Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.2
,
Jun
e
2
015
, pp
. 71
~76
I
S
SN
: 225
2-8
8
0
6
71
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Ret
r
ospective Ass
e
ssm
ent of Maln
utrition amon
g Under-F
i
ve
Children
in Ayd
e
r Ref
e
rral Hospi
t
al, Tigray Ethiopia
Dest
a Mebr
ah
tu
1
, Girum Se
bsibie
2
,
Te
k
l
em
a
r
ia
m G
u
lt
ie
3
1
Department of
Pediatrics, Sh
ire
Hospital,
Tigr
a
y
,
Eth
i
opia
2
Department of
Nursing and Midwifer
y
,
Addis
Ababa
Uni
v
ersi
t
y
,
Ad
di
s A
b
ab
a,
Et
hi
opi
a
3
Department of
Midwifer
y
,
Arb
a
Mi
nch Univ
ersity
, Arba Minch
,
Ethiopia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Ja
n 23, 2015
Rev
i
sed
Feb
20
, 20
15
Accepted Apr 26, 2015
Currentl
y
world
w
ide there ar
e about 60 m
illion childr
e
n with moderat
e
acut
e
and 13 million
with sever
e
acu
t
e mal
nutrition.
About 9% of s
ub-Saharan
African and 15
% of south Asian childre
n hav
e
moderate acute
malnutritio
n
and about 2%
of children in devel
oping
countries have s
e
vere
acute
m
a
lnutrition
.
Th
e obje
c
t
i
ve of
ai
m
the stud
y was
to assess the m
a
gnitud
e
of
m
a
lnutrition
in
under-fiv
e
chi
l
dren in A
y
d
e
r
referr
al hospit
a
l using
a
retrospective cr
oss-sectional stud
y
d
e
sign. Th
is stud
y
showed that male
childr
e
n, 168(5
8
.1%), wer
e
higher than female, 121(41
.9%). Majority
,
133(46%), were in the
age gro
up b/n
12 to 2
4
months .More than half
,
186(64.4%) wer
e
rural
dwell
e
rs. The
t
y
pes of
m
a
lnutrition
identified
wer
e
Marasm
us, kwashiorkor, Mar
a
sm
ic kwash and
underweight
which
accou
n
t
for 116(40.1%)
,
69(23.9%)
,
54(18.7%) and
50(17.5%) r
e
spectively
.
Marasmus
was
the predominant ty
pe of
malnutrition in all age groups of
under-five malnourished child
ren with prevalence of 40.1
%
where as
underweight was the prevalent ty
pe of
malnutrition (17.3
%). More over the
infant f
eeding
pr
act
ices such
as e
x
cl
usive br
east f
eeding
,
tim
e
l
y i
n
itia
tion of
complementar
y
feeding
,
and having hist
or
y
of
breast feed
ing once in their
life during in
fan
c
y
wer
e
relatively
high
er amon
g the child
ren as compared
with oth
e
r studies.
Keyword:
Kwas
h
io
r
k
o
r
Maln
u
t
rition
Mar
a
sm
u
s
Retro
s
p
ectiv
e
Un
de
rwei
ght
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Tek
l
em
aria
m
Gu
ltie,
Depa
rt
m
e
nt
of
M
i
dwi
f
e
r
y
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
,
Ar
ba M
i
nc
h,
E
t
hi
opi
a.
Em
ail: tekledb2002@gm
a
il.com
1.
INTRODUCTION
Gl
o
b
al
l
y
, hu
n
g
er a
nd m
a
l
nut
ri
t
i
on ar
e t
w
o
of t
h
e m
o
st
si
gni
fi
cant
chal
l
e
nges [
1
]
.
Gl
o
b
al
l
y
,
maln
u
t
ritio
n
is a risk
fact
o
r
fo
r illn
ess an
d
d
eath
,
with
m
i
l
lio
n
s
of
p
r
eg
n
a
n
t
wo
m
e
n
an
d
yo
un
g
ch
ildren b
e
ing
affected due to infections,
poor a
n
d ina
d
e
q
uate diet. Ma
ln
utritio
n
in
creases th
e risk
an
d
worsen
s th
e
sev
e
rity
o
f
infection
s
[2
]. In
fan
t
s and
you
ng
ch
ildren
are m
o
st
affected
b
y
maln
u
t
rition
as
th
ey h
a
v
e
i
n
creased
nut
ri
t
i
onal
ne
eds t
o
s
u
pp
o
r
t
gr
o
w
t
h
[
3
]
.
U
nde
rn
o
u
ri
sh
ed
ch
ildren, as well as ch
ild
ren
with sev
e
re
m
a
l
nut
ri
t
i
on,
h
a
ve a
hi
g
h
e
r
ri
s
k
of
dy
i
n
g t
h
an
chi
l
d
ren
wi
t
h
an
opt
i
m
al
nut
r
i
t
i
onal
st
at
us
[
4
]
.
Th
e term
“
m
aln
u
t
rition
”
is u
s
u
a
lly u
s
ed to
d
e
scrib
e
p
r
o
t
ein
en
erg
y
m
a
ln
u
t
ritio
n
(PEM). The
com
p
rehe
nsive
term
of PEM
is uni
versally accepted a
n
d it
s seve
re
form
s
are called Marasm
us, kwas
hiorkor
an
d Marasm
ic k
w
ash
i
o
r
k
o
r
[5
]. Th
e term
sev
e
re acu
te
m
a
ln
u
t
rition
(SAM) co
m
b
in
es all th
e d
i
fferen
t
form
s
o
f
PEM
,
as SAM refers to
a weig
h
t
-fo
r-heig
h
t
b
e
l
o
w
70
% referred
to as “wasted
”
o
r
p
r
esen
ce of p
ittin
g
ed
em
a
in
b
o
t
h
feet referred
as “ed
em
a
t
o
u
s
maln
u
t
rition
”
. Sev
e
re fo
rm
s o
f
SAM can
also b
e
co
m
p
licate
d
b
y
in
fection
s
. Th
e d
i
fferen
t
fo
rms still h
a
v
e
d
i
fferen
t cau
s
es and
are t
h
erefor
e treated
d
i
fferen
tly [6
]. Ex
cept for
sub
-
Sa
ha
ran
A
fri
ca, t
h
e n
u
t
r
i
t
i
onal
st
at
us
of
chi
l
d
re
n i
s
i
m
pr
o
v
i
n
g gl
obal
l
y
.
