Barriers to appropriate complementary feeding and the use of ultra-processed foods: A formative qualitative study from rural Oromia, Ethiopia.

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents) and grandmothers (23 respondents) of children aged 6-23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notes before qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuits and lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored.

Research protocol local ingredients-based supplementary food as an alternative to corn-soya blends plus for treating moderate acute malnutrition among children aged 6 to 59 months: a randomized controlled non-inferiority trial in Wolaita.

BACKGROUND: In Ethiopia, 12.5% of children below 5 years are wasted, and 9.7% are moderately wasted. The present strategy for the management of moderate acute malnutrition (MAM) is a supplementary feeding program; however, this is only provided to chronically food-insecure areas. This randomized controlled non-inferiority trial examines if Local ingredients-based supplement (LIBS) is as effective as corn-soya blends plus (CSB+) in treating moderate acute malnutrition among children aged 6-59 months. METHODS: A randomized controlled non-inferiority trial will be conducted with moderately wasted children aged 6 to 59 months in Wolaita, Ethiopia. The calculated sample size is 324 (i.e. with 162 children in each of two arms, to be assigned by randomization). The daily ration will be: 100 g of LIBS plus 25.2 g of sugar with 8 ml oil in the intervention group, and 150 g of CSB+ with 16 ml of oil in the control group. These interventions will be provided for a maximum period of 12 weeks, with follow-up performed on a weekly basis. Data analysis will be done using SPSS and STATA software. Both intention-to-treat and per protocol analyses will be done. Hazard ratio and Kaplan-Meier (log rank) curves of survival analysis will be done to predict the probability of recovery rate. Logistic regression will be used to test for interactions between independent and dependent variables. Analysis of variances, t-tests, fisher's exact test and chi-square tests will be used to assess baseline characteristics. CONCLUSIONS: This paper will introduce to the existing research locally available nutritious foods which have the potential to enhance recovery from moderate acute malnutrition and to reduce the burden of malnutrition. The perceptions of mothers on feeding children with local ingredient-based supplementary food to assist recovery from moderate acute malnutrition will be the focus of in a qualitative study to follow; this will provide a further contribution in an evolving area of research. TRIAL REGISTRATION: Pan-African Clinical Trial Registration number: PACTR201809662822990, retrospectively registered on 11/09/2018.

An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.

A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed.

Predicted implications of using percentage weight gain as single discharge criterion in management of acute malnutrition in rural southern Ethiopia.

Mid-upper arm circumference (MUAC) is increasingly used in identifying and admitting children with acute malnutrition for treatment. It is easy to use because it does not involve height assessment, but its use calls for alternative discharge criteria. This study examined how use of percentage weight gain as discharge criterion would affect the nutritional status of children admitted into a community-based management programme for acute malnutrition in rural southern Ethiopia. Non-oedematous children (n = 631) aged 6-59 months and having a MUAC of <125 mm were studied. By simulation, 10%, 15% and 20% weight was added to admission weight and their nutritional status by weight-for-height z-score (WHZ) was determined at each target. Moderate and severe wasting according to World Health Organization WHZ definitions was used as outcome. Applying the most commonly recommended target of 15% weight gain resulted in 9% of children with admission MUAC <115 mm still being moderately or severely wasted at theoretical discharge. In children with admission MUAC 115-124 mm, 10% of weight gain was sufficient to generate a similar result. Children failing to recover were the ones with the poorest nutritional status at admission. Increasing the percentage weight gain targets in the two groups to 20% and 15%, respectively, would largely resolve wasting but likely lead to increased programme costs by keeping already recovered children in the programme. Further research is needed on appropriate discharge procedures in programmes using MUAC for screening and admission.

The reaction of secondary school and university students toward COVID-19-induced lockdown.

Background: The Coronavirus pandemic triggered a worldwide partial lockdown. The lockdown instigated the school's shutdown making the students follow their courses in the virtual modalities while staying at home. Methods: The data were collected using an online survey using a semi-structured questionnaire. The study involved anonymous as well as voluntary 77 secondary schools (Grades 9th to 12th) and 132 university students (class standing 1st to 5th year). Results: The lockdown introduced excruciating experiences for most of the students; however, it also created unanticipated opportunities to learn new skills and develop insights on how to mitigate unforeseen crises while remaining reasonably productive. The steps taken to reduce exposure to the coronavirus infection showed a gender discrepancy. Accordingly, males were disproportionately taken risks regardless of the curfew imposed, while females were deeply concerned about the lockdown-induced break of social connections. Students who were attending public schools, presumably from low-income families were found to be more productive during the lockdown compared to their private school counterparts. This shows that, in some instances, the Coronavirus pandemic is a blessing in disguise. The lockdown created mixed feelings; accordingly, the students reported significantly varied responses towards it. This also introduced some inconsistencies in the response of the students. Perceptions about the lockdown and its impact in most instances significantly varied among students, which unlocked the opportunities to learn new lessons on how to manage unprecedented crises. Conclusion: Policymakers need to take into account gender and living standard while developing strategies to mitigate unprecedented challenges.

