Prevalence of acute malnutrition and associated factors among children in schools with and without feeding programs: a comparative cross sectional study

Acute malnutrition was defined as a BMI-for-age Z-score (BAZ) below − 2 standard deviations. School-based feeding programs may be associated with lower occurrences of acute malnutrition. This study aimed to compare the prevalence of acute malnutrition and associated factors among children in primary schools with and without school feeding programs in the Hadiya Zone, southern Ethiopia, in 2022. A comparative cross-sectional study was conducted among 326 schoolchildren aged 10–14 years, with 163 recruited from schools implementing a feeding program and 163 from schools without a feeding program. Participants were selected using systematic sampling based on class rosters. Data were collected through anthropometric measurements and structured questionnaires. Separate multivariable logistic regression models were fitted within each group with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. The prevalence of acute malnutrition was 13.5% (95% CI: 8.7–19.7) in schools with a feeding program and 18.4% (95% CI: 12.8–25.2) in schools without. Among children in schools with feeding programs, factors significantly associated with acute malnutrition included low meal frequency (fewer than three meals per day) (AOR = 6.96, 95% CI: 1.92–25.27), lack of a functional latrine at school (AOR = 3.84, 95% CI: 1.04–14.20), and no deworming in the last six months (AOR = 13.50, 95% CI: 3.71–49.08). Among children in schools without feeding programs, significant factors included family size greater than five (AOR = 13.00, 95% CI: 2.27–74.45), no deworming in the last six months (AOR = 12.21, 95% CI: 3.10–48.12), and lack of a functional latrine at school (AOR = 15.00, 95% CI: 4.10–54.88). Children in schools without a feeding program had a higher prevalence of acute malnutrition compared to those in schools with a feeding program. Lack of deworming, absence of functional latrines, low meal frequency, and large family size were significant associated factors. Strengthening deworming programs, improving sanitation facilities, and supporting school feeding initiatives may contribute to reductions in acute malnutrition.