Stunting is a condition that affects children’s nutritional status when their body length or height-for-age z-score is less than minus two standard deviations (SDs) compared to the standard population (1). Stunting often begins in utero, and the first 1,000 days of a baby’s life are a crucial period during which a child can become stunted. In developing countries, the majority of cases of stunting occurs during the first 2 years of life (2, 3). Most studies conducted in low- and middle-income countries have shown that growth faltering typically begins during pregnancy and by 2 years of age (4).

It is a severe and multigenerational growth impairment. Globally, 149 million (21.9%) children under the age of five were reported to be stunted, with more than half of them living in Asia (5, 6). Stunting is a major public health issue and a well-established indicator of chronic malnutrition that accurately reflects prior nutritional history and current environmental and socioeconomic conditions (6). Stunted children are more susceptible to disease and are at a higher risk of developing degenerative diseases in adulthood. Stunting not only affects health but can also impact the level of intelligence in children (7). Stunting during childhood impacts functional ability and causes growth delays, leading to short stature in adolescence and adulthood (8).

The prevalence of stunting in Africa is among the highest globally, and current trends indicate a stagnation rather than progress in addressing this issue (9). Stunting is a serious public health issue in Ethiopia (10). According to the Ethiopia Demographic and Health Survey (EDHS) 2019, the prevalence of stunting among children is 37% in Ethiopia and 35.6% in Oromia (11).

The WHO’s global target is to reduce childhood stunting by 40% in 2025 (12), and the reduction of stunting in children is also included in the United Nations Sustainable Development Goals. Therefore, it is recommended to establish policies aimed at preventing and reducing the incidence of stunting among children. However, these efforts are still not functioning effectively in the majority of low- and middle-income countries, including Ethiopia (13). Although several research studies have been conducted in Ethiopia, the majority of these studies have focused on rural areas rather than urban areas (14). As a result, little is known about the prevalence and predictors of stunting among children under the age of five in urban areas, especially those close to the capital city of the country (Addis Ababa). Sheger City is located very close to the boundary of the capital city of Ethiopia; however, no studies have been conducted in this area. Additionally, the majority of stunting-related studies have focused on children over the age of five; therefore, there is no sufficient evidence on stunting and its predictors among children under the age of five. Community-level predictors, in particular, have received little attention in studies on stunting in under-five children (15).

Assessing the prevalence of stunting and its predictors among under-five children at the community level is of paramount importance to identify high-risk cases and formulate appropriate intervention measures. Therefore, this study aimed to assess the prevalence of stunting and its predictors in Lega Tafo Lega Dadi, Sheger City, Oromia, Ethiopia. Hence, this evidence is crucial for policymakers and may aid public health planners in developing strategies for addressing the issue and enhancing children’s nutritional status.

Overall, the prevalence of stunting in this study was 18.9%. The findings of this study are in agreement with those of a study conducted elsewhere in Ethiopia (19.7%) (18) and in Addis Ababa (18.5%) (19). The similarity implies that in developing countries, the nutritional status does not change over time and the pattern of stunting persists as children age. It could also be explained that as children grow older, their bodies’ need for nutrients increases without a corresponding increase in nutrient supply (20). In contrast to the current findings, studies conducted in different parts of Ethiopia, including the one conducted by the EDHS 2016 and in West Gojam Zone, Debre Berhan town, and Addis Ababa, reported higher prevalences of stunting among under-five children, with rates of 45.8, 43.2, 41.0, and 38.0%, respectively (15, 21–23). The discrepancy could be attributed to socio-demographic differences, variations in sample size, and differences in study periods. The nutritional status of under-five children is critical as it can make them more susceptible to disease and infection, hinder their mental and physical development, and increase the likelihood of stunting, preventing them from reaching their full height and cognitive potential compared to children with normal nutrition (24).

According to the present study, stunting is significantly associated with the mother’s occupation and educational status, paternal occupational status, family size, average birth interval, total duration of breastfeeding, history of diarrhea in the past year, meal frequency per day, the HFIAS, underweight status, and dietary diversity. Similar results were observed in studies conducted in Ethiopia, particularly in West Gojam (21), the West Guji Zone, Oromia (24), and northern Ethiopia (25).

Our findings reported that the under-five children whose mothers were daily laborer were more likely to be stunted than those whose mothers were housewives. A previous study from Bangladesh (26) corroborates our finding, suggesting that mothers involved in work, such as daily labor, may lack sufficient time to care for their children. This situation leads to poor hygiene practices, inadequate health-seeking behavior, and poor feeding practices, ultimately resulting in the child becoming undernourished (26). Likewise, the under-five children born to fathers who were daily laborers were 4 times more likely to be stunted than those whose fathers were government or NGO employees. Various studies conducted in different areas have shown that fathers play a significant role in the prevention of stunting (27, 28). Daily laborers may be linked to low household income, as a study conducted in Addis Ababa showed that low household income is one of the factors associated with household food insecurity (29), which is a well-known predictor of stunting.