Antimicrobial activity of medicinal plants used for urinary tract infections in pastoralist community in Ethiopia.

BACKGROUND: Medicinal plants have wide medicament application used to prevent and management of many ailments. These plants are used for primary health care in pastoralist communities who are deprived of modern medical care. They possess extensive therapeutics bioactive coupled with varied chemical structures. However, scientific validation of efficacy and safety of plants used to treat the urinary tract infections haven't been fully exploited. The aim of this study was to evaluate antimicrobial activity and screening phytochemicals of medicinal plants used to treat urinary tract infections. METHODS: In-vitro experimental study was carried out to evaluate the antimicrobial effect and screening phytochemical of Rumex abyssinicus, Cucumis pustulatus, Discopodium penninervium, Lippia adoensis, Euphorbia depauperata, and Cirsium englerianum. Against drug resistance microbes. 80% methanol was used for extraction of the plant parts. The susceptibility tests were investigated using disc diffusion and broth micro-dilution methods. RESULTS: The majority of tested extracts showed antimicrobial activity on two or more drug-resistant bacteria with MIC value (1.0-128.0 µg/ml) and 9-27 mm inhibition zone in diameter. Extracts obtained from C.englerianum and E. depauperate showed more potent antibacterial activity on MRSA and Enterococcus faecalis with IZ 25 and 27 mm respectively. E. coli and K. pneumoniae were inhibited by those extracts with IZ ranging 9-25 mm and 11-27 mm respectively. E.faecalis and K. pneumoniae were more susceptible bacteria to the respective extracts. R. abyssinicus showed promising antifungal effect with had 21 mm IZ and MIC range 16-32 µg/ml on C.albicans. Alkaloids, flavonoids, phenolic and terpenoid were common phytochemical characterized in majority of screened plants. CONCLUSION: Tested extracts exhibited significant antibacterial and antifungal activity. Hence, further structural elucidation of bioactive that inhibited the growth of microbes aforementioned plants may be used as precursors for the synthesis of new antibiotics in the future.

COVID-19: socio-economic impacts and challenges in the working group.

The COVID-19 pandemic has influenced the lives of the global community, consequently, many parts of people's lives have been jeopardized. Therefore, there is a need to curb the spread of coronavirus. Accordingly, countries are enforcing partial or full-fledged lockdown to restrict all sorts of socialization. However, studies reported that people have despised the ordinances. The study assessed the economic, societal, and psychological impacts of the pandemic and the practice of abiding by curfews by staying and working from home. One hundred thirty-three government, private, and self-employed workers have anonymously and voluntarily completed an online survey. The change in lifestyle associated with the pandemic influenced the working group economically, socially, emotionally, and spiritually. In addition to inflation in the prices of food and commodity, workers have spent unintended costs for the prevention of the COVID-19 such as hand sanitizer and facemask. Furthermore, staying home was unbearable for the majority of the respondents and led to stress, boredom, and confined feelings which forced them to leave their homes to liberate themselves. Nevertheless, flexibility in time management, reduced commuting, and being safe from COVID-19 made the lockdown advantageous for some of the respondents. Telecommuting is influenced by factors such as home suitability to work, availability of supplies, and the behavior of the workers. Home suitability to work and access to vital working facilities varied between government, private, and self-employed individuals. Government employees exceptionally lack appropriate homes and resources to work. Therefore, to minimize the impact of COVID-19 on people's life it is important to make timely adjustments to the enforced orders to make them more productive.

Preoperative Nutritional Status and Its Consequences on Abdominal Surgery in Wolaita Zone, Southern Ethiopia: An Institution-Based Observational Study.

