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\title{Assessment of the Nutritional Status and Associated Factors of Orphans and Vulnerable Preschool Children on Care and Support from Nongovernmental Organizations in Hawassa Town}
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             \author[1]{Bisrat  Getaneh}

             \affil[1]{  Mekelle University}

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\date{\small \em Received: 14 December 2015 Accepted: 1 January 2016 Published: 15 January 2016}

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\begin{abstract}
        


Background: United Nation Children"s Fund estimates that as of 2010 there were 153 million orphaned children and adolescents living in the world. Thirty six percent of the world"s orphans lives in Sub Saharan region. As of 2012, Ethiopia is estimated to have 1,988,731 Orphans of whom 530,630 are orphans due to HIV /AIDS and is one of the largest populations of Orphan and Vulnerable Children in Africa. However there is a little information about the effect of orphan hood and child vulnerabilities on child nutritional status in the study setting.Objective: To assess the nutritional status and associated factors among orphans and vulnerable preschool children on care and support from a nongovernmental organization.

\end{abstract}


\keywords{nutritional status, orphans and vulnerable preschool children, care and support, hawassa.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction a) Background}]{Introduction a) Background}\par
n estimated 24 million children across the world live without their parents, and numbers of children live outside parental care are. The effects of the loss of parental care on children can be devastating. Children without parental care find themselves at greater risk of discrimination, inadequate care, abuse and exploitation. Inadequate care can impair children"s education, emotional and physical development and health. It is widely recognized that the most preferable form of such alternative care is usually care within a family setting such as kinship care or foster care, and that large scale institutional care should be avoided where possible \hyperref[b0]{(1)}.\par
Poverty and deprivation have a major impact on children"s ability to stay with their parents, and may also affect the ability of extended or other families to offer homes for children. Poverty also interacts with other determinants of children"s care choices, such as HIV, migration and abuse or neglect in the home \hyperref[b1]{(2)}.\par
Historically, the fostering of children by extended family members, including aunts, uncles, grandparents, and other relatives, is common throughout sub-Saharan Africa. Extended family members have fostered children for a variety of reasons including the deaths of mothers in childbirth \hyperref[b2]{(3)}. The tradition of fostering by extended family continues today and is a vital coping mechanism in nations with high HIV prevalence and growing orphan populations. Throughout sub-Saharan Africa, an estimated 90\% of orphaned children in households live with extended family members \hyperref[b3]{(4)}. The advantages of extended-family fostering are that it is culturally acceptable and assumed to be sustainable throughout a child"s development, partially because communities will band together to support these households. In most cases, children can find stability, love, and emotional support in relatives" homes \hyperref[b4]{(5)}.\par
United Nation Children"s Fund estimates that as of 2010 there were 153 million orphaned children and adolescents living in the world. While13\% of the world"s children under the age of 18 years live in Sub-Saharan Africa, 36\% of the world"s orphans lives in Sub Saharan region \hyperref[b5]{(6)}. Approximately 27\% of these orphans were orphaned due to HIV/AIDS \hyperref[b6]{(7)}.\par
With a total population projection of over 86 million, Ethiopia is the second most populous country in Africa, More than half (55.5\%) of the population is constituted by children below the age of 18 years (8). Though the national prevalence of HIV in Ethiopia, estimated to be 1.3\%, is considerably lower than rates in other sub-Saharan African countries, As of 2012, Ethiopia is estimated to have 1,988,731 Orphans of whom 530,630 are orphans due to HIV /AIDS, one of the largest populations of Orphan and vulnerable children (OVC) in Africa (9).\par
A number of factors have been suggested to affect both the level of food security at household level and the children"s nutritional status, some of which are independently associated with households in which orphans live. These can broadly be classified into child characteristics (e.g., age and gender), household characteristics (e.g., household income, and number of children in the household), parental characteristics (e.g., occupation, education level and age of the household head) and community factors (e.g., water supply and sanitation) \hyperref[b6]{(7)}. 
\section[{b) Statement of the problem}]{b) Statement of the problem}\par
Despite being highlighted as one of the priority development issues under the Millennium Development Goals framework, malnutrition remains an important public health concern and one of the main causes of early child morbidity and mortality in developing countries \hyperref[b7]{(10)}. Many OVC suffer from cycles of poverty as a result of the illness and death of their parents and they are especially vulnerable and are at an increased risk of malnutrition and ill-health \hyperref[b8]{(11)}.\par
Communities and families in sub-Saharan Africa have been faced with a growing challenge of providing care for orphans and vulnerable children. Over 90\% of all orphans not living with a surviving parent are cared for by extended families \hyperref[b9]{(12)}. Malnutrition is among the most series health problem facing in Ethiopia .The prevalence of child malnutrition that is stunting, wasting and under weight is 44.1\%, 7.6\% and 28.3\% respectively for SNNPR. However, there is little information about the effect of orphan hood and child vulnerability on child nutritional status in study setting and only Few evidence examining the nutritional status of Orphans and vulnerable children (OVC) who are on care and support from NGO while children 6 to 59 month is one of the critical window of opportunity for Intervention to address under-nutrition through the Lifecycle Approach as Stated in the National Nutrition Program and moreover OVC are potentially at greater risk of poor health and nutrition because they are more likely to be extremely poor, may receive less care and may themselves be HIV-infected via parent-to-child transmission.\par
Therefore, this study will address the information gap by estimating the magnitude and identifying the potential factors affecting the nutritional status of OVC who are on care and support from NGO. c) Significance of the study II. 
\section[{Literature Review a) Prevalence of malnutrition in Orphans and Vulnerable}]{Literature Review a) Prevalence of malnutrition in Orphans and Vulnerable}\par
Children Malnutrition is a leading cause of morbidity and mortality among children in the developing world, contributing to more than half of all child deaths \hyperref[b10]{(13)}. Worldwide, nearly one in four children under five ages are stunted, an estimated 101 million children of under five age are underweight and 52 million children are moderately or severely wasted \hyperref[b11]{(14)}.\par
In Sub Saharan Africa, Malnutrition is a leading cause of morbidity and mortality. More than one third of countries in sub Saharan Africa with high prevalence rates 40\% of children are stunted, 25\% of children are underweight and wasted \hyperref[b11]{(14)}.\par
A study conducted on influence of socioeconomic factors on nutritional status of children in a rural community of osun state, Nigeria revealed that the prevalence rates of underweight, wasting and stunting were 23.1\%, 9 \% and 26.7\% respectively \hyperref[b12]{(15)}.\par
Nationally, The National Demographic Health Survey conducted by Central Statistic agency (CSA) in Ethiopia in 2011 showed that the prevalence of stunting, Information regarding the nutritional status of orphan and vulnerable children is limited in the study setting and most studies mainly focus on the general population than these segments of population. Currently a number of Non Governmental Organization in Ethiopia are providing different types of care and support to OVC based on the Guideline developed by the Ministries Of Women"s Affaires on care and support for orphan and vulnerable children, However; little is known about their nutritional status and therefore determining the magnitude and associated factors affecting the nutritional status of the Orphans and Vulnerable Children will be helpful to provide information for policy maker, NGO"s and other stakeholders and the information can be used as a baseline for further research.\par
wasting, and underweight was 44\%,10\% and 29\% and varies from region to region (8).\par
A cross sectional study conducted in North West Ethiopia shows prevalence of malnutrition in the community with 28.5\% of the children underweight, 24 \% stunted and 17.7\% wasted \hyperref[b13]{(16)}. A community based cross-sectional survey conducted in West Gojam zone revealed that 49.2 \% children were found to be underweight, 43.2 \% of the children under age five were suffering from chronic malnutrition and 14.8 \% acutely malnourished \hyperref[b14]{(17)}. The cross sectional survey conducted in rural communities of Tigray region also revealed that, the levels of stunting, under weight and wasting were 42.7\%, 38.3\% and 13.4\%, respectively \hyperref[b15]{(18)}. A cross sectional study conducted in Aynalem village in Tigray region, the overall prevalence of stunting, underweight and wasting were 45.7\%,43.1\% and 7.1\% ,respectively \hyperref[b16]{(19)}. According to research conducted in Gimbi district, Oromia region indicated that, 32.4 \% stunted, 23.5 \% underweight and 15.9\% of the children were wasted. Prevalence of severe stunting, severe underweight and severe wasting respectively were 15.7\%, 8.0 \% and 5.7\% \hyperref[b17]{(20)}. A community-based cross-sectional study conducted in rural kebeles of Haramaya district revealed, the prevalence of stunting, underweight, and wasting were 42.2\%, 36.6\%, and 14.1\%, respectively \hyperref[b18]{(21)}.\par
The prevalence of stunting, wasting, and underweight reported for SNNPR is 44.1\%, 7.6\% and 28.3\% respectively (8). 
\section[{b) Factors affecting the nutritional status of an OVC}]{b) Factors affecting the nutritional status of an OVC}\par
