia the true picture and extent of the burden is still lacking since
not much is documented in detail yet specially to know the prevalence of school age children in
school feeding beneficiary. This study would be designed to address this gap by providing
information on the nutrition status and associated factor burden among schoolchildren.

1.4.2 Associated factor of nutritional status

1.4.2.1 Socio-Demographic and economic status

Nutritional status of children does reflect the socioeconomic status of the family and social
wellbeing of the community on a whole (60). There is also an association between a place of
resident and nutritional status of an individual. For example, geographical location of either rural
areas or urban localities exposes children to the risk of malnutrition; this is because urban people
8
are more exposed to poor environmental conditions (overcrowding, poor quality drinking water,
sanitation and accumulation of uncollected waste). In rural areas, over ignorance and difficult
living conditions are likely to result in improper food habits, low awareness of health care use and
hygiene (60).The surrounding environment which is sometimes influenced by socioeconomic
status also affects the nutritional status of SAC (60). According to Srivastava et al., (60), reported
that mothers’ educational status was a strong predictor of child nutritional status. Among Iranian
SAC, mothers and fathers without formal education have been reported to have more stunted
children (pvalue<0.05; Malekzadeh et al.(59). in this study had Unemployed caregivers more
stunted children than employed caregivers. It has also been established that there is an inverse
relationship between household income and nutritional status (60).

In a study among Nairobi SAC, (61) found that household with low incomes have more stunted
children than those with higher incomes (p=0.025).And Household monthly income is significant
when it comes to access to food, health care and housing facility. It has been reported that SAC
living in poor quality houses such as non-permanent rooms were more likely to be
undernourished (62). Also, According to Malekzadeh et al., (59) found a significant relationship
between caregiver’s occupation and stunting among rural Iranian SAC. study of primary school
children in pastoral and agro-pastoral communities, MiesoWoreda, Somali Region reported by
Abdulkadir et’ al (8) thinness was significantly associated with family size, the source of drinking
water, availability of latrine, household wealth tertiles. Another Study show according to
Zenebeet”al the study was conducted School-based comparative cross-sectional in Sidama Zone,
Boricha district, Southern Ethiopia, the socio-demographic variables, among SFP beneficiary
groups were significantly associated (P < 0.05) in maternal and father education, mother’s
occupation (43). Father's education is important because he plays more active role in certain
health-seeking decisions and household income in our social set up. It is another important
determinant and has a positive impact on child health and nutritional status. Usually father is the
main earner and decision maker of a family and so their higher level of education plays an
important role to ensure better nutritional status of children (63). also revealed in Addis-abeba,
The higher prevalence of undrenutrition with higher Children belonging to households with 6–8
members were high risks of children being under nutrition because the children in such families
will not have sufficient recommended amount of food required for their growth due to poor
distribution (20). A study conducted in Chronic under nutrition is prevalent among school age
children living in Aman sub-town, South-West Ethiopia, maternal occupation were major factors
associated with stunting in school children. (40).

9
 1.4.2.2 Dietary diversification
Dietary diversity is one of the most important factors that affect child nutrition & health outcomes
(64). All people need a variety of foods to meet requirements for essential nutrients, and the value
of a diverse diet has long been known. Individuals consuming more diverse diets are thought to be
more likely to meet their nutrient needs. Nutritional status of children is influenced by diet and
both under nutrition and over nutrition could be reduced by increasing the diversity of foods
available for consumption (65). Inadequate daily Vitamin A intake of food has been associated
with poor health and nutritional status (55). This is so because some nutrients may be lacking in
these type of diets. SAC, on the other hand need all nutrients in their right amount to promote
healthy growth. Whiles assessing nutritional status of 394 school age children in Nigeria, Hassan
et al., (58), detected a linear relationship between nutrient adequacy of a child’s diet and their
nutritional status. An important aspect of dietary intake is dietary diversity. According to FAO,
(66), dietary diversity reflects the nutrient quality of an individual’s diet. In a study of 4570 SAC
from Iran and India, it was reported that increasing dietary diversity scores (DDS) were associated
with higher BMI of children (65). Also, there was a positive relationship between height for age
z-scores and DDS (65).According to Zenebeet”al the study was conducted School-based
comparative cross-sectional in SFP and NSFP, the mean (±SD) of DDS among SFP non-
beneficiaries (3.5 ± 0.7) was significantly lower than the beneficiaries(5.8 ± 1.1) (p< 0.001) (43).

1.4.2.3 Infection and Diseases

It is indisputable that infectious diseases have an important and significant impact on the growth
of individual children. Diarrhoeal diseases and lower-respiratory infections have been particularly
implicated in this regard. Children with repeated illness are also at risk for nutritional problems
due to poor intake of nutrients, increased caloric demands or impaired organ function for
synthesis of nutrients (67). Food intake and disease are immediate causes of child under nutrition
(68). In the study Tanzania, found the prevalence of under nutrition among adolescent school
children at Kilosa; whereby boys were found to be more undernourished (25.4%) than girls
(15.7%), (69). Food and disease interacts each other to create a vicious cycle. Diarrhea and other
infectious diseases manifests in the form of fever affecting dietary intake, utilization and
absorption of nutrients which may results to under nutrition (70). In developing countries, studies
indicate that infectious diseases cause malnutrition and prevent children from achieving normal
growth.Study conducted In Bangladesh, under nutrition is a problem affecting many parts of the
country and it is the main cause of morbidity and mortality among children whereby 20% were
wasted (36). Study conducted cross sectional study conducted by Jennifer F. et al in Kenyan

10
preschool children indicate that under nutritional children had more malaria parasitemia (odds
ratio [OR] 1.98, P< 0.0001), high-density parasitemia (OR 1.84; P< 0.0001), clinical malaria (OR
1.77; P< 0.06), and severe malarial anemia (OR 2.65; P< 0.0001) than non-under nutritional
children (71). According to Abdulkadir et’ al (8) in primary school thinness was significantly
associated with diarrheal illness.

1.4.2.4 Environmental factors

Study which is conducted in Pastoral Community of Korahay Zone, Somali Regional State,
Ethiopia 2016, using unprotected well (AOR: 3.41, 95% CI 1.96, 5.93) as source of water supply
showed significant association with stunting (72). Mizan-aman town, bench maji zone Ethiopia,
also confirms that children whose drinking water is from a non-improved water source are more
likely to be stunted than children with access to an improved water source (73). Study conducted
in rural Somalia confirms that, toilet facilities availability had significant association with risk of
being stunted (AOR: 1.71, 95% CI 1.13-2.58).According to Ministry Of Education, 2012 the
majority of primary schools in Ethiopia have sanitation facilities, with 86% having some toilet or
latrine provision. However, the majority are traditional pit latrines and only 31% of school
toilets or latrines are classified as ‘improved sanitation’. Many schools lack adequately separated
facilities for boys and girls, as well as provisions for special needs and young age groups.
As a result of inadequate sanitation provision, only about half (49%) of all schools are considered
to be free from open defecation. Hand washing is equally vital to ensure a healthy school
environment for the school community. Only about one fifth of primary schools (21%) report
having hand washing facilities and only 5% have soap (74). According to Abdulkadir et’ al (8) in
primary school thinness was significantly associated with availability of latrine.

1.5 Conceptual Framework

The frame work describes the Nutritional status of the school children is the outcome of several
interrelated household and community factors which include food intake and infectious diseases.
Food intake, infectious diseases, source of water, toilets available, washing hands reflect
individual’s factors. Socio economic factors of the parents at a household level include
occupation and education level, and socio demographic factors which include child’s age, sex,
family size and walking long distances to school lack of morning meals at home. Out of home
food can be modified by school feeding programme, since SAC Individuals consuming more
diverse diets and to be more likely to meet their nutrient needs. Dietary intakes from the home are
also predicted by socioeconomic status and diseases status of SAC. Undernourishment leads to
impaired learning abilities and also lesser motivation both socially and psychologically to attend

11
 school on a regular basis. Therefore, Figure 1 reflects the relationships among factors and their
influences on children’s nutritional status in this study.

Socio-demographic Status
and Socioeconomic

 Age
 Sex
 Parental education
 Parental
Occupation
 Family size
 Family income Infection diseases
 Household wealth
 diarrhea, fever, cough and others

Environmental Health
Nutritional status condition;
(wasting and stunting)
 Source of drinking
water
 Latrine facility
availability
 Hand washing
Total Individual Dietary intake

 Dietary Intakes from the home and

 Out of home intake from School
Feeding Programme

Figure 1 conceptual framework of nutritional assessment and associated factors among

primary school children in school feeding program adopted from different
litratures(65,75,76,77)

12
 2. Objectives

2.1 General objective

• To compare the nutritional status and associated factors among children on school feeding
program and non- school feeding program in Amibara District, Afar Regional State, Ethiopia,
2018.

2.2 Specific objectives

 To determine the prevalence of wasting among selected school feeding program
beneficiary children and non-school feeding program beneficiary children.
 To determine the prevalence of stunting among selected school feeding program
beneficiary children and non-school feeding program beneficiary children.
 To compare the prevalence of Wasting and Stunting among selected school feeding
program beneficiary children and non-school feeding program beneficiary children.
 To identify factors associated with wasting among school feeding program children
beneficiary and non-school feeding program beneficiary.
 To identify factors associated with Stunting among school feeding program children
beneficiary and non-school feeding program beneficiary.

13
 3. Methods and Materials

3.1 Study area and period

This study was conducted in the Amibara woreda a primary school is located 280 km and 400 km
away from Addis Ababa and Semera cities respectively. It is one out of 34 woreda from Afar
National regional state in North East Ethiopia it is found zone 3 (geberesu zone) administrative
parts covers an area 3,994.00 square kilometer.

This study was conducted in Amibara Woreda is bordered on the south by Awash Fentale
woreda, on the west by the Awash River which separates it from Dulecha woreda to the southwest
then on the northwest by the Administrative Zone 5, on the north by Buromodaytu woreda, and
on the east by the Oromia Region. The total Population of the woreda by the year 2004E.C
estimated to be 80,050 in which 44,828 are males and 35,222 of them are females. Among this,
90 per cent of them encompass to a pastoral lifestyle

Amibara Woreda District has 18 primaries, 14 first cycle secondary and 19 Alternative Basic
Education (ABE), 4, secondary school and 2 Preparatory school which are owned by government.
In Amibara district 6893 children attend in Primay School, those the total primary schools where
school meals are served for 4339 children.

