| Summary: | Abstract Background In Ethiopia, stunting is the most common form of undernutriton. Identifying the determinants of severe stunting among children is crucial for public health interventions to improve child health. Therefore, this study aimed to identify the determinants of severe stunting among under-five children in Ethiopia. Methods A community-based cross-sectional study design was employed. A two stage stratified cluster sampling technique was used. A multilevel ordinal logistic regression model was fitted to identify independent determinants. Adjusted odds ratio (AOR) and median odds ratio (MOR) with its 95% confidence interval at p-value< 0.05 were used to declare statistical significance. Results The result of this study showed that about 18% of the children were severely stunted. Being male increased the severity of stunting in children by 26% adjusted odds ratio (AOR): 1.26 (95% CI: 1.09–1.46), compared to female sex; over-weight mothers increased the severity of stunting in their children AOR: 3.43 (95% CI: 2.21–5.33) compared to normal BMI mothers; and children from middle, poorer, and poorest wealth index households were 1.84 (95% CI:1.27–2.67), 2.13 (95% CI, CI:1.45–3.14) and 2.52 (95% CI,1.72–3.68). In contrast, severe stunting was reduced by 62% (AOR: 0.38, 95% CI: 0.20–0.74) and 48% (AOR = 0.52, 95% CI: 0.37–0.72) in children of educated mothers compared to children of uneducated mothers and children of underweight mothers compared with those children of normal BMI mothers respectively. For each one-unit increase in maternal height, there is a 5% significant reduction in the child’s odds of being severely stunted. After controlling for other factors, the effect of predictors on the likelihood of stunting in high risk clusters increased by a median odds ratio (MOR) of 1.83 (95% CI: 1.69–2.00). Conclusions The magnitude of severe childhood stunting was still high with regional variation in Ethiopia. Child age, sex, maternal height, age, education and household wealth index as well as administrative regions were significantly associated factors with severe stunting. Significant interventions shall be implemented at the individual, household and community levels in order to reduce the problem.
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