It is clear that Infection and nutritional status of children are interrelated where malnutrition can accelerate disease progression, and Infection worsens malnutrition by weakening the immune system and hindering nutrient intake, absorption, and storage. Globally, between 1995 and 2005, one in three preschool-age children were deficient in vitamin A due to inadequate dietary intake. A study conducted by FAO shows that one in four had experienced symptoms of illness including fever, cough, and/or diarrhea in the previous two weeks; and 55\% had been ill during the previous 6 months. Four percent were reported to have tested HIV positive, and HIV infection was suspected in another 2.0 \% \hyperref[b20]{(23)}.\par
In sub-Saharan Africa, AIDS is the leading cause of death among those aged 15-59 years old and 80.0\% of them who have lost a parent by AIDS in the developing world are living in this region. Even once the HIV infection rates stabilize or begin to decline, the number of orphans will continue to grow or remain high for many years due to the time lag between HIV infection and death. Orphaned children are at an increased risk for malnutrition and illness in addition to a lack of access to health care \hyperref[b21]{(24)}.\par
A study conducted in Angolela tera Woreda north Ethiopia revealed that One-third of the participants were found to have a protozoan infection, while 7.1\% were found to have a helminthic infection. Approximately 11\% of the students were stunted, 19.6\% were wasted, and 20.8\% were underweight. \hyperref[b22]{(25)}. 
\section[{iii. Child care and OVC}]{iii. Child care and OVC}\par
Care affects nutritional status in three ways: through feeding practices such as breast-feeding and the preparation of nutritious foods for weaned infants and others in the household; through health and hygiene practices both within the family and within the community; and through support to the mother, both by the family and by the community, so that she has sufficient time to care for the child. \hyperref[b0]{(1)} A study conducted about attributes of care giving Reveled that, Caregivers, whose mean age at enrolment was 42.9 (S.D 13.3) years, were predominantly female (87\%), and 25\% per cent were married. Fifty-five percent were biological parents of the child participants. Forty-five percent of caregivers were known to be illiterate, and the mean number of years of education was 4.9 (S.D 3.7). Forty-five percent of caregivers reported their own health to be fair, poor, or very poor; 24\% reported symptoms in the previous two weeks; and 56\% reported illness in the previous 6 months \hyperref[b23]{(26)}. 
\section[{iv. Socio demographic variables}]{iv. Socio demographic variables}\par
A study conducted about poor health in less wealthy country showed the median age at enrolment was 10 (standard deviation, S.D 2.1) years. Fifty-seven percent of the OAC were paternal orphans; 16\% were maternal orphans, and 17\% were double orphans \hyperref[b24]{(27)}.\par
Vulnerable children who live in household sizes of 4-6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95\% CI: 1.13-2.01, OR = 9.02, 95\% CI: 4.62-17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19, 95\% CI 0.07-0.33). Single orphans with an HIV positive parent were less i. Inadequate Dietary intake Globally, 39 per cent of infants less than 6 months old were exclusively breastfed and only 60 per cent of children aged 6-8 months receive solid, semisolid or soft foods, highlighting deficiencies in the timely introduction of complementary foods in 2011 \hyperref[b11]{(14)}. The study conducted in Nairobi, Kenya prevailed that orphans living in households in informal settlements in Nairobi are indeed more vulnerable with regards to food security than non-orphaned children, most particularly paternal orphans. In preliminary studies completed by UNICEF in Malawi and Jamaica, the percentage of nonorphans who were food insecure was 15\%, compared to 39\% among paternal and double orphans in the same region \hyperref[b19]{(22)}.\par
ii. Disease and Malnutrition likely to be fully immunized than single orphans with an HIV negative parent (28). 
\section[{Environmental and hygiene and OVC}]{Environmental and hygiene and OVC}\par
Unsafe water, poor sanitation and unhygienic conditions claim many lives each year. An estimated 1.2 million children die before the age of 5 years from diarrhea. Poor urban areas where insufficient water supply and sanitation coverage combine with overcrowded conditions tend to maximize the possibility of fecal contamination (29). Globally, urban dwellers enjoy better access to improved drinking water sources (96 per cent) than do people living in rural areas (78 per cent). Even so, improved drinking water coverage is barely keeping pace with urban population growth; access to an improved water source does not always guarantee adequate provision. Without sufficient access to safe drinking water and an adequate water supply for basic hygiene, children"s health suffers (29). 
\section[{Impact of malnutrition in OVC}]{Impact of malnutrition in OVC}\par
physical consciences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intelligent quotient (IQ), greater behavioral problems and deficient social skills; susceptibility to contracting disease. Under nutrition and micronutrient deficiencies contribute substantially to the global burden of disease. Under nutrition reduces immunological capacity to defend against diseases, and diseases deplete and deprive the body of essential nutrients. Under nutrition and infectious diseases further exacerbate poverty through lost wages, increased health care costs, and most insidiously impaired intellectual development that can significantly reduce earning potential \hyperref[b26]{(30)}. The immediate causes of malnutrition are inadequate food intake and infectious diseases, which in turn, result from a combination of three underlying causes that relate to the nutrition, social and health environment of the child. Inadequate household food security, inadequate maternal and child care, insufficient services and unhealthy environment are the underlying causes, which in turn, result from basic causes; Formal and non-formal institutions, political and ideological superstructure economic structure and potential resources (Figure \hyperref[fig_1]{1}) \hyperref[b27]{(31)}. 
\section[{Volume XVI Issue II Version I}]{Volume XVI Issue II Version I} 
\section[{III.}]{III.} 
\section[{Study Objectives a) General objective}]{Study Objectives a) General objective}\par
To assess the nutritional status and associated factors of orphans and vulnerable preschool children on care and support from a nongovernmental organizations in Hawassa town, Southern Ethiopia.  
\section[{Methods and Materials a) Study period and Setting}]{Methods and Materials a) Study period and Setting}\par
The study was conducted from January 27 to April 1, 2014 in Hawassa town administrative council, which is the capital of Southern Nation Nationalities People"s Regional state. Hawassa town is found 273 km south of Addis Ababa, the capital city of Ethiopia. Its boundaries are Shashmene town in the north, Wondo-Genet district in the east, Malga district in the Southeast and Hawassa Lake in the west. It has a projected population for 2013/14 was 316,842 people, out of this 163,039 are males and 153,803 are females with the annual population growth rate 4.02. The municipality has 8 sub-city and 32 kebeles \hyperref[b28]{(32)}.\par
The potential health coverage of the City administration was 92 \% in 2013 G.C. There are one referral hospital, one district hospitals, three private hospitals, 10 health centers, 15 health posts, 47 private clinics, 49 drug stores, 11 diagnostic laboratories and 12 pharmacies in the City administration. The total number of OVC on care and support in Hawassa Town was 10,693 and out of this 3000 was under five and there were 28 NGO"s that provide care and support for OVC \hyperref[b29]{(33)}.   
\section[{d) Sample size determination}]{d) Sample size determination}\par
To determine the number of Orphan and Vulnerable Children to be included in the study, the single population formula was used to calculate the sample size for first specific objective and for this proportion the most prevalent form of malnutrition (44.1\%) was taken from EDHS 2011GC (8). The sample size is calculated using 372 with 90\% response rate =372*1/0.9= 414 ? Since the total population is < 10,000 correction was made and n final was calculated as n final=n/(1+n/N)=414/(1+414/3000)=364 
\section[{Sample size for second objective}]{Sample size for second objective}\par
This is the Main Factors affecting the nutritional status of Children from literature and then the second objective is calculated using OPEN EPI 2.3 version as follows with the \hyperref[b17]{(20,}\hyperref[b18]{21)}. Assumption 95\% CI, power of 80\% and Ratio of case to controls 1:4 ? Since the sample size calculated for the first objective could accommodate the second objectives 364 was selected due to representativeness. 
\section[{e) Sampling procedures}]{e) Sampling procedures}\par
All sub cities in Hawassa town were identified by name and then using simple random sampling technique by lottery Methods 4 sub city was selected and the sample size for the sub city was proportionally allocated. The sampling frame was prepared for subjects were identified and household survey was conducted using mother child supporting groups as a guiders at each sub cities who know house the selected orphan and vulnerable children were located.  
\section[{g) Data collection procedures and measurements}]{g) Data collection procedures and measurements}\par
The data collection instruments were a structured pretested interviewer administered questionnaire, 24 hours dietary recall measurements at individual level and anthropometric measurements. Questionnaire was adapted from different relevant studies and standards and was prepared originally in English language and then it was translated into Amharic language for data collection purpose and then back to English for reconsideration. Data were collected from mother/caretakers and measurements from orphan and vulnerable preschool children aged 6-59 month who were on care and support in NGO"s during the time of data collection 
\section[{h) Data quality control}]{h) Data quality control}\par
The pretest of the instrument was carried out in Tula Sub city which was not selected for this study in 5\% of the sample and pretest ensures validity of the instrument. The pre-tested data were not included as part of the main data of the study.\par
The data collections were facilitated by 4 enumerators who are diploma nurses and two health officers as supervisors. Enumerators and supervisors were given one day training by principal investigator in Hawassa health center on the objectives of the study, on the contents of the questionnaire, on the methodology of the study, on the issues of the confidentiality of the responses, on the use of instruments and on the procedures how to take anthropometric measurement. All measurements were carried out using standard procedures by explaining the procedure to the mother /care takers. 