Pro
g
re
ss i
s
ho
we
ver
,
hi
n
d
ere
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 2
,
Jun
e
201
5
:
7
1
–
76
72
because of poverty, infection and i
n
effective
governa
n
ce. E
v
en t
h
ough
glob
al data shows
a decrease in
unde
r
n
u
t
ritio
n
,
th
e
maln
u
t
ritio
n
st
atistics fo
r Eastern
Africa
are
increasing [7]. There
i
s
not
eno
u
gh i
n
f
o
rm
at
i
on
av
ailab
l
e on
t
h
e prev
alen
ce
o
f
sev
e
re or ed
em
ato
u
s
m
a
l
n
u
t
ritio
n
in
commu
n
ities. The d
a
ta av
ailab
l
e fro
m
hos
pi
t
a
l
s
o
n
l
y
sho
w
s t
h
e se
ve
re cases an
d t
h
eref
ore m
a
l
nut
ri
t
i
on i
n
g
e
ne
r
a
l
i
s
not
al
way
s
reco
rde
d
bec
a
use i
n
m
o
st cases it is the sec
o
nda
ry
diagnosis [8].
In Cent
ral
Ho
sp
ital o
f
Mapu
t
o
th
e
o
ccurrence of m
a
ln
u
t
ritio
n
i
n
th
e presen
ce
of in
fection
s
, ex
clu
d
i
ng
m
easles
,
was
g
r
eater in 2
001
th
an
in
19
83
. M
o
re ch
ild
ren
had
m
a
rasm
u
s
th
an
kw
ash
i
o
r
ko
r
in
20
01
[
7
].
In
1
9
9
0
a
n
e
s
t
i
m
a
t
e
d one
out
of
t
h
ree
c
h
i
l
d
re
n
(1
7
7
m
i
ll
i
on) y
o
u
n
g
er t
h
an
fi
v
e
y
ears i
n
t
h
e
d
e
v
e
l
o
p
i
n
g
world
were
or h
a
d
b
een
m
a
ln
o
u
rish
ed
at on
e stag
e in
their liv
es. Mal
n
u
t
riti
o
n
is still o
n
e
o
f
t
h
e
lead
in
g
cau
s
es
o
f
m
o
rb
id
ity an
d
m
o
rtality
in
ch
ild
ren
yo
ung
er th
an
fiv
e
y
ears and
sev
e
re PEM still
affects 2
-
3% of
t
h
e pe
di
at
ri
c
p
o
p
u
l
a
t
i
o
n wo
rl
d
w
i
d
e
[
9
]
,
[1
0]
.
In 2
0
0
0
-
2
0
0
2
an
est
i
m
at
ed
852
m
i
l
l
i
on
chi
l
d
re
n were
m
a
lno
u
r
i
s
he
d, o
f
whi
c
h 81
5
m
i
ll
i
on were
i
n
d
e
v
e
l
o
p
i
n
g
cou
n
t
ries [11
]
an
d
34
millio
n
in
d
e
v
e
lop
e
d
co
un
tries [12
]
. During
th
is time
m
a
ln
u
t
rition
was
di
rect
l
y
resp
on
si
bl
e fo
r ab
out
30
0 0
0
0
deat
hs pe
r y
ear an
d i
ndi
rect
l
y
fo
r ab
out
hal
f
o
f
al
l
deat
hs i
n
y
o
u
n
g
chi
l
d
re
n [
1
1]
. M
o
re t
h
a
n
19
9
m
i
ll
i
on chi
l
d
r
e
n y
o
u
n
g
er t
h
a
n
fi
ve y
e
a
r
s su
ffe
r fr
om
acut
e
or c
h
r
o
ni
c pr
ot
ei
n
and ene
r
gy de
ficiencies [12].
In
2004 a
n
esti
mated 55
%
of child deaths
worl
dwi
d
e were th
e resu
lt
o
f
un
d
e
r
nut
ri
t
i
on [4]
.
The
pre
v
al
enc
e
of st
unt
i
n
g
h
a
s fal
l
e
n i
n
de
vel
o
pi
n
g
co
u
n
t
r
i
e
s fr
om
47%
i
n
1
9
8
0
t
o
3
3
%
i
n
2
0
0
0
,
al
t
hou
g
h
p
r
o
g
r
ess has
been
u
n
eve
n
i
n
di
ff
er
ent
regi
on
s. I
n
som
e
count
ri
e
s
rat
e
s of st
unt
i
ng are
ri
si
n
g
,
whi
l
e
in m
a
ny others they rem
a
in distur
bingly high [13]. The
r
e are still about
800 m
i
llion unde
rnouris
h
ed
people in
the worl
d a
n
d in s
o
m
e
count
ries seve
re m
a
lnutrition is
the m
o
st
co
m
m
on
reason for pe
diatrics
hos
p
italization.
Ar
ou
n
d
2
7
% o
f
t
h
e chi
l
d
ren
y
o
u
nge
r t
h
a
n
f
i
ve y
ears of a
g
e i
n
t
h
e devel
o
pi
n
g
w
o
rl
d are
un
der
w
ei
g
h
t
,
32 %
are stunted, a
n
d
10 %
wasted
[14].
In b
r
oad cat
e
g
o
r
i
e
s m
a
l
nut
r
i
t
i
on i
s
cl
assi
fi
ed i
n
t
o
t
h
re
e;
unde
r wei
g
ht
, st
u
n
t
i
ng a
nd
wast
i
n
g.
Wastin
g is fur
t
her classified
in
to three categories whic
h i
n
cl
u
d
e k
w
a
s
hi
o
r
k
o
r
, m
a
rasm
us and
m
a
rasm
us
kwas
hi
or
ko
r.
Thi
s
st
u
d
y
t
r
i
e
d t
o
i
d
e
n
t
i
f
y
t
h
e
m
a
gni
t
ude
of
m
a
l
nut
ri
t
i
on a
m
ong u
nde
r fi
ve chi
l
d
ren i
n
Ay
de
r
refe
rral ho
spita
l.