In the current study, maternal educational status was statistically significantly associated with stunting among the under-five children. Specifically, the children whose mothers had primary education were more likely to be stunted than those whose mothers had a degree or higher education. This finding is supported by the findings of previous studies conducted in Ethiopia (30, 31), Nigeria (32), China, and Indonesia (33, 34). It is known that more literate mothers are generally more concerned about their child’s wellbeing than illiterate or less literate mothers (35). This may also be due to the fact that an educated mother is more likely to have better knowledge about the importance of dietary diversity and which foods provide greater nutritional value. Educated mothers may also have greater decision-making abilities and confidence at home and may be more effective in improving their family’s and children’s nutritional status.

The study result revealed that the children with a birth interval of <24 months were more likely to be stunted compared to the children with a birth interval of ≥24 months. This finding is supported by the findings of studies conducted in Ethiopia and Bangladesh (19, 36). When the birth interval is short, there is a higher probability of premature cessation of breastfeeding, which may lead to undernutrition, such as stunting. This study pointed out that stunting was strongly associated with family size. The children born into families with five or more children were more likely to experience stunting than those born into families with four or fewer children. This finding is in line with the findings of the studies conducted in Ethiopia (19, 25, 30, 31, 37). In addition, this finding is consistent with the findings of studies conducted in Vietnam, Bangladesh, Nigeria, and Ghana, where children from families with more than two children were more likely to be stunted than children from families with fewer than two children (32, 36, 38, 39). Food deficiencies are likely to increase as family size grows, leading to food insecurity, especially in families with a fixed income. A larger family size means less food is available for each family member compared to smaller families with the same economic resources. This may also be explained by the higher prevalence of infections or diseases in such families due to the overcrowded living conditions, which create a favorable environment for disease transmission from one family member to a child, potentially leading to childhood malnutrition (40).

Furthermore, the duration of breastfeeding was statistically significantly associated with the risk of stunting in the study. The children who were breastfed for less than 24 months were more likely to be stunted than the children who were breastfed for 24 months or more. This finding is supported by the finding of a previous study conducted in Ethiopia (41). A high prevalence of stunting was observed among the children with a history of diarrhea in the past year. This finding is in line with the finding of a study conducted in Ethiopia (21). Numerous studies have shown a reciprocal relationship between diarrhea and malnutrition: diarrhea leads to malnutrition, particularly undernutrition such as stunting, while malnutrition is also a predisposing factor for diarrhea. In our study, underweight was another predictor of stunting among the under-five children. Underweight is defined as low weight-for-age. A child who is underweight may be stunted, wasted, or both (42).

The under-five children living in food-insecure households were more likely to become stunted than their counterparts. This finding is in line with the findings of studies conducted in Nigeria and Ethiopia (32, 37). The possible reason for this is that the majority of the families in this study had low to medium socio-economic status, which are immediate causes of undernutrition. Low-income households are especially vulnerable to changes in food prices. In addition, food-insecure households do not have the ability to purchase diversified and nutritionally balanced food.

Finally, the present study showed that dietary diversity was statistically significantly associated with stunting. The children from families with inadequate dietary diversity were more likely to be stunted than children from families with adequate dietary diversity. Dietary diversity is an important component of children’s diet quality; consuming a wider variety of foods and food groups is linked to higher nutritional adequacy (43). A similar finding was reported in studies conducted in Iran and India (44). This can be explained by the fact that the lack of diversity is a particularly severe problem among poor populations in the developing world, where diets are predominantly based on starchy staples, with few or no animal products and only seasonal fruits and vegetables (45). Everyone needs a variety of foods to live a healthy life and meet basic nutritional requirements. A diverse diet provides essential micronutrients and adequate energy. The majority of the micronutrients we need come from our daily diet, so consuming a well-balanced diet rich in a variety of foods is essential. Given the wide range of health issues and the rising prevalence of diet-related chronic diseases, dietary diversity is crucial for preventing chronic diseases, including stunting in children (21).

The prevalence of stunting among the under-five children in the current study area was 18.9%, which is considered moderate. In this study, stunting in the children under the age of five was predicted by maternal educational and occupational status, paternal occupational status, average birth interval, family size, history of diarrheal disease in the past year, duration of breastfeeding, daily diet frequency, the HFIAS, underweight status, and diet diversity. Therefore, various levels of government stakeholders and other concerned organizations should work to improve maternal educational status, enhance household food security, and empower vulnerable families to provide proper nutrition for their children and prevent diarrhea and related diseases caused by poor hygiene and sanitation.