Adequate provision of nutrients from the early stages of life is crucial to ensure good physical and mental development and long-term health. The double burden of malnutrition is an increasing public health problem worldwide (1). Acute malnutrition is a devastating disease of epidemic proportions. Globally, acute malnutrition continues to threaten the lives of an estimated 7.7% or approximately 52 million children younger than 5; more than two-thirds (69%) live in Asia, and more than one-quarter (29%) live in Africa. In Africa, 14 million children under 5 years are wasted, of whom 4.1 million are severely wasted and 4.2 million are from Eastern African countries (2). Ethiopia has made encouraging progress in reducing malnutrition over the past decades. However, the baseline levels of malnutrition remain so high that the country must continue to make significant investments in nutrition. Accordingly, the proportion of children underweight decreased more substantially by 39% over the period between 2000 and 2014 (3). However, there was only a small decline in the prevalence of wasting over the last 15 years. Recent data indicate that 10% of Ethiopian children are wasted, and 3% are severely wasted (3, 4).

Malnutrition is categorized into severe and moderate acute malnutrition according to the degree of wasting and the presence of edema. Severe acute malnutrition is defined as severe wasting (WFH <70% of the median of the WHO child growth standards or WFH < -3 z-score using the WHO child growth standards) (5–7). Acute malnutrition is defined as moderate acute malnutrition if weight-for-height is between 70 and 80% of the median of the WHO child growth standards or weight-for-height < minus 2 z-score using the WHO child growth standards, and edematous cases are always classified as severe (5, 6). Another criterion used to define and classify acute malnutrition is mid-upper arm circumference (MUAC). By using MUAC, acute malnutrition is defined as a child with MUAC < 110 mm, and moderate acute malnutrition is defined as MUAC ≥ 110 mm and < 125 mm (8). MUAC cutoff points are controversial, and the World Health Organization recommends that countries have their own cutoff points to define acute malnutrition; accordingly, Ethiopia sets MUAC cutoff points below 110 mm to define SAM and 110 mm to less than 120 mm to define MAM (9).

In Africa, hunger is estimated to result in a cost of $ 154 million in 2009 for 4.4 million additional clinical episodes associated with undernutrition in children aged 5 years and younger. The study estimated that Ethiopia has lost approximately $ 4.7 billion as the result of undernutrition which is equivalent to 16.5% of its gross domestic product (GDP) (10).

Acute malnutrition is a major public health issue, with its prevalence varying across different regions due to varying local determinants. Ethiopia has one of the highest rates of child undernutrition in sub-Saharan Africa. However, an understanding of the underlying causes remains insufficient. It is crucial to better document the key factors contributing to child malnutrition in Ethiopia and to assess their relative significance. In addition, identifying these determinants can significantly enhance the effectiveness and efficiency of interventions. Therefore, this study aims to identify the factors contributing to acute malnutrition among children admitted to public hospitals in Jimma town, South West Ethiopia.

A total of 234 participants were included in the study, consisting of 78 cases and 156 controls. The mean age of the participants was 18.29 ± 10.23 months for the cases and 16.6 ± 10.2 months for the controls. Regarding weight, the average for the cases was 6.6 ± 1.7 kg, while for the controls it was 9.0 ± 2.9 kg (Table 1).

This study showed that 34 (43.6%) of the cases and 20 of the controls (12.8%) had a history of diarrhea in the last 2 weeks prior to data collection. Similarly, approximately two-thirds of the study participants (both cases and controls) had been exclusively breastfed for 6 months (Table 2).

The results of the multivariable logistic regression analysis identified several factors that were significantly associated with acute malnutrition. These included being a female child (AOR = 2.99, 95% CI, 1.07 to 8.38), belonging to a low wealth index (AOR = 3.76, 95% CI, 1.24 to 11.38), and having a mother with no formal education (AOR = 4.08, 95% CI, 1.46 to 11.40).

This study also showed that having more than five family members (AOR = 3.24, 95% CI, 1.14 to 9.21), infrequent hand washing practices (AOR = 5.57, 95% CI, 1.82 to 16.97), a history of diarrhea (AOR = 3.58, 95% CI, 1.15 to 11.07), bottle-feeding (AOR = 3.98, 95% CI, 1.29 to 12.36), and poor maternal knowledge about child feeding (AOR = 5.97, 95% CI, 1.83 to 19.44) were all found to increase the likelihood of acute malnutrition (Table 3).

