Stata data set.

IntroductionIn Ethiopia, maternal undernutrition is a major public health concern. However, comprehensive evidence is lacking in the southern part of Ethiopia, specifically the household and community-level related determinants of undernutrition. Besides, the evidence about the prevalence and determinants of undernutrition is not yet documented in the current study setting. Thus, this study aimed to determine the prevalence of undernutrition and identify its determinants among pregnant women in Hawela Lida district of the Sidama region, Ethiopia.MethodsA community-based cross-sectional study was conducted on a sample of 515 pregnant women from June 1–25, 2024. A multi-stage sampling method was utilized to select eligible pregnant women. We collected data using a structured and pretested interviewer-administrated questionnaire and an anthropometric measurement. Data were collected using the Open Data Kit smart phone device and exported it to Stata version 17 for further processing and analysis. A multi-level mixed-effects modified Poisson regression analysis with robust variance was used to account for confounders and between and with cluster effects.ResultThe prevalence of undernutrition among pregnant women was 41.7% (95% CI: 37.3–45.6). The prevalence of undernutrition was associated with planned pregnancy (adjusted prevalence ratio [APR]: 0.80; 95% CI: 0.66–0.98), household food insecurity (APR: 1.64; 95% CI: 1.26–2.13), inadequate dietary diversity (APR: 1.79; 95% CI: 1.43–2.25), and women’s poor knowledge of nutrition (APR: 1.68; 95% CI: 1.32–2.12) at individual levels. The identified determinants of undernutrition at the community level were low community literacy rates (APR: 4.62; 95% CI: 1.13–18.79) and low community wealth status (APR: 1.91; 95% CI: 1.10–3.31).ConclusionTwo in five pregnant women had an undernutrition problem in the study setting. Individual and community-level determinants contributed to the high prevalence of undernutrition. Thus, any prevention and control approaches to undernutrition should consider inter-sectorial collaboration to account for determinants at various levels. Besides, any program must emphasize the delivery of nutrition education about dietary diversity, particularly targeting pregnant mothers who have poor knowledge of nutrition and unplanned pregnancy at the individual level. Moreover, creating a small business reform for the community with low wealth status using agricultural extension workers must be considered.

一、引言
在埃塞俄比亚，孕产妇营养不良是一项重大公共卫生问题。然而，埃塞俄比亚南部地区，尤其是与营养不良相关的家庭及社区层面决定因素的综合证据仍存在缺失。此外，当前研究区域内关于营养不良患病率及其决定因素的相关证据尚未被记载。因此，本研究旨在明确埃塞俄比亚锡达马（Sidama）地区霍韦拉利达（Hawela Lida）县区的孕妇群体中营养不良的患病率，并识别其相关决定因素。

二、研究方法
本研究于2024年6月1日至25日开展了一项基于社区的横断面研究（cross-sectional study），共纳入515名符合条件的孕妇作为研究样本。研究采用多阶段抽样方法筛选合格孕妇。我们通过结构化且经过预试验的访谈员施测问卷，以及人体测量学检测（anthropometric measurement）来收集数据。数据采集使用Open Data Kit智能手机设备（Open Data Kit），并导出至Stata 17统计分析软件（Stata）中进行后续处理与分析。为控制混杂因素（confounders）并考虑集群间与集群内效应，本研究采用带有稳健方差的多水平混合效应改良泊松回归分析方法。

三、研究结果
本研究中孕妇群体的营养不良患病率为41.7%（95%置信区间：37.3%~45.6%）。个体层面上，营养不良患病率与计划妊娠（校正患病率比[APR]：0.80；95%CI：0.66~0.98）、家庭粮食不安全（APR：1.64；95%CI：1.26~2.13）、膳食多样性不足（APR：1.79；95%CI：1.43~2.25）以及孕妇营养知识匮乏（APR：1.68；95%CI：1.32~2.12）存在相关性。社区层面识别出的营养不良决定因素包括较低的社区识字率（APR：4.62；95%CI：1.13~18.79）与较低的社区财富水平（APR：1.91；95%CI：1.10~3.31）。

四、结论
本研究区域内五分之二的孕妇存在营养不良问题。个体与社区层面的因素共同导致了较高的营养不良患病率。因此，任何针对营养不良的防控策略均应考虑跨部门协作，以覆盖不同层面的决定因素。此外，相关项目应着重开展针对膳食多样性的营养教育，尤其针对个体层面存在营养知识匮乏与非计划妊娠的孕妇群体。同时，还应考虑通过农业推广人员为财富水平较低的社区开展小型商业扶持改革。