Delays to treatment initiation and emergence of drug resistance among new adult tuberculosis patients in Tigray, Northern Ethiopia.

Introduction. Studies in Ethiopia have indicated that tuberculosis (TB) patient's elapsed a long time before initiating treatment.Gap Statement. However, there is very limited evidence on the association of treatment initiation delay with drug resistance.Research Aim. To investigate the association of delayed treatment initiation with drug resistance among newly diagnosed TB patients in Tigray, Ethiopia.Methods. We conducted a follow-up study from October 2018 to June 2020 by recruiting 875 pulmonary tuberculosis (PTB) patients from 21 randomly selected health facilities. Delays to initiate treatment and drug resistance were collected using a standardized questionnaire and standard laboratory investigation. The association of delay to initiate treatment with acquired drug resistance was modelled using penalized maximum-likelihood (PML) regression models. Data were analysed using stata software version 15. Statistical significance was reported whenever the P-value was less than 0.05.Result. The median total delay to treatment initiation was 62 days with an inter-quartile range of 16-221 days. A unit change in time to initiate treatment reduced the risk of acquired drug resistance by 3 %. Being smear-positive at the end of treatment and after 2 months of treatment initiation were significantly associated with a higher risk of acquired drug resistance. Whereas, having a mild clinical condition was associated with a lower risk of drug resistance.Conclusion. Time to treatment initiation delay is associated with an increased risk of the emergence of drug resistance. Efforts targeted towards reducing the negative effects of PTB should focus on reducing the length of delay to initiate treatment.

Causes of death among women of reproductive age during the war in Tigray, Ethiopia.

BACKGROUND: In resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray. METHODS: This community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions. RESULTS: A total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%). CONCLUSIONS: The high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray.

Maternal mortality during war time in Tigray, Ethiopia: A community-based study.

OBJECTIVE: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. DESIGN: Community-based cross-sectional study. SETTING: Tigray region of Northern Ethiopia, between November 2020 and May 2022. POPULATION: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. METHODS: The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. MAIN OUTCOME MEASURES: Maternal mortality ratio level and cause-specific mortality. RESULTS: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. CONCLUSIONS: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.

Immediate health and economic impact of the Tigray war on internally displaced persons and hosting households.

Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors.

Child health services and armed conflict in Tigray, North Ethiopia: a community-based study.

BACKGROUND: Access to basic health services, notably child health services, is severely hampered by the armed conflict in Tigray, North Ethiopia. Little is known regarding the impacts of the armed conflict during the war in Tigray on access to child health services. The current study investigates the impact of the armed conflict on the utilization of child health services in Tigray. METHODS: 4,381 caregivers from randomly recruited households (HHs) with at least one child younger than 1 year old participated in a community-based cross-sectional survey. We collected data on childhood immunizations and illness-related treatment seeking from August 4 to 20, 2021. We describe data using frequency and percentage and carry out an internal comparison among the study participants using chi-square tests. RESULTS: 4,381 children under the age of one included in the study. In total, 39% of infants received no basic vaccines, 61.3% of the children under the age of one received at least one vaccine, and 20% received all the vaccinations recommended for their age. About 61% of children were affected by at least one childhood ailments where majority of them were from rural areas. Mothers who did not seek postnatal care (PNC) were responsible for more than 75% of reported childhood illnesses. CONCLUSIONS: A sizable portion of children were unvaccinated and had at least one childhood sickness while the war was in progress. Particularly, people who live in rural areas reported a higher percentage of children's illnesses but a lower use of child health services. To lower childhood morbidity and mortality in the besieged area, such as Tigray, local to global actors need to get coordinated and warrying parties should stop weaponization of vaccination healthcare services.

Erratum: The association of socio-demographic and environmental factors with stunting among under-five children in Hawassa City, Sidama National Regional State, Ethiopia - CORRIGENDUM.

[This corrects the article DOI: 10.1017/jns.2022.29.].

Erratum: The association of socio-demographic and environmental factors with stunting among under-five children in Hawassa City, Sidama National Regional State, Ethiopia - CORRIGENDUM.

[This corrects the article DOI: 10.1017/jns.2022.29.].

War and Health Care Services Utilization for Chronic Diseases in Rural and Semiurban Areas of Tigray, Ethiopia.