The study conducted from may, 2018 up to August, 2018 g.c.

The Study
Area
Amibara
Woreda

Figure 2 Map of the study Area Amibara Wored

3.2 Study Design
School based comparative cross-sectional study was employed.

14
 3.3 Source Population
All school aged students enrolled in the Amibara woreda in primary schools for the academic year
of 2017/18

3.4 Study Population

All School age children who enrolled in the four selected primary school in the 2018 academic
year.

3.5 Sample Unit

Children and their parents who are randomly selected from both two programme and two non
programme in the randomly primary schools (grade 1-8) in the 2018 academic year.

3.6 Inclusion and Exclusion criteria

3.6.1 Inclusion criteria:

 All elementary school children enrolled to regular program, in the randomly selected
primary schools (grade 1-8)

3.6.2 Exclusion criteria:

 Children who are physical deformity that height measurement.

3.7 Sample Size

Sample size was determined by double population proportion formula using Epi-Info Softwareversion.7.0.
by assuming prevalence of which comparative cross-sectional study was conducted the prevalence of
stunting and wasting were 11.5 and 22.9% respectively from a similar study done in Primary School
MiesoWoreda, Shinele Zone, Somali Region(8). Therefore, the sample size of this study were taken 22.9%
prevalence of wasting was assumed non-school feeding primary children and the prevalence of wasting of
school feeding beneficiaries were used 32.9%, to detect 10 % difference between the two study
groups(since there were no previous specific studies conducted among SFP children in primary
school), 5% type I error, 80% power, 10% non-response rate and the population allocation ratio between n
1 and n2:1:1 to get equal sample size the two study group. Based on the above assumptions each two
study group sample size were 335 participants.
Since total school children was less than 10, 000 which 6893 beneficiary of school feeding
program and non-beneficiary control group of school children, therefore used the correction
formula to determine the final sample size n,
nf= no/1+no/N
nf= 335/1+335/6893
nf= 319(each study group sample size).

15
By adding 10% non-response rate and the final sample size 350 was obtained for each beneficiary
and non-beneficiary school children group.

3.8 Sampling Procedures

There are 14 primary schools children in Amibara woreda District which was supported with the
contemporary WFP school feeding program during the last years and still in the 2018 academic
year. This study conducted on two of them; To select the study participant, the schools were first
stratified based on feeding or school feeding program and non school feeding program, schools
which were selected with simple random sampling method along with two other non supported
schools and by independently assigning 350students involved in school feeding program and 350
in non-school feeding. The number of school children from each school and grade included in the
study was determined by using proportional allocation (PPS) to size.Finally, Simple random
sampling system was applied to select the study participants from each grade and sex using the
respective class rosters for 2018academic year as the sample frame.In collaboration with school
directors and instructors a study subjects were informed the purpose of the study and
communicated to call their parents on scheduled dates. The parents’ of a study subjects were
further informed the purpose of the study and those who are gave their consent to participate in
the study were involved.

the main reasons for choosing and selected this site are it is offer potential accessibility to
compare data of my Study and both supported and non supported households have similar
characteristics (in terms of ; income, household head age and education level distribution,
livelihood, climate) .

16
 Figure 3 Schematic Presentation of sampling procedure

List of Amibara woreda

District Primary Schools

Stratify and SRS

4 primary schools in Amibara

woreda District
Proportional size

2 primary schools with 2 primary schools

SFP Two Population Proportion without

350 students 350 students

Bedhamo bonta(500) gedemayto(269)

sidhafage(750)
(753)

140 257 93
210

SRS

700

17
 3.9 Study Variables

3.9.1 Dependent variable

 wasting
 stunting

3.9.2 Independent variables

Socio-demographic characteristics, educational status of the care givers, school
performance/attendance status, socioeconomic status and family size, individual dietary intake,
health status (sickness in the last 2 weeks and type of illness (diarrhea, fever, cough and others)),
environmental factors (source of drinking water, availability of latrine at school and home, hand
washing practice at critical times).

3.10 Operational Definition

Stunting (Chronic malnutrition): It refers to height-for-age (HAZ) < -2 SD of median value of
the WHO Anthroplus, 2007 international growth reference (WHO, 2007).

Wasting/thinness (Acute malnutrition) : It refers to BMI-for-age (BAZ) < -2 SD of the median

value of the WHO Anthroplus, 2007 international growth reference (WHO, 2007).

Minimum dietary diversity (MDDS): Proportion of school aged children who received foods
from four or more food groups of the seven food groups over a 24-hour period preceding the
survey. The seven food groups used for tabulation of this indicator were as follows: cereals, roots
and tubers; legumes and nuts; dairy products (milk, yoghurt and cheese); flesh foods (meat, fish,
poultry and liver/organ meats); eggs; vitamin A-rich fruits and vegetables and other fruits and
vegetables (WHO, 2007)

3.11 Data collection procedure

3.11.1 Data collection tool, technique and procedure

The quantitative data were collected using structured Qafar’af version questionnaire via face
to face interview of the study participants. The primary data was collected from the
parents/primary caregiver of the index children. The structured questioner composed of socio-
demographic characteristics, educational status of the care givers, school performance/attendance
status, socioeconomic status and family size, individual dietary intake and DDS, health status
sickness in the last 2 weeks and type of illness (diarrhea, fever, cough and others), environmental
factors (source of drinking water, availability of latrine at school and home, hand washing

18
practice at critical times) of the students in the school feeding program were compared with the
students not in the school feeding program . Eight diploma graduate clinical nurses recruited as
data collectors supervised by four-degree graduate clinical nurses after three days’ training given
to both groups. The data were collected from May 02, to June 20, 2018.

3.12 Anthropometric measurements

3.12.1 Height
Height was measured using the standardized vertical seca 213 portable stadiometer measurement.
once with a Portable Height Scale to the nearest 0.1cm. The subject stand erect & bare footed on
the scale with a movable head piece & height will be recorded to the nearest 0.1cm. Procedure for
height measurements were as follows:

 The stadiometer were placed on an even, uncarpeted surface.

 The participant asked to remove socks and shoes
 The participant asked to stand with heels together, arms to the side, legs straight,
shoulders relax and head in the Frankfort horizontal plane.
 Shoulder blades, buttocks and heels had to be touching the measuring rod.
 The sliding headpiece then lowered upon the highest point of the head with adequate
pressure to compress the hair and the reading were taken.
 The height measurements read to the nearest 0.1cm and 2 readings were taken. An average
value was calculated from the 2 readings.

3.12.2 Weight
It was measured by Seca weighting scale. Instruments were checked daily against a standard
weight for accuracy. Calibration of the indicator against zero reading was checked before
weighing every child. Students were weighted in to the nearest 0.1kg in light clothes and no
shoes. When documents such as obtained from vaccination cards were available, school and
confirmed from their parents. they were used to determine the age of the children. In the absence
of documentation, a local seasonal calendar method was used by the team as they were trained on
how to assess age of the children.

The following method was used:

 The scale calibrated against zero reading was checked and also using a 1 kg weight and
measured correctly.

19
  The participant asked to remove socks and shoes as well as any additional clothing that
could contribute extra weight (i.e. jerseys, jackets, coats, sweaters).
 The participant asked to stand in the middle of the scale with body weight equally
distributed on both feet and with hands at their sides.
 The participant asked to stand flat footed; feet slightly apart in a relaxed position facing
the enumerator looking straight ahead.
 The participants stand still until the measurements were recorded and step aside from the
scale and wait for zero reading to appear on the scale for second measurement.
 The weight recorded to the nearest 0.1kg.
 The weight measurement carried out twice and an average value will be calculated and
recorded.
 All measurements taken twice and the average computed, if the two measurements differ
by one unit the measurement otherwise repeated.

3.12.3 Dietary diversity

The dietary diversity of children was assessed whether they had eaten the different food groups
from yesterday’s sun rise to today’s sun rise (24hours recall method) prior to the survey date
according to their mothers or caregiver’s responses. Then based on reports of their mothers or
caregivers, food items consumed by the children were grouped in to seven food groups. The seven
food groups were starchy staples (grains, roots, and tubers), legumes, nuts and seeds, vitamin-A
rich fruits and vegetables, other fruits and vegetables, egg, dairy products (milk, yoghurt, and
cheese); and flesh foods (meat, fish, poultry, and organ meats). Finally, dietary diversity score of
children was calculated out of the seven food groups. A child with a DDS of four and above was
classified as having good dietary diversity, otherwise classified as poor (66). The score range from
1-3 food group lowest dietary diversity group consuming. Medium dietary diversity (4-5 food groups) and
high dietary diversity (5-7 food groups) scores (66).

3.13 Data quality control issues

The English version of the structured questionnaire were translated in to the local language of
“Qafar’af” for demographic information purpose and later back translated to English by another
translator to assure the consistency of the questions. To ensure for accuracy and precision of
measurements, a data collector (Nurses) were trained in 3 days to administer the questionnaire
and to conduct anthropometry in a standardized manner. The weighing scale was calibrated with a
standard weight daily thought a data collection. Each day after data collection, the questionnaires

20
reviewed to ensure accuracy. Where responses will miss respondents was contacted by a follow
up visit or phone call to clarify responses.

The questionnaire was pre-tested on 35 individuals (10% of the sample size of the study) out of
the study similar setting to ensure clarity, ordering, consistency and acceptance. It was finalized
by making necessary corrections based on the results of the pre-test. Before data collection, clear
introduction on the purpose of the study was having given to respondents.

3.14 Data management and analysis

After the data collected, the quantitative data were coded, entered into Epi-Info version 3.1 and
then export to SPSS version 16, and cleaning and verifying. The World Health Organization’s
(WHO) Anthro plus software which is for the global application of the WHO reference 2007
for 5-19 years to monitor the growth of school age children was used to assess the nutritional
status of the children. Nutritional status of all the selected children was assessed by measuring
body height (cm) and weight (kg) which is compared with the WHO Growth Reference
(WHO, 2007). Two indicators were measured by this software: height for age and body mass
index for age. The indicators were used to calculated by Z-score for all children. HAZ, BAZ less
than -3SD shows severe stunting and severe wasting. HAZ and BAZ between -3SD to -2SD is
classified as moderately stunted and moderately wasted. Children with HAZ and BAZ between -
2SD to +1SD would be classified as normal height and normal body mass index. bivariate and
binary logistic regression analysis were performed. The crude odds ratio(COR) with 95%
confidence interval used to estimated the association between each independent variable and
the outcome variable. Variables with p-value<0.25 in the univariable logistic regression analysis
was considered in the multivariable logistic analysis. Adjusted Odds Ratio (AOR) with 95%
confidence interval was estimated to assess the strength of the association, and a p-
value<0.05 used to declare the statistical significance in the multivariable analysis. Variables with
p-value<0.05 in the multivariable logistic regression analysis were considered independent
predictors of dependent variable. An independent sample t- test were used to compare means of
the feeding and non feeding group, and statistical significance were assigned for p values less
than 0.05.

