{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:02:41Z","timestamp":1790146961124,"version":"4.0.1"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":264,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Nutrition and Metabolism"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Underweight, a composite indicator of both acute and chronic undernutrition, remains a major public health concern among under\u2010five children in Ethiopia, contributing to increased morbidity, mortality, and impaired growth and development. Ethiopia\u2019s 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\u201359\u2009months in East Gojjam Zone, Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A community\u2010based comparative cross\u2010sectional 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\u2010for\u2010age Z\u2010score &lt; \u22122 standard deviations. Bivariable and multivariable logistic regression analyses were performed to identify independent predictors of underweight, with statistical significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall prevalence of underweight was 22.7% (95% CI: 19.0\u201326.0). 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\u2009=\u20092.49; 95% CI: 1.56\u20133.98), household food insecurity (AOR\u2009=\u20092.67; 95% CI: 1.60\u20134.46), low household income (AOR\u2009=\u20093.77; 95% CI: 2.34\u20136.08), inequitable intrahousehold food allocation disadvantaging children (AOR\u2009=\u20091.64; 95% CI: 1.02\u20132.65), and use of unprotected drinking water sources (AOR\u2009=\u20091.82; 95% CI: 1.10\u20132.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jnme\/9041634","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:24:08Z","timestamp":1790144648000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Underweight Among Children Aged 6\u201359\u2009Months in Transformed and Nontransformed Districts of East Gojjam, Ethiopia: A Community\u2010Based Comparative Cross\u2010Sectional Study"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3537-7556","authenticated-orcid":false,"given":"Berhanu Abebaw","family":"Mekonnen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1853-7223","authenticated-orcid":false,"given":"Kassahun Bishaw","family":"Anagaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5547","authenticated-orcid":false,"given":"Netsanet","family":"Fentahun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_15_1_2","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1651-2227.2006.tb02378.x","article-title":"WHO Child Growth Standards Based on Length\/Height, Weight and Age","volume":"95","author":"WHO Multicentre Growth Reference Study (WMGRS) Group","year":"2006","journal-title":"Acta Paediatrica"},{"key":"e_1_2_15_2_2","volume-title":"Levels and Trends in Child Malnutrition: Key Findings of the 2020 Edition","author":"World Health Organization","year":"2020"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13434"},{"key":"e_1_2_15_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-12875-w"},{"key":"e_1_2_15_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0816-y"},{"key":"e_1_2_15_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-020-02154-1"},{"key":"e_1_2_15_7_2","unstructured":"UNICEF World Health Organization andWorld Bank Joint Child Malnutrition Estimates (JME): Levels and Trends 2025."},{"key":"e_1_2_15_8_2","unstructured":"World Health Organization United Nations Children\u2019s Fund andWorld Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2021 Edition 2021."},{"key":"e_1_2_15_9_2","volume-title":"Improving Child Nutrition: The Achievable Imperative for Global Progress","author":"UNICEF","year":"2013"},{"key":"e_1_2_15_10_2","first-page":"1","article-title":"Global Prevalence of Malnutrition: Evidence From Literature","volume":"1","author":"Dukhi N.","year":"2020","journal-title":"Malnutrition"},{"key":"e_1_2_15_11_2","unstructured":"Ethiopian Public Health Institute (EPHI) and ICF Mini Demographic and Health Survey Key Indicators 2019."},{"key":"e_1_2_15_12_2","volume-title":"Assessing the Impact on Child Nutrition of the Ethiopia Community-based Nutrition Program","author":"White J.","year":"2012"},{"key":"e_1_2_15_13_2","volume-title":"Nutrition Landscape Information System (NLIS) Country Profile Indicators: Interpretation Guide","author":"World Health Organization","year":"2010"},{"key":"e_1_2_15_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09675-5"},{"key":"e_1_2_15_15_2","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v21i1.46"},{"key":"e_1_2_15_16_2","doi-asserted-by":"publisher","DOI":"10.2147\/phmt.s288071"},{"key":"e_1_2_15_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40795-019-0290-y"},{"key":"e_1_2_15_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.70083"},{"key":"e_1_2_15_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.06.054"},{"key":"e_1_2_15_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu14010034"},{"key":"e_1_2_15_21_2","first-page":"13","article-title":"Relationship Between Antenatal Visits and Under-Five Under-Nutrition: A Case Study of Ekpoma, Edo-Nigeria","volume":"1","author":"Ozor M.","year":"2014","journal-title":"American Journal of Food Sciences and Nutrition"},{"key":"e_1_2_15_22_2","unstructured":"AliveandThrive IYCF Practices Beliefs and Influences in Tigray Region Ethiopia. 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