\section[{Anthropometric measurements}]{Anthropometric measurements}\par
Age: were collected from the mother/caretakers and looking up age in official registers for counter check. The in standing-up position while the child being barefooted and free of any head wearing in children >2 years old and was recorded to the nearest 0.1 cm.\par
Weight: weight was measured using a 25 kg hanging spring scale graduated by 100 g for children while clothes are removed and was recorded to the nearest 0.1 kg. The scale was calibrated immediately before and during each session by placing standard calibration weights of 5 kg iron on the scale to ensure accuracy. MUAC: were measured for children >65cm in height using color coded standard MUAC tape meter by calculating the midpoint of the child"s left upper arm by first locating the tip of the child"s shoulder and the tip of the elbow through right angle position and measurement was taken in the mid point by straighten the child"s arm and read the measurement to the nearest 0.1cm. 
\section[{Households Food Insecurity Access scale}]{Households Food Insecurity Access scale}\par
Was Calculated on the basis of the number of food groups consumed within the 24 hours recall period from the total of 11 food groups. The food group consumption frequency score (FGFS) was calculated by assigning a score of 0 if not consumed during the previous 24 hours, 1 if consumed. For children 6 months to 5 years was scored as high DDS if the score out of the 9 is ?4 and as low DDS if < 4 \hyperref[b31]{(35)}. 
\section[{Volume XVI Issue II Version I}]{Volume XVI Issue II Version I}\par
Year 2016( D D D D ) L\par
15th day of the month was used when the date of birth is unknown and if the month of birth was unknown, the midpoint of the year of birth was used. Sex: Was recorded as male and female.\par
Length/Height: were measured using Wooden board in recumbent position while the child barefooted and free of head wearing in children <2 years old to the nearest 0.1 cm and height was measured using Wooden board First code was given to the completed questionnaire and then data was entered and clean up using EPI-info version 3.5.1 software and SPSS analysis statistical package to cheek for frequencies, accuracy, outliers, and consistencies and missed values and variables and Anthropometric measurement data was entered, clean up using ENA SMART. Any error was identified and corrected. 
\section[{j) Data Analysis and Presentation}]{j) Data Analysis and Presentation}\par
The prevalence of malnutrition among OVC was assessed by calculating the percentages of children 6-59 months using ENA SMART and analysis was made using WHO Standard cut off point below -2 S.D to determine nutritional status as stunting, wasting or underweight using z-scores. Odds ratio with 95\%confidence interval was computed to assess the k) Operational Definition An orphan: was a child aged 6 to 59 month whose mother, father, or both have died.\par
Social orphans: one or both their parents may still be alive but who have been unable to perform parental duties because of illness or acute poverty among other reasons.\par
Vulnerability: high probability of a negative outcome which results from risky or uncertain events and lack of appropriate means to deal with them. Vulnerable children: were defined as being under the age of 59 month and currently at high risk of lacking adequate care and protection. and Data were then exported to SPSS and Binary and multivariate Logistic analysis was carried out to see the effect of each independent variable on nutritional status. Logistic regression was used to control any confounders at p value 0.05. . Bar graph was used for diagrammatic summarization of categorical variables and tables were used for summarization variables. 
\section[{strength of the association and statistical significance}]{strength of the association and statistical significance} 
\section[{Standard Definition}]{Standard Definition}\par
Stunting which is below -2 S.D from median height for age of reference population, Wasting which is below -2 S.D from median weight for height of reference population Underweight which is below -2 S.D from median weight for age of reference population.\par
Based on the responses given to the nine questions and frequency of occurrence over the past 30 days, households are assigned a score that ranges from 0 to 27. A higher HFIAS score is indicative of poorer access to food and greater household food insecurity. The lower the score, the most food secured a household was. A score of<17 was classified as food secured and a score of ?17 classified as food insecure. Household Food Security was assessed during the site assessment using the household level component of HFIAS \hyperref[b30]{(34)}. 
\section[{Individual dietary diversity score l) Ethical consideration}]{Individual dietary diversity score l) Ethical consideration}\par
The study proposal was submitted to the ethical Review Board of Mekelle University College of health sciences and was approved. Following the endorsement by ethical Review Board, official permission was secured from Hawassa city administration department Women"s, children and youth Affairs through a support letter from the department of public health, college of health sciences, Mekelle University. Selected Sub cities respected service providing organization for management of malnutrition and the result of this study will help us to know the nutritional status of orphans and vulnerable preschool children and to improve services provided by NGO"s for Orphans and vulnerable preschool children. 
\section[{m) Dissemination of Information}]{m) Dissemination of Information}\par
The results of this study will be communicated to Mekelle University, college of health sciences, the Bureau of women"s affairs, the Regional Health Bureau and other concerned bodies through hard copy and presentation. Publication on an appropriate journal will also be attempted.\par
were parents and female parents constituted 347(96.7\%) were females and among the care takers 168(46.8\%) were attended primary education. Concerning the occupation of care takers, majority 216(60.2\%) was unemployed and majorities of the care takers were married 323(90\%) and almost half of them the households were headed by husband/wife of husband (Table \hyperref[tab_2]{-1}). were informed about the objective and purpose of the study through a support letter from the Hawassa city administration department Women"s, children and youth Affairs. The participants were informed about the objective and purpose of the study and parental informed written consent was obtained from each participant during data collection and anthropometric measurement. Introduction of the study, method of the questioning and confidentiality letters was attached to the cover page of the questionnaires. 
\section[{Global Journal of}]{Global Journal of}
\begin{quote}
Medical Research\end{quote}
\par
The participants were informed that they have a full right to participate or decline from participating in the study and information was collected anonymously. There was no serious harm to the participants and children who were malnourished using MUAC tape meter during data collection was notified to the V. 
\section[{Results}]{Results} 
\section[{a) Socio-demographic characteristics}]{a) Socio-demographic characteristics}\par
A total of 359 aged OVC 6-59 months were participated in the study with an age category 48-59 month accounted 161(44.8\%) followed by \hyperref[b32]{36}  
\section[{b) Water, sanitation and hygiene characteristics}]{b) Water, sanitation and hygiene characteristics}\par
The source of water for the 200(55\%) of the OVC is public stand and the amount of water used per day which was >15L was 323(90\%).Majorities 344(95.8\%) used Container as a means of water storage. Furthermore, 355(98.9\%) of the household had hand washing facilities. Three hundred and forty four (95.8\%) of the house hold had access for latrine and nearly half (47\%) of latrine was pit type. Over half (57.1\%) used municipality service for domestic waste. Hundred and one (28.1\%) of the house hold have separated kitchen for cooking (Table \hyperref[tab_4]{2}).  Three hundred and sixteen (88\%) care takers had ANC follow up during their previous pregnancy and Two hundred and seventy three (76\%) of them gave birth at health facilities. over three fourth (76.6\%) of the OVC had ever received vaccination and majorities (86.2\%) of the OVC were received vitamin A supplementation (Table \hyperref[tab_6]{4}). ) and underweight 8.9 \% (95\% C.I 6.4 -12.3) among orphans and vulnerable children. (Figure 3)  
\section[{g) Factors associated for malnutrition among OVC}]{g) Factors associated for malnutrition among OVC}\par
The multivariate logistic regression analysis identified children who have parents, marital status and educational status of the care takers, first complementary food the child received as determinant factors for stunting. The odds of stunting among OVC whose either parent were alive were 3.717 times an increased risk than those who were not alive (AOR 3.717; 95\% CI 1.405, 9.804).OVC of married care taker were 74.1\% at reduced risk to be stunted than those OVC of single care takers (AOR .259; 95\% CI .751,.089). The odds of stunting among OVC care takers whose educational status primary were 2.777 times at an increased risk when compared to OVC of care takers their educational status were secondary and above (AOR 2.777; 95\% CI The multivariate logistic regression analysis identified cough prior to 2 weeks of this survey, HH food security and food and nutritional support from NGO were identified as determinant factors for Wasting. The odds of wasting among OVC who were have cough prior to 2 weeks of this survey were 2.272 times an increased risk than OVC who were not have cough (AOR 2.272; 95\% CI 1.997, 5.181) The odds of wasting among OVC from food in secured HH were 2.667 at increased risk than to be those who were from food secured (AOR 2.667; 95\% CI 1.072, 6.667). The odds of wasting among OVC who have no food and nutritional support from NGO were 6.251times at increased risk to be wasted when compared to OVC who do have food and nutritional support.(AOR.6.251; 95\% CI. 1.427, 9.778).(Table \hyperref[tab_15]{9}).  The multivariate logistic regression analysis identified family size and duration of breast feeding as determinant factors for underweight. The odds of underweight among OVC from >= 5 family size were 2.78 times at an increased risk than those who family size < 5(AOR 2.778; 95\% CI 1.148, 6.721). the odds of underweight among OVC who were breast feed for 6-12 month were 3.26 times at an increased risk when compared to OVC who were breast feed for >=12 month (AOR 3.257; 95\% CI 1.344, 7.891). (Table10).  
\section[{Global Journal of}]{Global Journal of}
\begin{quote}
Medical Research\end{quote}
 
