The influence of household structure and composition on the introduction of solid, semisolid and soft foods among children aged 6-8 months: An analysis based on Ethiopia Demographic and Health Surveys.

The early and late introduction of complementary food, both prevalent in Ethiopia, are associated with morbidities, growth faltering and developmental risks in children. The interhousehold network around the primary caregiver's intrahousehold network is critical in influencing the age of introducing complementary foods. This study examined the influence of household composition and structures on complementary food introduction. This is a secondary data analysis of four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. The household structure and composition variables were calculated from household members' kinship status and attribute, respectively. The introduction of solid, semisolid or soft foods was dichotomised as whether the children within 6 to 8 months have been given complementary foods. Multivariable logistic regression with adjustment for the primary caregiver and household characteristics was run to examine the associations between household structure and composition variables and the introduction of complementary foods. The marginal effects (ME) were calculated to facilitate the practical interpretation of the study findings. Large households (>3 nonredundant contacts) with extended family or unrelated people (high effective size, ME = 6.01%, 95% confidence interval [CI]: -8.53, -3.49) lowered the proportion of children starting food within the recommended 6-8 months. Households with close kins (high constraint) (ME = 7.22%, 95% CI: -13.65, 28.09) and greater age diversity (ME = 0.65%, 95% CI: 0.15, 1.15) increased the proportion of children receiving complementary food at an appropriate age. This study revealed that interhousehold structure and composition influence the age of introduction of complementary foods. These factors, therefore, need to be considered in designing interventions to improve age at the introduction of complementary foods.

Prevalence and predictors of adolescent linear growth and stunting across the urban-rural gradient in eastern Ethiopia.

OBJECTIVE: To assess the magnitude and factors associated with adolescent linear growth and stunting in two eastern Ethiopian communities. METHODS: This cross-sectional study was conducted in the urban Harar Health Demographic Surveillance Site (HDSS) and rural Kersa Demographic Surveillance and Health Research Center (KDS-HRC). Univariate analysis was used to describe the data. Multiple regression models examined predictors of linear growth. Logistic regression was used to examine factors associated with stunting. RESULTS: The study included 2010 adolescents. The prevalence of stunting was 26.9% (95% CI 24.9, 28.9), with 8.1% among urban adolescents (95% CI 6.5, 9.9) vs. 47.9% among rural ones (95% CI 44.6, 51.1). There was a significant interaction between residence and sex on the risk of stunting [AOR = 4.17 (95% CI 2.66, 9.9), P < 0.001], and height-for-age z score (HAZ) (ß = -0.51, P < 0.001). For urban adolescents, older age (18 to 19 years) was negatively associated with linear growth (ß= -0.29; P < 0.001). In the rural setting, handwashing practice after toileting was positively associated with HAZ (0.62; P < 0.001) and with lower risk of stunting [AOR = 0.51 (95% CI 0.34, 0.76)]. Urban females had significantly higher HAZ than urban males [ß = 0.52; P < 0.01)], and a significantly lower risk of stunting [AOR = 0.29 (95% CI 0.18, 0.48)]. CONCLUSIONS: There are significant disparities in the magnitude of stunting between urban and rural adolescents. The gender gap in stunting and linear growth, along with a high prevalence of stunting in early adolescence, calls for age-appropriate and gender-sensitive interventions. Particular attention and context-specific interventions are warranted for adolescents in these and similar rural eastern Ethiopian communities.