2.
R
E
SEARC
H M
ETHOD
Stud
y desi
gn
and se
ttin
g
:
A ret
r
osp
ect
i
v
e cross sect
i
o
nal
st
udy
was
con
duct
e
d am
ong chi
l
d
re
n
below t
h
e a
g
e
of fi
ve years
from
January
2012 t
o
December 2013. T
h
e
resea
r
ch
was
carried
out i
n
Ayde
r
referral
ho
sp
ital in
Tigray
reg
i
o
n
a
l
state, Eth
i
o
p
i
a. Th
e
ho
spital is lo
cated
Mek
e
lle city wh
ich is 783
k
m
away
fr
om
Addi
s
A
b
aba.
Stud
y p
o
pul
ation
and s
a
m
p
ling tech
niq
u
es:
T
h
e sample size was calculated usi
ng the si
ngle
po
p
u
l
a
t
i
on
pr
o
p
o
r
t
i
o
n f
o
rm
ul
a base
d o
n
ass
u
m
e
d po
pul
at
i
on
pa
ram
e
t
e
r. The c
o
n
f
i
d
e
n
c
e
i
n
t
e
rval
,
p
r
o
p
o
r
t
i
o
n
o
f
m
a
ln
u
t
ritio
n, an
d m
a
rg
in
of erro
r were
95
%, 0.5 an
d 5% resp
ectiv
ely
.
Hen
c
e,
ad
d
i
ng
5
%
no
ne resp
on
se
rate a sam
p
le s
i
ze o
f
289
ind
i
v
i
du
al reco
rd
s
o
f
ch
ild
ren
d
i
ag
no
se
with
m
a
ln
u
t
rition
were in
clu
d
e
d
.
List
o
f
all
chi
l
d
re
n di
a
g
n
o
se
d wi
t
h
m
a
lnut
ri
t
i
on i
n
t
h
e
st
udy
pe
ri
o
d
were s
o
rt
e
d
f
r
o
m
t
h
ei
r
m
e
dical
recor
d
s a
n
d si
m
p
le
rando
m
sa
m
p
li
n
g
techn
i
qu
es
were u
s
ed
t
o
select th
e stud
y particip
an
ts.
Data c
o
llection procedu
re and quality control:
T
h
e so
urce
of dat
a
f
o
r t
h
e st
udy
wa
s i
ndi
vi
du
a
l
d
i
agn
o
sed with m
a
ln
u
t
ritio
n
med
i
cal record card
s
.
Th
e
card
s
con
s
isted
of in
fo
rm
atio
n
reco
rd
ed
at ad
m
i
ssion
suc
h
as, se
x, a
g
e of the chil
d, anthropom
etry
m
easur
em
ents, adm
i
ssion medical hist
ory, physical
exam
ination
and m
e
dications. T
h
e cards
also recorde
d
the follow-up
anthropom
e
try
measurem
ents
and clinical feature
s
,
ro
ut
i
n
e m
e
di
cat
i
ons an
d o
u
t
c
om
e st
at
us. Al
l
t
h
ese dat
a
were collected using a
un
ifo
r
m
ex
tractio
n
format
.
Inform
atio
n
such
as th
e lev
e
l o
f
m
a
tern
al ed
u
cation
a
l a
r
e not inde
xed in t
h
e m
e
dical record ca
rds. Fi
ve
Nurses were recru
ited
for d
a
t
a
co
llec
tio
n
and
two
h
ealth
o
f
ficers fo
r su
p
e
rv
isors. To
k
e
ep
th
e qu
ality o
f
d
a
ta,
t
h
e dat
a
c
o
l
l
ect
ors a
n
d
su
pe
r
v
i
s
o
r
s
were t
r
ai
ned
fo
r a
da
y
on
h
o
w a
n
d
what
i
n
f
o
rm
at
i
on t
h
ey
s
h
ou
l
d
be
co
llectin
g
from th
e reco
rd
card
s. On
d
a
ily b
a
sis, th
e
filled
-
i
n
in
form
at
i
o
n
ex
traction
fo
rm
ats were rev
i
ewed
b
y
th
e sup
e
rv
i
s
o
r
s and
inv
e
stig
ato
r
s to
scru
tin
y an
y prob
lem
s
. Wh
en
ev
er t
h
ere ap
p
e
ars in
co
m
p
lete
n
e
ss,
erro
rs, an
d amb
i
gu
ities o
f
reco
rd
ing
,
th
e i
n
fo
rm
atio
n
fo
rm
ats were cro
ssch
eck
ed
with
t
h
e sou
r
ce card
on
sp
o
t
.
St
at
ist
i
ca
l analy
s
is:
T
h
e
data
was
entered in to, clea
ned a
n
d analyze
d
us
ing
SPSS
versi
o
n 16. T
h
e
missin
g
v
a
lu
es were less th
an
3
%
in
all facto
r
s. Th
e
pr
op
or
tion
o
f
Mal
n
u
t
r
itio
n
ou
tcomes w
e
r
e
categ
or
ized
rep
o
rte
d
as ‘
k
washi
o
r
k
or
’, ‘
m
ar
as
m
i
c kwashiorkor’,
‘m
a
r
asm
u
s’, an
d
‘u
n
d
er
wei
g
ht
’
usi
n
g n
u
m
b
ers a
n
d
perce
n
t
a
ge
.
Ethical state
ments
:
Et
hi
ca
l
app
r
o
v
al
wa
s obt
ai
ned
fr
o
m
M
e
k
e
lle Un
iv
ersity, Co
lleg
e
of Healt
h
Sci
e
nces.
C
o
ns
ent
s
were
al
so
obt
ai
ne
d
f
r
om
respect
i
v
e
dep
a
rt
m
e
nt
of t
h
e
hos
pi
t
a
l
.