\section[{Discussion}]{Discussion}\par
The present study investigated nutritional status and associated factors of orphans and vulnerable preschool children on care and support from nongovernmental organizations in Hawassa town, southern Ethiopia 2014GC. 
\section[{a) Stunting}]{a) Stunting}\par
In this study, the prevalence of stunting is a bit higher than the studies done among orphans and vulnerable children in Zambia (29\%), Nigeria (23.1\%), Mongolia (15.6\%), Gumberiti (24\%) respectively \hyperref[b12]{(15,}\hyperref[b13]{16,}\hyperref[b32]{36,} {\ref 37)}.This might be due to the difference in study period, socioeconomic characteristics, health service delivery, study area and age difference.\par
However, the magnitude of stunting in the present study was found to be a bit lower than a studies conducted among similar age groups in west Gojiam (43.2\%), Tigray (42.7\%), Haramaya (42.7\%), EDHS (44\% \& 44.1\%) Bangladesh (42\%) respectively (8, \hyperref[b14]{17,}\hyperref[b15]{18,}\hyperref[b18]{21,} {\ref 38)}. The variation might be due to involvement of special segments of the study subject who are on care and support.\par
The magnitude of stunting was found to be consistent with the regional prevalence of Dire Dawa (36.3\%), Harari (29.8\%), Nepal (37\%) (8, 39).This might be due to similarities in socio economic characteristics and age categories.\par
The analysis of this study indicated that children who have parents, marital status and educational status of the care takers, first food the child received were identified as determinant factors.\par
Although it is generally held that maternal orphans are at greater risk for health problems because of the loss of their primary caregiver, children who had lost a father were more likely to be malnourished than non-orphans, indicating that loss of a father may be at least as significant as loss of a mother. As to the finding of this result, The odds of stunting among OVC whose either parent were alive were 3.717 times an increased risk than those who were not alive (AOR 3.717; 95\% CI 1.405, 9.804).More ever, A study conducted on poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe showed that OVC aged 6-59 months were more likely to be stunted than non-OVC \hyperref[b32]{(36)}.\par
Concerning marital status, there was significant association between the marital status of the care takers and stunting, OVC of married care taker were 74.1\% at reduced risk to be stunted than those OVC of single care takers (AOR .259; 95\% CI .751,.089).This could be due to the reason that married caretaker have an opportunities to have economic strengthen and other support from their partner than single caretakers and will have an impact on nutritional status of orphan and vulnerable children. Regarding educational status, there was significant association between the educational status of the care takers and stunting, The odds of stunting among OVC care takers whose educational status primary were 2.777 times at an increased risk when compared to OVC of care takers their educational status were secondary and above (AOR 2.777; 95\% CI 1.272, 6.063).Similar findings are reported in other studies in Garhiwali Himalyas and Bostwana respectively  {\ref (40,} {\ref 41)}.This could be due to the reason that as the educational level of the caretakers of OVC increase their knowledge to different nutritional program and adherence to nutritional education given by supportive NGOs will increase. So, they can apply it to their children in order to make their children well nourished. 
\section[{Assessment of the Nutritional Status and Associated Factors of Orphans and Vulnerable Preschool}]{Assessment of the Nutritional Status and Associated Factors of Orphans and Vulnerable Preschool}\par
Children on Care and Support from Nongovernmental Organizations in Hawassa Town\par
Concerning first complementary food the child received, there was significant association between first complementary food the child received and stunting, The odds of stunting among OVC whose first food porridge were 2.463 times an increased risk than OVC whose first complementary food were milk (AOR 2.463; 95\% CI 1.328, 4.568). This could be due to the fact that in the first six month of life, all the infant"s nutritional needs are met by the mother"s breast milk, but from the age of six month onwards breast milk alone can"t provide the entire nutrient. In the current study it was found that children who began complementary feeding with milk were significantly at reduced risk to being stunted compared to those children who began complementary feeding with porridge. This could be due to the reason that the process of making porridge make the porridge less content in nutrients and May exposes the Orphan and vulnerable children to the risk of infection and malnutrition than making milk. 
\section[{b) Wasting}]{b) Wasting}\par
The magnitude of wasting was found to be more or less consistent with the regional prevalence of Amhara (9.9\%),oromia (9.7\%) and Harar (9.1\%) and among orphans and vulnerable children in Zambia (5\%) were wasted respectively  {\ref (8,}\hyperref[b28]{32)}. The figure in this study is however bit higher than Addis Ababa (4.6\%). And lower than Dire Dawa (12.3\%),Gambella (12.3\%), Afar (22.2\%)and Southern Sudan (22\%)  {\ref (8,} {\ref 42)}. This difference also probably the difference in due to study period, study area, study subjects, socioeconomic characteristic. There was significant association between children who have cough prior to 2 weeks of this survey and wasting, The odds of wasting among OVC who were have cough prior to 2 weeks of this survey were 2.272 times an increased risk than OVC who were not have cough (AOR 2.272; 95\% CI 1.997, 5.181). This is due to the fact that Infection and nutritional status of children are interrelated where malnutrition can accelerate disease progression, and Infection worsens malnutrition by weakening the immune system and hindering nutrient intake, absorption, and storage which further affect the nutritional status of the child according to the vicious cycle of malnutrition. There was also a significant association between Household food insecurity and Wasting, The odds of wasting among OVC from food in secured HH were 2.667 at increased risk than to be those who were from food secured (AOR 2.667; 95\% CI 1.072, 6.667).This could be due to the reason previously demonstrated that household food insecurity is increased among orphans living in households (43).And that orphans are more vulnerable to food insecurity than non-orphans (44). It has also been demonstrated that orphaned children in sub-Saharan Africa tend to have more malnutrition compared to non orphans (45). A similar study conducted in Nigeria revealed that foodinsecure households were five times more likely to have wasted children than food secure households (46). Concerning food and nutrition support from NGO, there was significant association between food and nutrition support from NGO and Wasting. The odds of wasting among OVC who have no food and nutritional support from NGO were 6.251times at increased risk to be wasted when compared to OVC who do have food and nutritional support.(AOR.6.251; 95\% CI.1.427, 9.778). This could be due to the reason that food and nutrition support along with other support from the supportive organization make Orphan and Vulnerable Children will have the access for food and nutrition which enable them to have adequate intake and prevent from being wasted. 
\section[{c) Underweight}]{c) Underweight}\par
The prevalence of Underweight in OVC was 8.9 \% (95\% C.I 6.  {\ref 4 -12.3}) in this survey. The magnitude of Underweight was found to be consistent with the regional prevalence of DireDawa, Harari and Somalia and significantly varied from other region and might be due similarities in the nature of study setting and involvement of special segments of the study subject respectively (8). The prevalence of Underweight in the current study is lower than a study done among orphans and vulnerable children in Zambia prevailed (19\%) \hyperref[b32]{(36)}. this could be due to the difference in the study subject. Where use study was from a town, receiving care and support form NGO and this might contributed to lower underweight compared to national and regional figure by EDHS 2011. . Regarding associated factors of malnutrition, analysis of this study indicated that family size in households and duration of breastfeeding were identified as determinant factors for Underweight. There was also a significant association between family size households and Underweight. The odds of underweight among OVC from >= 5 family size were 2.778 times at an increased risk than those who family size < 5(AOR 2.778; 95\% CI 1.148, 6.721). This could be due to the reason that Orphans and Vulnerable Children could not be able to get adequate and balanced food required for their growth and development as the number of family size increase. Thus, larger family sizes have adverse effect on the nutritional status of a child. Moreover when economically inactive members in a household increases relative to the number of economically active members of a household, the limited available food resources will be depleted without satisfying the required nutrition (47).\par
As to duration of breast feeding, there was significant association between duration of breast feeding and Underweight. the odds of underweight among OVC who were breast feed for 6-12 month were 3.257 times at an increased risk when compared to OVC who were breast feed for >=12 month (AOR 3.257; 95\% CI 1.344,7.891).Currently recommended and preferred infant feeding option in the context of HIV by WHO as well as national ministries of health of most developing countries is; during the first six months of life exclusive breastfeeding; then after appropriate complementary foods should be introduced at six months of age with continued breastfeeding until nutritionally adequate diet without breast milk can be provided. Early cessation and abrupt weaning of breastfeeding should be avoided (48). In line with this facts, in this study the longer the OVC on breast feeding, the decreased risk to be underweight. health problems in orphans and vulnerable children who were in care and support from nongovernmental organization in Hawassa town, Ethiopia. 2. Parental status, marital status, educational status, and first food the child received was significantly associated with stunting. 3. Identified cough prior to 2 weeks of this survey, HH food security and food and nutritional support from NGO Households were associated with wasting. 4. Having more (>=5) Family size in the household and duration of breast feeding Orphan of Vulnerable children were associated with underweight among orphans and vulnerable preschool children in this study. 
\section[{VII.}]{VII.} 
\section[{Strength}]{Strength}\par
X. 
\section[{Recommendation}]{Recommendation} 
\section[{Community based nutrition program targeting}]{Community based nutrition program targeting}\par
Orphan and Vulnerable Children should be established to tackle the problem of malnutrition at community level depending on the severity of malnutrition identified 2. Nutrition education by supportive organization in coordination with health extension workers should be strengthening to improving the child feeding practice of parents on appropriate infant and young children feeding. 
\section[{Nutritional Intervention by supportive organization to}]{Nutritional Intervention by supportive organization to}\par
improve the food security and care of orphaned and vulnerable children in the community 4. Integrating Food and nutrition support by supportive organization is mandatory to improve the nutritional status of orphans and vulnerable children 5. Continued attention should mandatory to duration of breast feeding practices mothers/caretakers to avoid malnutrition among orphans and vulnerable by supportive organization.\par
6. Woreda health office should be collaborated with BOWA and supportive organization to improve access health facilities having special attention to Orphan and Vulnerable Children. 7. Further comparative study should be done to see OVC from other segments of population in the study setting that were not included in the present study XI. administration department of womens", children and Youth affairs, Enumerators and Supervisors and study participants for their cooperation to the successful accomplishment of my research project in the study area. Finally, my special appreciation goes to my friends, MSF national and international staffs, for their valuable feedbacks and support and family who encouraged me morally and supported me during the thesis work. 48. WHO. Guidelines on HIV and Infant feeding 2010, principles and recommendations for infant feeding in the context of HIV and a summary of evidence, 2010. 
\section[{XII.}]{XII.} 
\section[{Acronyms/abbreviations}]{Acronyms/abbreviations} 
\section[{Annex I: Information sheet}]{Annex I: Information sheet}\par
Hello my Name is ---------------------------I am a data collector for public health nutrition master"s student project at Mekelle University .The objective of this study is to assess the nutritional status and associated factors among orphans and vulnerable preschool children on care and support from nongovernmental organization in Hawassa town. The information collected from you will be useful for the health care provider, Bureau of women"s affairs, the Regional Health Bureau and other concerned bodies to improve the service given to OVC. An interview question will present to you and anthropometric measurement will be taken from your child. Your child has been selected randomly in this study and you and your child name will not be mentioned in the questionnaire and the information you have given will be kept in confidence. You can quit at any point of interview or you can skip questions. We would like to thank you in advance for participating in our study. For additional information you can contact the principal investigator with the following address: Name of principal investigator: Mr.Bisrat Getaneh Mobile. Cell phone: +251(0)911881252. Email:bisratlove@gmail.com.\par
As to the information given ahead, I have been informed that the objective of this study is to assess the nutritional status and associated factors among orphans and vulnerable preschool children aged 6-59 months. I have understood that participation in this study is entirely voluntarily and study has no any risk. My name will not be written on this form and the information I give will never be shared to others. I may not answer any questions that I don't want to answer and I may end this interview at any time I want therefore I am giving my written consent to participate in this study in titled "Nutritional status and associated factors among Orphans and vulnerable preschool children aged \hyperref[b5]{6}   \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_1}Figure 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-3.png}
\caption{\label{fig_2}}\end{figure}
       \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.06002824858757062\textwidth}P{0.3661723163841808\textwidth}P{0.03001412429378531\textwidth}P{0.16927966101694913\textwidth}P{0.08884180790960451\textwidth}P{0.0012005649717514123\textwidth}P{0.05522598870056497\textwidth}P{0.07923728813559322\textwidth}}
\tabcellsep \tabcellsep \tabcellsep \tabcellsep 8\tabcellsep \\
\tabcellsep \multicolumn{2}{l}{Addis ketema sub}\tabcellsep \multicolumn{2}{l}{Bahale Adarash}\tabcellsep \\
\tabcellsep city\tabcellsep \tabcellsep \tabcellsep sub city\tabcellsep \\
\tabcellsep N=415 OVC\tabcellsep \tabcellsep \tabcellsep N= 385 OVC\tabcellsep \\
Year 2016\tabcellsep \multicolumn{2}{l}{( Z1 -?/2 ) d}\tabcellsep \multicolumn{4}{l}{2 *P *(1 -P) = (1.96) 2 Proportional to size allocation 2 *0.441(1 -0.441 ) = 3.84 16 *0 .44 1*0.559 = 372 0.05 2 0.0025}\\
Volume XVI Issue II Version I\tabcellsep \% cases exposed n=112 OVC\tabcellsep \multicolumn{2}{l}{? 1000 33.4\%}\tabcellsep Employed 38\% n=104 OVC\tabcellsep \tabcellsep Literate 13\% n=84 OVC\tabcellsep 17\% caring for 3 or more orphans n=64 OVC\\
D D D D ) L\tabcellsep \% controls exposed\tabcellsep \multicolumn{2}{l}{<1000 66.6\%}\tabcellsep \multicolumn{2}{l}{Unemployed 62\%}\tabcellsep No Education 44\%\tabcellsep 54\% caring for 1\\
(\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep Sample Size for\tabcellsep \tabcellsep 25\tabcellsep \multicolumn{2}{l}{47 N=364}\tabcellsep 25\tabcellsep 19\\
\tabcellsep cases\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{OVC}\\
\tabcellsep Sample size for controls\tabcellsep \tabcellsep 98\tabcellsep 186\tabcellsep c\tabcellsep 99\tabcellsep 75\\
\tabcellsep Total Sample size\tabcellsep \tabcellsep 137\tabcellsep 264\tabcellsep \tabcellsep 137\tabcellsep 104\\
\tabcellsep with 90\% RR\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \multicolumn{4}{l}{selected sub city in Hawassa town depending on}\tabcellsep \\
\tabcellsep \multicolumn{4}{l}{registration from sub city and then by using simple}\tabcellsep \\
\tabcellsep \multicolumn{4}{l}{random sampling method using random number table}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}HH income in birr Employment status Education of mother/caretaker N o orphan children cared for}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7104332953249716\textwidth}P{0.05718358038768529\textwidth}P{0.0823831242873432\textwidth}}
Mahale\tabcellsep Hayke Dar\\
sub city\tabcellsep sub city\\
N= 313 OVC\tabcellsep N= 237 OVC\\
\tabcellsep \tabcellsep Year 2016\\
\tabcellsep \tabcellsep 33\\
Using simple random sampling Technique (PPS)\tabcellsep \tabcellsep Volume XVI Issue II Version I\\
\tabcellsep \tabcellsep D D D D ) L\\
\tabcellsep \tabcellsep (\\
\multicolumn{2}{l}{Proportional to size allocation =total number of OVC in each selected sub cities/ the sum of OVC in selected sub}\tabcellsep Medical Research\\
cities *total sample size f) Study variable Dependent Variable Nutritional status-stunting, wasting, underweight Figure 3: Schematic presentation of sampling procedure Independent Variables\tabcellsep \tabcellsep Global Journal of\\
Demographic factors (age, sex, ethnicity,\tabcellsep \\
education, number of children in HH, marital status),\tabcellsep \\
Socio economic variables (income, employment), Child\tabcellsep \\
health care (immunization, sickness), Environmental\tabcellsep \\
/sanitation factors (source of water, latrine, domestic\tabcellsep \\
waste disposal), food in security variables, Dietary intake\tabcellsep \\
(breast feeding, Individual Dietary Diversity Score).\tabcellsep \\
\tabcellsep © 2016 Global Journals Inc. (US)\end{longtable} \par
 