Importance: The war in Tigray, Ethiopia, has disrupted the health care system of the region. However, its association with health care services disruption for chronic diseases has not been well documented. Objective: To assess the association of the war with the utilization of health care services for patients with chronic diseases. Design, Setting, and Participants: Of 135 primary health care facilities, a registry-based cross-sectional study was conducted on 44 rural and semiurban facilities of Tigray. Data on health services utilization were extracted for patients with tuberculosis, HIV, diabetes, hypertension, and psychiatric disorders in the prewar period (September 1, to October 31, 2020) and during the first phase of the war period (November 4, 2020, to June 30, 2021). Main Outcomes and Measures: Records on the number of follow-up, laboratory tests, and patients undergoing treatment of the aforementioned chronic diseases were counted during the prewar and war periods. Results: Of 4645 records of patients with chronic diseases undergoing treatment during the prewar period, 998 records (21%) indicated having treatment during the war period. Compared with the prewar period, 59 of 180 individuals (33%; 95% CI, 26%-40%) had tuberculosis, 522 of 2211 (24%; 95% CI, 22%-26%) had HIV, 228 of 1195 (19%; 95% CI, 17%-21%) had hypertension, 123 of 632 (20%; 95% CI, 16%-22%) had psychiatric disorders, and 66 of 427 (15%; 95% CI, 12%-18%) had type 2 diabetes records, which revealed continued treatment during the war period. Of 174 records of patients with type 1 diabetes in the prewar period, at 2 to 3 months into the war, the numbers dropped to 10 with 94% decline compared with prewar observations. Conclusions and Relevance: This study found that the war in Tigray has resulted in critical health care service disruption and high loss to follow-up for patients with chronic disease, likely leading to increased morbidity and mortality. Local, national, and global policymakers must understand the extent and impact of the service disruption and urge their efforts toward restoration of those services.

War-related sexual and gender-based violence in Tigray, Northern Ethiopia: a community-based study.

INTRODUCTION: Sexual and gender-based violence (SGBV) during armed conflicts has serious ramifications with women and girls disproportionally affected. The impact of the conflict that erupted in November 2020 in Tigray on SGBV is not well documented. This study is aimed at assessing war-related SGBV in war-affected Tigray, Ethiopia. METHODS: A community-based survey was conducted in 52 (out of 84) districts of Tigray, excluding its western zone and some districts bordering Eritrea due to security reasons. Using a two-stage multistage cluster sampling technique, a total of 5171 women of reproductive age (15-49 years) were randomly selected and included in the study. Analysis used weighted descriptive statistics, regression modelling and tests of associations. RESULTS: Overall, 43.3% (2241/5171) of women experienced at least one type of gender-based violence. The incidents of sexual, physical and psychological violence, and rape among women of reproductive age were found to be 9.7% (500/5171), 28.6% (1480/5171), 40.4% (2090/5171) and 7.9% (411/5171), respectively. Of the sexual violence survivors, rape accounted for 82.2% (411/500) cases, of which 68.4% (247) reported being gang raped. Young women (aged 15-24 years) were the most affected by sexual violence, 29.2% (146/500). Commonly reported SGBV-related issues were physical trauma, 23.8% (533/2241), sexually transmitted infections, 16.5% (68/411), HIV infection, 2.7% (11/411), unwanted pregnancy, 9.5% (39/411) and depression 19.2% (431/2241). Most survivors (89.7%) did not receive any postviolence medical or psychological support. CONCLUSIONS: Systemic war-related SGBV was prevalent in Tigray, with gang-rape as the most common form of sexual violence. Immediate medical and psychological care, and long-term rehabilitation and community support for survivors are urgently needed and recommended.

Effects of continuum of care for maternal health service utilisation on intention to use family planning among pastoralist women of Ethiopia: a robust regression analysis and propensity score matching modelling.

