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Acute malnutrition is a recent and severe weight loss (wasting) as a result of acute food shortage and/or illness and is measured by weight for height or Mid Upper Arm Circumference (MUAC) [1].

Malnutrition is associated with more than half of all child mortality worldwide [2].

Malnutrition is a serious problem in the world; currently, 195 million under-five children are affected by malnutrition globally; 55 million of them suffer from acute malnutrition and around 26 million under-five children are severely acute malnourished. Among the total under-five children suffering from malnutrition, 90% lives in sub-Saharan Africa and South Asia. Every year, 3.5 million children die of malnutrition- related causes in the world [3,4]. Hence, it is at third level in the world of the disease burden in this age group [5].

In sub-Saharan Africa, the prevalence of stunting is declining but remains over 30% [6]. Among sub-Saharan countries, the prevalence of wasting in Ethiopia is 10%, and the prevalence of stunting is 38% [7].

Many studies in developing countries including Ethiopia showed that household characteristics like income [8-12], less access to health service, [9-11], household head [9-11], lack of toilet, [13,14] mothers’ education, [15,16], paternal education [17], hand washing, [18-20], household food insecurity [21,20], poor exclusive breast feeding [21,22] and number of under-five children or family size [23,24], has explained the occurrence of acute malnutrition.

The aim of this systematic review and meta-analysis is to determine the association between Employment status of mothers and acute malnutrition in children in Ethiopia.

Thus, this finding will be used as a source of information on the association between employment status of mothers and acute malnutrition among under five children in Ethiopia (Table 1).

Table 1: Employment status of mothers and acute malnutrition among under five children in Ethiopia.

Electronic databases were searched on reference manager software and quality assessment of the included studies was performed. Using assessment of risk of bias tool.

A meta-analysis was applied to determine the effect of mother’s employment status on acute malnutrition among fewer than five children in Ethiopia.

Words used to search related literatures on the topic were ‘Acute Malnutrition’, ‘Employment status of mothers in Ethiopia, Determinants of Acute Malnutrition in Ethiopia’ were used.

The PRISMA statement [25] for the reporting of systematic reviews recommended by the Cochrane Collaboration was followed while conducting this meta-analysis (Figure 1).

Figure 1: Study flow diagram.

The first searching of databases results in 1008 articles.

After removing duplicates, we have got 184 studies on acute malnutrition among fewer than five children in Ethiopia.

Forty five [26] full-text articles assessed for eligibility and 11 studies met the inclusion criteria.

The rest were excluded due to studies not assess employment status of mothers and acute malnutrition among under five children in Ethiopia.

Using data from 11 studies in Ethiopia we performed a meta- analysis with a specific focus on acute malnutrition among under five children.

We applied a random effects analytic model and calculated a pooled odds ratio.

The meta-analysis is done using RevMan software version 5.3 and meta essential software.

When we see the employment status of mothers, 35% (1857) employed mothers and 65% (3444) house wife mothers were included in this study.

The proportion of acute malnutrition among employed mothers is 26.1% (484) and among house wife mothers is 24% (825).

Meta-analysis

The odds ratios for all studies revealed no statistically significant association of Acute Malnutrition among under five children with employed mothers compared to house wife mothers.

OR MH, Random, 95% CI, 0.93, (0.66, 1.32)

Heterogeneity Tau²=0.26; Chi²=50.14, DF=10 (P<0.00001); I²=80%

Test for overall effect: Z=0.39 (P=0.70) (Figures 2-5).

Figure 2: The association between employment status of mothers and acute malnutrition among under five children in Ethiopia.

Figure 3: Abbe plot for the association between employment status of mothers and acute malnutrition among under five children in Ethiopia.

Figure 4: Galbraith plot for the association between employment status of mothers and acute malnutrition among under five children in Ethiopia.

Figure 5: Funnel plot for the association between employment status of mothers and acute malnutrition among under five children in Ethiopia.

The Abbe plot shows that 3 studies are above zero effect and the rest below zero effect. Galbraith plot shows that 95% of the studies are within the range of two-color lines and there is no outlier of effect size.

The funnel plot shows that there is no publication bias as Egger Regression p value is 0.882 and Begg and Mazumdar p value is 0.815 (Table 2).

Table 2: The funnel plot shows that there is no publication bias as Egger regression p value is 0.882, Begg and Mazumdar p-value is 0.815.

This systematic review and meta-analysis show that there is no statistical significant association between employment status of mothers and acute malnutrition among under five children in Ethiopia and this finding is similar with previous studies Wolayta Sodo Town [26], Konso, Southern Ethiopia, [27], Afar Region, Northeast Ethiopia [28], Karat Town Public Health Facilities, Southern Ethiopia [29], Hadaleala district, Afar region, northeast Ethiopia [30], analysis of the 2016 Ethiopia demographic and health survey [31] two Public Hospitals, North West Ethiopia [32].

The explanation for our finding may be majority of mothers have maternal leave and children get the same care by employed and house wife mothers.

This finding is not similar with previous studies Gedeo Zone, Ethiopia [33] Ethiopia [34].Ekpoma, Edo-Nigeria [35], Mazowe District of Zimbabwe [36], Adama Town, Central Ethiopia. [37], in Tanzania [38], in Addis Ababa [39], Chapel Hilly, Job Arket Paper [40], in Nghean Vietnam [41], in Aydyn, a western city of Turkey [42-44].

The explanation for the observed differences in the findings of our study and other previous studies may be difference in sample size and geographic variations.

Our findings suggest that employment status of mothers has not statistical significant association with acute malnutrition among under five children in Ethiopia.

Kaleab Tesfaye Tegegne, ElenI Tesfaye Tegegne and Mekibib Kassa Tessema was responsible for conceptualization, project administration, software, supervision, and development of the original drafting of the manuscript.

Kaleab Tesfaye Tegegne,, ElenI Tesfaye Tegegne and Mekibib Kassa Tessema were participated in quality assessment of articles, methodology, validation, and screening of research papers.

All authors contributed with data analysis, critically revised the paper, and agreed to be accountable for their contribution.

We would like to thank all the primary authors of the included articles.