OBJECTIF: Evaluer l'ampleur et les facteurs associés à la croissance linéaire et au retard de croissance chez les adolescents dans deux communautés de l'est de l'Ethiopie. MÉTHODES: Cette étude transversale a été menée dans le site de Surveillance Démographique de Santé (SSDS) de Harar, en milieu urbain et dans le Centre de Surveillance Démographique et de Recherche sur la Santé (KDS-HRC) de Kersa, en milieu rural. L'analyse univariée a été utilisée pour décrire les données. Les modèles de régression multiple ont examiné les prédicteurs de la croissance linéaire. La régression logistique a été utilisée pour examiner les facteurs associés au retard de croissance. RÉSULTATS: L'étude a porté sur 2.010 adolescents. La prévalence du retard de croissance était de 26,9% (IC95%: 24,9-28,9), avec 8,1% (IC95%: 6,5, 9,9) chez les adolescents en milieu urbain et 47,9% (IC95%: 44,6, 51,1) chez les adolescents en milieu rural. Il existait une association significative entre la résidence et le sexe avec le risque de retard de croissance [AOR = 4,17 (IC95%: 2,66, 9,9), P < 0,001] et le score Z de la taille pour l'âge (ZAT) (ß = -0,51 ; P < 0,001).). Pour les adolescents en milieu urbain, l'âge plus élevé (18 à 19 ans) était associé négativement à la croissance linéaire (ß = -0,29 ; P < 0,001). En milieu rural, la pratique du lavage des mains après la toilette était positivement associée au score ZAT (0,62; P < 0,001) et à un risque plus faible de retard de croissance [AOR = 0,51 (IC95%: 0,34-0,76)]. En milieu urbain les femmes avaient un score ZAT beaucoup plus élevé que les hommes [ß = 0,52; P < 0,01)] et un risque significativement plus faible de retard de croissance [AOR = 0,29 ; IC95% 0,18-0,48]. CONCLUSIONS: Il existe des disparités significatives dans l'ampleur du retard de croissance entre les adolescents en milieu urbain et rural. L'écart entre les sexes en matière de retard de croissance et de croissance linéaire, ainsi que la prévalence élevée du retard de croissance au début de l'adolescence appellent à des interventions adaptées à l'âge et tenant compte du genre. Une attention particulière et des interventions spécifiques au contexte sont nécessaires pour les adolescents dans ces communautés rurales de l'est de l'Ethiopie et dans des communautés similaires.

Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community.

Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.

The Role of Household Structure and Composition in Influencing Complementary Feeding Practices in Ethiopia.

While the household in which a child grows up is considered a critical environment that influences nutrition outcomes, there is little research examining the influence of household composition and structure on complementary feeding practices. This study examined the influence of household structure and composition on complementary feeding practices, using the Ethiopian Demographic and Health Survey (EDHS), 2000 to 2016. The composition variables were calculated from the attributes of household members (alters) and the structure variables from their kinship status. A multilevel mixed-effects regression model, specifying survey rounds as the random effect, was used to examine the association between household structure/composition and the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). The average Marginal Effects (MEs) were calculated to facilitate practical interpretation. Children of caregivers with a higher number of alters (degree), unique number of kinship category (effect size), closely related (constraint), and mixed-age alters (age diversity) seemed to increase the probability of meeting the MDD. Degree and effective size decreased the probability of meeting MMF, while constraint increased it. Overall, this study revealed some associations between household structure and composition and complementary feeding practices. Hence, complementary feeding interventions could be adapted to account for the household structure and composition variations.

The Facilitators and Barriers of Adopting Amylase-Rich Flour to Enhance Complementary Foods in the Kersa District Community of Eastern Ethiopia.

Achieving the optimal transition to a family diet over the first two years of life has remained a challenge in Ethiopia. The use of amylase-rich flour (ARF) can improve complementary foods. However, utilisation requires an effective delivery strategy for upskilling the community to use ARF. The aim of this study was to explore facilitators and barriers of cascading ARF skills to improve complementary foods. The study was conducted in Gale Mirga kebele of Kersa district in Eastern Ethiopia in 2016. The study utilised exploratory qualitative research that used participatory action. Focus group discussions (FGDs) were conducted with the Health Development Army (HDA) leaders, religious leaders, and observation of participatory complementary food demonstrations. Cultural acceptability and the presence of HDA structure that supports skill development were identified as key facilitators to ARF use. On the other hand, the potential barriers to expanding ARF skill were lack of sustainability of external skill support for HDA leaders, perceived time constraints, unsuitable demonstration settings, cooking method, and large group size. The indigenous community's knowledge of germination has not been used to improve complementary foods. The universal use of ARF requires integration into the Health Extension Programme (HEP) with support and supervision for HDA leaders.