This study aimed to determine the prevalence of malnutrition and its association with wound healing and length of hospitalization among patients undergoing abdominal surgery admitted to hospitals in the Wolaita zone in southern Ethiopia. Methods. An institution-based prospective observational study was conducted in three hospitals in the Wolaita zone from August to October 2016. All eligible individuals aged between 19 and 55 years were recruited in this study. Anthropometric and biochemical analyses, such as serum albumin (Alb) and total lymphocyte count (TLC), were taken for nutritional assessment during the preoperative period. Quantitative variables were compared using Student's t test. Cox's regression was employed to determine which variables were possible risk factors for poor wound healing. Results. A total of 105 patients aged 19 to 55 with a mean age (±SD) of 34 ± 9.6 years were included, and the prevalence of preoperative malnutrition was 27.6%, 87%, according to BMI and nutritional risk index, respectively. Poor wound healing was significantly associated with underweight patients (BMI < 18.5 kg/m2) (AHR: 6.5 : 95%CI: 3.312.9), postoperative weight loss (AHR: 4.9; 95%CI: 2.8-8.5), and nutritional risk index (NRI) less than 97.5 (AHR 1.8; 95% CI: 1.09-3.1). Conclusion. The prevalence of malnutrition is high in our study setup; this is associated with an increased risk of adverse postoperative outcomes. Therefore, our results emphasize the need of routine preoperative nutritional assessment, optimizing nutritional status of patients and postoperative nutritional support.

Choosing Anthropometric Indicators to Monitor the Response to Treatment for Severe Acute Malnutrition in Rural Southern Ethiopia-Empirical Evidence.

The World Health Organization (WHO) recommends the assessment of nutritional recovery using the same anthropometric indicator that was used to diagnose severe acute malnutrition (SAM) in children. However, related empirical evidence from low-income countries is lacking. Non-oedematous children (n = 661) aged 6-59 months admitted to a community-based outpatient therapeutic program for SAM in rural southern Ethiopia were studied. The response to treatment in children admitted to the program based on the mid-upper arm circumference (MUAC) measurement was defined by calculating the gains in average MUAC and weight during the first four weeks of treatment. The children showed significant anthropometric changes only when assessed with the same anthropometric indicator used to define SAM at admission. Children with the lowest MUAC at admission showed a significant gain in MUAC but not weight, and children with the lowest weight-for-height/length (WHZ) showed a significant gain in weight but not MUAC. The response to treatment was largest for children with the lowest anthropometric status at admission in either measurement. MUAC and weight gain are two independent anthropometric measures that can be used to monitor sufficient recovery in children treated for SAM. This study provides empirical evidence from a low-income country to support the recent World Health Organization recommendation.

Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia.

Weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) are two independent anthropometric indicators for diagnosing and admitting children with severe acute malnutrition (SAM) for treatment. While severely wasted children are at high risk of mortality, MUAC and WHZ do not always identify the same population of children as having SAM. Understanding how this discrepancy relates to age and sex may provide valuable information for care programmes for children with SAM. Age and sex distribution for differences between children identified as SAM by MUAC and WHZ were examined and the degree of agreement calculated. Children (n = 4297) aged 6-59 months with validated anthropometric measures were recruited from a population-based survey conducted in rural southern Ethiopia. MUAC < 115 mm and WHZ < -3 were used to define severe wasting as per the World Health Organization (WHO) classification. The kappa coefficient (κ) was calculated. There was fair agreement between the MUAC and WHZ definitions of severe wasting in boys (κ = 0.37) and children younger than 24 months (κ = 0.32) but poor agreement in girls (κ = 0.15) and children aged 24 months and above (κ = 0.13). More research is needed on response to treatment and prediction of mortality using different anthropometric measurements in relation to ages and sex of children.

Challenges in Implementing the Integrated Community-Based Outpatient Therapeutic Program for Severely Malnourished Children in Rural Southern Ethiopia.

Currently, treatment of uncomplicated severe acute malnutrition is managed in the integrated Community based Outpatient Therapeutic Program (C-OTP) using ready-to-use therapeutic foods (RUTFs). The aim of this study was to determine challenges in implementing the critical steps in C-OTP and caregivers' perceptions of service provision in southern Ethiopia. A total of 1048 caregivers of children admitted to the OTP and 175 Health Extension Workers (HEWs) from 94 selected health posts were included in the study. Program admission, follow-up and exit information was collected from caregivers during home visits. HEWs were interviewed at their respective health posts. Only 46.6% (481/1032) were given the recommended amount of RUTF and 19.3% (196/1015) were given antibiotics on admission. During C-OTP participation 34.9% (316/905) had uninterrupted provision of the recommended amount of RUTF. Of the children who left the program, 220/554 (39.7%) exited the program in line with the national recommendation. Caregivers (42.9% (394/918) and HEWs (37.1%, 62/167) perceive that RUTFs were being sold as a commodity. Inadequate provision and unintended usage of RUTFs, lack of antibiotics and inappropriate exit from the program were major constraints. For successful saving of lives, adequate resources must be allocated, and providers must be trained regularly, and supervised properly.

Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia.

BACKGROUND: Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers' and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia. METHODS: This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied. RESULTS: RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs. CONCLUSION: Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child.