3.15 Research Ethics

The ethical approval and clearance was obtained from Research stream Review committee of
Samara University, College of Medical Science department of Public Health. Then Official letters
submitted to Regional and woreda education office; the Regional and woreda education office

21
was sent a formal letter to the Amibara Districts primary school. Verbal ascent was taken from
school age children parents. Before each interview, clear explanation was given about the aim of
the study is neither to evaluate the performance of the individual nor to blame anyone for
weakness but to gather information and opinions that may lead to eventual improvement in the
situation. Each respondent were assured that the information provided by her were confidential
and use the only for the purpose of research. School children who not volunteer to continue from
the beginning or from any part of the interview were respected right to do so. Privacy and strict
confidentiality were maintained during the interview process.

3.16 Dissemination of Results

After the study was completed, reports was submitted to Samara University, College of Health
Sciences, Department of Public Healthand AfarRegional Health Bureau, DistrictHealth Offices
Subsequently, attempts was made to present it on the annual and biannual meetings of Afar Heath
Bureau and other meetings and conferences in the region and publication in reputable journals.

22
 4. Result
4.1 Participant’s socio-demographic characteristics
A total of 700 study subject, from grade 1 to grade 8 were, the response rate was 679 (97 %). The
results of the survey obtained from 679 students presented as follows.

From the total of sample population 50.7% were Islam, 22.8 % were orthodox Christians, 5.0%
were Catholic and 21.5% were protestant Christians.

Out of 679 study subjects who responded to the interviews, 340 (50.07%) were enrolled in the
SFP School (Intervention Group) of which, 183 students were male (53.8 %,) and 339(49.9%)
participants in the non-SFP group (control Group), 173 (51.0%) were males. this indicates
gender composition study subjects is almost equal between the two groups are with nearly
comparable proportions in their nutritional status. A majority of both school feeding and non-
school feeding children 10-14 age category involved (63.8% and 65.8%, respectively).

Majority of the children who are the feeding program and out of the school feeding program had a
family size of greater than three, this can be an indicator that big family size might always has a
negative effect on nutritional status of the children when we see in prevalence of Wasting and
Stunting in two group based on family size.

Most of the children in the feeding program were living with their mothers only which 70
respondents, can be a major factor for poor nutrition status of the children because mothers are
not capable of fulfilling the basic need of their children as most of their occupation rate fall in the
category of 'other'. Most of the mothers, 188 (55.5 %) among non-beneficiary and 192 (56.4 %) of
the beneficiary groups, did not attend formal education. While the study revealed that school
feeding children of fathers of the respondents were 171(50.3%) and 161(47.5%) in the non-school
feeding children have did not attend formal education.

From the majority of mothers 165 (48.5 %) in school feeding children and 167 (49.3 %) in non-
school children were housewives. These communities are rural and housewives in this sense mean
they really did not do anything economically, but rather depend on their husbands. Even if they
did the proceeds will go to their husbands.

The education level of Father of school feeding children group was on the illiteracy level (25.3%),
had a primary school level (35.0%) and College and above (6.8%) whereas NSFP group was on
the illiteracy level, had a primary school level and College and above (25.1%, 36.6%, 7.7%

23
respectively).The education levels of caregiver are statistically significant for both groups of
school children.

A majority of school feeding and non-school feeding children caregivers 266 (78.2%) and 275
(81.1%), respectively, reported a household income of greater than 900 Ethiopian birr.

Most of Caregivers of school age children in the SFP and NSFP had Similar socio-demographic
characteristics except that the majority 154 (45.4%) of father of the SAC in the NSFP were in
government employed and whereas the SFP were 95(27.9%)government employed.

Table 1 Socio demographic characteristics of students both SFP and NSFP of Amibara District
Elementary schools

SF NF
N % F %
Gender Male 183 53.82353 173 51.0
Female 157 46.17647 166 49.0
Total
Age 5-9 Years 28 8.2 58 17.1
10-14 Years 217 63.8 223 65.8
15-19 Years 95 27.9 58 17.1
Total 340 100.0 339 100.0
Grade Grae 1-4 172 50.6 182 53.7
Grade 5-8 168 49.4 157 46.3
Total 340 100.0 339 100.0
Family Size < = 3 Persons 27 7.9 33 9.7
4-5 Persons 115 33.8 88 26.0
> 5 Persons 198 58.2 218 64.3
Total 340 100.0 339 100.0
Caregiver Type Brother Sister 5 1.5 6 1.8
Father 15 4.4 15 4.4
Grand Father 8 2.4 4 1.2
Grand Mother 11 3.2 11 3.2
Mother 70 20.6 39 11.5
Mother and Father 230 67.6 264 77.9
Uncle Aunt 1 .3 0 0.0
Total 340 100.0 339 100.0
Religion Muslim 144 42.4 200 59.0
Orthdox 87 25.6 68 20.1
Cathloic 23 6.8 11 3.2
Protestant 86 25.3 60 17.7
Total 340 100.0 339 100.0
Father Educational Can not read and write 86 25.3 85 25.1
Able to read and write 85 25.0 76 22.4
Grade 1-8 119 35.0 124 36.6
Garde 9-12 27 7.9 28 8.3
College and above 23 6.8 26 7.7
Total 340 100.0 339 100.0
Mother Educational Can not read read and write 131 38.5 125 36.9
Able to read and write 61 17.9 63 18.6

24
 Grade 1-8 127 37.4 109 32.2
Grade 9-12 15 4.4 31 9.1
College and above 6 1.8 11 3.2
Total 340 100.0 339 100.0
Father Occupation Pastoralist 41 12.1 62 18.3
Farmer 22 6.5 12 3.5
Agro pastoral 36 10.6 17 5.0
Government employer 95 27.9 154 45.4
Merchant 40 11.8 24 7.1
Daily labrour 106 31.2 70 20.6
Total 340 100.0 339 100.0
Mother Occupation House wife 165 48.5 167 49.3
Pastoralist 26 7.6 29 8.6
Farmer 6 1.8 1 .3
Agro pastoral 14 4.1 33 9.7
Government employer 31 9.1 37 10.9
Merchant 57 16.8 61 18.0
Daily labrour 41 12.1 11 3.2
Total 340 100.0 339 100.0
Monthly income Less than 600 Birr 36 10.6 26 7.7
600-900 Birr 38 11.2 38 11.2
Greater than 900 Birr 266 78.2 275 81.1
Total 340 100.0 339 100.0

4.2 Respondent’s parent/care giver socio -economic status.

Out of 679 study participants 511(75.3%), 324 (47.7 %), 380 (56.0%),112 ( 16.5%), 37(5.4%) ,
515(75.8%),225 ( 33.1%), 313(46.1%) , 263(38.7%), 44 ( 6.5%) and 130(19.1%) had access and
ownership to Electricity, Radio, TV, refrigerator, wired phone, mobile phone, cow , Goats Sheep
Camel and farming land set respectively (Table 3).The major sources of fuels used during the
cooking were wood 392(57.7%). The majority of the study households 383(56.4%) cook in their
separate room. In school feeding program ,the number of students who had access to Electricity,
Radio, TV, refrigerator, wired phone and mobile phone, set were 231 (67.9%), 126 (37.1%),
197(57.9%),62 (18.2%%), 10 (2.9%%) and 278 (81.8%%),respectively. Almost more than half of
the children parents /guardian of school feeding children 196 (57.6%) were use Wood for
cooking, 196(57.6%) of them were cooking in their separate room used as kitchen. While children
who are not involved in school feeding program parents/guardian who had access to Electricity,
Radio, TV, refrigerator, wired phone and mobile phone set were 280 (82.6%), 198 (58.4%),
183(54.0%), 50( 14.7%), 27(8.0%) and 237(69.9%), respectively. Almost more than half of the
children parents of non-school feeding children 196(57.8%) were use Wood for cooking,
196(68.4%) of them were cooking in their separate room, this indicates the similar type of fuel
does their house hold mainly used for cooking were woods and uses separate rooms of
parents/guardians of children in school feeding and non feeding program.
25
Table 2 socio economic status of parents of both SFP and NSFP Amibara Woreda
elementary school children ,Jan,2018(n=679)
School Type
School Non School Feeding
Feeding
Tot % Count Row N % Count Row N %
al
Do you have Yes 511 75. 231 67.9% 280 82.6%
Electricity? 3
No 109 64.9% 59 35.1%
Do you have No 214 60.3% 141 39.7%
Radio? Yes 324 47. 126 37.1% 198 58.4%
7
Do you have No 143 47.8% 156 52.2%
Television? Yes 380 56. 197 57.9% 183 54%
0
Do you have No 278 49.0% 289 51.0%
Refrigerator? Yes 112 16. 62 18.2% 50 14.7%
5
Do you have No 330 51.4% 312 48.6%
None Mobile Yes 37 5.4 10 2.9% 27 8.0%
Telephone ?
117f. Do you No 62 37.8% 102 62.2%
have Mobile Yes 515 75. 278 81.8% 237 69.9%
Telephone? 8
Do you have No 228 50.2% 226 49.8%
cow ? Yes 225 33. 112 32.9% 113 33.3%
1
Do you have No 203 55.5% 163 44.5%
Goats ? Yes 313 46. 137 40.3 176 51.9%
1
Do you have No 218 52.4% 198 47.6%
Sheep ? Yes 263 38. 122 35.9% 141 41.6%
7
Do you have
Camel ? No 321 50.6% 313 49.4%
Yes 44 6.5 19 5.6% 25 7.4%
Do you have No 251 45.7% 298 54.3%
farming land/ Yes 130 19. 89 26.2% 41 12.1%
1

4.3 Dietary history of the participants

According to the program standard, each SFP beneficiary student gets a 150 g of meal prepared
from wheat, corn or bean once a day from Monday to Friday. Majority school children on the

26
school feeding programme eat between 2 and 3 times their home in a day while those in schools
without the school feeding programme eat between 3 and 4 times their home in a day. On
average the SFP children consumed 2.37 (±.640) meals at their home per day , and when
including Mid-morning meal CSB among SFP , the average number of meals increased to 3.37
(±.640), corresponding to 1 CSB porridge per child per 1days. The mean (±SD) of meals eaten at
their home per day among SFP (including CSB) beneficiaries (3.37±.640) was higher than the
non-beneficiaries (3.28 ± .650). However the mean (±SD) of DDS among SFP beneficiaries
(1.57±.613) was lower than the non-beneficiaries (1.66 ± .656).

the breakfast intake the majority 251 (74.0%) of the non school feeding children were taking
breakfast at home in every morning before going to school than, While About a nearly half
146 (42.9 %) of school feeding programs students goes to school without eating breakfast.

