Paste youYom Institute of Economic Development
Joint Master Program with Debre Markos University
Effect of Infant and Young Child Feeding Practice on Nutritional Status of Children age group of 6-23 months in Ethiopia: A Propensity Score Matching Analysis
Submitted by: Tolesa Regasa
Advisor: Dr. Zerihun Berhane (PhD)
MSc Thesis Submitted to the Department of Project Planning and Management of Debre Markos University and Yom Institute of Economic Development
A Thesis Submitted to the Department of Project Planning and Management of Debre Markos University and Yom Institute of Economic Development, in Partial Fulfillment for the Requirements of Master of Science Degree in Project Planning and Management
October, 2016
Addis Ababa, Ethiopia
DECLARATIONS
I, the undersigned, registration number/ID number GSE/309/06, do hereby declare that this thesis is my original work and that it has not been submitted partially, or in full, by any other person for an award of degree in any other university or institution.
Submitted by:
Tolesa Regasa Signature: ______________ Date: ______________
Approved by:
This thesis has been submitted for examination with my approval as University College supervisor
Advisor: Zerihun Berhane Signature: ____________ Date: ________________
APPROVAL
The undersigned certify that they have read and hereby recommend to Debre Markos University and Yom Institute of Economic Development to accept the thesis submitted by Tolesa Regasa and entitled “Effect of Infant and Young Child Feeding Practice on Nutritional Status of Children age group of 6-23 months in Ethiopia: A Propensity Score Matching Analysis’’ in partial fulfillment of the requirements for the award of a master degree in Project Planning and Management.
Submitted by:
Tolesa Regasa Signature: ____________ Date: ___________
Approved by:
Name of Advisor: Zerihun Berhane Signature: __________ Date: _________
Name of Supervisor: _______________________ Signature: __________ Date: _________
Name of Internal Examiner: __________________ Signature: __________ Date: ________
Name of External Examiner: ___________________ Signature: __________ Date: _________
Name of Head of Department: __________________ Signature: __________ Date: _________
TABLE OF CONTENTS
LIST OF FIGURES 6
LIST OF TABLES 7
LIST OF ACRONYMS/ABBREVIATIONS 8
ABSTRACT 9
CHAPTER ONE: INTRODUCTION 11
1.1. Background 11
1.2. Problem Statement 15
1.3. Objectives of the study 19
1.3.1. General Objective 19
1.3.2. Specific Objectives 19
1.4. Research Questions 20
1.5. Research Hypotheses 20
1.6. Scope of the study 20
1.7. Limitations of the study 20
CHAPTER TWO: LITERATURE REVIEW 22
2.1. Determinants of Child Nutritional Status or Child Growth 25
2.1.1. Care for Children/Child Care Giving Behaviors 25
2.1.2. Health (Disease and dietary intake) 27
2.1.3. Household Food Insecurity 27
2.1.4. Maternal Resources (Determinants of maternal care giving Behaviors or child nutritional status) 28
2.1.5. Community/Infrastructure Resources 33
2.1.6. Community Context 34
2.1.7. Biological factors (both child and maternal factors) 35
CHAPTER THREE: RESEARCH METHODS 36
3.1. Description of the study area 36
3.2. Methods and Materials 37
3.2.1. Counterfactual Model 38
3.2.2. Measurement 39
CHAPTER FOUR: RESULTS 45
4.1. Descriptive statistics 45
4.1.1. Socio demographic characteristics of child’s caregivers 45
4.1.2. Health Care Utilization of Mothers of Children aged 6-23 months 48
4.1.3. Socio Demographic Characteristics of Children aged 6-23 months 48
4.1.4. Dietary Diversity of Ethiopian Children aged 6-23 months 49
4.1.5. Infant and Young Child Feeding Practices and the Feeding Index 51
4.1.6. Prevalence of Stunting and Wasting among Children age group 6-23 months 52
4.2. Effect of infant and young child feeding practices on nutritional status of Ethiopian children age group 6-23 months 53
4.2.1. Selection of covariates and algorithm for matching 53
4.2.3. Matching on the Propensity Score 56
4.2.4. Impact Assessment of Child Care Practices on Child Nutritional Status 57
4.2.5. Checking Quality of Matching 58
4.2.5.1. Balance of covariates before and after matching 58
4.2.5.2. Description of the estimated Propensity Scores and common support 63
4.2.6. Robustness of matching 64
4.2.7. Sensitivity Analysis 64
4.3. Factors influencing appropriate infant and young child feeding practices 65
CHAPTER FIVE: DISCUSSION 70
CHAPTER SIX: CONCLUSION AND RECOMMENDATION 73
References: 74
LIST OF FIGURES
Figure 1. Model of child care————————————————-22
Figure 2. Map of Ethiopia —————————————————-35
Figure 3. Analytical framework showing variables used in analysis—–41