OBJECTIVES: This study examines the effect of continuum care for maternal health service utilisation on intention to use family planning among the pastoralist community in Ethiopia. DESIGN: A community-based cross-sectional study. SETTING: Data were collected from three districts of the pastoralist community of the Afar region. PARTICIPANTS: Randomly selected 891 married pastoralist women. PRIMARY OUTCOME: Intention to use family planning. RESULTS: Intention to use family planning would increase (ß=0.122, 95% CI: 0.036, 0.287) or by 12.2%, if all married pastoralist women received continuum of care for maternal health service utilisation compared with their counterparts. Results from the robust regression analysis indicate that intention to use family planning was higher among women who had a discussion about family planning with their husband (ß=0.31, SE=0.035, p<0.001), women who possessed an electronic devices (ß=0.096, SE=0.029, p<0.001) and women who had an unmet need for family planning (ß=0.056, SE=0.026, p<0.000). However, intention to use family planning was lower for women who were in a polygamous marriage (ß=-0.168, SE=0.065, p<0.01). There was a significant linear increase in the score of intention to use family planning for attitude towards family planning (ß=0.009, SE=0.001, p<0.000), subjective norm (ß=0.003, SE=0.001, p<0.003) and perceived control over family planning (ß=0.002, SE=0.008, p<0.024) given other explanatory variables in the model. CONCLUSION: Continuum of care for maternal health service utilisation increases pastoralist women's intention to use family planning. Maximising any opportunity to counsel women who come to health facilities about family planning would be vital to increase their intention to use family planning. TRIAL REGISTRATION NUMBER: NCT03450564.

Armed conflict and household food insecurity: evidence from war-torn Tigray, Ethiopia.

BACKGROUND: Exposure to armed conflicts result in strongly adverse and often irreversible short- and long-term effects which may transmit across generations. Armed conflicts directly cause food insecurity and starvation by disruption and destruction of food systems, reduce farming populations, destroying infrastructure, reducing resilience, and increasing vulnerabilities, disruptions in access to market, increasing food price or making goods and services unavailable altogether. The objective of the present study was to determine the status of household food insecurity in the armed conflict affected communities of Tigray in terms of Access, Experience and Hunger scale. METHOD: Community-based cross-sectional study was conducted to assess impact of armed conflict on household food insecurity among households with children with under one year. FHI 360 and FAO guidelines were used to quantify household food insecurity and Household hunger status. RESULTS: Three-fourth of the households had anxiety about food supply and eat undesired monotonous diet due to lack of resources. Households were obliged to eat few kinds of foods, eat smaller meals, eat foods they do not want to eat, or went a whole day without eating any food. Household food insecurity access, food insecurity experience, and hunger scales significantly increased by 43.3 (95% CI: 41.9-44.7), 41.9 (95% CI: 40.5-43.3) and 32.5 (95% CI: 31.0-33.9) percentage points from the prewar period. CONCLUSIONS: Household food insecurity levels and household hunger status of the study communities was unacceptably high. The armed conflict has significant negative effect on food security in Tigray. It is recommended that the study communities need to be protected from the immediate and long-term consequences of conflict-induced household food insecurity.

Unimproved water and sanitation contributes to childhood diarrhoea during the war in Tigray, Ethiopia: a community based assessment.

Access to water, sanitation, and hygiene (WASH) is a global public health problem. The situation is worst in conflict areas, where people are displaced from their usual homes. Household supply of WASH and the incidence of diarrhoeal disease among children during the war in Tigray are not known or documented. The objective of this study was to investigate the sources of drinking water, sanitation and hygiene practices, and the incidence of diarrhoeal diseases among children during the war in Tigray, Ethiopia. A cross-sectional study was conducted to collect data on selected WASH indicators in six zones of Tigray from August 4-20, 2021. Data were collected from a total of 4381 sample households selected by lottery. Descriptive analysis was performed and the analysed data are presented in tables, figures and explanatory notes. Binary logistic regression was performed to examine the relationship between independent and dependent variables. A total of 4381 households from 52 woredas participated in the study. Approximately 67.7% of the study participants reported that they relied on an improved source of drinking water during the war. Coverage of sanitation, hand washing, and menstrual hygiene during the war was reported as 43.9%, 14.5%, and 22.1%, respectively. The prevalence of diarrhoeal diseases among children was 25.5% during the war. Water source, latrine type, solid waste disposal and health extension worker visits were the significant predictors of the likelihood of diarrhoea in children (p < 0.05). The results of the study show that a decrease in services from WASH is associated with a higher prevalence of diarrhoeal disease among children during the war in Tigray. To prevent the high prevalence of diarrhoeal disease among children in war-torn Tigray, Ethiopia, improved access to water and sanitation is recommended. In addition, collaborative efforts are needed to engage health extension workers to provide appropriate promotion and prevention services to war-affected communities in Tigray, Ethiopia. Further comprehensive surveys of households with children over one year of age are recommended to assess access to WASH and the burden of WASH associated diseases.