In
t
h
e
exi
s
t
i
n
g sy
st
e
m
of
th
e n
a
tio
n, th
ere is n
o
way to
co
mm
u
n
i
cate
with
th
e p
a
tients o
n
ce th
ey g
e
t d
i
sch
a
rg
ed
fro
m
th
e treat
m
e
n
t
. As
suc
h
, i
n
f
o
rm
ed co
nse
n
t
f
r
om
t
h
e
pare
nt
s/
care
g
i
v
e
r
s
of
t
h
e c
h
i
l
d
re
n
was
n
o
t
obt
ai
na
bl
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Retro
s
p
ective
Assessmen
t o
f
Ma
lnu
t
ritio
n
among
Un
d
e
r
Five Ch
ild
ren
in Ayd
e
r .... (
D
esta
Meb
r
ah
tu
)
73
Th
e st
u
d
y
d
i
dn
’t
g
i
v
e
an
y su
pp
lem
e
n
t
ary in
terv
en
tion
s
t
o
th
e
p
a
rticip
an
ts.
As it was co
ndu
cted
b
a
sed
on
th
e
med
i
cal reco
rds an
d
was
n
o
t
sen
s
itiv
e, th
e co
n
s
en
t relied
on
th
e eth
i
cal bo
ard
’
s app
r
ov
al an
d
written
con
s
ent fro
m
resp
ectiv
e d
e
p
a
rtm
e
n
t
was ob
tain
ed
. Fu
rt
h
e
rm
o
r
e, t
h
e research
et
h
i
cal b
o
a
rd
was also
aware
of the is
sue
before its a
p
proval
th
at inform
ed
co
n
s
ent co
u
l
dn’t b
e
ob
tain
ed fro
m
t
h
e stud
y p
a
rticip
an
ts.
To
app
e
nd
, any p
a
tien
t
id
en
tifyin
g
in
form
at
i
o
n wasn’t en
cod
e
d to
k
e
ep
t
h
e con
f
i
d
en
tiality
of th
e in
form
a
tio
n
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
C
h
ar
ac
te
ri
sti
c
s o
f
the c
h
i
l
d
ren
A t
o
t
a
l
of
28
9
chi
l
d
ren
’
s m
e
di
cal
rec
o
r
d
w
e
re r
e
vi
e
w
ed
a
n
d
1
6
8
(
5
8.
1%)
fem
a
l
e
and
1
2
1
(
41
.9%
)
,
m
a
l
e
. M
a
jori
t
y
13
3(
4
6
%)
wer
e
i
n
t
h
e age
gr
ou
p
b/
n 1
2
t
o
2
4
m
ont
hs b
u
t
i
t
ran
g
es f
r
om
1 t
o
5
9
m
ont
hs.
M
o
r
e
th
an
h
a
l
f
, 18
6(64
.4
%) were
rural resid
e
n
t
s wh
ile th
e
rest
were ur
ba
n dwel
l
e
rs (
T
abl
e
1). The t
y
pes o
f
m
a
l
nut
ri
t
i
on i
d
ent
i
f
i
e
d
du
ri
n
g
t
h
e st
udy
per
i
od
were M
a
r
a
sm
us, kwas
hi
or
k
o
r, M
a
rasm
i
c
kwas
hi
o
r
k
o
r
a
n
d
un
de
rwei
ght
w
h
i
c
h acc
o
unt
f
o
r
1
1
6
(
4
0
.
1
%
),
6
9
(
2
3.
9%)
,
54
(1
8.
7%
) a
n
d
5
0
(
1
7.
5%)
res
p
e
c
t
i
v
el
y
.
Tw
o h
u
n
d
r
ed
s
e
vent
y
f
o
ur
(94.8%) c
h
ildren were
vaccinat
e
d,
14
(4.8%)
were
not vacci
nated a
n
d the
vaccination sta
t
us of
one
chi
l
d was
not rec
o
rde
d
.
T
w
o h
u
n
d
r
ed
seve
nt
y
ni
ne
(9
6.
5%
) ha
d
bre
a
st
f
e
d a
n
d
10
(
3
.
5
%)
ha
d
not
.
F
r
om
t
hos
e w
h
o
g
o
t
brea
st
feedi
n
g
,
2
00(
71
.7
) w
e
r
e
on ex
clusiv
e
br
east f
eed
i
n
g fo
r t
h
e
1
st
6m
onth, 73(26.2)
we
re on
m
i
xed
type of fe
eding,
4 c
h
ildren
were
on re
placem
ent form
ula feeding a
n
d t
w
o
ch
ild
ren
n
o
i
n
fo
rm
atio
n
in th
eir m
e
d
i
ca
l reco
rd
.
Fo
rt
y n
i
n
e
(17
%
) ch
ild
ren
were o
n
bo
ttle feed
ing,
2
13(73
.7
%) were
n
o
t
tak
i
ng
b
o
ttle fe
ed
ing
an
d 27(9.3
%
)
h
a
d no
i
n
fo
rm
atio
n
in th
eir
med
i
cal record. seven
t
y
sev
e
n
(27
.
6
)
ch
ild
ren
were in
itiated
co
m
p
le
m
e
n
t
ary feed
in
g
b
e
fore th
e ag
e
o
f
6
m
o
n
t
h
,
73
(26
.
2
)
start at
6m
ont
h,
1
1
5
(
4
1
.
2
)
st
art
t
h
ei
r
com
p
l
e
m
e
nt
ary
feedi
n
g
aft
e
r
6 m
ont
h
an
d
14
(
5
%)
chi
l
d
re
n
had
n
o
i
n
f
o
r
m
at
i
on
on their m
e
dic
a
l record (T
abl
e
2).
Tabl
e
1.
Soci
o-
dem
ogra
phi
c c
h
aract
er
st
i
c
s o
f
t
h
e c
h
i
l
d
re
n i
n
Ay
de
r
refe
rral
h
o
spi
t
a
l
Variables
Nu
m
b
e
r
(%)
Sex
Male
168(
58.
1)
Fe
m
a
le
121(
41.
9)
Age in
m
onths
<=6
30(
10.
4)
6-
12
59(
20.
4)
13-
24
133(
46)
24-
59
67 (
23.
2)
Residential addr
ess
Rural
186(
64.
4%
Ur
ban
103(
35.
6%)
Weight f
o
r age
<60
170(
58.
8.
9%)
60-
80
119(
41.
2)
W
e
ight for
height
<70
120(
41.
5%)
70-
80
101(
34.
9)
80-
90
64(
22.
