Correction to: Fetal macrosomia and its associated factors among singleton live-births in private clinics in Mekelle city, Tigray, Ethiopia.

Following publication of the original article [1], we have been notified that the name of one author was spelled incorrectly as Kidanemariam Berhe Tekola, when the correct spelling is Kidanemaryam Berhe Tekola.

Fetal macrosomia and its associated factors among singleton live-births in private clinics in Mekelle city, Tigray, Ethiopia.

BACKGROUND: Despite an increased number of infants born with macrosomia globally, low birth weight infants have currently attracted more attention. Macrosomia is a growing problem in most developing countries and it directly or indirectly contributes to morbidity, mortality, and disability worldwide. The main objective of this study was to assess the level of macrosomia and its associated factors in the private clinics of Mekelle city, Tigray region, Ethiopia, 2017. METHODS: An institution based cross-sectional study with a total of 309 pregnant mothers was conducted. We collected data from the pregnant mothers as well as from their medical records using structured questionnaire and checklist respectively. We entered and analyzed the data using statistical package for social science (SPSS)-21 by applying binary logistic regression to identify the factors associated with macrosomia. Finally, we used texts and tables to summarize the results of the study. RESULTS: The prevalence of macrosomia was 19.1% (95% confidence interval (CI) = 14.9, 23), and the mean ± standard deviations of birth weights were 3440 ± 543 g. Macrosomia was significantly associated with: weight gain during pregnancy ≥16 kg (adjusted odds ratio (AOR) = 11, 95% CI: 3, 37), pre-pregnancy overweight (AOR = 5, 95% CI = 2, 13), pre-pregnancy obesity (AOR = 15, 95% CI = 5, 50), maternal age (AOR =2.6, 95% CI = 1.2, 5.8) and giving birth to macrosomic baby in the last pregnancy (AOR = 2.7, 95% CI = 1.1, 7). CONCLUSION: We found that prevalence of macrosomia was high, and significantly associated with pre-pregnancy body mass index (BMI), pregnancy weight gain, maternal age and giving birth to a macrosomic baby in the last pregnancy. Hence, we recommend that emphasis should be given to maternal counseling for weight management before and during pregnancy.

Maternal dietary pattern and its association with birthweight in Northern Ethiopia: A hospital-based cross-sectional study.

Birthweight is a useful public health measure of maternal health, nutrition, healthcare delivery, and child morbidity and mortality. Previous research did not focus on dietary patterns but rather on a single or a few foods or nutrients. This study aimed to assess the maternal dietary pattern and its association with birthweight in northern Ethiopia. A hospital-based cross-sectional study was conducted among 373 pregnant mothers in their third trimester of pregnancy who came to attend their routine antenatal care service. The food frequency questionnaire was collected from the previous week, and the birthweight data were collected from the medical records after delivery. Three maternal dietary patterns were identified; dietary pattern includes eggs, milk, milk products, and certain fruits and roots. Dietary pattern 2 includes certain vegetables, green leafy vegetables, vitamin A-rich vegetables, pulses such as beans, peas, and chickpeas, and drinks like coffee, tea, and soda. Dietary pattern 3 includes meat, nuts, and grains such as teff, corn, wheat, and white flour. Dietary pattern 1 (ß = 52.45, p = .03) and dietary pattern 2 (ß = 66.76, p = .01), residency (ß = 287.08, p < .001), a mid-upper-arm circumference of 21-23 cm (ß = 187.10, p = .02), a mid-upper-arm circumference of >23 cm (ß = 272, p = .01), and gestational age at delivery (ß = 12.58, p = .004) were the factors significantly associated with increased birthweight. The maternal dietary pattern has a significant association with birthweight. The focus should be given to maternal dietary patterns to prevent suboptimal and high birthweight.

Barriers to utilize nutrition interventions among lactating women in rural communities of Tigray, northern Ethiopia: An exploratory study.

BACKGROUND: While lactation is a physiological process requiring high energy demand to fulfill the nutrient requirements of the mother and the breastfeeding child, many factors affecting maternal nutrient intake can lead to nutritional deficits. Previous studies in Ethiopia have reported the prevalence of maternal and child undernutrition and related complications. However, qualitative studies exploring potential barriers to utilizing available nutrition interventions are limited. This study, therefore, sought to qualitatively explore barriers hindering the uptake of nutrition services among lactating mothers from rural communities in Tigray, northern Ethiopia. METHODS: We conducted 6 in-depth interviews, 70 key informant interviews, and 13 focus group discussions among purposively selected community groups, experts, and lactating mothers between November- 2017 and January- 2018. Audio records of all interviews and focus group discussions were transcribed verbatim (word-to-word) and translated into English. Then, translated data were analyzed thematically using qualitative data analysis software Atlas ti-version 7.4. RESULTS: The participants in this study perceived that lactating mothers in their study area are not properly utilizing available and recommended nutrition interventions, and as a result, their nutrient intake was reported as inadequate. Participants identified inadequate accessibility and availability of foods, feeding practices, cultural and religious influences, focus on agricultural production and productivity, barriers related to health services and poor access to water, sanitation and hygiene as major barriers hindering the uptake of nutrition interventions by lactating women in Tigray, northern Ethiopia. CONCLUSION: The uptake of nutrition intervention services was low among lactating mothers and was hindered by multiple socio-cultural and health service related factors requiring problem-specific interventions at community, health facility, and administrative levels to improve the nutritional status of lactating mothers in the study area.