Trends in and predictors of animal source food consumption among 6-23 months age children in Tigrai, Northern Ethiopia: evidence from three consecutive ethiopian demographic and health surveys, EDHS 2005-2016.

BACKGROUND: Despite numerous interventions, child undernutrition continues as a problem of global concern. Although consumption of animal source foods has shown positive associations with child undernutrition, no much evidence exists on its trends and predictors among children in Tigrai. OBJECTIVES: This study aimed to investigate the trends in and predictors of consumption of animal source foods among children 6-23 months of age in Tigrai. METHODOLOGY: This study used complex data of 756 children extracted from three consecutive Ethiopian Demographic and Health Surveys. Data were analyzed using STATA 14.0 by accounting for sampling weight and cluster and strata variables. Multivariable logistic regression was used to determine the independent predictors of animal source foods consumption. Odds ratio and 95% confidence interval were used to measure strength of association at a statistical significance of p < 0.05. RESULTS: Although statistically not significant (p-trend = 0.28), animal source foods consumption increased from 31.3% to 2005 through 35.9% in 2011 to 41.5% in 2016. For every month increase in the age of a child, a 9% increment in the odds of animal source food consumption was observed. Muslim children showed 3.1 times higher odds of animal source food consumption than Orthodox Christians. The likelihood of animal source foods consumption were 33% lower among children born to mothers who didn't attend formal education as compared to their counterparts. A unit increase in the number of household assets and number of livestock led to a 20% and 2% increase in the odds of animal source foods consumption, respectively. CONCLUSION: Animal source foods consumption showed a statistically non-significant increase over the three consecutive Ethiopian Demographic and Health Surveys. This study found out that consumption of animal source foods might be increased through pro-maternal education policies, programs with household asset increasing schemes, and pro-livestock projects. Our study also highlighted the need for considering religion as one important player when planning or undertaking ASF programs.

Prevalence and multi-level factors associated with acute malnutrition among children aged 6-59 months from war affected communities of Tigray, Northern Ethiopia, 2021: a cross-sectional study.

BACKGROUND: Armed conflicts greatly affect the health, nutrition, and food security of conflict affected settings particularly children. However, no empirical data exist regarding context specific factors contributing towards acute malnutrition in the war-torn Tigray, Ethiopia. Thus, this study aimed to identify individual and community level factors associated with acute malnutrition among children aged 6-59 months from armed conflict affected settings of Tigray, Ethiopia. METHODS: A community based cross-sectional study was conducted among 3,614 children aged 6-59 months in Tigray, from July 15 to Aug 15, 2021. Study participants were selected using a two-stage random sampling method. A structured questionnaire was used to collect data by interviewing mothers/caregivers. Mid upper arm circumference (MUAC) measurements were taken from upper left arm of the children using MUAC tapes. Multivariable multilevel logistic regression analysis was used to determine factors associated with acute malnutrition. Adjusted Odds ratio (AOR) with 95% CI were estimated to describe the strength of associations at p < 0.05. RESULTS: More than half (52.5%) of the sampled children were males in sex. Immediately after the first nine months into the conflict, the prevalence of severe, moderate, and global acute malnutrition was very high (5.1%, 21.8%, and 26.9%, respectively) in Tigray. The lowest and highest burden of child acute malnutrition was reported from Mekelle zone (13.3%) and Southeastern zone (36.7%), respectively. Individual-level factors such as older child age (AOR = 0.13, 95% CI: 0.10, 0.18), female child sex (AOR = 1.24, 95% CI 1.05, 1.480.95), Vitamin-A supplementation (AOR = 1.3, 95% CI: 1.05, 1.65), and history of diarrhea (AOR = 1.22, 95%CI: 1.02, 1.53) and community-level factors like unimproved drinking water source (AOR = 1.31, 95%CI: 1.08, 1.58), unimproved toilet facility (AOR = 1.24, 95% CI: 1.01, 1.52), and severe food insecurity (AOR = 1.55, 95% CI: 1.16. 2.07) were significantly associated with childhood acute malnutrition. CONCLUSIONS: The burden of acute malnutrition is a severe public health problem in Tigray. To prevent the untimely suffering and death of children, regular nutrition screening, speedy, and appropriate referral of all malnourished children to nutritional services and large-scale humanitarian assistance including access to food; nutrition supplies; water, sanitation and hygiene supplies; and health care in a timely manner are required. In the prevailing armed conflict, these have been very difficult to achieve. Thus, immediate international intervention is needed.