1)
>90
4(
1.
4)
Height f
o
r age
<85
112(
38.
8%)
85-
90
99(
34.
3)
90-
95
67(
23.
2%)
>95
11(
3.
8)
MUAC in C
m
<11
129(
44.
6)
11-
12.
5
117(
40.
5)
12.
5-
13.
5
12(
4.
2)
>13.
5
7(
2.
4)
Vaccination status
Vaccinated
274(
94.
8)
Not vaccinated
14(
4.
8)
Not recorded
1(
0.
3)
Ever breast
f
eed
Yes
279(
96.
5)
No
10(
3.
5)
Patterns of feedin
g in the first 6
m
onths
Exclusive
200(
71.
7)
M
i
xed
73(
26.
2)
Only
replace
m
e
nt
4(
1.
4)
Not recorded
2(
0.
7)
Bottle feeding
Yes
49(
17)
No
213(
73.
7)
Not recorded
27(
9.
3)
Initiation of co
m
p
l
e
m
e
ntary
f
eeding
Befor
e
6
m
onths
77(
27.
6)
At 6
m
onths
73(
26.
2)
After
6
m
onths
115(
41.
2)
Not recorded
14(
5%)
T
y
pe of
m
a
lnutr
ition diagno
sed
Kwashiorkor
69(
23.
9)
Maras
m
u
s
116(
40.
1)
M
a
r
a
s
m
ic kwash
54(
18.
7)
Under
weight
50(
17.
3)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 2
,
Jun
e
201
5
:
7
1
–
76
74
Tabl
e
2. C
h
ara
c
t
e
rst
i
c
s of
m
a
lnut
ri
t
i
on
wi
t
h
s
o
ci
o
d
em
ogra
p
hi
c va
ri
abl
e
s
Variable
T
y
pes of
m
a
lnutr
i
tion
Kwash
N (%)
Maras
m
u
s
N (%)
M
a
r
a
s
m
ic kwash
N (%)
Under
weight
N (%)
Age
0-
6 m
onth
3(
10)
12(
40)
12(
40)
3(
10)
6-
12
15(
25.
4)
24(
40.
7)
13(
22)
7(
11.
9)
12-
24
38(
28.
6)
50(
37.
6)
22(
16.
5)
23(
17.
3)
24-
59
13(
19.
4)
30(
44.
8)
7(
10.
4)
17(
25.
4)
Sex
Male
39(
23.
2)
61(
36.
3)
35(
28.
8)
33(
19.
6)
Fe
m
a
le
30(
24.
8)
55(
45.
5)
19(
15.
7)
17(
14)
Addr
ess
Ur
ban
28(
27.
2)
38(
36.
9)
13(
12.
6)
24(
23.
3)
Rural
41(
22)
78(
41.
9)
41(
22)
26(
14)
Vaccination status
Vaccinated
68(
24.
8)
107(
39.
1)
41(
17.
9)
50(
18.
2)
Not vaccinated
1(
7.
1%)
8(
57.
1)
5(
35.
7)
0(
0)
Not recorded
0(
0)
1(
100)
0(
0)
0(
0)
BF status
BF
64(
22.
9)
112(
40.
1)
54(
19.
4)
49(
17.
6)
Not BF
5(
50)
4(
40)
0(
0)
1(
10)
Bottle feed
Yes
7(
14.
3)
23(
46.
9)
17(
34.
7)
2(
4.
1)
No
60(
28.
2)
80(
37.
6)
30(
14.
1)
43(
20.
2)
Not recorded
2(
7.
4)
13(
48.
1)
7(
25.
9)
5(
18.
5)
pattern of BF in the
fir
s
t six
m
onths
EBF
45(
22.
5)
84(
42)
(
27(
13.
5)
44(
22)
M
i
xed BF
17(
23.
3)
28(
38.
4)
24(
32.
9)
4(
5.
4)
Only
replace
m
e
nt
2(
50)
2(
50)
0(
0)
0(
0)
Not recorded
2(
100)
0(
0)
0(
0)
0(
0)
Initiation of
co
m
p
le
m
e
ntar
y
f
eeding
Befor
e
6
m
onths
19(
24.
7)
32(
41.
5)
23(
29.
9)
3(
3.
9)
At 6
m
onths
16(
21.
9)
22(
30.
1)
5(
6.
9)
30(
41.
1)
After
6
m
onths
27(
23.
5)
52(
45.
2)
20(
17.
4)
16(
13.
9)
Not recorded
6(
42.
9)
4(
28.
6)
3(
21.
4)
1(
7.
1)
3.2.
Anthr
o
pometric meas
u
rement
finding
Weight for
age:
o
n
e
hu
n
d
re
d
seve
nt
y
(5
8.
8
%
) we
re c
h
i
l
d
r
e
n wi
t
h
wei
ght
fo
r age
o
f
l
e
ss
t
h
an
60
%,
out
o
f
t
h
e
s
e1
1
6
(6
8.
2%
) had
M
a
rasm
us
an
d 54
(
3
1
.
8
)
we
re
M
a
rasm
i
c
k
w
ashi
or
k
o
r
.
O
n
e hu
n
d
re
d ni
net
een
(4
1.
2%
) ha
d
wei
g
ht
fo
r a
g
e
bet
w
ee
n 6
0
%
and
80
%,
ou
t
o
f
th
ese
50
(42
%
)
w
e
r
e
un
der
w
e
igh
t
,
6
9
(5
8%)
kwas
hi
or
ko
r a
n
d
n
o
c
h
i
l
d
ha
d
wei
g
ht
f
o
r
ag
e ab
ove
8
0
.
Weig
ht fo
r heig
ht:
one
hu
n
d
re
d t
w
e
n
t
y
(4
1.
5%)
were se
verel
y
wast
ed
had
wei
g
ht
fo
r
hei
ght
l
e
ss
t
h
an 7
0
,
1
0
1
(
3
4
.
9
%)
were m
ode
rat
e
l
y
wast
ed ha
d wei
ght
fo
r hei
g
ht
7
0
t
o
8
0
, 6
4
(
2
2.