Food taboos and related misperceptions during pregnancy in Mekelle city, Tigray, Northern Ethiopia.

INTRODUCTION: Most communities, rural or urban, have taboos regarding foods to avoid during pregnancy, and most have local explanations for why certain foods should be avoided. Such taboos may have health benefits, but they also can have large nutritional and health costs to mothers and fetuses. As such, understanding local pregnancy food taboos is an important public health goal, especially in contexts where food resources are limited. Despite this, information regarding food taboos is limited in Ethiopia. Therefore, this study assessed food taboos, related misconceptions, and associated factors among pregnant women in Northern Ethiopia. METHODS: A cross-sectional study of 332 pregnant women in antenatal care (ANC) follow-up at selected private clinics in Mekelle city, Tigray, Ethiopa, recruited between April and May, 2017. Using a semi-structured questionnaire, we assessed whether respondents' observed food taboos, what types of foods they avoided, their perceived reasons for avoidance, diversity of respondents' diets during pregnancy, and respondents' socio-demographic characteristics. After reporting frequency statistics for categorical variables and central tendencies (mean and standard deviation) of continuous variables, bivariate and multivariable logistic regression analyses were conducted to identify the socio-demographic factors and diet diversity associated with food taboo practices. RESULTS: Around 12% of the pregnant women avoided at least one type of food during their current pregnancy for one or more reasons. These mothers avoided eating items such as yogurt, banana, legumes, honey, and "kollo" (roasted barley and wheat). The most common reasons given for the avoidances were that the foods were (mistakenly) believed to cause: abortion; abdominal cramps in the mother and newborn; prolonged labor; or coating of the fetus's body. Maternal education (diploma and above) (AOR: 4.55, 95% CI: 1.93, 10.31) and marital status (single) were found to be negatively associated (protective factors) with observances of pregnancy food taboos. Approximately 79% of respondents had pregnancy diets that were insufficiently diverse, although we did not find any statistical evidence that this was associated with adhering to food taboos. CONCLUSION: The misconceptions related to pregnancy food taboos should be discouraged insofar as they may restrict women's consumption of nutritious foods which could support maternal health and healthy fetal development. Health providers should counsel pregnant women and their husbands about appropriate pregnancy nutrition during ANC visits.

Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia.

OBJECTIVES: The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit. DESIGN: A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach. SETTING: The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People's Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings. PARTICIPANTS: Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed. RESULTS: We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs' self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs. CONCLUSION: Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.

Effect of pregnancy weight gain on infant birth weight among mothers attending antenatal care from private clinics in Mekelle City, Northern Ethiopia: A facility based follow-up study.

INTRODUCTION: Weight gain during pregnancy is an important indicator of maternal and fetal nutrition during pregnancy. However, information regarding the effect of pregnancy weight gain on birth weight is lacking from developing countries. OBJECTIVE: To determine the effect of pregnancy weight gain on the newborn's birth weight in mothers attending antenatal care (ANC) services from private clinics. METHODS: Health facility-based follow-up study was conducted among 332 pregnant mothers attending their antenatal care in Mekelle city, from October 2016 to June 2017. Before 28 weeks of gestation, pregnancy weight was collected retrospectively, then, mothers were followed-up until the time of infant delivery to record their birth weight. Data were also collected by a structured questionnaire and checklists and analyzed using SPSS version 21. The relationship between dependent and independent variables was assessed and presented using descriptive statistics, as well as t-test, ANOVA, and multivariable linear regression analysis. Variables:-pre-pregnancy BMI, maternal age, parity, decision making power on monetary resources, pregnancy interval, availability of housemaid, women dietary diversity score, maternal occupation, and pregnancy weight gain were included in the multivariable analysis. RESULTS: Maternal weight increased monthly at a mean ± SD rate of 2 ± 0.7 kg in the second trimester, and 1.5 ± 0.7 kg in the third trimester. The mean ± SD of pre-pregnancy body mass index (BMI) and total pregnancy weight gain was 23.8 ± 4.6 kg/m2, and 12 ± 2.8 kg respectively. The mean ± SD of birth weight was 3440 ± 542 grams. Weight gain has a significant effect on infant birth weight, a 1 kg increase in the pregnancy weight was associated with 94 g increase in BW (ß = 97, 95% CI: 73-120). After dividing the pre-pregnancy weight into four groups (< 18.5, 18.5-24.9, 25-29.9 and ≥30) kg/m2 based on the Institute of Medicine (IOM), we found a statistically significant birth weight difference between each group. CONCLUSION: Pregnancy weight gain has a significant effect on birth weight. Thus, ANC counseling services should focus on maternal weight gain to prevent sub-optimal birth weight.