Acute malnutrition is a major cause of death in children in developing countries, and the magnitude of acute malnutrition persists longer without reduction. Although studies with robust designs, like the present one, are the preferred method for identifying the determinants of acute malnutrition and informing strategies for its reduction, there has been limited research on the predictors of acute malnutrition among children aged 6–59 months in the study area. Thus, this study was designed to determine the determinant factors of acute malnutrition among children aged 6–59 months attending public health facilities in Jimma town, South West Ethiopia.

The children whose mothers did not attend formal education were four times more likely to be acutely malnourished than children whose mothers attended formal education which is consistent with the study conducted in North Gondar, West Ethiopia (12–15). However, it was observed that paternal education was not significantly associated with acute malnutrition, which is not consistent with other studies (13, 16). The possible explanation may be the culture and tradition in the study area, where mothers are more responsible for child care than fathers. In addition, fathers of children are usually involved in agriculture and outdoor activities.

This study showed that female children were more likely to be affected by acute malnutrition than their male counterparts, which is consistent with other studies (17–19). The reason is unclear, but it may be because of culture or tradition, which provides a strong buffer for male children which may lead to female children being disadvantaged in terms of care and nutrition.

The findings of this study showed that participants living with more than five family members were more likely exposed to acute malnutrition compared to their counterparts. Studies have also shown that having a large number of family members is a significant contributor to under-five malnutrition (12, 14). This may be because a large family size leads to competition for food or because families with more children experience more economic strain for food consumption and are thus more likely to suffer from poor nutritional status. In other words, inadequate allocation of household resources among many children may lead to low nutritional status.

This study indicated that children from low-wealth index households were more likely to be acutely malnourished than children from households with a high-wealth index. A study conducted in North Shewa indicated that children belonging to the low-income group were at a higher risk of being wasted than children of higher-income families (20, 21). Low income levels in developing nations limit the kinds and amounts of food available for consumption. Low income also increases the likelihood of infection through mechanisms such as inadequate personal and environmental hygiene. On the contrary, households with a high wealth index have greater purchasing capacity for food and other goods needed to ensure the health of children (4, 22, 23).

Children who had diarrhea disease in the last 2 weeks prior to the survey were found to be approximately four times more likely to be exposed to malnutrition compared to children who had no diarrhea. This may be due to excessive loss of fluids and electrolytes, loss of appetite, and failure to absorb food during diarrheal episodes. A similar finding was seen in the studies conducted in Gimbi (16). On the other hand, the present study did not show a significant association between the morbidity status of the child with fever preceding 2 weeks before the onset of acute malnutrition. This is consistent with similar studies in Gimbi and Hidhabu Abote (16, 21).

In terms of feeding and care practices and knowledge, the bottle-fed child was more likely to have acute malnutrition than a non-bottle-fed child. Many studies have shown that bottle-feeding should be discouraged at any age because it is usually associated with an increased risk of illness, especially diarrhea, due to hygienic problems, that is to say, difficulty in sterilizing the teats properly. This study also found a statistically significant difference in knowledge of the recommended optimal child feeding between caregivers of acutely malnourished children and the controls (3, 13).

In this study, household food insecurity was not found to be statistically significantly associated with acute malnutrition. This finding suggests that food security alone may not be sufficient to ensure adequate nutrition. It supports the idea that while households may have access to enough food, this does not necessarily translate into proper nutrition, as food security does not always address the quality or nutritional value of the food consumed. This distinction highlights the need for interventions that focus not just on food availability but also on improving the nutritional content of the diet to prevent malnutrition (5, 9, 17, 23).

The main strength of the study was that the researchers’ use of measures other than data collectors to minimize interviewer bias, and the design used was able to evaluate the association of acute malnutrition with other exposure variables. The findings of this study may have a significant implication for the prevention of acute malnutrition, and emphasis should be given to strengthening caregivers’ socioeconomic status and knowledge regarding child-feeding practices.

However, this study has limitations, such as the reliance on self-reported data for some explanatory variables, which could be subject to recall and social desirability bias. Furthermore, the study did not address environmental enteropathy. In addition, this study was conducted only among hospitalized children and cannot be easily generalized to malnourished children in home or community settings. Hospitalized children often represent more severe cases of malnutrition, and their circumstances, including healthcare access, socioeconomic factors, and food availability, may differ from those in less critical conditions outside of hospitals.

The findings of this study can be summarized as the sex of the child, family size, birth order, maternal educational status, household wealth index, bottle-feeding, liquid waste disposal, diarrhea, and maternal knowledge were found to be independent predictors of acute malnutrition. In general, emphasis should be given to improving caregivers’ socioeconomic status and their knowledge of childcare practices. In addition, the government should create job opportunities and include low-income households in programs such as safety-net programs to address the issues of undernutrition.