1
%
) we
re m
i
l
d
l
y
wast
ed
had
wei
ght
f
o
r
hei
g
ht
bet
w
ee
n
8
0
a
n
d
9
0
a
n
d
onl
y
4 c
h
i
l
d
re
n
(
1
.
4
%)
ha
d
we
i
ght
fo
r a
g
e a
b
ove
9
0
%
.
Heigh
t
for
age
:
one hu
nd
r
e
d t
w
el
ve (
3
8.
8%) c
h
i
l
d
re
n
were se
verel
y
st
unt
e
d
wi
t
h
h
e
i
ght
f
o
r ag
e
l
e
ss
t
h
a
n
85
%, 99
(
3
4
.
3%
) we
r
e
m
oderat
e
l
y
st
unt
bet
w
ee
n 8
5
%
a
n
d 90
%, 67
(
2
3
.
2%
) we
r
e
m
i
l
d
st
u
n
t
be
t
w
ee
n
9
0
% an
d 95
%
an
d on
ly 11
child
r
e
n h
a
d
h
e
igh
t
fo
r ag
e gr
eat
er
th
an
95
%.
M
UAC
:
O
n
e
hu
nd
re
d t
w
ent
y
ni
ne (
4
4.
6) c
h
i
l
d
re
n
had m
easur
em
ent
of m
i
d u
ppe
r arm
ci
rcum
ference
l
e
ss t
h
an
11
c
m
, 117(
4
0
.
5
%)
had
1
1
-
1
2.
5
cm
, 12
(4
.2%
)
had
1
2
.
5
-
1
3.
5
c
m
and
7(
2.
4
%
) ha
d
>1
3.5
c
m
.
Th
e
rem
a
in
in
g
24
ch
ild
ren
were no
t ind
i
cated
for MUAC
.
4.
DISS
CUSSI
O
N
From
289 m
a
lno
u
r
i
s
he
d chi
l
d
re
n i
n
cl
u
d
e
d
i
n
t
h
i
s
st
udy
,
m
a
jori
t
y
(9
64
.
4
%)
were f
r
o
m
rural
areas
.
Si
m
ilar
l
y N
F
CS (5
3)
f
oun
d th
at urb
a
n ch
ildr
e
n w
e
r
e
less af
f
ected b
y
m
a
ln
u
t
r
itio
n
(
o
n
l
y abo
u
t
17
%).
O
n
the
ot
he
r han
d
i
n
t
h
i
s
st
u
d
y
fr
o
m
t
h
e
t
o
t
a
l
27
8
st
unt
e
d
c
h
i
l
d
re
n,
3
4
.
8
%
,
were f
r
om
urb
a
n w
h
ere as m
a
jori
t
y
,
65.1%,
we
re
from
rural area
. Ot
her res
earc
h
ers
from
S
o
u
t
h A
fri
ca
ha
ve
al
so
re
po
rted
that rural a
r
ea
s ha
d
m
o
re st
unt
ed c
h
i
l
d
re
n (
5
4)
. T
h
i
s
di
f
f
ere
n
ce i
n
p
r
eval
e
n
ce
o
f
m
a
l
nut
ri
t
i
on am
ong
ru
ral
an
d u
r
ba
n a
r
eas
m
a
y
be
expl
ai
ne
d
by
chi
l
d
re
n i
n
r
u
ral
areas are
m
o
re l
i
k
el
y
to be e
x
p
o
se
d
t
o
di
ffe
re
nt
di
arr
h
eal
an
d
ot
he
r
comm
unicable diseases a
n
d
they are
m
o
re lik
ely to
g
e
t
care fro
m
p
a
re
nts who are
expecte
d
to
be less
educate
d
a
n
d l
e
ss awa
r
e
of these problem
s
.
I
n
th
is stud
y 46
% of
th
e m
a
l
n
our
ish
e
d
ch
ild
r
e
n
w
e
r
e
in
th
e ag
e gr
oup
o
f
13-
24
m
o
n
t
h
s
. Sim
ilar
st
udi
es i
n
M
o
z
a
m
b
i
que i
ndi
c
a
t
e
d t
h
at
5
5
.
6
% of t
h
e m
a
l
nou
ri
she
d
c
h
i
l
d
r
e
n we
re i
n
t
h
e
age g
r
ou
p
of
13
-
2
4
m
ont
hs [
7
]
.
E
v
en t
h
ou
g
h
t
h
e
avera
g
e a
g
e
o
f
m
a
l
nouri
s
hed
chi
l
d
re
n i
n
t
h
i
s
st
udy
i
s
rel
a
t
i
v
el
y
l
o
w t
h
e
peak
ag
e
o
f
th
e ch
ild
ren
for m
a
ln
utritio
n
is
q
u
ite
si
m
ilar.
Ab
o
u
t
hal
f
(
4
4
.
6%
) t
h
e
chi
l
d
r
e
n
had
a M
U
A
C
of
l
e
ss t
h
a
n
11
.0cm
(1
1
0
m
m
) whi
c
h i
ndi
c
a
t
e
d se
vere
maln
u
t
ritio
n
an
d
40
.5
%
h
a
d
a MUAC in between
11
.1
an
d
12
.5
cm
wh
ich
sho
w
ed
m
o
d
e
rate
m
a
ln
u
t
ritio
n.
The m
e
di
an M
UAC
f
o
r t
h
e m
a
l
nou
ri
she
d
chi
l
d
re
n i
n
t
h
i
s
st
udy
was
11
cm
. Thi
s
sho
w
s t
h
at
t
h
e num
bers
of
childre
n
who a
r
e seve
rely m
a
lnouris
h
ed a
r
e
a bit higher
t
h
an
th
at of m
o
derately
m
a
ln
o
u
rish
ed
. Th
e
p
o
ssib
l
e
expl
a
n
at
i
o
n f
o
r suc
h
di
ffe
re
n
ces co
ul
d
be s
e
verel
y
m
a
l
nouri
s
hed i
ndi
vi
d
u
al
s are m
o
re
l
i
k
el
y
t
o
vi
si
t
heal
t
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Retro
s
p
ective
Assessmen
t o
f
Ma
lnu
t
ritio
n
among
Un
d
e
r
Five Ch
ild
ren
in Ayd
e
r .... (
D
esta
Meb
r
ah
tu
)
75
facilities not only because of the m
a
lnutrition
but al
so because
of the
possibl
e com
p
lication that might
hap
p
e
n
ed
.