The dietary intake of school children was mostly cereals, pulse, legumes and nuts and roots and
tubers, other fruit and vegetables than animal’s source food and green leafy vegetables. Majority
of the school meals were from plant origin and there is insufficient serving of quality proteins
which is most found in animal food sources. Students involved in SFP and nonschool feeding
program in the study were less likely to consume food groups such as meats, eggs, and vitamin A
rich fruits and vegetables.

27
 120
97.4 99.4
100 87.4 84.7
78.8
80 70.2

60
42.5
40 32.9 34.2 28.8
27.1
23.2 23.3
19.7
20 SFP children
NSFP children
0

Figure 4: 7 Food Groups consumed by children in the past 24 Hours

60

49.4
50
44 44.1 4570%

40

DDS school Fedding

30
DDS non School Fedding

20

10.3
10 6.5

0
Low 1-3 Medium 4-5 High > 5

Figure 5: DDS

4.4 Participants Incidence of ill health

Caregiver who said the past 2 week, had their child fallen sick within two weeks before the data
collection were 166 (48.8%%) of children in school feeding children and 100 (29.5%%) in non-
school feeding children. Thirty nine (11.5%) of children in school feeding children while 12.4%%

28
in non-school feeding children had episodes of diarrhea two weeks preceding this survey.
Common infection like diarrhea last longer and are more severe in malnourished children.
Seventy eight (22.9%) of children in school feeding children as compared to 18.6%% in non-
school feeding children had episodes of Malaria two weeks preceding this survey.

Fifty four (15.9%) of children in the school feeding and 10.3 % in non-school feeding children
parents said fever in their children. Malaria and other infections present symptoms such as fever.
Malaria being endemic in these communities could be the reason why in both groups mentioned
fever as the main ailment in their children. Malaria and fever significantly associated with wasting
among non-school feeding children.

4.5 Participants Sanitation and hygiene

All schools had latrine but none of them had hand washing facilities. In terms of latrine
ownership, 64.4 % of the beneficiary and 58.7 % of the non-beneficiary households had latrine.
About type of latrine both school feeding and non-school feeding households Morley used pit
latrine without slab 181 (53.2%) and 167 (49.3%) where as 105 (30.9 %) and 100 (30.9 %) of
them used open field respectively.

The main source of drinking water 88.2% % of school feeding children households and 70.5 % of
non-school feeding children households source their drinking water from protected sources such
as Tap water, protected spring. However, 11.2% and 28.9% of school feeding children households
and non-school feeding children households source their drinking water from unprotected sources
such as unprotected spring, pond, surface water and car trench.

4.6 Participants School performance

The school performance, drop out and repeat level in this study was measured by number of
school children who repeated classes and or who had dropped out of classes as well as The
students last semester average grade score. Generally students who had below (< 50) and above
(>=50) mean score from school feeding program were results children was 27.1% (n 92) and 72.9
% (n 248) respectively while from non-school feeding group, 85.5% (n 290) of them score above
mean score and small number of students score below mean score 14.5% (n 49) which also
indicate that more number of students from the feeding group score below mean score than non-
feeding group. School feeding program is not helps students to improve academic performance
rather drop out than non-school feeding program children.

Table 3: Feeding Characteristics,Health and Sanitation Practices of the respondent of both

SFP and NSFP Amibara Woreda elementary school Children,Jan,2018(n=679)

29
 School Type
School Feeding Non School
Feeding
Count Row N Count Row N
% %
Did you take you No never 146 42.9% 3 0.9%
any breakfast 2=Yes, 92 27.1% 23 6.8%
before going to sometimes (about
school? once a week)

3.= Yes, about 2- 71 20.9% 62

3 days a week 18.3%
4.=Yes almost 31 9.1% 251 74.%
everyday
Meal taken your <=2 Meal 62.60% 37 10.9%
home 213
>= 3 Meal 127 37.40% 302 89%
In the past 2 No 174 42.1% 239 57.9%
week, has your Yes 166 29.5%
child ever fallen 48.8% 100
sick?
Diarrhea 39 11.5% 42 12.4%
Malaria 78 22.9% 63 18.6%
Fever 54 15.9% 35 10.3%
Cough 201 59.1 181 53.4
Does your No 121 46.4% 140 53.6%
household have
latrine Yes 219 199 58.7%
64.4%
Does this latrine No 214 50.1% 213 49.9%
has hand washing Yes 37 24 7.1%
10.9%
type of latrine? Ventilated 3 0.9% 32 9.4%
improved pit
latrine
Pit latrine with 40 11.8% 14 4.1%
slab
Pit latrine with 181 53.2% 167 49.3%
no slab/open pit
Have no latrine?
1. Toilet 60 17.6% 83 24.5%
Where do you
2. Open flied 105 30.9% 100 29.5%
defecate?
What is your main Tap water 289 85.0% 234 69.0%
source of drinking Spring (protected) 11 3.2% 5 1.5%
water?
Spring 3 0.9% 3 0.9%
(unprotected)
pond 0 0.0% 20 5.9%
Surface water 35 10.3% 11 3.2%
Car trench 0 0.0% 64 18.9%

30
Have you ever No 317 51.0% 305 49.0%
drop out? Yes 20 5.8% 34 10.02%
Have you ever No 276 46.9% 313 53.1%
repeat class? Yes 60 17.64% 26 7.6%
School Pass 248 72.9 85.5
performance 290
result Fail 92 27.1 49 14.5

4.7 Nutritional status of all the school age children

From the total study population, 23.3% were wasted when Body Mass Index-for-age criteria was
used (7.5% severely and 15.8% moderately wasted). Stunting was 28.9% when Height-for-age
criteria was used (8% severely, 20.9% moderately stunted). According to WHO 2007, in older
children, that is, above 10 years, weight-for-age is not a good indicator as it cannot distinguish
between height and body mass in an age period where many children are experiencing the
pubertal growth spurt and may appear as having excess weight (by weight for-age) when in fact
they are just tall. BMI-for-age is the recommended indicator for assessing thinness, overweight
and obesity in children 10-19 years.

Table 4 :Anthropometric measurement of the all study sample

Degree of Stunting Wasting

Malnutrition

Freq. Percent Freq percent

Severe 54 8 51 7.5
Moderate 142 20.9 107 15.8
Normal 483 71.1 521 76.7
Total 679 100 679 100

4.7.1 Nutritional status for the School feeding group

When the data was analyzed independently for the two groups nutritional status, prevalence of
wasting among the feeding group was found to be 23.2% (9.7 % sever thinness and 13.5% were
moderately) 76.8 % were normal. The prevalence of stunting for the feeding group was found to
be 31.5% (7.9% severely and 23.5% moderately) and were 68.5% Normal.

Figure 6:prevalence of malnutrition for the school feeding group

31
 90

80 76.8
68.5
70

60

50
Stunting
40
Wasting
30 23.5
20
13.5
7.9 9.7
10

0
Severe Moderate Normal

4.7.2Nutritional status for the non feeding group

The prevalence of wasting for children who were not involved in the non-school feeding was
22.71% (5.31% severely and 17.4% moderately) and 77.29% were Normal.

The prevalence of stunting for the non-school feeding was 26.3% (8% severely and 18.3%
moderately) and 73.7% were Normal.

Figure 7: Prevalence of malnutrition for non school feeding group

32
 90
80 77.29
73.7
70
60
Stunting
50
Wasting
40
30
18.3 17.4
20
8
10 5.31

0
Severe Moderate Normal

4.8 Factors associated with nutritional status

4.8.1 Factors associated with wasting

The results of the final multivariate logistic regression model demonstrate that, father’s and
mother occupations, low monthly income and Vitamin A were significantly associated with
wasting among school feeding children.

In this present study revealed Children whose father had Agro pastoral, 71.3% were less likely to
be wasted compared to those whose Father Daily laborer in school feeding children [AOR=.287
CI= .088-.941 ] .

In this present study revealed Children whose mother had Agro pastoral, 5.78 times were more
likely to be wasted compared to those whose mother housewife’s in school feeding children
[AOR= 5.783 CI= 1.532-21.829 ].

Among the socio-economic variables, this presented study show caregivers who had get Less than
600 Birr in monthly were 2.85 times more likely to be wasted than those gets income greater than
nine hundred caregivers in school feeding children [AOR= 2.855 CI= 1.1-7.292 ].

In this present study revealed Children whose father had Agro pastoral, 71.3% were less likely to
be wasted compared to those whose Father Daily laborer in school feeding children [AOR=.287
CI= .088-.941 ] .

33
In this present study revealed Children who not ate vitamins A food containing, 50.8% times were
less likely to be wasted compared with those who ate vitamin A food containing in school feeding
children [AOR= .492 CI= .272-.892 ].

Similarly, big family size, poor family income and type of latrine were factors associated with
wasting in non school feeding group (Table 8).

In this present study revealed caregivers having large family size (>6) 13.216 times more likely to
be wasted than those households <= 3 members in the non school feeding children group. [AOR=
13.216 CI= 1.255-139.151].

In this present study revealed Caregivers who had Pit latrine with no slab, 80.3% times were less
likely to be wasted compared to those Caregivers who had Ventilated improved pit latrine in non-
school feeding children [AOR= .197 CI=.050-.775 ].