Figure 4. Dietary diversity of Ethiopian children age 6-23 months——49
Figure 5. Standardized percent of bias reduction across covariates pre and post matching—57
Figure 6. Common support of treated and control groups by the propensity score ——–62
LIST OF TABLES
Table 1: Socio demographic characteristics of mothers/caregivers of children age group 6-23 months, 2011, Ethiopia 46
Table 2: Health care utilization of mothers’ of children age group of 6-23 months, 2011, Ethiopia 48
Table 3: Socio demographic characteristics of children aged 6-23 months, 2011, Ethiopia 49
Table 4: Dietary diversity of Ethiopian children aged 6-23 months, 2011 50
Table 5: Components of Feeding Practices used in Constructing Infant and Child Feeding Index and the Feeding Index of Ethiopian Children age group 6-23 months, 2011 52
Table 6: Prevalence of stunting and wasting among children aged 6-23 months, Ethiopia, 2011 53
Table 7. Shows variables used to estimate propensity score 55
Table 8. Shows common support of good child care vs. poor child care practices 56
Table 9. Matching estimates shows impact assessment of good infant and young child feeding practices on child nutritional status i.e. stunting 57
Table 10. Balancing of covariates before and after matching 59
Table 11. Estimated propensity scores 63
Table 12. A sensitivity analysis using Mantel-Haenszel (1959) bounds for variable stunting 64
Table 13. Shows factors associated with appropriate infant and young child feeding practices of children age group 6-23 months, Ethiopia, 2011 67
LIST OF ACRONYMS/ABBREVIATIONS
EDHS———Ethiopian Demographic and Health Survey
EMDHS—— Ethiopian Mini Demographic and Health Survey
UNICEF——- United Nation Child Fund
WHO———- World Health Organization
HIV———— Human Immune Virus
AIDS———- Acquired Immune Deficiency Syndrome
USA ———-United State of America
USAID——- United States of America International Development
HAPCO—— HIV/AIDS Prevention and Control Office
UNPFA—— United Nation Fund Agency
UKFID—— United Kingdom International Development
CDC——— Center for Disease Control
Abstract
Introduction: Under nutrition continues to be a major problem among children in Ethiopia. There are factors that directly or indirectly influence a nutritional status of children including food insecurity. Amongst others, proper infant and young child feeding practice is crucial for development, growth and nutritional status of children. However, there is a scanty of information on factors influencing mother’s care giving behaviors and role of appropriate infant and child feeding practice on nutritional status of children in Ethiopia. Thus, this study aimed to identify factors influencing appropriate infant and young child feeding practice and evaluate its effect on nutritional status of children age group of 6-23 months in Ethiopia.
Methods: This study used data from Ethiopia Demographic Health survey, 2011. This study employed propensity score matching method to estimate the impact of infant and child feeding practice on nutritional status. Logit regression analysis was used to identify factors influencing infant and young child feeding practice. A series of tests was conducted related to variable choice of the propensity score specification, quality of matching and robustness checks. Mantel-Haenszel bounds was used to check sensitivity of estimated treatment effects on the treated to hidden bias in order to validate the propensity score matching analysis.
Results: A proportion of infants and children received appropriate feeding practice found to be very small (3%). Maternal educational status, place of residence, maternal exposure to media, being male headed household and being married/living with partners were associated with appropriate feeding practice of children age group 6-23 months. Also, a propensity score matching revealed that a significant effect of good infant and child feeding practice in reducing stunting by around 19% among children aged 6-23 months.
Conclusion: Maternal educational status, place of residence, maternal exposure to media, being male headed household and being married/living with partners are important factors influencing appropriate feeding practice of children age group 6-23 months. Good infant and child feeding practice has a positive and significant effect in decreasing stunting among children 6-23 months but should be interpreted with a caution due to the presence of unobserved heterogeneity.
Key words: Nutritional status, infant and child feeding practice, propensity score matching, sensitivity, Ethiopia
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