Regarding imm
unization status of th
e children, 94.8%,
of
the children in
this study we
re
vaccinated.
Less tha
n
40%
of infa
nts in the de
veloping
world
recei
ve i
mmediate breastfeeding a
f
ter
birth. Only 39% of
b
a
b
i
es
pu
t to
t
h
eir m
o
th
ers
breast o
n
e
hou
r after
b
i
rth
d
e
sp
i
t
e th
e fact th
at
early in
itiatio
n
o
f
breastfeed
i
ng
can
co
n
t
ribu
te to
red
u
c
ed
n
e
on
at
al
m
o
rtality
th
roug
h
sk
in-to-sk
in
con
t
act th
at can
p
r
ev
en
t h
ypo
th
erm
i
a (35
)
.
Acco
r
d
i
n
g t
o
t
h
e
WH
O
(5
1)
,
excl
usi
v
e
bre
a
st
feedi
n
g
f
o
r
si
x m
ont
hs i
s
recom
m
ended.
In
S
out
h A
fri
ca, t
h
e
SA
DH
S sh
o
w
e
d
t
h
at
2
0
.
1
% o
f
chi
l
d
ren
wer
e
neve
r b
r
east
f
ed an
d o
n
l
y
1
1
.
9%
of i
n
fa
nt
s zero t
o
fo
u
r
m
ont
hs
o
l
d
w
e
r
e
ex
cl
usiv
ely b
r
eastf
ed
(5
5)
. How
e
ver
,
in
th
is study o
n
l
y 3
.
5% wer
e
n
e
v
e
r
b
r
east f
e
d
and
,
7
1
.7
%,
o
f
the childre
n
were e
x
clusively breast fe
d.
Acco
r
d
i
n
g t
o
UN
IC
EF
’s
20
0
8
re
p
o
rt
,
w
o
rl
d
w
i
d
e
3
7
%
of i
n
fa
nt
s y
o
u
nge
r
t
h
an
si
x m
ont
hs
of a
g
e a
r
e
excl
usi
v
el
y
br
east
f
ed.
The
ra
t
e
i
s
l
o
w i
n
A
f
ri
ca wi
t
h
l
e
ss t
h
an
o
n
e t
h
i
r
d
of i
n
fa
nt
s y
o
u
nge
r t
h
a
n
si
x
m
ont
hs
receiving e
x
cl
usive
breastfee
ding (56)
. Ove
r
the last te
n to fifteen year
s e
x
clusi
v
e breast
f
eedi
ng i
n
crea
s
e
d in
A
f
r
i
ca fro
m
3
3
%
i
n
1
995
t
o
3
8
% in
2
008
(
3
5
)
,. A
c
co
rd
ing
t
o
a
study u
n
d
e
r
t
ak
en
i
n
Br
azil on
ch
ild
r
e
n
adm
i
t
t
e
d t
o
ho
spi
t
a
l
,
19
.2
% of m
o
t
h
ers ne
ver
breast
f
ed a
nd
49
.5
% o
f
chi
l
d
re
n we
re b
r
east
f
e
d
f
o
r l
e
s
s
t
h
a
n
t
w
o m
ont
hs (
5
7
)
. O
v
e
r
al
l
t
h
e fi
ndi
n
g
on
excl
usi
v
e b
r
e
a
st
feedi
n
g i
n
t
h
e curre
nt
st
udy
i
s
very
hi
gh as
com
p
ared with the above st
at
ed st
u
d
i
e
s an
d t
h
e rep
o
r
t
pres
ent
e
d
by
UN
I
C
EF. Thi
s
vari
at
i
on m
i
ght
be due t
o
t
h
e reas
on
t
h
at
pare
nt
s
of t
h
e
chi
l
d
re
n i
n
t
h
i
s
st
udy
a
r
ea ha
ve bet
t
e
r
k
n
o
w
l
e
dge
rega
r
d
i
n
g t
h
e i
m
port
a
n
ce o
f
breast
fee
d
i
n
g
and t
h
e ri
s
k
of m
i
xed feed
i
ng as a res
u
l
t
of t
h
e p
r
o
v
i
s
i
on
of c
ont
i
n
u
ous
heal
t
h
ed
u
cat
i
o
n
t
h
r
o
u
g
h
heal
t
h
ext
e
nsi
on
w
o
r
k
ers a
n
d ot
her
heal
t
h
pe
rs
on
n
e
l
.
Ad
di
t
i
onal
l
y
m
o
t
h
ers o
f
t
h
e pat
i
e
nt
s
pr
e
s
ent
e
d
t
o
h
o
s
p
i
t
a
l
s
co
ul
d
ha
ve b
e
t
t
e
r k
n
o
wl
e
dge
a
n
d
heal
t
h
seek
i
ng
be
havi
or t
h
an
t
h
ose
wh
o
di
d
n
’t
vi
si
t
h
eal
t
h
facilities.
All typ
e
s of maln
u
t
rition
were foun
d co
mmo
n
l
y in
ch
ildren
fro
m
ru
ral area. Majo
rity of th
e patien
t
s
with
all typ
e
s
o
f
m
a
ln
u
t
ritio
n were ev
er breast fed, and
h
a
d
no
h
i
story of
b
o
ttle feed
ing
.
Th
e
po
ssib
l
e
reason
mig
h
t
b
e
t
h
at m
o
st o
f
th
e clien
t
s were
from
ru
ral ar
eas i
n
wh
ich
p
e
op
le h
a
v
e
no
access fo
r
bo
ttle feed
ing.
C
h
i
l
d
re
n fr
om
ru
ral
area prac
t
i
ce poo
r pers
o
n
al
hy
gi
ene
w
h
i
c
h can
pre
d
i
s
po
se chi
l
d
r
e
n
t
o
di
ffe
re
nt
di
arr
h
eal
and ot
her com
m
unicable dise
ases.
5.
CO
NCL
USI
O
N
In t
h
i
s
st
u
d
y
t
y
pes of m
a
l
nut
ri
t
i
on, di
st
ri
bu
t
i
on o
f
m
a
l
nut
ri
t
i
on by
ad
dr
e
ss and se
x we
r
e
assessed
.