Clinical presentation, maternal-fetal, and neonatal outcomes of early-onset versus late onset preeclampsia-eclampsia syndrome in a teaching hospital in a low-resource setting: A retrospective cohort study.

BACKGROUND: Pre-eclampsia-eclampsia syndrome remains the leading cause of maternal and neonatal mortality worldwide. Both from pathophysiologic and clinical stand points, early and late onset preeclampsia are thought to be two different disease entities. However, the magnitude of preeclampsia-eclampsia and maternal-fetal and neonatal outcomes of early and late onset preeclampsia are not adequately investigated in resource-limited settings. This study sought to examine the clinical presentation and maternal-fetal and neonatal outcome of these two entities of the disease in Ayder comprehensive specialized hospital, an academic setting in Tigray, Ethiopia, from January 1, 2015-December 31, 2021. METHODS: A retrospective cohort design was employed. The patient charts were reviewed to see the baseline characteristics and their progress from the onset of the disease in the antepartum, intrapartum and postpartum periods. Women who developed pre-eclampsia before 34 weeks of gestation were defined as having early-onset pre-eclampsia, and those who developed at 34 weeks or later were identified as late-onset preeclampsia. We used chi-square, t-test and multivariable logistic regression analyses to determine differences between early- and late onset diseases in terms of clinical presentation, maternal-fetal, and neonatal outcomes. RESULTS: Among the 27,350 mothers who gave birth at the Ayder comprehensive specialized hospital, 1095 mothers had preeclampsia-eclampsia syndrome, with a prevalence of 4.0% (95% CI: 3.8, 4.2)]. Of the 934 mothers analyzed early and late onset diseases accounted for 253 (27.1%) and 681 (72.9%) respectively. Overall, death of 25 mothers was recorded. Women with early onset disease had significant unfavorable maternal outcomes including having preeclampsia with severity features (AOR = 2.92, 95% CI: 1.92, 4.45), liver dysfunction (AOR = 1.75, 95% CI: 1.04, 2.95), uncontrolled diastolic blood pressure (AOR = 1.71, 95% CI: 1.03, 2.84), and prolonged hospitalization (AOR = 4.70, 95% CI: 2.15, 10.28). Similarly, they also had increased unfavorable perinatal outcomes, including the APGAR score at the 5th minute (AOR = 13.79, 95% CI: 1.16, 163.78), low birth weight (AOR = 10.14, 95% CI 4.29, 23.91), and neonatal death (AOR = 6.82, 95% CI: 1.89, 24.58). CONCLUSION: The present study highlights the clinical differences between early versus late onset preeclampsia. Women with early-onset disease are at increased levels of unfavorable maternal outcomes. Perinatal morbidity and mortality were also increased significantly in women with early onset disease. Therefore, gestational age at the onset of the disease should be taken as an important indicator of the severity of the disease with unfavorable maternal, fetal, and neonatal outcomes.

Co-design and implementation of a mHealth intervention targeting fathers and mothers to improve breastfeeding.

BACKGROUND: Evidence has shown that SMS text message-based health education is effective in improving exclusive breastfeeding. However, there is limited evidence on the development and design of SMS messaging intervention targeting fathers and mothers. METHOD: This is the formative assessment and intervention design for a larger trial targeting both fathers and mothers for breastfeeding support in Tigray, Ethiopia. A total of 42 parents of children less than 2 years of age were involved in the design process that also included nutrition experts. We recruited 128 expectant couples to the intervention (1-month antenatally) who continued for 3 months postnatally. RESULTS: Sixteen messages were developed specific to feeding in the antenatal and postnatal periods. These messages were revised with parents and experts and pretested with parents. Over 4 months 87% of fathers and mothers received 3 or more SMS text messages. All fathers and 97% of mothers read the weekly SMS text messages. Almost 90% of mothers and fathers indicated their willingness to continue to receive SMS text messages related to infant feeding. CONCLUSION: Development of SMS based breastfeeding interventions should involve the target population in content design. The role of experts and target population in the co-design process is also crucial.

