Peer-reviewed article

The association between anthropometric failure and zinc deficiency among preschool-age children in rural Sidama region, Ethiopia: a community-based cross-sectional study.

Kare AP, Alemu YD, Desalegn BB, Astatkie A · 3 Jul 2026

Abstract

Background Malnutrition remains a significant global public health challenge, particularly affecting preschool-age children in low- and middle-income countries. Zinc, an essential micronutrient for growth and immunity, is often deficient in such settings, exacerbating undernutrition risks. Despite evidence linking zinc deficiency to poor anthropometric outcomes, findings remain inconsistent. Limited research exists on its association with combined growth failures, assessed via the Composite Index of Anthropometric Failure (CIAF). In Ethiopia, where undernutrition rates are high, localized data-especially from regions like Sidama-are scarce. This study examines the prevalence of anthropometric failures and their association with zinc deficiency among rural preschool-age children (24-59 months) in Sidama, Ethiopia. Methods A community-based cross-sectional study was conducted from September 17 to October 3, 2024 with 364 children selected via multistage sampling. Data were collected electronically (KoboCollect), and anthropometric indices (stunting, wasting, underweight) were analyzed using WHO Anthro 2007. Serum zinc levels were measured at the Ethiopian Public Health Institute's Nutrition Laboratory. Zinc deficiency was defined as < 65 µg/dL in morning non-fasting samples and < 57 µg/dL in afternoon non-fasting samples. Modified Poisson Regression assessed associations and determinants in Stata 17. Result The prevalence of CIAF (Composite Index of Anthropometric Failure) was 29.67% (95% CI: 24.96-34.39), with 20.05% (n = 73), 7.97% (n = 29), and 1.65% (n = 6) failing one, two, or all three indices, respectively. Stunting (23.08%; 95% CI: 18.73-27.43), underweight (10.16%; 95% CI: 7.05-13.28), and wasting (7.69%; 95% CI: 4.94-10.44) were observed. Zinc deficiency showed no significant association with CIAF (APR(adjusted prevalence ratios) = 0.89; 95% CI: 0.65-1.23). However, compared to children aged 24-35 months, older children had markedly lower CIAF prevalence: those aged 36-47 months had 35% lower prevalence (APR = 0.65; 95% CI: 0.44-0.96), and those aged 48-59 months had 52% lower prevalence (APR = 0.48; 95% CI: 0.34-0.69).Children from households using unimproved water sources had 48% higher CIAF prevalence (APR = 1.46; 95% CI: 1.03-2.07). Unexpectedly, household wealth, dietary diversity, maternal education, and food security showed no significant associations. Conclusion The findings indicate a high prevalence of composite anthropometric failure among preschool-aged children in rural Sidama Region. Zinc deficiency was not a significant predictor. Younger age and unimproved water access were key determinant factors, highlighting the need for targeted nutrition and WASH (water, sanitation, and hygiene) interventions to mitigate undernutrition in this vulnerable population.