Table 5: Multivariate Results for socio Demographic and feeding factors associated with wasting in
SFP
Variables Wasting SFP COR (95%) Adjusted OR p-value
(95%CI)
Yes (%) No (%)
Father occupational
status
Pastoralist 10(2.9%) 31 (9.1%) .857(.373-1.966) .474(.147-1.524)
.210
Farmer 3 (.9%) 19 (5.6%) .419(.115-1.524) .328(.086-1.248)
.102
Agro pastoral 6 (1.8%) 30 (8.8%) .531(.200-1.408) .287(.088-.941)
.039*
Government employer 19(5.6%) 76(22.4%) .664 (.343-1.284) .653 (.312-1.368)
.259
Merchant 14(4.1%) 26(7.6%) 1.430 (.657-3.111) 1.133(.491-2.614)
.769
Daily laborer 29(8.5%) 77(22.6%) 1 1

Mother Occupation
status
House wife 30 (8.8%) 135 (39.7%)
1 1
Pastoralist 9 (2.6%) 17 (5.0%) 2.382(.969-5.857) 2.237(.728-6.873)
.160
Farmer 1 (3%) 5 (1.5%) .900(.101-7.987) 1.229(.124-12.214)
.860
Agro pastoral 6 (1.8%) 8 (2.4%) 5.783 (1.532-
3.375 (1.090-10.448)
21.829)
.010*

Government employer 10 (2.9%) 21 (6.2%) 2.143(.915-5.017) 1.842(.743-4.563)

.187

34
Merchant 17 (5.0%) 40 (11.8%) 1.912(.958-3.820) 1.712(.812-3.611)
.158
Daily laborer 8 (2.4%) 33 (9.7%) 1.091(.458-2.598) .953(.373-2.431)
.919
Monthly income
Less than 600 Birr 13 (3.8%) 23 (6.8%) 1.860(.890-3.887) 2.855(1.1-7.292)
.028*
600-900 Birr 6 (1.8%) 32 (9.4%) .617(.247-1.544) 1.060(.397-2.828)
.907
Greater than 900 Birr 62 (18.2%) 204 (60.0%) 1
1
Vitamin A
yes 35 (10.3%) 77 (22.6%)
1
no 46(13.5%) 182 (53.5%) .556(.333-.930) .492(.272-.892)
.019*
COR-crude odds ratio

AOR (adjusted odds ratio).

* P-value less than 0.05

Table 6:multivariate results for socio demographic,health history and feeding factors associated
with wasting in NSFP
Variables Wasting non Sfp COR (95%) Adjusted OR p-value
(95%CI)
Yes (%) No (%)
Family Size
< = 3 Persons 10 (2.9%) 23 (6.8%)
1
4-5 Persons 21 (6.2%) 67 (19.8%) .721(.296-1.755) 7.447(.616-90.088)
.114
> 5 Persons 46 (13.6%) 172 (50.7%) 13.216(1.255-
.615(.273-1.384)
139.151)
.032*

have brother and/ or

sister
Yes 68 (20.1%) 251 (74.0%) .331(.132-.832) .107(.011-1.019) .052

No 9 (2.7%) 11 (3.2%)
1 1
Father Educational
Cannot read and write 21 (6.2%) 64 (18.9%) .620(.241-1.597) .319(.021-4.914)
.413
Able to read and write 17 (5.0%) 59 (17.4%) .544(.206-1.438) .317(.022-4.561)
.399
Grade 1-8 25 (7.4%) 99 (29.2%) .414(.035-4.888)
.477(.190-1.196) .484
Grade 9-12 5 (1.5%) 23 (6.8%) .411(.116-1.448) .285(.016-5.040)
.391
College and above 9 (2.7%) 17 (5.0%)
1 1
Monthly income
Less than 600 Birr 8 (2.4%) 18 (5.3%) 1.465(.609 -3.527) 14.507(.801- .070

35
 262.619)

600-900 Birr 5 (1.5%) 33 (9.7%) .500(.187-1.333) 1.716(.258-11.401)

.576
Greater than 900 Birr 64 (18.9%) 211 (62.2%) 1 1

Do have Goat
Yes 33 (9.7%) 143 (42.2%) 1 1

No 44 (13.0%) 119 (35.1%) 1.602(.960-2.675) 2.451(.802-7.493) .116

Malaria
Yes 10 (5.5%) 53 (29.3%) .606(.273-1.347) .289(.078-1.063) .062

No 28 (15.5%) 90 (49.7%) 1 1

Age
5-9 Years 8 (2.4%) 50(14.7%) 1 1

10-14 Years 54 (15.9%) 169 (49.9%) 1.997(.891-4.475) 1.811(.472-6.940)

.386

15-19 Years 15 (4.4%) 43 (12.7%) 2.180(.843-5.637) 2.198(.336-14.372)

.411
Type of latrine
Ventilated improved pit 11 (5.2%) 21 (9.9%) 1 1
latrine
Pit latrine with slab 2 (.9%) 12 (5.6%) .318(.060-1.682) .507(.060-4.281)
.533
Pit latrine with no 35 (16.4%) 132 (62.0%) .506(.223-1.148) .197(.050-.775)
slab/open pit .020*

COR-crude odds ratio

AOR (adjusted odds ratio).

* P-value less than 0.05

4.8.2 Factors associated with stunting

Having farmland and television significantly associated with stunting among school feeding
children (Table, 9).

In this present study revealed Caregivers who had no farmland 2.009 times more likely to be
stunted than those Caregivers had farmland in school feeding children [AOR= 2.009 CI= 1.05-
3.841].

In this present study revealed Caregivers who had no television 51.3% were less likely to be
stunted than those Caregivers had television in school feeding children [AOR= .487 CI= (.264-
.901)].

36
Similarly, Age and who had uses the main source of drinking water (Surface water) significantly
associated with stunting among non-school feeding children.

In the current study it is found that children at age groups of 10-14 Years, 2.389 times more
likely to be stunting when compared with adolescent at age groups of 15-19 years among non-
school feeding children [AOR= 2.389 CI= 1.022-5.58].

In this present study revealed children whose family’s source of drinking water was surface
water were 4.3 times more likely to be stunted than whose family’s source of drinking water
was Car tanker among non-school feeding children [AOR= 4.3 CI= 1.035-18.247].

Table 7: Multivartate Results for household asset and feeding factors associated with stunting in
SFP
Variables Stunting SFP COR (95%) Adjusted OR p-value
(95%CI)
Yes (%) No (%)
Grade
Grae 1-4 49(14.4%) 123(36.2%) .756(.477-1.196) .664 (.395-1.117) .123

Grade 5-8 58(17.1%) 110 (32.4%) 1

Family Size
< = 3 Persons 11 (3.2%) 16 (4.7%) 1 1

4-5 Persons 32 (9.4%) 83 (24.4%) .561(.235-1.338) .648(.256-1.640)

.360
> 5 Persons 64 (18.8%) 134 (39.4%) .695(.305-1.583) .925(.378-2.262)
.864
Radio
Yes 46 (13.5%) 80 (23.5%) 1 1

No 61 (17.9%) 153 (45.0%) .693 (.434-1.108) .631 (.380-1.048) .075

brother
<= 2 Brother 89 (26.2%) 181 (53.2%) 1

3-4 Brother 16 (4.7%) 47 (13.8%) .692 (.372-1.289) .678 (.345-1.331)

.259
>4 Brother 2 (.6%) 5 (1.5%) .813 (.155-4.276) .835 (.143-4.859)
.841
have farming land
Yes 21 (6.2%) 68 (20.0%) 1
1
No 86 (25.3%) 165 (48.5%) 1.688 (.969-2.938) 2.009 (1.05-3.841)
.035*
have latrine
Yes 64 (18.8%) 155 (45.6%)

No 43 (12.6%) 78 (22.9%) 1.335 (.832-2.142) 1.290 (.748-2.225)

.360
wash hands with soap
after using the toilet

37
Not at all 35 (10.3%) 52 (15.3%) 1.471 (.787-2.749) 1.444 (.698-2.985)
.322
45 (13.2%) 122 (35.9%)
.806 (.456-1.424)
Sometime .663 (.359-1.224) .189

Always 27 (7.9%) 59 (17.4%)

1
Religion
Muslim 46 (13.5%) 98 (28.8%)
1 1

Orthodox 35 (10.3%) 52 (15.3%) 1.434(.824-2.494) 1.290 (.672-2.477)

.444
Catholic 4 (1.2%) 19 (5.6%) .449(.144-1.394 .570(.168-1.939)
.369
Protestant 22 (6.5%) 64 (18.8%) .732(.403-1.331) .669(.330-1.355)
.264
have Television
Yes 67 (19.7%) 130 (38.2%)
1
1
No 40 (11.8%) 103 (30.3%) .754 (.471-1.205) .487 (.264-.901)
.022*
COR-crude odds ratio

AOR (adjusted odds ratio).

* P-value less than 0.05

Table 8: multivariate results for Environmental and feeding factors with stunting in NSFP
Variables Stunting non sfp COR (95%) Adjusted OR p-value
(95%CI)
Yes (%) No (%)
Age
5-9 Years 18 (5.3%) 40 (11.8%) 1.923 (.813-4.546) 2.580 (.984-6.766)
.054
10-14 Years 60 (17.7%) 163 (48.1%) 1.573 (.765-3.2320 2.389 (1.022-5.58)
.044*
15-19 Years 11 (3.2%) 47 (13.9%) 1 1

The main source of

drinking water
Tap water 58 (17.2%) 176 (52.2%) 1.077 (.562-2.062) 1.092 (.55-2.152)
.799
Spring (protected) 2 (.6%) 3(.9%) 2.178 (.332-14.27) 1.870 (.280-12.45)
.518
Spring (unprotected) 1 (.3%) 2 (.6%) 1.633 (.138-19.29) 1.581 (.120-20.8)
.728
pond 7 (2.1%) 13 (3.9%) 1.759 (.594-5.20) 1.799 (.493-6.570)
.374
Surface water 6 (1.8%) 5 (1.5%) 3.920 (1.047-14.7) 4.3 (1.035-18.247)
.045*
Car tanker 15 (4.5%) 49 (14.5%) 1 1

wash your hands with

soap after using the
toilet
Not at all 19 (5.6%) 35 (10.3%) 1.598 (.811-3.145) 1.292(.528-3.163)
.575

38
Sometime 35 (10.3%) 112 (33.0%) .920 (.536-1.577) .828(.473-1.452)
.510
Always 35 (10.3%) 103 (30.4%) 1 1

Eggs
Yes 16 (4.7%) 63 (18.6%) 1 1

No 73 (21.5%) 187 (55.2%) 1.537 (.834-2.834) 1.357 (.707-2.60) .359

Vitamin A
Yes 25 (7.4%) 91 (26.8%) 1 1

No 64 (18.9%) 159 (46.9%) 1.465(.863-2.487) 1.214 (.685-2.15) .507

COR-crude odds ratio

AOR (adjusted odds ratio).

