Under-nutrition and its associated factors among under-five children across urban and rural settings of Ethiopia: a cross-sectional comparative study

Background: Under-nutrition is a major public health concern among under-five children, especially in low- and middle-income countries like Ethiopia. Despite the Ethiopian government’s efforts, it remains a pressing issue among children. Prior studies often overlooked the exploration of under-nutrition across different residential settings and failed to apply composite measures of under-nutrition. Therefore, this study aimed at assessing the prevalence of under-nutrition and its associated factors among under-five children in the urban and rural settings of Ethiopia, using a composite measure of under-nutrition. Methods: Cross-sectional data from the most recent 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) was used in this study. After appropriate data processing, a total of 4,935 single-birth children aged 0 to 59 months were included. Descriptive statistics were used to summarize the data, while a multivariable binary logistic regression model was employed to identify factors associated with under-nutrition among under-five children. Statistical significance was determined at the p-value < 0.05 for each predictor, and the strength of association was assessed using odds ratios with 95% confidence intervals (CIs). Result: In this study, the overall prevalence of under-nutrition among under-five children was 39.72% (95%CI: 38.35, 41.08), with 43.38% (95%CI: 41.80, 44.95) in rural areas and 27.56% (95%CI: 24.96, 30.15) in urban areas. Factors such as being female (AOR = 0.86, 95%CI: 0.75, 0.99), children having higher age, lower preceding birth interval, lower maternal age and education, low wealth status, region and lack of media exposure (AOR = 1.25, 95%CI: 1.05, 1.52) were significantly associated with increased likelihood of under-nutrition in rural areas. In urban areas, having lower maternal education (no education: AOR = 1.93, 95%CI: 1.11, 3.37; primary: AOR = 2.38, 95%CI: 1.45, 3.89), being in the higher age group, and larger family size (6+) (AOR = 2.25, 95%CI: 1.29, 3.93) were associated with increased likelihood of under-nutrition. Conclusion: In this study, high prevalence of under-nutrition was observed, with notable disparities between rural and urban areas. Various factors associated with under-nutrition were identified through residential settings. Therefore, concerned stakeholders should address under-nutrition by promoting income-generating activities, initiating educational programs, and running media campaigns on nutrition. Future policies must consider regional and rural-urban disparities to create targeted interventions among children.