\caption{\label{tab_1}sub cities in Hawassa town Using simple random sampling}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.5411870503597123\textwidth}P{0.14064748201438848\textwidth}P{0.16816546762589926\textwidth}}
Variable\tabcellsep Frequency\tabcellsep Percent (\%)\\
Age of the child in Month\tabcellsep (n= 359)\tabcellsep \\
6 -11\tabcellsep 10\tabcellsep 2.8\\
12 -23\tabcellsep 42\tabcellsep 11.7\\
24 -35\tabcellsep 61\tabcellsep 17.0\\
36 -47\tabcellsep 85\tabcellsep 23.7\\
48 -59\tabcellsep 161\tabcellsep 44.8\\
Mean age (SD)\tabcellsep \tabcellsep \\
Sex of the child (n=359\tabcellsep )\tabcellsep \\
Male\tabcellsep 187\tabcellsep 52.1\\
Female\tabcellsep 172\tabcellsep 47.9\\
\multicolumn{2}{l}{Under 5 children in HH (n=359)}\tabcellsep \\
<2\tabcellsep 294\tabcellsep 81.9\\
>=2\tabcellsep 65\tabcellsep 18.1\\
\multicolumn{2}{l}{Family members in HH (n=359)}\tabcellsep \\
<5\tabcellsep 162\tabcellsep 45.1\\
>= 5\tabcellsep 197\tabcellsep 54.9\end{longtable} \par
 