Th
e ov
erall resu
lt in
d
i
cates that with
a p
o
ssib
ility o
f
d
i
fferen
t
exp
l
an
ation
s
ch
ild
re
n
fro
m
rural area accou
n
t
ed
fo
r m
a
jori
t
y
o
f
i
n
di
vi
dual
s
wh
o
were
di
a
g
n
o
se
d
fo
r t
h
e di
f
f
ere
n
t
t
y
pes
of
m
a
l
nut
ri
t
i
on.
I
n
fa
nt
feedi
n
g
p
r
actices su
ch
as ex
clu
s
iv
e
b
r
east feed
ing
,
timely
in
itia
t
i
o
n
o
f
co
m
p
le
m
e
n
t
ary feed
ing
,
an
d
h
a
v
i
n
g
h
i
sto
r
y of
breast
feedi
n
g
once
i
n
t
h
ei
r
l
i
f
e du
ri
n
g
i
n
f
a
ncy
we
re rel
a
t
i
v
el
y
hi
ghe
r a
m
ong t
h
e c
h
i
l
d
re
n i
n
t
h
e st
u
d
y
as
co
m
p
ared
it
with
o
t
h
e
r stud
ies.
Mo
st o
f
th
e child
ren
in
th
e st
u
d
y
were p
r
esen
ted
with
severe acu
te
m
a
ln
u
t
ritio
n. Th
eref
ore g
r
owth
m
o
n
ito
rin
g
activ
ities sh
ou
ld
b
e
streng
th
en
in
g in
all lev
e
l
s
as th
is
h
a
s
a critical i
m
p
o
r
tan
ce to
d
e
tect
th
o
s
e
ch
ild
ren
with m
a
ln
u
t
ritio
n
early an
d to
treat th
em
. M
o
re i
n
fo
rm
atio
n
h
a
s to
b
e
d
i
ssem
i
n
a
ted
to
the
co
mm
u
n
ity th
ro
ugh
co
mm
u
n
i
ty h
ealth
ag
en
t
s
on
ch
ild
feedi
n
g practice and hea
l
t
h
seeki
n
g
be
havi
ors
.
Th
is stud
y is in
stitu
tio
n
b
a
sed
stud
y and
it mig
h
t
n
o
t
reflect th
e actu
a
l pro
b
l
em
in
th
e co
mm
u
n
ity, so
t
h
ere
has t
o
be
m
o
re researc
h
do
ne i
n
t
h
e
c
o
m
m
uni
t
y
wi
de
by
usi
n
g
di
ffe
r
e
nt
st
u
d
y
desi
g
n
.
ACKNOWLE
DGE
M
ENTS
The aut
h
ors are very grateful
to Ayder Hos
p
ita
l
ad
m
i
ni
st
rat
i
v
e and m
e
dical
perso
n
n
el
. We w
oul
d
l
i
k
e t
o
t
h
an
k
t
h
e sc
ho
ol
of
M
e
di
ci
ne,
co
l
l
e
ge o
f
m
e
di
ci
ne an
d
heal
t
h
sci
e
nce, M
e
kel
l
e
U
n
i
v
e
r
si
t
y
for
pr
o
v
i
d
i
n
g t
e
c
h
ni
cal
an
d
fi
na
n
c
i
a
l
sup
p
o
rt
.
LIST
OF A
B
BR
EV
ITIONS
AND
A
CRONY
MS
M
UAC
:
m
i
d up
pe
r arm
ci
rcum
ference
UNICEF
:
Un
ited Nation
s
ch
ildren fu
nd
SAM
:
sev
e
re acu
te maln
u
t
rition
PEM :
p
r
o
t
ein
en
erg
y
maln
u
t
ritio
n
WHO
:
world h
ealth org
a
n
i
zation
NFC
S
:
nat
i
onal
f
o
o
d
c
ons
um
pt
i
on s
u
rvey
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 2
,
Jun
e
201
5
:
7
1
–
76
76
REFERE
NC
ES
[1]
Duggan M., Golden B., “Deficienc
y
diseases, in Human Nutrition
”
, United Kingdom: Elsevier Church
ill
Livingstone, 200
5.
[2]
A
y
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BIOGRAP
HI
ES OF
AUT
HORS
Mr. Desta Mebrahtu was born in Mekelle Ethiopi
a in 1991. I graduated
from Mekelle university
in ch
ild h
e
alth
and pediatrics with masters’ degr
ee. I
hav
e
b
een
working in
Shire
hospital Tigr
ay
Ethiopi
a
as a
pe
diatri
cs pra
c
t
itio
ner unt
il now
.
Mr. Girum Sebisibie was born in Debre Berhan
,
Shoa in 1985. I have attended
my
pr
imar
y
and
secondar
y
schoo
l in Hailemariaam Mamo schoo
l.
I gr
aduated fr
om Addis Ababa University
,
Ethiopia with b
a
chelor of scien
c
e in Nursing in
2005 and with
masters’ degree
in pediatrics an
d
child health in 2
012 from Mekelle University
. I
ha
ve been working as a lecturer
and resear
cher
for the last eight
y
e
ars in
Addis A
b
aba Univ
ersity
,
Eth
i
opia.
Mr. Teklem
ari
a
m
Gultie was b
o
rn in Addis
Ab
aba,
Shoa in 1988. I have atten
d
ed m
y
prim
ar
y
and secondar
y
school in Dejazimach Wendi
r
a
d school. I g
r
aduated from Addis Ababa
University
, Eth
i
opia with
bachelor of science in
2008 and with
masters’ degree
in Reprod
cutiv
e
health in
2013.
I have been
working as a lectur
er
and
researcher for th
e last six
y
ears
in Arb
a
Minch Universit
y
, E
t
hiopi
a. Sin
ce 2014 in additi
on to lecturing
and research activi
ties I am
working as a p
r
oject coordinator of JHPIEG
O Ethiopia Human resource for
health project
funded b
y
USAID. I h
a
ve publis
hed fiv
e
r
e
sear
ch
articles in
diff
eren
t r
e
putable jo
urnals.
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