* P-value less than 0.05

39
 5. Discussion
5.1 Nutritional Status of children
The study sought to compare nutritional status of school age children (SAC) enrolled in schools
benefiting from the school feeding programme and those that do not for the purpose of identifying
which group has the higher rate of malnutrition. Anthropometric measurements of respondents
were taken to evaluate the nutritional status of the children and the indices that directly reflect the
socio-economic status of the family, health and social wellbeing of the population. Thinness and
stunting were the anthropometric indicators used to measure malnutrition in the children. Our
study found an over-all prevalence of 23.3% was wasted among the school children in the
Amibara District.

The prevalence of Wasting in this study higher than which Study conducted School-Aged
Children Felling Hunger at School Were at a Higher Risk for Thinness in Kersa District, Eastern
Ethiopia (42) Thinness affected were 11.6% However the prevalence of Wasting in this study
lower than in Northwest of Ethiopia, a study revealed Wasting (37.2%) was more prevalent
among SAC (41). The children who were stunting in this study accounted for 28.9% when
Height-for-age criteria was used (8% severely, 20.9% moderately stunted). This rate is
comparable to the prevalence of stunting was 30.7%, study conducted in the school children in
rural community of Fogera district, northwest Ethiopia done by Mekonnen et al, (2013) (41).
moreover this result an indicator that the prevalence of malnutrition among rural areas are higher
than in any urban country of Ethiopia areas even though the problem in both cases has its own
public health significance.

5.2 Difference in Nutritional status of children in the school feeding program and
non school feeding program
With regards our finding to wasting, a total of 23.2% children in the in the school feeding
program, higher than compared to 22.71% in the non school feeding program children , were
wasted. There was no a statistically significant difference between the two groups (p-value
0.733). The T-test statistic is .342 and the 95% confidence interval of the difference is between -
.053 and .075. The interval implying that there is no significant difference between SFP and Non
SFP children in terms of Wasting.

For children who were stunted (H/A), 31.5% were from school feeding program as compared to
26.3% in non school feeding program. Again there was no statistically significant difference
between the incidences of stunting in the two groups (p-value 0.134). There was no statistical

40
difference with respect to nutritional status of children in the school feeding program and the
control children. The null hypothesis of no difference between the two groups cannot be rejected.
Moreover the study showed that the food supplement has not made any impact as far as the
nutritional status of school feeding children concerned.

Generally our study found Surprisingly observed the prevalence of thinness and Stunting was found
higher among children in schools with the feeding programme than in those in schools without the feeding
programme which concur with result of a similar study done in the study done in the Nkwanta South
District, In comparing the prevalence among children in schools on feeding programme to
children in schools not on feeding programme, it was noticed that prevalence of stunting (63.0%)
and thinness (21.5%) was higher among children in schools on feeding programme compared
with 44.7% stunting and 18.5% thinness among those in schools not on feeding programme. (22).
another on the line with recent study show (2018) in Denkyebour district of Ghana, the
prevalence of wasting was two times higher (9.3%) among children in schools on the SFP than in
children in schools that do not implement the SFP (4.6%) (51). As well as a study in Ashanti
Region revealed that participating in SFP did not contribute to nutritional status of participants
(50). On the contrary to this study Whiles evaluating the impact of school feeding on nutritional
status of school children, it was reported that the average of Body Mass Index increased by
0.62points of participants higher than the average BMI, this represents a 4.3 percent increase
compared to the average BMI of schoolchildren in the control group (70). and a study conducted
in Kenya (47) reported that Children participating in the school feeding programme were less
wasted and stunted than children in the control group (8.1% BAZ scores of participant’s verses
16.3% of non-participants and 30% stunted participants against 53.1% of non-participants.
Another study show According to Zenebe et”al the study was conducted School-based
comparative cross-sectional in Sidama Zone, Boricha district, Southern Ethiopia, the mean BMI-
for-age z-score and the mean HAZ of the beneficiary students was significantly increased as
compared with that of the non-beneficiaries(43).

5.3 Factors associated with nutritional status (BAZ, HAZ)

5.3.1 Factors associated with low BMI for age (BAZ)

The results of the final multivariate logistic regression model demonstrate that, father’s and
mother occupations, low monthly income and Vitamin A were significantly associated with
wasting among school feeding children.

41
In this present study revealed Children whose father had Agro pastoral, 71.3% times were less
likely to be wasted compared to those whose Father Daily laborer in school feeding children
[AOR=.287 CI= .088-.941 ] . These findings surprising that these men who had Agro pastoral
consume in their households variability food rather have their children malnourished.

In this present study revealed Children whose mother had Agro pastoral, 5.78 times were more
likely to be wasted compared to those whose mother housewife’s in school feeding children
[AOR= 5.783 CI= 1.532-21.829 ]. However, these communities are rural and housewives in this
sense mean they really did not do anything economically, but rather depend on their husbands.
Even if they did the proceeds will go to their husbands. This finding inconsistent due to the fact
that financially empowered mother are more spontaneous to spend their income for the welfare of
the children, including their nutrition and seeking good medical care at the first sign of a child’s
illness (61).

Among the socio-economic variables, this presented study show caregivers who had get Less than
600 Birr in monthly were 2.85 times more likely to be wasted than those gets income greater than
nine hundred caregivers in school feeding children [AOR= 2.855 CI= 1.1-7.292 ]. This finding
Consistent with according to Zenebe et”al the study was conducted School-based comparative
cross-sectional in Sidama Zone, Boricha district, Southern Ethiopia, households who had low
monthly income is significant association with wasted (43).

In this present study revealed Children who not ate vitamins A food containing, 50.8% times were
less likely to be wasted compared with those who ate vitamin A food containing in school feeding
children [AOR= .492 CI= .272-.892 ]. This finding is inconsistent with the study done by FAO
and WHO (2005) jointly, Insufficient vitamin A intake suggested a risk for malnutrition (55).

Similarly, in this present study revealed caregivers having large family size (>= 6) 13.216 times
more likely to be wasted than those households <= 3 members in the non school feeding children
group. [AOR= 13.216 CI= 1.255-139.151]. this study findings was in line with finding of studies
done other finding reported by Degarege et’ al (20) and Abdulkadir et’ al (8), thinness was
significantly associated with Children belonging to households with >= 6 members were high
risks of children being under nutrition because the children in such families will not have
sufficient recommended amount of food required for their growth due to poor distribution.

42
In this present study revealed Caregivers who had Pit latrine with no slab, 80.3% were less likely
to be wasted compared to those Caregivers who had Ventilated improved pit latrine in non-school
feeding children [AOR= .197 CI=.050-.775 ].

Factors associated with low HAZ for age (HAZ)

In this present study revealed Caregivers who had no farmland 2.009 times more likely to be
stunted than those Caregivers had farmland in school feeding children [AOR= 2.009 CI= 1.05-
3.841].

In this present study revealed Caregivers who had no television 51.3% were less likely to be
stunted than those Caregivers had television in school feeding children [AOR= .487 CI= (.264-
.901)]. However this finding is inconsistent with according to Mekonen et al” was reported the
television uses as to be protective against stunting (42). This could be because families with
television might get better information on health and nutrition, feeding practices and care
for children.

Similarly, In the current study it is found that children at age groups of 10-14 Years, 2.389 times
more likely to be stunting when compared with adolescent at age groups of 15-19 years among
non-school feeding children [AOR= 2.389 CI= 1.022-5.58]. This is in line with a study done in
Mizan-Aman town, Ethiopia, Children within the age group of 10 to 14 is 1.8 times more likely to
be stunted than counterpart (40). however this study findings contrary to study done in meqnso
woreda primary school that stunting was significantly associated with age; 15 to 19 years old
children had higher odds to be stunted compared with 10 to 14 age groups (8).

In the present study revealed children whose family’s source of drinking water was surface
water (unprotected water source for drinking) were 4.3 times more likely to be stunted than
whose family’s source of drinking water was Car tanker among non-school feeding children
[AOR= 4.3 CI= 1.035-18.247]. The findings of study support the fact that unfavorable
environmental and personal conditions such as inadequate and unsafe water, poor sanitation,
and poor personal hygiene can increase the probability of infectious diseases and, in turn,
cause or aggravate malnutrition. This study consistent with the study done in meqnso woreda
primary school that stunting were significantly associated with the use of unprotected water
source for drinking (8).

43
Our results showed that there was no significant association of Children sex and caregivers
educational status with nutritional status. In the current studies which are different from finding in
other similar studies (42, 8.)

This presented study shows the mean (±SD) of DDS among SFP beneficiaries (1.57±.613) was
lower than the non-beneficiaries (1.66 ± .656). However, this result was inconsistent with other
cross-sectional studies conducted in the previous study, In Ghana, Martens (48), Observed that
SFP increased the dietary diversity scores (DDS) of the participating children by 1.0 ± 0.8 and
also according to Zenebe et”al, the SFP has improved the dietary diversity (43). The reason for
this might be most of Scholl feeding program children has skipped their breakfast in their home
and they are faced challenges of meal fed per week, like the porridge is served only three or four
times a week due to shortage or scarcity of resource of CSB. Also another reason is in this study
area population including Afar Regional population predominantly food consumption habit is
Cereals form an important part of the diet of many people, due to this reason their diversify food
score would be decrease both two groups.

5.4 Strengths and Limitations of the Study

5.4.1 Strength of the Study

It addresses the less studied & less focused as well as providing information on the nutrition status and
associated factor burden among schoolchildren.

5.4.2 Limitation of the Study

Cross-sectional design used in the study was not appropriate to establish a causal relationship
between provision of school meals and nutritional status (stunting and thinness). We could not
also estimate the effect of challenges facing the feeding programme such as missed and irregular
meals. Some limitations of the study could be the information about age of the children that was
obtained from school records might be underestimated. This may incur some information bias that
may have impact on the estimates of anthropometric indicators. Efforts were made to cross-check
the recorded age by asking the parents and some of the children.