Theory-based mHealth targeting fathers and mothers to improve exclusive breastfeeding: a quasi-experimental study.

BACKGROUND: Exclusive breastfeeding remains sub-optimal in low-income countries contributing to infant mortality. Mobile health (mHealth) interventions, delivered through personal mobile phones, to improve exclusive breastfeeding have shown promise, but very few include fathers or have been applied in low-income countries. The aim of this study was to assess the effectiveness of a SMS-based breastfeeding intervention targeting fathers and mothers in improving exclusive breastfeeding at three months in a low-income country. METHODS: A quasi-experimental study was carried out with couples in their last trimester of pregnancy, at health centers, Mekelle, Tigray. This study was conducted from September 2018 to March 2019. The SMS-based intervention delivered a total of 16 SMS text messages to two arms: mothers-and-fathers, and mothers-only with the third group acting as the control. The main outcome measure was exclusive breastfeeding at months one, two and three after birth. RESULT: There were no significant differences in exclusive breastfeeding at month one between the three, mothers-and-fathers (95.1%), mother-only (90.2%), and control group (85%). At month three 85% of babies were exclusively breastfed in the mothers-and-fathers compared to 60% in the control group (p = 0.01). At month three 80% of babies were exclusively breastfed in the mothers-only compared to 60% in the control group (p = 0.04). In the multivariate analysis, babies born to mothers in the mother-and-fathers group were almost five times more likely to be exclusively breastfeed at three months than babies born to mothers who received standard care [AOR: 4.88, 95% CI (1.35,17.63)]. CONCLUSION: An mHealth intervention targeting fathers and mothers, and mothers increased the likelihood of babies being exclusively breastfed at three months. The risk of not exclusively breastfeeding in the control group increased over time. A low-cost SMS-based breastfeeding intervention targeting fathers and mothers showed potential to improve exclusive breastfeeding. Such mHealth interventions could be integrated into the antenatal and postnatal follow-up services provided by midwives. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) 12,618,001,481,268.

Knowledge, attitude, and determinants of exclusive breastfeeding during COVID-19 pandemic among lactating mothers in Mekelle, Tigrai: a cross sectional study.

BACKGROUND: Due to the nutritive and immunologic benefits of breastmilk, children should be exclusively breastfed for the first 6 months of life, even during the corona virus pandemic. However, fear of transmission risk and pandemic-related restrictions could undermine the practice of breastfeeding. This study aimed to assess the knowledge, attitude, and determinants of exclusive breastfeeding (EBF) during COVID-19 among lactating mothers in Mekelle, Tigrai, Ethiopia. METHODS: A community based cross-sectional study was conducted among 621 lactating mothers living in Mekelle city, Tigrai, from April to June, 2021. Data were collected using an adapted form of a standard KAP questionnaire. Binary logistic regression was used to determine the independent determinants of EBF at a statistical significance of p < 0.05. The strength of the association was measured by odds ratio and 95% confidence interval. RESULTS: Four hundred (64.4%) mothers exclusively breastfed their children. Infants from female-headed households had twice (AOR 2.21; 95% CI 1.31, 3.71) higher odds of EBF. Higher educational status was associated with higher odds of EBF practice. A unit increase in parity was associated with a 23% increase in the odds of EBF. Mothers who received breastfeeding information had a 73% (AOR 1.73; 95% CI 1.17, 2.56) higher odds of EBF. Moreover, mothers with high knowledge score and positive attitude showed a 74% higher (AOR 1.74; 95% CI 1.20, 2.51) and more than double (AOR 2.35; 95% CI 1.50, 3.70) odds of EBF, respectively. CONCLUSION: About two-thirds of the mothers practiced EBF. Household head, maternal educational, parity, breastfeeding information, knowledge of breastfeeding, and attitude towards EBF were significant determinants of EBF. Our study findings highlighted that programs that enhance women's participation in education and decision-making could improve EBF practice. Besides, during the COVID-19 pandemic, providing lactating mothers with adequate and up-to-date breastfeeding information could be significant in improving EBF practice.