\caption{\label{tab_2}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.5962686567164179\textwidth}P{0.11417910447761194\textwidth}P{0.13955223880597015\textwidth}}
Care taker\tabcellsep 160\tabcellsep 44.6\\
Husband/wife of care takers\tabcellsep 186\tabcellsep 51.8\\
Others ***\tabcellsep 1 3\tabcellsep 3.6\end{longtable} \par
 
\caption{\label{tab_3}of the family (n=359)}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.5368421052631579\textwidth}P{0.13421052631578947\textwidth}P{0.1789473684210526\textwidth}}
Variable\tabcellsep Frequency\tabcellsep Percent (\%)\\
Source of water (n= 359)\tabcellsep \tabcellsep \\
Pipe\tabcellsep \tabcellsep \end{longtable} \par
  {\small\itshape [Note: 37Volume XVI Issue II Version I © 2016 Global Journals Inc. (US)]} 
\caption{\label{tab_4}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.85\textwidth}}
Variable\end{longtable} \par
 
\caption{\label{tab_5}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.7024793388429752\textwidth}P{0.07024793388429752\textwidth}P{0.07727272727272727\textwidth}}
\multicolumn{2}{l}{Age Started complementary feeding (n = 359)}\tabcellsep \\
Immediately after birth\tabcellsep 20\tabcellsep 5.6\\
Within 1-6 month\tabcellsep 75\tabcellsep 20.9\\
Oils and Fats\tabcellsep \tabcellsep \\
Yes\tabcellsep 186\tabcellsep 48\\
No\tabcellsep 173\tabcellsep 52\end{longtable} \par
 
\caption{\label{tab_6}Table 4 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.46484375\textwidth}P{0.1328125\textwidth}P{0.25234375\textwidth}}
Never\tabcellsep 59\tabcellsep 16.4\\
Rarely\tabcellsep 19 1\tabcellsep 63. 6\\
Sometimes\tabcellsep 56\tabcellsep 18. 6\\
Often\tabcellsep 53\tabcellsep 17. 6\\
Eat just a\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_7}able to eat the kinds of food you preferred Because of lack of resources? (n= 359)}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.5616834170854271\textwidth}P{0.05125628140703517\textwidth}P{0.08329145728643216\textwidth}P{0.15376884422110554\textwidth}}
Never\tabcellsep \tabcellsep 45\tabcellsep 12.6\\
Rarely\tabcellsep \tabcellsep 21 2\tabcellsep 67. 5\\
Sometimes\tabcellsep \tabcellsep 55\tabcellsep 17. 5\\
Often\tabcellsep \tabcellsep 47\tabcellsep 15.0\\
\multicolumn{2}{l}{Eat food that you preferred not to eat}\tabcellsep \tabcellsep \\
Because Of lack of resources?\tabcellsep (n=359)\tabcellsep 81\tabcellsep 22.6\\
Rarely\tabcellsep \tabcellsep 192\tabcellsep 69 .0\\
Sometimes\tabcellsep \tabcellsep 53\tabcellsep 19 .0\\
Often\tabcellsep \tabcellsep 43\tabcellsep 15 .4\\
Eat a smaller because there were\tabcellsep not enough\tabcellsep \tabcellsep \\
Food? (n=359)\tabcellsep \tabcellsep \tabcellsep \\
Never\tabcellsep \tabcellsep 63\tabcellsep 17.5\\
Rarely\tabcellsep \tabcellsep 20 1\tabcellsep 67 .9\\
Sometimes\tabcellsep \tabcellsep 62\tabcellsep 20. 9\\
Often\tabcellsep \tabcellsep 33\tabcellsep 11.1\\
Eat a fewer meal because there W\tabcellsep ere not\tabcellsep \tabcellsep \\
enough food? (n= 359)\tabcellsep \tabcellsep \tabcellsep \\
Never\tabcellsep \tabcellsep 43\tabcellsep 12.0\\
Rarely\tabcellsep \tabcellsep 22 2\tabcellsep 70. 2\\
Som etimes\tabcellsep \tabcellsep 54\tabcellsep 17.0\\
Often\tabcellsep \tabcellsep 40\tabcellsep 12.6\\
No\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_8}few kinds of food day after Day due to lack of resources ? (n= 359)}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.40865384615384615\textwidth}P{0.16346153846153846\textwidth}P{0.2778846153846154\textwidth}}
Never\tabcellsep 147\tabcellsep 69 .3\\
Rarely\tabcellsep 151\tabcellsep 71.2\\
Sometimes\tabcellsep 49\tabcellsep 22.2\\
Often\tabcellsep 12\tabcellsep 5 .6\end{longtable} \par
 