This study does not address micronutrient deficiencies like anemia and vitamin A deficiency and
other morbidities (for example, dental caries), that are observed to be highly prevalent among
children. They are equally important as protein-energy malnutrition, but it is very costly and time
consuming. Further studies are required to explore the micronutrient deficiencies among school
children.

44
The available research on the prevalence of school age children in school feeding beneficiary is limited
in the study area setting so we are unable to compare the findings of this study with other studies.

45
 6. Conclusion and Recommendation

6.1 Conclusion
These results show that, in spite of improved food supplement from WFP, the nutrition of
children in the intervention area continues to be affected. the prevalence of acute malnutrition of
school feeding group children was found to be high compared to non school feeding children. The
nutritional status of the school children involved in the feeding program was not statistically
different from those who were not involved in the program. The available school feeding program
implemented in this study showed not shown any improvement or not positive effects on
reduction of prevalence of acute malnutrition, and degree of food diversity despite total dietary
intake and reducing drop out.

All School Feeding children engaged in 3 or more eating events on their home and school days,
however the majority of SFP children Dietary diversity score were below less than four food
groups or have poor dietary diversity habit this might lead the study subjects to poor nutrient
intake which in turn affects their nutritional status. The mean (±SD) of DDS among SFP
beneficiaries (1.57±.613) was lower than the non-beneficiaries (1.66 ± .656).

Results from this study indicate that most of the socio-economic characteristics, age and water
source related variables predict significantly nutritional deficits among SAC.

Factors living with in a large family size, employment status, household income, vitamin A, have
no farm land and no available latrine facilities significantly associated with nutritional deficits
among SAC. Conversely, sex and educational status not significantly associated to nutritional
status of among SAC.

An evaluation of the implementation of the school feeding programme is recommended for future
studies.

6.2 Recommendation
To reduce the prevalence of malnutrition among school children it is better to work on the factors
contributing for poor nutrition.

The available school feeding program is not sufficient enough to address most of the school
children who are in need of feeding. Moreover, the program is not sustainable to bring about long
term effect on the children's nutritional status. School feeding program should be considered as a

46
basic and an important way of improving the quality of life of school children and should be
consistent enough in order to deliver nutrition and energy dense food.

Fulfilling the need of school children nutrition is the basic requirement for having healthy and
productive citizens for the country. Therefore, it will be better if feeding program can be use
different widened and implemented approaches along with the primary school curriculum to
improve the nutritional status of school children.

The school officials should work with health sectors and families in order to improve health and
educational status of children.

Empowerment should be created to parents and communities to improve their economic status as
well as on the negative effects of undernourishment.

47
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53
ANNEX 1 Consent form
Consent form Title:

Under Nutritional status and Associated Factor of school children in Amibara Woreda District will be
involved in school feeding program; a comparative Cross sectional study

Principal Investigator: Habib Mohammednur Humed

Introduction

The nutritional status of children is a good indicator of health status of a community. School age is the
active growing phase of childhood, Primary school age is a dynamic period of physical growth as well as
of mental development of the child.

The consequences of malnutrition among school age children streams from severe undernutrition such as
underweight, stunted and wasted to over-nutrition. Poor nutrition and health among children have been
identified to contribute to the general inefficiency of educational systems world-wide.

Procedures

If you agree to participate, we will asking your students some basic information, measure their weight and
height by trained person.

Risks

From the assessment of nutritional status of the school children, there is no risk other than that students
will contribute their break time.

Benefits

There are no direct benefits to you or your child. However the results will possibly help others. Based on
the finding I will inform the authorized person and respective stakeholders to work on it

Compensation

There will be no financial compensation for participating

Participant Rights

If have said things that are not clear to you, you may ask me without any fear and I will give you answer
and explanation .you may feel free and ask questions. Your child participation in the study is entirely

54
volunteer and up to you to decide. There is no penalty if you don’t agree to participate. You can say no
without worry.

Parent’s right

You have the right to ask about anything that are not clear and I wish you could understand the whole
process and you may ask me without any fear and I will give you answer and explanation to you and
please feel free and ask questions as parent/guardian . Your child participation in the study is entirely
volunteer and up to you to decide. There is no penalty if your child or you don’t agree to participate. You
can say no without worry. The school administration on or all stakeholders will assist for your child or for
you as usual.

Confidentiality

By excluding names and other identifying numbers from the questionnaire confidentiality of
information will be assure. The nutritional status assessment results and any information about your
students will be kept confidential. Only the research team will have access to your students' information.
When I write a report, everyone's information will be put together so that information about your students
cannot be seen because your students will be coded.

Persons to contact:

If you have any questions, you can ask any time. If you have additional questions or any other concern
about the study, you may contact:

Habib Mohammednu Humed;

Phone Number; 09 25 22 87 65

If you allow your child to participate in the study? Thank youfor your cooperation!

VOLUNTEER AGREEMENT

The above document describing the benefits, risks and procedures for the research title Nutritional status
and Associated Factor of children benefited from school feeding program in selected elementary school,
Awash district primary school. The study has been explained to me and my questions have been answered
to my satisfaction. I agree to participate in this study.

____________________ ______________________________________________

Child’s name Name of child’s guardian/parent

____________________ _________________________________________

55
Date Signature or mark of child’s guardian/parent

ANNEX 2 Questionnaires (English Version)

Interview for students parents/Guardians

ID ----------------------------------

Date of Interview -------------------------------------------

Starting Time ------------------------------------------------

Ending Time ---------------------------------------------------

Name of Keble: ___________________________________

Name of school: ___________________________________

Status of School ___________________________________

A) Socio – Demographic Characteristics of the students:-

1. Sex 1. Female 2. Male

2. Date of birth…………………… Age in years……………………..

3. Grade ------------------------------

4. How many people including yourself, live in your household?

______ Number of people

5. Do you Have Brother and /or Sisters?

1. Yes 2. No if no skip for to number 7 quetsion

6. If yes how many are they?

Brother --------------- Sister ------------------

7. Your position ---------------

8. How do you go from your home to the school?

1. Take Taxi/Bus 2.on foot 4. Bicycle 5. Motorcycle

9. How long does it Time taken to reach school in minute?

56
10. Caregiver Type

1. Mother 2. Father 3.Mother and Father

4. Brother Sister 5.Grand Mother 6.Grand Father

7. Uncle Aunt 8. Other

11. Religion

Muslim Orthodox Catholic

Protestant Other

B) Educational level of caregivers

12. What is your father Educational Status?

1. Cannot read and write

2. Informal education

3. Grade 1-8

4. Grade 9-12

5. above grade 12

13. What is your mother Educational Status?

1. Cannot read and write

2. Informal education

3. Grade 1-8

4. Grade 9-12

5. above grade 12

C) Occupation of Caregivers

14. What are your father occupations?

1. Pastoralist
2. Farmer
3. Government employer
4. Merchant
5. Daily laborer
6. Other, specify

57
15. What are your mother occupations?

1. House wife
2. Pastoralist
3. Farmer
4. Government employer
5. Merchant
6. Daily laborer
7. Other, specify

16. What is your household average monthly income? [ ____ ] Birr

D) Socioeconomic status,

16. Tell me please what your house has from this?

1.Radio 1.Yes 2.No

2.Television 1. Yes 2. No

3.Refrigerator 1/Yes 2, No

3.None Mobile Telephone 1.Yes 2. No

4. Mobile Telephone 1.Yes 2. No

5. Cow 1.Yes 2.No

How many?

6. Goats 1.Yes 2.No

How many?

7. Sheep 1. Yes 2.No

How many?

8. Camel 1.Yes 2.No

How many?

17. What type of fuel does your house hold mainly used for cooking?

1.Electric 2. Kerosene 3.Charcoal Wood

18.Do You have a separate room used as kitchen?

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1.Yes 2. No

19. Did you take you any breakfast before going to school?

1. No never 2=Yes, sometimes (about once a week) 3.= Yes, about 2-3 days a week 3.=Yes almost
everyday

20. How many meals did you take at your home per day?

F) School feeding status of the children.

21. Are you involved the school feeding program

1. Yes 2. No If the answer is "no" go to Q 24

If yes.

22. When did you start using the program (years) ___________

23. How many meals are you given at school per day? ……………………………………

G. Health information of student

24. In the past 2 week, has your child ever fallen sick?

1= Yes 2= No never

If yes

25. If yes, what illness did you suffer from?

1=Malaria 2=Diarrhoea 3=Fever 4= Other (specify) __________

H. Personal hygiene and sanitation information student

26. Does your school have latrine (Confirmed by observation) ?

1. Yes 2. No

27. Do this latrine has hand washing (Confirmed by observation) ?

1. Yes 2. No

28.31. Does your household have latrine

1. Yes 2. No If the answer is "no" go to Q31

29. 32. Does this latrine has hand washing

1. Yes 2. No

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 30. If Yes for Q. 29 which type of latrine?

1 Ventilated improved pit latrine 2 Pit latrine with slab

3. Pit latrine with no slab/open pit 4.other specific

31. Where do you defecate?

1. Toilet 2. Open flied

32. What is your main source of drinking water?

1. Tap water 2. Spring (protected) 3. Spring (unprotected) 4. pond 5 Surface water 6 others if the answer
is "1" go to Q 33

33. How long does it take to collect water in round trip? _________times

34. How often did you wash your hands with before eating?

1. Not at all 2. Sometime 3.always

35. How often did you wash your hands with soap after using the toilet or latrine?

1. Not at all 2. Sometime 3.Always

I. Diet Diversity characteristics of students (7 food groups)

36. 24 Hour dietary Recall, Foods eaten preceding 24 hours? ): If at least one food from the food group has
been given between sunrise yesterday and sunrise today, if ‘Yes’ write 1 in the column below. If no food
has been given in the food groups, ‘No.’ write 2

Foods የምግብ ምድቦች

Home +school
Food Group 1.Yes 1.Yes
2. No 2. No
1 Grains, Bread, biscuits, cookies, Porridge, rice, noodles, pasta(macaroni), Injera,
roots and kita, nufea, or other foods made from grains oats, maize, barley, wheat,

tubers: White potatoes, white yams, Enset (false banana), cassava, or any other foods
made from roots

2 VITAMIN A Ripe mangoes, ripe papayas, or ripe melon፣ Pumpkin, carrots, squash, or sweet
RICH fruits potatoes that are yellow or orange inside

and Any dark green leafy vegetables like gomen, spinach, swiss chard etc

VEGETABLE
3 Other fruits Any other fruits or vegetables (like cactus pair, strawberries (Wild fruits?

