Determinants and Regional Variations of Childhood Stunting among Under-Five Children in Ethiopia: A Multilevel Analysis of Mini EDHS Data, 2019

<title>Abstract</title> <p>Background Childhood stunting remains a major public health challenge in Ethiopia, with long-term consequences for health, cognitive development, and socioeconomic well-being. Despite ongoing interventions, substantial disparities persist across population groups and regions. This study aimed to identify the determinants of childhood stunting and assess regional variations among under-five children in Ethiopia using a multilevel logistic regression approach. Methods A secondary analysis of data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) was conducted. A total of 5,126 children aged 0–59 months with complete anthropometric measurements were included. Descriptive statistics were used to summarize participant characteristics and stunting prevalence. A multilevel logistic regression model with region-specific random intercepts was fitted to identify factors associated with stunting while accounting for regional clustering. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results The prevalence of stunting was 36.9% (95% CI: 35.6%–38.2%), with marked regional variation ranging from 14.3% in Addis Ababa to 51.4% in Tigray. Compared with children whose mothers had no formal education, those whose mothers had secondary (AOR = 0.52, 95% CI: 0.40–0.69) and higher education (AOR = 0.43, 95% CI: 0.30–0.62) had lower odds of stunting. Female children (AOR = 0.85, 95% CI: 0.75–0.96), children from rich households (AOR = 0.68, 95% CI: 0.57–0.82), and children born to mothers aged 35–49 years (AOR = 0.67, 95% CI: 0.48–0.95) were less likely to be stunted. The odds of stunting increased significantly with child age, peaking among children aged 24–35 months (AOR = 4.36, 95% CI: 3.43–5.55). Children who had never been breastfed were more likely to be stunted (AOR = 1.30, 95% CI: 1.02–1.66). Significant regional heterogeneity remained after adjustment for covariates. Conclusion Childhood stunting remains highly prevalent in Ethiopia and is influenced by maternal education, household wealth, maternal age, child age, child sex, breastfeeding practices, and regional context. Interventions targeting these factors and addressing regional disparities are essential to reduce the burden of stunting.</p>