\caption{\label{tab_9}food at all because there were Not enough resources? (n= 359)}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5} \par 
\begin{longtable}{P{0.85\textwidth}}
Year 2016\\
39\\
Volume XVI Issue II Version I\\
D D D D ) L\\
(\\
Medical Research\\
Global Journal of\end{longtable} \par
  {\small\itshape [Note: © 2016 Global Journals Inc. (US)]} 
\caption{\label{tab_10}Table 5 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{6} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_11}Table 6 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.02457482993197279\textwidth}P{0.4784863945578231\textwidth}P{0.003854875283446712\textwidth}P{0.30646258503401363\textwidth}P{0.03662131519274377\textwidth}}
\tabcellsep Never\tabcellsep \tabcellsep 97\tabcellsep 27.0\\
\tabcellsep Rar ely\tabcellsep \tabcellsep 183\tabcellsep 69.8\\
\tabcellsep Sometimes\tabcellsep \tabcellsep 54\tabcellsep 20.6\\
\tabcellsep Often\tabcellsep \tabcellsep 25\tabcellsep 9.5\\
\tabcellsep \multicolumn{2}{l}{Whole day eating anything because There was}\\
\tabcellsep \multicolumn{2}{l}{not enough food? (n= 359)}\\
Year 2016\tabcellsep \multicolumn{2}{l}{Never e) OVC care and support characteristics in selected Rarely sub city, Hawassa town, Ethiopia, 2014 Sometimes Often Seventy one percent of the OVC get nutritional support from nongovernmental organization through direct assessment and supplementation as a main means of support which was 51\%. About 170 (47.4\%) of}\tabcellsep 174 activities and access to credit 111(30.9\%) and 86 (24\%) 48.5 133 respectively .About 221(61.6\%) of the OVC had 71.8 42 22 .7 10 5.4 educational support from supportive organization through direct assistance 99 (27.6\%). About 232(64.6\%) of the OVC had Psychological support from supportive organization through Training of Psycho social support\\
\tabcellsep \multicolumn{2}{l}{the OVC had health care support from the supportive}\tabcellsep 86 (24.0\%). About 153(42.6\%) of the OVC had legal\\
\tabcellsep \multicolumn{2}{l}{organization through free health care access as a main}\tabcellsep support from supportive organization and About\\
D D D L D ) Volume XVI Issue II Version I\tabcellsep \multicolumn{2}{l}{Variable ANC follow -up (n= 359) Yes No Place of deliver (n= 359) Health facility Home means of support (52.6\%).About 170 (46.5\%) of the supportive organization through income generating OVC had economic strengthening support from}\tabcellsep Frequency 316 43 273 86 142(42.6\%) of the OVC had shelter and care support Percent (\%) 12 .0 88 .0 76 .0 24 .0 from supportive organization (\\
(\tabcellsep \tabcellsep \\
\tabcellsep \multicolumn{2}{l}{Who attend the deliver (n= 359)}\\
\tabcellsep TBA\tabcellsep \tabcellsep 84\tabcellsep 23.4\\
\tabcellsep Health personnel\tabcellsep \tabcellsep 275\tabcellsep 76.6\\
\tabcellsep \multicolumn{2}{l}{Child received Vaccination (n= 359)}\\
\tabcellsep Yes\tabcellsep \tabcellsep 333\tabcellsep 92.8\\
\tabcellsep No\tabcellsep \tabcellsep 25\tabcellsep 7 .0\\
\tabcellsep Not known\tabcellsep \tabcellsep 1\tabcellsep .3 0\\
\tabcellsep \multicolumn{2}{l}{Type Vacci nation received (n= 315)}\\
\tabcellsep BCG\tabcellsep \tabcellsep 62\tabcellsep 19.7\\
\tabcellsep Polio\tabcellsep \tabcellsep 64\tabcellsep 20.3\\
\tabcellsep Measles\tabcellsep \tabcellsep 11\tabcellsep 3.5\\
\tabcellsep All\tabcellsep \tabcellsep 178\tabcellsep 56.5\\
\tabcellsep \multicolumn{2}{l}{Vitamin A supplementation (n= 359)}\\
\tabcellsep Yes\tabcellsep \tabcellsep 311\tabcellsep 13.4\\
\tabcellsep No\tabcellsep \tabcellsep 48\tabcellsep 18.6\\
\tabcellsep \multicolumn{2}{l}{Measles Infection( n= 359)}\\
\tabcellsep Yes\tabcellsep \tabcellsep 52\tabcellsep 14 .5\\
\tabcellsep No\tabcellsep \tabcellsep 307\tabcellsep 85. 5\\
\tabcellsep Cough in 2 weeks\tabcellsep (n= 359)\\
\tabcellsep Yes\tabcellsep \tabcellsep 78\tabcellsep 21.8\\
\tabcellsep No\tabcellsep \tabcellsep 281\tabcellsep 78.3\end{longtable} \par
 
\caption{\label{tab_12}Sleep at night hungry because There was not enough food? (n= 359)}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5.7} \par 
\begin{longtable}{P{0.6707608695652174\textwidth}P{0.014782608695652174\textwidth}P{0.04527173913043478\textwidth}P{0.07206521739130434\textwidth}P{0.0471195652173913\textwidth}}
Diarrhea in 2 weeks\tabcellsep (n= 359)\tabcellsep \tabcellsep \\
Yes\tabcellsep \tabcellsep 54\tabcellsep 15 .0\\
No\tabcellsep \tabcellsep 305\tabcellsep 85 .0\\
Fever in 2 weeks\tabcellsep (n= 359)\tabcellsep \tabcellsep \\
Yes\tabcellsep \tabcellsep 98\tabcellsep 27.3\\
No\tabcellsep \tabcellsep 261\tabcellsep 72.7\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep Year 2016\\
\multicolumn{4}{l}{Variable Food and nutrition support (n= 359) No Through Assessment and supplementation Through Link to health center Through Training The prevalence of stunting 35.1\% (95\%CI: 30.3, 40.2), wasting 7.5 \% (95\% C.I 5.2 -10.7Frequency Percent (\%) 103 28.7 183 51.0 59 16.4 31 8.6}\tabcellsep Volume XVI Issue II Version I\\
\multicolumn{2}{l}{Health care (n=359 ) No}\tabcellsep 189\tabcellsep 52.6\tabcellsep ( D D D D ) L\\
Through free access\tabcellsep \tabcellsep 131\tabcellsep 36.5\\
Through Home visit\tabcellsep \tabcellsep 48\tabcellsep 13.4\\
Through Training\tabcellsep \tabcellsep 18\tabcellsep 5.0\\
\multicolumn{2}{l}{Economic strengthening (n=359)}\tabcellsep \tabcellsep \\
No\tabcellsep \tabcellsep 192\tabcellsep 53.5\\
\multicolumn{2}{l}{Through Vocational training}\tabcellsep 79\tabcellsep 22\\
\multicolumn{2}{l}{Through Income g enerating activities}\tabcellsep 111\tabcellsep 30.9\\
\multicolumn{2}{l}{Through Access to credits}\tabcellsep 86\tabcellsep 24.0\\
\multicolumn{2}{l}{Education support (n=359)}\tabcellsep \tabcellsep \\
No\tabcellsep \tabcellsep 138\tabcellsep 38.4\\
\multicolumn{2}{l}{Through Direct assistance}\tabcellsep 99\tabcellsep 27.6\\
\multicolumn{2}{l}{Through Identifying and promoting}\tabcellsep 91\tabcellsep 25.3\\
Through Training\tabcellsep \tabcellsep 61\tabcellsep 17\\
\multicolumn{2}{l}{Psychological support (n=359)}\tabcellsep \tabcellsep \\
No\tabcellsep \tabcellsep 127\tabcellsep 35 .4\\
\multicolumn{2}{l}{Through Training of Psycho social support}\tabcellsep 86\tabcellsep 24.0\\
Through Support\tabcellsep \tabcellsep 129\tabcellsep 35.9\\
Through Parenting\tabcellsep \tabcellsep 41\tabcellsep 11.4\end{longtable} \par
  {\small\itshape [Note: © 2016 Global Journals Inc. (US)]} 
\caption{\label{tab_13}Table 5 ) . Table 7 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{8} \par 
\begin{longtable}{P{0.08215613382899628\textwidth}P{0.16273234200743494\textwidth}P{0.44869888475836434\textwidth}P{0.06319702602230483\textwidth}P{0.08847583643122676\textwidth}P{0.004739776951672862\textwidth}}
\tabcellsep \tabcellsep Legal protection (n=359)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep No\tabcellsep 206\tabcellsep 57.4\\
\tabcellsep \tabcellsep Through Protection\tabcellsep 82\tabcellsep 22.8\\
\tabcellsep \tabcellsep Through Link to\tabcellsep 89\tabcellsep 24.8\\
\tabcellsep \tabcellsep Shelter and care (n=359)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep No\tabcellsep 218\tabcellsep 60.7\\
\tabcellsep \tabcellsep Through Support family\tabcellsep 98\tabcellsep 27.3\\
\tabcellsep \tabcellsep Through Assessment\tabcellsep 29\tabcellsep 8.1\\
\tabcellsep \tabcellsep Through Improve shelter\tabcellsep 29\tabcellsep 8.1\\
\tabcellsep \tabcellsep Duration of support (n=359)\tabcellsep \tabcellsep \\
Year 2016\tabcellsep \tabcellsep < 6 month >= 6 month Adequacy of support (n=359)\tabcellsep 41 318\tabcellsep 11.4 88.6\\
\tabcellsep \tabcellsep Adequate\tabcellsep 108\tabcellsep 30.1\\
\tabcellsep \tabcellsep Not adequate\tabcellsep 248\tabcellsep 69.1\\
( D D D D ) L Volume XVI Issue II Version I\tabcellsep \multicolumn{2}{l}{No answer 10 15 20 25 30 35 40 f) Prevalence of malnutrition among OVC 35.1 percentage of malnutrtion}\tabcellsep 3 7.5\tabcellsep .8\tabcellsep 8.9\\
\tabcellsep \tabcellsep 5\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 0\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep stunting\tabcellsep wasting\tabcellsep \multicolumn{2}{l}{underweight}\\
\tabcellsep i.\tabcellsep Factors associated for stunting\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_14}Table 8 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{9} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_15}Table 9 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{10} \par 
\begin{longtable}{P{0.030774800868935553\textwidth}P{0.1834178131788559\textwidth}P{0.1501810282404055\textwidth}P{0.2677407675597393\textwidth}P{0.12371469949312092\textwidth}P{0.000615496017378711\textwidth}P{0.09355539464156408\textwidth}}
\tabcellsep Variable\tabcellsep \multicolumn{2}{l}{Wasting}\tabcellsep \multicolumn{2}{l}{COR (95\% CI)}\tabcellsep AOR (95\% CI)\\
\tabcellsep Cough\tabcellsep Yes N (\%)\tabcellsep No N (\%)\tabcellsep \tabcellsep \\
\tabcellsep Yes\tabcellsep 10(37.0\%)\tabcellsep 68(20.5\%)\tabcellsep \multicolumn{3}{l}{2.421(1.072, 6.667) * 2.272(1.997,5.181) **}\\
\tabcellsep No\tabcellsep 17(63.0\%)\tabcellsep 263(79.5\%)\tabcellsep 1\tabcellsep \tabcellsep 1\\
\tabcellsep HH food security\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep Food secured\tabcellsep 19(70.4\%)\tabcellsep 287(86.7\%)\tabcellsep 1\tabcellsep \tabcellsep 1\\
Year 2016\tabcellsep Food and nut. Supp. Yes No Food in secured\tabcellsep 8(29.6\%) 25(92.6\%) 2(92.6\%)\tabcellsep \multicolumn{4}{l}{44(13.3\%) 230(69.5\%) 101(30.5\%) 5.495(1.277,13.811)* 6.251(1.427,9.778) ** 2.747(1.134,6.667) * 2.667(1.072,6.667) ** 1 1}\\
\tabcellsep Fever\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Volume XVI Issue II Version I\tabcellsep Yes No Diarrhea Yes No IDDS High DD Less DD Measles Vaccination Yes No\tabcellsep 10(10.2\%) 17(6.5\%) 6(11.1\%) 21(6.9\%) 16(6.5\%) 11(9.6\%) 6(11.5\%) 21(6.8\%)\tabcellsep \multicolumn{3}{l}{88(89.8\%) 244(93.5\%) 48(88.9\%) 284(93.1\%) 229(93.5\%) 2.079 (0.745,5.744) * 2.917(1.314,6.468) * 1 1.334 (0.662,2.682) * 1 103(90.4\%) 1 46(88.5\%) 1.018 (0.982,1.038) * 286(93.2) 1}\tabcellsep 1.62(0.93,2.82) 1 0.997 (0.966,1.014) 1 1.014(0.873,1.175) 1 0.824(0.492,1.355) 1\\
D D D D ) L\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
(\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \multicolumn{2}{l}{iii. Factors associated for under weight}\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep Variable\tabcellsep \multicolumn{2}{l}{Under weight}\tabcellsep COR (95\% CI)\tabcellsep \tabcellsep AOR (95\% CI)\\
\tabcellsep Family size\tabcellsep Yes N (\%)\tabcellsep No N ( \%)\tabcellsep \tabcellsep \\
\tabcellsep <5\tabcellsep 21(65.6\%)\tabcellsep 141(43.1\%)\tabcellsep 1\tabcellsep \tabcellsep 1\\
\tabcellsep >=5\tabcellsep 11(34.4\%)\tabcellsep 186(56.9\%)\tabcellsep \multicolumn{3}{l}{2.518(1.176, 5.394) * 2. 256 (1.148, 6.721) **}\\
\tabcellsep Duration breast feeding\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep < 6 month\tabcellsep 2(7.1\%)\tabcellsep 12( 3.9\%)\tabcellsep 3.285(.623,17.317)\tabcellsep *\tabcellsep 3.026(.612, 14.952)\\
\tabcellsep 6-11 month\tabcellsep 13(46.4\%)\tabcellsep 63(20.3\%)\tabcellsep \multicolumn{3}{l}{3.746(1.654, 8.484) * 3.257(1.344, 7.891) **}\\
\tabcellsep >=12 month\tabcellsep 13(46.4\%)\tabcellsep 23.6(75.9\%)\tabcellsep 1\tabcellsep \tabcellsep 1\\
\tabcellsep Vitamin A supp\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep Yes\tabcellsep 2(4.2\%)\tabcellsep 46(95.8\%)\tabcellsep 1\tabcellsep \tabcellsep 1\\
\tabcellsep No\tabcellsep 30(9.6\%)\tabcellsep 281(90.4\%)\tabcellsep \multicolumn{2}{l}{1.47 5(0.52,4.21) *}\tabcellsep 1.37 2(0.39 1,4.87 6)\end{longtable} \par
 