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 and Tomato, onion, including wild vegetables?)
vegetables:

4 FLESH Any meat, such as beef, lamb, goat, chicken, camel or duck,
MEATS Liver, kidney, heart, tongue, brain, or other organ meats
Fresh or dried fish, shellfish, or seafood
5 Eggs Eggs
6 LEGUMES, Any foods made from beans, peas, lentils, nuts, or seeds
NUTS AND
SEEDS
7 MILK AND Cheese, yogurt, or other milk products
MILK
PRODUCTS

J. SCHOOL ATTENDANCE AND ACADEMIC PERFORMANCE

37. Have you ever drop out or repeat class?

1. Yes 2.No

38. If yes how many times? ____________________________

39. Have you ever repeat class?

1. Yes 2.No

40. If yes how many times? ____________________________

41. What was the performance of your end term results?

K. Anthropometry

Reading 1 Reading 2 Reading 3 Average

42. Weight ………… kg Height …………………… cm

Weight ………… kg Height …………………… cm

Weight ………… kg Height …………………… cm

IDDS (Children) 7 Food Groups

Grains, roots or tubers,

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 Vitamin A-rich plant foods,
Other fruits or vegetables,
Meat, poultry, fish, seafood,
Eggs,
Pulses/legumes/nuts,
Milk and milk products,

ANNEX 3 Questionnaires (Afar Version)

Barteenitih Dayyowte Essero

Kood

Essero Aben Ayro

Esserok Qeda Waq

Esserok Gab Kala Waq

Awda Migaq

Barritto Buxah Migaq

S.N Essero Gacssa Kor

Ayyuntiino Kee Maddur Oyta
A Barteeni(na) Caalata _______________
101 Nado 1. Labih 2. Sayih
102 Karma
103 Baritto Caddo
104 KooLuk Ku Buxah Addal Magide Takken?
SinamQadad
105 Tookobok Labim Kee Sayim Litoo? AalleW
1. Liyoh aytek
2. Mayyu 107
Hayto
esserok
fanah
kor
106 Teellek Magidey ? 1. Labim
2. Sayim

107 Makinhayto Baxa(Baxa) kinnitoo?

108 BuxaakBarittoBuxafanahMalafGexxaa 1. Iba
2. saykili

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 3. motor saykili
4. Baabuxu
109 Buxaa kea Baritto Buxa fanah Abta Gexo kok Beyta waqla Makina Minit minit
Takkee
110 Kallih Qarissam 1.Ina
2.Abba
3.Ina kee Abb
4.Tookobo
5.Aboyya
6.Kaxxabba
7.Ina maqanxa/qammi
8.Kalah
111. Diini 1.muslim 3.Kaatoolik
2.ortoxoksi 4.protestanti
5.kalah

B Buxa Marak Baritto Caddo

112. AbbakBaritto Caddo 1.kutbe keekiryaatiDuudesinnim
2. kutbe kee kiryaatiDuuda meri
3.1-8 Footima
4.9-12 Footima
5.jaamiqat keetohukirohbarittem
113. Inak Baritto Caddo 1.kutbe kee kiryaati Duudesinnim
2. kutbe kee kiryaati Duuda meri
3.1-8 Footima
4.9-12 Footima
5.jaamiqat kee tohuk iroh barittem
C BuxamarakTaama Caalat
114 AbbakTaama caalat 1.Dacarsittoh xiinaytu
2.buqre Abeyna
3. Dacarsittoh kee buqre Abeyna
4.Doolat TaamaAbeyna
5.Tellemo Abeyna
6.Ayro TaamaAbeyna
7.Kalah
115. InakTaama Caalat 1.Buxah Ina
2.Dacarsittoh xiinaytu
3.Buqre Abeyna
4. Dacarsittoh kee buqre Abeyna
4.Doolat Taama Abeyna
5.Tellemo Abeyna
6.Ayro Taama Abeyna
7.Kalah
116. Buxak Alsi culenta (maalul)
D BuxaMarak sigo Caalat
117. Tahaak Gubal tanimik mayliton? 1. Eletirik ayfaf
2. Radiyo
3. Baadal Taysabbi
4. Firiij
5. Qari silki
6. Mobayli
7.Laa(magid )
8.Qas Wadar(magid )
Maddullen

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 9.Illi (magid )
10.Gaala (magid )
11.Buqrea(magid hecactara)
118. Maaqo ixxi Alayyu Edde Abyaanam maca 1.Boco
2.Diyyi
3.Qado Gaaz
4.Koorana
119 Maaqo ixxa elle Alassa debuk Buxa litonu 1.linoh
2.mannu
200 Baritto Buxa gexxaamak focca kuraq kaltaa (takmee) 1.Makala(makma)
2.Ayyaamal1 Ayro Akmeh
3.Ayyaamal 2-3 Ayro Akmeh
4.Kulli Kalah(Akmeh)
201 BuxahAddal 1Ayrot MakinWaqdi maaqo takmeeni?
E Maaqixxi AdoobaWagsiisa Essero
202 Baritto Buxal Adoobisan Urrut tantoo 1.Yeey 3. Akume
2.Maan waytek
205 fan
kor
203. Adooba Qedmissem malaqooy Sanatal
204. BarittoBuxahAddal 1 Ayrot makina waqdi Adoobittan
F Barteenitik Qaafiyat Oyta
205 Tatre 15 Ayro Addat biyaakite Awki(Awka)Yani(tani) 1.Yeey Anee
2.mayan weyk
Aneeweek 207 fan kor 207
fan kor
206 Yenek (tenek) ma biyakah biyaakiteni 1.Bagi gero(bagu)
2.Andeero
3.Qaso(xagarniqna)
4.Kecuu
5.Kalah
G Saytunanii ke lea hagidi
1. Yeey
207 Barritto Buxal Daaco Qari Yanii (mablal tamixxigem) 2. mayan

208 Daaco Qari Gaba Kaqaylih Arac lee (mablal tamixxigem) 1.Yeey
2.miyan
209 Sin Buxal Daaco Qari litoonu 1.yeey Yenek
2.mayana 302 tan
kor
300 Daaco Qari Gaba kaqaylih Arac lee 1.yeey
2.mali
301 Daaco QariYenek ma Qaynatih Daaco Qariy litoonum 1.Qusba teknoloojit bicsen a
Daaoco Qari
2.Afti baxale yan Daaco qari
3.Afti baxa simi Daaco qari
4.Kalah
302 Ankeey Daaco Elle Abtaanam 1.Daaco Qari
2.Garbo
303 Auqu bea lee kacc geytanam Annikeey 1.Birka
2.Dacayri meqe Dara
3.Dalayri sinni Dara
4.Atqa
5.Gexa Daqar

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 6. Kalah
-Gacsi 1 kalihimik sugtek 304 fan
kor
304 Abqa lee kak baahan rikee kee sin buxa fan gexxa gacal waqlak makina
minit beyaa
1.kalqiseh maaxiga
305 Maaqo Takmeemik Afal Kulli sakuu Gaba Kaliqisak sugtee 2.waqdik teyna kalqisak suge

3.kulli waqdi kalqisak suge

306 Daaco Qarik tawqe waqdi Gaba saabunut kalqisak sugtee 1.kalqiseh maaxiga

2.waqdik teena kalqisak suge

3.kulli saku kalqisak suge
G Maaqo ixxi Adoobih Essero
Baxaabaxsa le maaqixxilagoogatahaakgubal tan maaqixxittek (24 saaqatih) Addat Dagtemlitoo
307 Caxamixukee, Ramida, Lagooga, 1.Yeey 2.Hina
Daabbo, qingiira, kitta,nuufe, Loko,Ruddi, Baasta,Makorrani, KaxxaDaro,
Gabru, Qasdoro, ossoxinah, Dinnichi kalah Ramlida Lagok Bicsan
Maaqixxittek
308 Bitamiin A le caxaaxuwak 1.Yeey 2. Hina
AlayteMango,Babbayye,Cabcabay,Dubbaay,Kaarootuy,SokkorDinnichiy,
Gommaanay,Salaatay,Kostaywnu
309 Kalah ten Caxaaxuwilagooga ,Basaltuy,Kaariqay,Injorriy,Muuz Kee 1.Yeey 2. Hina
Apil
310 Cadol agooga Wadaray,Gaalay,Laay,DarrahikeekullumtiCadooda 1.Yeey 2. Hina
311 Naala Ganano 1.Yeey 2. Hina
312 Kali Caxa Miritte Baaulilay loozu 1.Yeey 2. Hina
QatrayMisiriy,Shunburay,Salit,Talbay,Nuuguy
313 Can Kee Canti Kalot Canay, Facsen Canay Qittay, Risiyiy, wtanim 1.Yeey 2. Hina
H BarittoBuxalGeysimaanamKeeBarittoKattaf
400 BarittoTirgiqehTaaxigee 1.yeey Arrege
2Margaqiyyo weak
402 kor
401 Makina Sanataay
402 Barittol Raddeh Taaxigee 1.Yeey Arrege
2.Margaqiyyo weak
404 kor
403 MakinaSanataay
404 Ellecabo Sanatih Ximmo Kok Magideey
I XagarNabna
500 Qilsak1 Kg
Qilsak 2 Kg
Qilsak Kg
Deddarti 1 CM
Deddarti 2 CM
Deddarti CM

GAXXA GEY

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ANNEX 4 Advisor’s Approval Sheet
This is to certify that the Proposal entitled Nutritional Status and Associated Factor in school feeding
program beneficiary is submitted in partial fulfillment of the requirements for the degree of General MPH
with specialization in Awash district Primary School children in School feeding program to the Graduate
Program of the College of Medical Science and Public Health of Samara University has been carried out
by Habib Mohammednur

ID No: SU 09 01 39 34 under my supervision. Therefore, I recommend that the student has fulfilled the
requirements and hence hereby can submit the Proposal to the Department.

________________________ ________________ _____________

Name of Major Advisor Signature Date

________________________ ________________ _____________

Name of Co advisor Signature Date

Declaration

I hereby declare that this General MPH Proposal is my original work and has not been presented for a
degree in any other university and all sources of material used for this Proposal have been duly
acknowledged.

Name: ____________________

Signature:

Date:

This General MPH Proposal had been submitted for examination with my approval as Proposal advisor.

Name: ______________________________

Signature: _______________

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Date: _ ________________

67