Aksum University

College of Health Science

Department of Nursing

Post-Graduate Programme

ARTICLE CRITIQUE:
Research Article: Risk Factors Associated with Under-Five Stunting,
Wasting, and Underweight Based on Ethiopian Demographic Health
Survey Datasets in Tigray Region, Ethiopia

Submitted by: Eset Gebru

Submitted to: Dr

August 1, 2024
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 1. Overview

The research title selected for the critique is “Risk Factors Associated with Under-Five Stunting,
Wasting, and Underweight Based on Ethiopian Demographic Health Survey Datasets in Tigray
Region, Ethiopia’. The study is based on survey data from the Ethiopian Demographic and
Health Survey (EDHS) 2016 conducted in cooperation between the Central Statistics Agency
(CSA), the Ministry of Health (MOH), and the Ethiopian Public Health Institute from January
18, 2016–June 27, 2016. The article is retrieved from Hindawi Journal of Nutrition and
Metabolism Volume 2019, Article ID 6967170, 11 pages https://doi.org/10.1155/2019/6967170.
The study authors are Berhanu Teshome Woldeamanuel, Department of Statistics, Salale
University and Tigist Tigabie Tesfaye , Department of Statistics, Mekelle University. .Their
article is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

Below, I provide a critique of the study based on the provided CHECKLIST FOR
ANALYTICAL CROSS SECTIONAL STUDIES Critical Appraisal (1) used to assess the
methodological soundness of a study and to determine the extent to which a study has addressed
the possibility of bias in its design, conduct and analysis and other standard research article
evaluation guidelines.

THE BODY/CRITIQUE /

2. Title

The title is descriptive of the purpose and content of the study. It is characterized by clarity and
precision, relevance to the research area, and reflective of the research methodology. It is also
easy to understand and remember and helps predict the content of the paper. Because the title is the
part of a paper that is read the most, and it is usually read first, the authors have taken the
necessary care to include the purpose, scope, as well as method and data source in the title (2).

3. Authors

The authors’ qualifications, or academic titles/ranks are not mentioned perhaps because of policies
specific to the journal or publisher but both authors are staff members in statistics departments,
specializing perhaps in biostatistics. The authors disclose that they have no conflicts of interest.
The authors also declare their respective contributions to the study apparently because the journal
requires public disclosure of the specific contributions of each author.

4. Abstract

A slight modification of the IMRAD format (INTRODUCTION, METHODS, RESULTS, and

DISCUSSION) as the standard which gives a brief account of the process of scientific research

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seems to be guiding the writing of the abstract in the particular article (3). The structured abstract
of the article provides all the major parts of the study in about 195 words.

5. Introduction

There is a multi-paragraph introduction typical of many scientific articles. The introduction

analyses the issues to be addressed in the study. There are no subheadings but the paragraphs
carry distinctive informational units that together strengthen the importance of the introductory
section. First information is provided on the subject of stunting in light of existing literature,
preparing the reader for the objectives of the study. The specific subject of under-five stunting
and the associated factors are elucidated based on the latest studies in the field in the form of a
literature review (which does not exist as a separate section owing to journal prescriptions). The
picture of stunting globally, continentally, sub-regionally, nationally and in the context of the
Tigray region is shown in logical steps so the reader has fairly enough information and
understanding about the subject in preparation for the study in the Tigray region. However, the
section fails to show that there are different perspectives on “stunting” in international nutrition
and child health research, program, and policy circles, for instance, the point that there is no
biological basis for the –2 SD cutoffs to define stunting (4).

Nevertheless, using updated and robust information, the authors show that there is a scarcity of
studies that use national databases for Tigray region regarding the severity, extent and magnitude
of under-5 stunting, wasting, and underweight while progress has been made in reducing the
magnitude of the problem in the region. While they do not indicate the methodological
shortcomings of previous studies, the authors indicate that their study is important to fill gaps in
the area and to help as input in relevant policy making and guide or inform the necessary
interventions by identifying the risk factors for stunting in the particular age group.

5. Materials and Methods

5.1 Sampling and samples

The sampling procedure and samples are clearly and adequately described and details
of the secondary databases are presented in full. First the sample data sources are clearly
fully described. Data are extracted from the Ethiopian Demographic and Health Survey (EDHS)
2016, which used a two-step sampling design. Sampling in this context is designed to address the
purpose of a survey in the determination of the link between an exposure and a
disease, condition or outcome such as stunting within a defined population (5).