\caption{\label{tab_16}Table 10 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.016531685977772523\textwidth}P{0.8169868763301017\textwidth}P{0.0016079451406951998\textwidth}P{0.0148734925514306\textwidth}}
Global Journal of Medical Research 50 Volume XVI Issue II Version I Year 2016 ( D D D D ) L Global Journal of Medical Research Global Journal of Medical Research 52 Volume XVI Issue II Version I Year 2016 ( D D D D ) L 54 Volume XVI Issue II Version I Year 2016 Year 2016 Volume XVI Issue II Version I ( D D D D ) L ( D D D L D )\tabcellsep \multicolumn{2}{l}{-59 months on care and support from nongovernmental organization Hawassa town.. Please Check box ( ) to that show the respondent"s commitment to participate in this study 1. Agree 2. Disagree (End the interview) Signature of Participant \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore Date \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Annex III: Interviewer Administered Questionnaire in English Data collection tools for Mekelle University, MPH/PHN research project on Nutritional status and Demographic factors, Socio economic variables, Child health care, Environmental /sanitation factors, food ? 4. Not Known college of health sciences, department of public health associated factors among Orphans and vulnerable preschool children on care and support from following Questionnaire classified in to 5 parts as socio ? 3. Both ? 4. D on"t Know ? 0. No nongovernmental organization Hawassa town. The ? Annex I: Consent form ? ? insecurity variables, Dietary intake and anthropometric measurements. CODE OF THE QUETIONNAIRE\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Name of the interviewer\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Signature\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Date of interview (dd/mm/yyyy) \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Result of interview: 1-Completed 2-Partially completed 3-Refused 4-Respondent not available Checked by supervisor; Part II: Sanitation and Hygiene related question Assessment Code Questions Coding categories Sk ip to Q. 101 Address of the child sub -city \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Kebele \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q. 102 Age of the child in Month \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore month Q. 103 Sex of the child ? 1. Male ? 2. Female Q. 104 Number of children in under Five in HH \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q. 105 How many members are present in the HH now \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q. 106 Religion of parents/caretaker ? 1. Orthodox ? 2. Muslim ? 3. Catholic ? 4. Protestant ? 5. Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q. 107 Ethnicity of the mother/caretakers ? 1. Sidama ? 2. Wolayita ? 3. Gurage ? 4. Amhara ? 5. Tigre ? 6. Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q. 10 8 Are the parents of the child alive ? 1. Yes ? 0. No If no, skip to Q. 110 Q. 10 9 If, yes, who is alive ? 1. Mother ? 2. Father Part I: Demography and socioeconomic characteristics Q.110 The respondent "s relation with the child ? 1. P arents ? 2. Brother ? 3. Sister ? 4.Grand parents ? 5.other relative ? 6.neighbour hood Q.111 Age of the care tak ers/ Guardian \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  years Q.112 Sex of the care taker / Guardian ? 1.male ? 2.female Q.113 Educational status of care taker ? 1. No formal education ? 2. Read \& write ? 3. Grade 1 -8 ? 4. Grade 9 -10 ? 5. Grade 10+2 \& above Q.114 Oc cupation of the care taker/Guardian ? 1. House wife ? 2. Private employee ? 3. Government employee ? 4. Daily laborer ? 5. Merchant ? 6. Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.115 Marital status of the care taker/Guardian ? 1. Single ? 2. Married ? 3. Divorced ? 4. Widowed ? 5. Separated If not married, skip to Q.117 Q.116 Occupation of the husband /wife ? 1. Private employee ? 2. Government employee ? 3. Daily laborer ? 4. Merchant ? 5. Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore  31 Q.117 Who is the head of the family? ? 1. car etakers ? 2. Husband /wife of care takers ? 3.other ,Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.118 What is your family total monthly income? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Eth. Birr Q.119 Where is your Source of water? ? 1. Pipe ? 2. publ ic stand ? 3. protected spring /well ? 4. Other, Specify \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.120 How much water used per day ? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore L/day Q.121 What Method used for water storage ? ? 1. Pot ? 2. Jeri Can ? 3. Bucket ? 4. Other, Specify \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.122 Do you was h your hands with soap and water Whenever you feed your child? ? 1.Yes ? 0. No Q.123 Do you have latrine? ? 1. Yes ? 0. No If no skip to Q.125 Q.124 What type of latrine available ? 1.pit latrine ? 2.Ventilated Improved latrine ? 3.Water carriage type Q.125 Where do You dispose domestic waste ? 1.Pit ? 2.Open ? 3.MunicipalityService ? 4.Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.126 Do you have separated kitchen ? 1. Yes ? 0. No Q. 201 Did the child Brest feed ? 1.Yes ? 2.No ? 3.Don"t know If not yes, skip to Q.206 Q.202 When did mother/caretakers first put the child on breastfeeding? ? 1.With in first hour of delivery ? 2.Within the firs t 8 hour of delivery ? 3.After 2 -3 days Part III: Dietary intake cassava, enset and other foods made from roots yesterday? Q.210 Did the ch ild eat any dark green leafy vegetables (kale, Swiss chard, cabbage) and other vegetables (tomato, onion) yesterday? ? 1. Yes ? 0. No Q.211 Did the child eat any fruits like ripe mango, papaya, banana, avocado and lemon and orange?) and other fr u its yesterday? ? 1. Yes ? 0. No Q.212 Did the child eat any flesh meat (beef, lamb, goat, chicken) and any organ meat Q.213 Did the child eat any eggs yesterday? ? 1. Yes ? 0. No Q.214 Did the child eat any fresh or dried fish yesterday? ? 1. Yes ? 0. No Q.308 Had the child suffer from infections like measles? Q.309 Fever for the past 2 weeks ? ? 1. Yes ? 0. No Q.310 Cough for the past 2 weeks ? ? 1. Yes because there was not enough food? ? 0. No Q.412 If yes, how frequent? ? 2.sometimes sanitation, optimal nutrition ? 1.rarely immunization, malaria prevention, hygiene and to Q.41 3 ? 3.training to caregivers on the importance of ? 0. No Did you or any household member eat fewer meals in a day ? 1. Yes If no, skip of the child Q.411 ? 1. Yes ? 3.often ? 2.Regular home visits to assess health status (liver, kidney, heart) yesterday? ? 1. Yes ? 0. No Q.304 Did the c hild receive vaccination? ? 1. Yes ? 2. No ? 3. Don"t know Q.305 Do you have vaccination card ? 1. Yes ? 0. No If no skip to Q.307 Q.306 What is the vaccination status? ? 1.BCG ? 2. Polio ? 3.Me sales ? 4 Other, Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.307 Is the chil d received vitamin A supplementation? (in the last 6 months) ? 1. Yes ? 0. No ? 3.often Q.407 Did you or any household member eat food that you preferred not to eat because of lack of resources to obtain other types of food? ? 1. Yes ? 0. No If no, skip to Q.40 9 Q.408 If yes , how frequent? ? 1.rarely ? 2.sometimes ? 3.often Q.409 Did you or any household member eat a smaller meal than you felt you needed because there was not enough food? ? 1. Yes ? 0. No If no, skip to Q.4 11 Q.410 If yes, how frequent? ? 1.rarely ? 2.sometimes interventions ? 3.training on nutrition, diet, and food preparation for care takers Q.503 If Health Care, what services provided? ? 1.free access to health services for OVC and guardians 6.Legal Protection 7.Shelter and Care Q.502 If Food and Nutrition, what services ? 2.links to other health and nutrition provided? ? 1.Nutritional assessment and supplementary feeding 5.Psychosocial Support ? 4.Other Q.203 Did the child exclusively breas tfeed ? ? 1. Yes ? 2. No ? 3. Don"t know Q.204 For how long the childe Breastfeed? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  month Q.205 At what age did you start to give food in Additio n to your breast milk? ? 1.Immediately after birth ? 2.Within 1 to 6 months ? 3.Within 6 to 12 months ? 4.Twelve month later Q.206 What is the first food mother/caretakers used to feed the child? ? 1. Milk ? 2. Adult food ? 3. Pourage ? 4.Other specif y Q.207 What do Mother/caretakers use d to feed the child? ? 1. Hand ? 2. Cup and spoon ? 3. Bottle ? 4. Don"t know Q.208 Did the child eat any flat bread, biscuits, or any other foods made from cereal (maize, sorghum, millet, wh eat, barely or teffe) yesterday? ? 1. Yes ? 0. No Q.209 Did the child eat any pumpkin, carrots, y/orange flesh sweet potatoes irish potato, white sweet potato, onion, white yam, Q.301 H as mother ever attended ANC during he r preg nancy of this child? ? 1.Yes ? 0.No Q.302 Where did mother give birth to the child? ? 1. Home ? 2. Health facility ? 3. Other ,Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.303 Who attended the delivery ? ? 1. TBA Morbidity variables Q.215 Did the child eat any food made from beans like kidney beans, haricot beans, field peas, cow peas, chick peas, nuts, lentils or others yesterday? ? 1. Yes ? 0. No Q.216 Did the chi ld drink milk and milk products yesterday? ( milk, cheese, yogurt or other milk products) ? 1. Yes ? 0. No Q.217 Did the child eat any food with oil, fat or butter yesterday? ? 1. Yes ? 0. No Q.218 Did the child eat any suga r or honey, sweet/soft dr ink yesterday? ? 1. Yes ? 0. No Q.219 Did the child eat any spices (black pepper, salt), condiments (soy sauce, hot sauce), and coffee, tea yesterday ? ? 1. Yes ? 0. No Part IV: Q.311 Diarrhea for the past 2 weeks? ? 1. Yes ? 0. No Q.312 Bilat eral pitting oedema on clinical examination ? 1. 0 ? 2. + ? 3. ++ ? 4. +++ Q.401 Did you worry that your household would not have enough food? ? 1. Yes ? 0. No If no, skip to Q.40 3 Q.402 If yes, how frequent? ? 1.rarely ? 2.sometimes ? 3.often Q.403 Were you or any household member not able to eat the kinds of food you preferred because of lack of resources ? ? 1. Yes ? 0. No If no, skip to Q.40 5 Q.404 If yes, how frequent? ? 1.rarely ? 2.sometimes ? 3.often Q.405 Did you or any household member eat just a few kinds of food day after day due to lack of resources ? ? 1. Yes ? 0. No If no, skip to Q.40 7 D D D Q.413 Was there ever no food at all in your household because there were not enough resources to get more ? 1. Yes If no, skip Q.504 If Economic Strengthening, what services ? 1.vocational training for caregivers ? ? 0. No to Q.41 5 Q.414 If yes, how frequent? ? 2.income-generating activities involving provided? small business ? 1.rarely ? 3.access to credit ? 2.sometimes Q.505 If Education ,what services provided ?1.Direct assistance to subsidize school costs ? 3.often Q.415 Did you or any household member go to sleep at night hungry because there was not enough food ? ? 1. Yes ?2.Identifying and promoting educational If no, skip opportunities ? 0. No to Q.41 7 ?3.Training caregivers to OVC who are not D Q.416 If yes, how frequent? ? 1.rarely ? 2.sometimes ? 3.often Q.417 Did you or any household member go a whole day without ? 1. Yes enrollment in school Q.506 If Psychosocial Support, what services ? 1. providing regular training to care givers on psychosocial support for OVC provided? ? 2.develope psychosocial support groups to If no, skip provide support to OVC and caregivers eating anything because there was not enough food? ? 0. No to Q.501 Q.418 If yes, how frequent? ? 1.rarely ? 2.sometimes ? 3.often Q.501 What type of Support Provided by NGO? 1.Food and Nutrition Part V: OVC Care and support ? 3.parenting and communication skills for caregivers, support during illness Q.507 If Legal Protection, what services provided? ? 1. protect children about the legal rights of children ? 2.link OVC and caretakers to legal services and child protection bodies when required Q.508 If Shelter and Care, what services ? 1.Supporting families with home visits (more than one answer is possible) 2.Health Care provided? ? 2.Regularly assess and identify the shelter ? 1. Yes ? 0. No ? 2. Health personnel ? 3.Other,Specify\textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.4 06 If yes, how frequent? ? 1.rarely ? 2.sometimes 4.Education 3.Economic Strengthening and care needs of OVC}\tabcellsep Year 2016 ( D D D D ) L Global Journal of Medical Research 51 Volume XVI Issue II Version I Year 2016 ( D D D D ) L Global Journal of Medical Research Global Journal of Medical Research Volume XVI Issue II Version I Year 2016 55 Volume XVI Issue II Version I Year 2016 ( D D D D ) L ( D D D D ) L\\
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Global Journal of Medical Research 60 Volume XVI Issue II Version I Year 2016 ( D D D D ) L Volume XVI Issue II Version I Year 2016 ( D D D D ) L\tabcellsep 1-???á??"?? 2-???? ???á??"?? ??????? ?? \}.l ??? Q.101 ????/? ????? Q.102 ????/? ??? (????) ? ??? I: ?????á??" ???-??á??" ????? 3-?????? 4-??? ??????? ????? ??? ?? ??? ?/? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  ??? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore ?? Q.103 ????/? ??? ? 1. ??? ? 2. ?? 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Q.110 ?? ???? ??????? ?? ????/? ?? ??? ???á??"? ? 1. ??? ? 2. ???? ? 3. ??? ? 4. ??? ? 5. ?? ??? ? 6.?? ?? ???? Q.111 ?????/? ???? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore á??"?? Q.112 ?????/? ??? ? 1.??? ? 2.?? Q.113 ?????/? ?????? ???? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  Q.114 ?????/? ??? ? 1. ??? ???? ? 2. ??? ???? ? 3. ?????? ???? ? 4. ??? ???? ? 5.??? ? 6. ?? ?? ???? Q.115 ?????/? ???? ?á??"?? ? 1.????/?????.? 117 ? 2.???/? ? 3. ????/? ? 5.?????/? ? 0.??? ? 4. ??/??? ????? ????/? ??? ?.? 117 ? 2. ?????? ???? Q.201 ???/? ?? ????/???? ? 0.??? ? 1.?? ? 3. ??? ???? ? 4. ??? ? 5. ?? ?? ???? Q.117 ????? ??? ?? ??? ? 1.????/? ? 2.?????/? ??/??? ? 3.?? ?? ???? Q.118 ????? ??? ??? ??? ??? ??á??"?? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  ??? ??? II ? ?????á??" ??? ???á??"? ?????? Q.119 ???? ?? ??? ??????? ? 1. ???? ? 2. ???? ??? ? 3. ???? ? 4. ?? ?? ???? 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Q.215 ?á??"?? ???? ????? ????? ???? ???? ? 1.?? ? 4. ????? Q.203 ???/? ?????? 6 ?? ?? ?? ????/???? ? 1.?? ? 2.??? ? 3.????? Q.204 ???/? ?? ??? ??? ?? ????/???? ????? ?á??" ?????? ????/??? ? 0.??? Q.216 ?á??"?? ???á??" ???? ???? KUdK? ?Ãw??`? ????/??? ? 1.?? ? 0.??? Q.217 ?á??"?? u²Ã?/upu? ¾\}c\textasciicircum  UÃ?"w/ K?KA? ??? ? 1.?? \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore \textunderscore  ??? Q.205 ???? ??? ????/? ???? ?????? ?? ???? ? 1.?? ???????/? ? 2.? 1??? 6 ?? ??? ?? ? 3.? 6 ???12 ?? ??? ?? ? 4.? 12 ?? ??? ? 5.????? Q.206 ???/? ?????? ?? ?????? ??? ?? ???? ? 1.??? ? 2.???? ??? ????? ????/??? ? 0.??? Q.218 ?á??"?? ???? ???? ???? ???? ??? g"¢\textasciicircum  ?ÑÇ ? ???? ????? ????/??? ? 1.?? ? 0.??? Q.219 ?""? pST-pSU? u<"? h?? ????/??; ? 1.?? ? 0.??? ??? 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 			\footnote{© 2016 Global Journals Inc. (US)} 			\footnote{© 2016 Global Journals Inc. (US) Part IV: Food insecurity and malnutrition} 		 		\backmatter   			 
\subsection[{Acknowledgments}]{Acknowledgments}\par
First and for most I give honor to God, the omnipotent for every protection he did to me. I would like to pass my special thanks to my advisors Dr.Usha kulkarni (Associate professor) and Mr.yemane G/mariam (B.Sc.,M.P.H) for their unreserved help throughout my whole work starting from the Proposal development to the final work of this thesis. Without them, the accomplishment of this work would have been impossible. My gratitude also goes to save the children for financial sponsoring of this study and Mekelle University College of health sciences department of public health for giving this chance. I am grateful to Mr. Ejigu Gebeye (MPH, MSc candidiate), Mr. Omer Said (BSc, MSc), Mr.Semaw Ferede (BSc,MSc) for their comments and supports. I am grateful to Hawassa city 			  			 			 			  				\begin{bibitemlist}{1}
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