Underweight Among Children Aged 6-59 Months in Transformed and Nontransformed Districts of East Gojjam, Ethiopia: A Community-Based Comparative Cross-Sectional Study.

BACKGROUND: Underweight, a composite indicator of both acute and chronic undernutrition, remains a major public health concern among under-five children in Ethiopia, contributing to increased morbidity, mortality, and impaired growth and development. Ethiopia's Health Extension Program promotes transformed districts to improve child health and nutrition outcomes; however, evidence comparing underweight between transformed and nontransformed districts remains limited. This study assessed the prevalence of underweight and its associated factors among children aged 6-59 months in East Gojjam Zone, Ethiopia. METHODS: A community-based comparative cross-sectional study was conducted among 627 children selected from transformed and nontransformed districts. Data were collected using structured questionnaires covering sociodemographic characteristics, household environment, childcare practices, and food security. Anthropometric measurements were obtained following World Health Organization standards, and underweight was defined as weight-for-age Z-score < -2 standard deviations. Bivariable and multivariable logistic regression analyses were performed to identify independent predictors of underweight, with statistical significance set at p < 0.05. RESULTS: The overall prevalence of underweight was 22.7% (95% CI: 19.0-26.0). Although underweight was more common among children in nontransformed districts (27.7%) compared with transformed districts (17.8%), this difference was not statistically significant. District transformation status was not independently associated with underweight after adjustment. Factors significantly associated with underweight included recent diarrheal illness (AOR = 2.49; 95% CI: 1.56-3.98), household food insecurity (AOR = 2.67; 95% CI: 1.60-4.46), low household income (AOR = 3.77; 95% CI: 2.34-6.08), inequitable intrahousehold food allocation disadvantaging children (AOR = 1.64; 95% CI: 1.02-2.65), and use of unprotected drinking water sources (AOR = 1.82; 95% CI: 1.10-2.99). CONCLUSIONS: Underweight remains a substantial public health problem in the study area and is driven primarily by household socioeconomic conditions, food insecurity, unsafe water access, and childhood illness rather than district transformation status alone. Strengthening multisectoral interventions that address poverty, food security, equitable child feeding, water safety, and infection prevention is essential to reduce underweight and improve child health outcomes.