5.2 Inclusion and Exclusion Criteria

Protocol requires that inclusion criteria for study participants are carefully specified for target
subject population have the characteristics that enable careful establishment of valid
conclusions for the study. Inclusion criteria are demographic features such as age, gender,
marital status, health status and educational experience that are used to recruit participants or

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characteristics that subjects must have if they are to be included. In the article, the inclusion
criteria are also specified for the children under study in light of the exposure of stunting
and underweight of under-fives. All women 15-49 who meet inclusion criteria
were observed. Exclusion criteria formed women outside of the brackets.

5.3 Variable Definition

Variables were clearly defined and classified into categories as predictors and outcome
variables and were validly and reliably measured. Variables are further identified as
determinants of stunting as demographic, socioeconomic and environmental-helping the
calculation of nutritional status of the child using three indicators: wasting (weight-for-height),
stunting (height-for-age), and underweight and outcome variables are identified as stunting,
wasting, and underweight among children aged 0–59 months. There were no confounding
variables.

5.4 Validity and Reliability of Measures

There were objective, standard criteria used for measurement of the condition of
stunting and underweight using measures of height and weight. The outcomes of
exposure i.e. stunting and underweight were measured in a valid and reliable way using
standard criteria based on the measurement literature.

5.5 Statistical Tests

The authors seem to have an added advantaged as statisticians since the study is
methodologically clearly strong.

The statistical tests were appropriate and of sufficient rigor to the goal of measurement
and establishing causation and prediction. The statistical analysis is executed very ably
using the SPSS software version 21. Summary statistics and frequencies are presented. Logistic
regression is used to help in the estimation of the effect of each demographic, socioeconomic,
and environmental factors on under-five stunting, wasting, and underweight. Further, bivariate
analysis using Pearson chi-square tests was used to estimate the degree of association between
the independent and dependent variable under-5 stunting, wasting, and underweight. The varied
statistical tests and the statistical analysis using regression are appropriate for the goals of the
study.

6. Results

The article presents descriptive results relating to the stunting problem among the study
population. Descriptive details include binary information about rural/urban, age of mother,
mothers’ and husbands’ education level. Background characteristics of respondents and data on
bivariate analysis of stunting, wasting, and underweight by background characteristics of the
mother and a child are presented in tables and explained textually. Prevalence of stunting,

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wasting, and underweight by place of residence in the Tigray region is also presented graphically
and explained.

Results of logistic regression of factors associated with stunting, wasting, and underweight
among under-five children in Tigray Regional State are presented in rich detail taking very many
factors included in the survey including medical conditions, drinking water availability, and
toilet facility availability. The results present a comprehensive picture of the problem of stunting
and underweights and related variables, demonstrating that the study is significant as the authors
tried to argue.

7. Discussion

The article presents a discussion section that discusses the findings in light of the literature in the
area, both nationally and internationally.

The authors interpret and describe the significance of their findings in relation to what was
already reported previously in other studies and to explain their new understanding and
insights in the present study. However, it may have been necessary to once again highlight
the original goals of the study first.

While the study draws implications from the data and makes recommendations, the study
limitations are not revealed while every study is likely to have some limitations that future
researchers can address often appropriate to mention as suggestions for further research

Also limitation related to use of a particular method or even data characteristics like secondary
data may be worth noting before others show them. The section could have done better if it
more assertively indicated the worth of the findings and how they make a difference in the effort
to address stunting as a problem in the Tigray region.

8. Conclusion

The conclusion is well-written in light of the expectations for this section. For instance, it
highlights highlighting the key findings in the article that provide fresh insights about the
research problem. It also reemphases the really new findings and insights as well as the
more well-known factors such as breastfeeding and access to clean water as important
determinants of stunting.. The section also recommends further studies by way of trend
analysis which should be a good point.

References

1. Joanna Briggs Institute, Joanna Briggs Institute. Checklist for analytical cross
sectional studies. Adelaide: The Joanna Briggs Institute. 2017 Nov 6;7.

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2. Tullu MS. Writing the title and abstract for a research paper: Being concise,
precise, and meticulous is the key. Saudi journal of anaesthesia. 2019 Apr
1;13(Suppl 1):S12-7.
3. Sollaci LB, Pereira MG. The introduction, methods, results, and discussion
(IMRAD) structure: a fifty-year survey. Journal of the medical library association.
2004 Jul;92(3):364.
4. Perumal N, Bassani DG, Roth DE. Use and misuse of stunting as a measure of
child health. The Journal of nutrition. 2018 Mar 1;148(3):311-5.
5. Schmidt NA, Brown JM. Evidence-based practice for nurses: Appraisal and
application of research. Jones & Bartlett Learning; 2024 Feb 6.