Our study indicates that there is a high prevalence of anaemia, stunting and being underweight among children in Kilimanjaro region of Tanzania. The high rates observed are similar to those observed elsewhere is East Africa, where up to 40% of the children have been observed to experience stunting [13
]. The mean anthropometric status of this population is significantly below the WHO references populations which is generally consistent with findings from other parts of East Africa [13
]. We observed that the risk factors for each of these nutritional deficiencies varied. For instance, stunting was closely associated with several sociodemographic factors in contrast to being underweight which was much more closely related to child’s health. These findings are consistent with the different aetiology of these two nutritional status indices and are consistent with earlier findings. HAZ is usually compromised following a period of chronic malnutrition, while being underweight is an indicator largely of short term nutritional compromise [2
]. These results indicate the need to monitor different indicators of a child’s nutritional status as part of the health monitoring programmes to be able to provide adequate and timely intervention.
Consistent with earlier reports we observed that age was a significant risk factor for poor physical growth [33
]. These results emphasize the need to implement early intervention to reduce the number of children experiencing growth restriction. Moreover, the results further emphasized the need to investigate factors that contribute to continued growth faltering during toddlerhood. Regional based studies of factors contributing to early growth faltering may be salient since growth faltering has been associated with socio-cultural and feeding practices during the weaning period factors that are likely to vary on a regional basis.
We observed high rates of anaemia in our sample which is consistent with findings from other developing countries [34
]. Moreover, the significant relationship between anaemia and maternal education has also been reported in earlier study from setting similar to ours [35
]. Further investigation on the exact mechanism by which maternal education influence the child’s anaemic status is warranted. We hypothesize that maternal education may simply be a proxy for other factors such as childrearing practices, health seeking behaviour or feeding practices which significantly affect the children’s health. For instance, in Korea [36
], it was observed that children of mothers who were better educated were less likely to be anaemic largely because better educated mothers were more likely to adopt healthier feeding habits.
Our results indicate that parental concerns of child’s growth and development was a strong predictor of child anthropometric status. These results have clear practical implications. The association between parental concerns and child anthropometric status provides validation for parental concerns and raise the question: to what extent can health workers utilize parental concerns as an indicator of child health? Can parental concerns be used as a screening instrument to identify children in need of closer monitoring, surveillance and intervention? In other fields dealing with child well-being, e.g., child development parental reports of concerns with child growth and development have been used to identify children who may be at-risk of poor developmental outcomes [37
]. Based on these finding it can be recommended that as part of the post natal health services, health workers need to discuss and address parental concerns. This approach has two major benefits: a) it may potentially provide a quick and relatively cheap screening tool for health workers and b) allows the parent to become an active participant in monitoring the child’s health status.
The most consistent indicator of child nutritional status was the maternal educational level; it was the only factor that was observed to significantly predict all the three nutritional indicators. The influence of maternal education could arise from various sources key amongst them is the impact it has on economic means (higher educated mothers have better jobs and more money) or more directly its influence on childrearing practices since mothers with more education have been observed to provide optimal care for their children. Regardless of the source of this influence our results further emphasize the need to invest in girls’/mothers’ education as a way to enhance child wellbeing in developing countries [39
The current study adds to the body of knowledge linking social, economic and demographic factors to the nutritional status of children in different settings. However, this study is cross-sectional in nature therefore limits our ability to make inferences on causation. Additionally, we did study other potentially salient predictors of nutritional outcomes. For instance we did not evaluate the impact of ill-health on nutritional status. Yet, anaemia has been strongly linked to ill health and especially helminthic infections [41
] and malaria particularly in malaria endemic areas [42
]. This forms another limitation of our study.