Educational intervention and livestock ownership successfully improved the intake of animal source foods in 6-23 months old children in rural communities of Northern Ethiopia: Quasi-experimental study.

BACKGROUND: Animal source foods (ASFs) are rich in high-quality proteins, including essential amino acids and highly bioavailable micronutrients vital for child growth and cognitive development. But, the daily consumption of ASFs among 6-23 months old children is very low in Tigray, Northern Ethiopia. OBJECTIVE: The study aimed to assess the effectiveness of nutrition education intervention to improve the consumption of ASFs among 6-23 months old children from rural communities with strict religious fasting traditions of avoiding intake of ASFs in Northern Ethiopia. METHODS: A quasi-experimental study was conducted in two food insecure districts namely Samre Seharti (intervention) and Tanqua Abergele (comparison). The mother-child pairs in the intervention group (n = 140) received nutrition education based on the barriers and available resources for optimal consumption of ASFs among children and followed up for nine months. The mother-child pairs in the comparison group (n = 153) received routine nutrition education. The data were collected using a pre-tested structured questionnaire. The baseline and endline data assessment included interviews on socio-demographic and socio-economic status, dietary intake, and child feeding practices. The effectiveness of the intervention was measured using the difference-in-difference (DID) analysis model. RESULTS: At endline, the consumption of ASFs among children was 19.5 percentage points higher in the intervention group compared with the comparison group (p = 0.008). In addition, there was a significant increase in egg consumption among children in the intervention group (DID of 16.9, p = 0.012) from the comparison group. No child was consuming meat at baseline in both the intervention and comparison arms and it was very low at endline (5.2% vs. 7.9%). Overall, the proportion of children that consumed eggs in the intervention group was higher than in the comparison group in households that owned sheep and goats (4.8% vs. 21.4%, p = 0.050) and chicken (6.3% vs. 43.8%, p = 0.002) after education interventions. However, no statistically significant difference was observed between cow ownership and milk consumption among children (p>0.05). CONCLUSIONS: Age-appropriate educational interventions for mothers and owning small livestock in the household can improve the consumption of ASFs and eventually the minimum diet diversity of children in communities with strict religious traditions of avoiding ASFs during the fasting seasons.

Magnitude and morphological types of anemia differ by age among under five children: A facility-based study.

Background: World Health Organization recently acknowledged the proportion of anemia attributable to iron deficiency among under-five children could be lower than the previously assumed 50%. Ethiopia reported 8.6% and 12.3% prevalence of iron deficiency anemia by serum ferritin and soluble transferrin receptor respectively. However, evidence generated from large samples on the magnitude of different types of anemias is limited. We aimed to determine the prevalence and morphological types of anemia in relation to age. Methods: A retrospective analysis was conducted using electronic records of hemoglobin and red blood cell indices of 4739 children of 6-59 months of age who visited Hawassa University Comprehensive and Specialized Hospital from May 2017 to May 2019. Microcytic hypochromic morphology combined with high red cell distribution width was used to estimate the prevalence of iron deficiency. Results: About 44.7% of the children were anemic. Anemia affected 6-23 months old children (53.1%) more than 24-59 (37.2%) months (p < 0.001) with no difference among boys and girls. Iron deficiency and iron-deficiency anemia, as explained by microcytic hypochromic morphology with high red cell distribution width combined model, were estimated to be 38.6% and 24.1%, respectively. About 54% of anemic children had iron deficiency which was higher among 6-23 months (63.5%) than 24-59 months (41.8%) (P < 0.001; X2 = 98.883). Regardless of anemia status, iron deficiency was two-fold higher among 6-23 months old children than 24-59 months of age. On the contrary, normocytic normochromic anemia affected significantly 24-59 months old children (23.1%) compared to 6-23 months. Less than 6% of the total anemia was macrocytic showing no significant relation with age. About 96% of macrocytic anemia was coupled with high red cell distribution width, indicating folate and vitamin B12 deficiency. Conclusions: Microcytic hypochromic anemia with high red cell distribution width was the most prevalent type affecting primarily under two children. Normocytic normochromic anemia was significant among 24-59 months while macrocytic anemia had no age-related pattern. An in-depth study of causes of anemia other than iron deficiency particularly among 24-59 months children is essential.