Prevalence of lifetime substances use among students in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: The use of substances is a growing concern in Ethiopia, and their impacts on younger generation have been a concern of different professionals. Even though students are at high-risk of substance abuse, there is lack of comprehensive evidence for policy decision on substance use among students. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence of common substances among students in Ethiopia. METHOD: A comprehensive literature searches were done from biomedical databases: PubMed/Medline, African Journal Online, HINARI, Science Direct, and Google Scholar for article published until Dcember 31, 2017, and Addis Ababa Uiversity's electronic library search of unpublished thesis and dissertations. Two authors autonomously selected studies, extracted data, and evaluated quality of studies. The prevalence of lifetime substances use was estimated using the random effects model. Q and I2 statistics were computed to measure the extents of heterogeneity. RESULTS: A total 676 study articles were identified from electronic databases, and 28 of them were included in meta-analysis. The analysis revealed that the lifetime prevalence of any substance use was 52.5% (95% CI 42.4-62.4%), khat 24.7% (95% CI 21.8-27.7%), alcohol 46.2% (95% CI 40.3-52.2%), and smoking cigarette 14.7% (95% CI 11.3-18.5%). Significant heterogeneity was observed but there was no significant publication bias. The lifetime prevalence of khat, alcohol, and cigarette smoking among high school vs university students was 22.5% (95% CI 15.2-30.7%) vs 25.1% (95% CI 21.9-28.5%), 41.4% (95% CI 22.1-62.1%) vs 47.8% (95% CI 39.9-55.7%), and 21.5% (95% CI 12.6-32.1%) vs 12.9% (95% CI 10.1-16.0%), respectively. CONCLUSION: This meta-analysis highlighted the extent of lifetime prevalence of any substance, khat, alcohol, and cigarettes smoking among students in Ethiopia. Significant percent of high school students have exposed to substances. Policy makers should devise and implement strictly binding regulation to curb widespread of substances around educational institution premises at national level. Priority should be given to intervention strategies that help delay first use of substance to prevent problems later in life. Besides, the problem warrants regular national-level educational institutions based studies focusing on the magnitude, trajectory, and consequences of substance use among students. Systematic review registration: PROSPERO CRD42018082635.

Implications of Ethiopian Productive Safety Net Programme on household dietary diversity and women's body mass index: a cross-sectional study.

INTRODUCTION: Poor nutritional status of women remains a critical problem in Ethiopia. Nutrition for women matters not only for the public health relevance of breaking the intergenerational cycle of malnutrition but for its high return in other sectors such as education and health. The Ethiopian Productive Safety Net Programme (PSNP) is a program that protects chronically food-insecure households against food insecurity through cash or food transfer. However, its effect on food access and women's body mass index (BMI) has remained unexplored. OBJECTIVE: This study was intended to assess differences in household dietary diversity (HDD) and women's BMI and associated factors among PSNP and non-PSNP households. METHODS: This community-based cross-sectional study was carried out in the Kombolcha District of Eastern Ethiopia from July 1 to 28, 2015. HDD and women's BMI were compared. Ordinal logistic regression was used to identify factors associated with women's BMI. RESULT: The prevalence of undernutrition was 27.3% (95% confidence interval [CI]: 23.8-30.9) and 20.2% (95% CI: 17.1-23.5) for women from PSNP and non-PSNP households, respectively. PSNP membership had a significant effect on HDD and minimal effect on women's BMI. Ordinal logistic regression yielded significant associations for medium wealth status, with an odds ratio (OR) of 0.533 (95% CI: 0.339-0.837), uptake of better health care services compared to previous year with an odds ratio (OR) of 0.647 (95% CI: 0.429-0.974) and reduction in selling assets for the sake of buying food with an OR of 1.575 (95% CI: 1.057-2.349). CONCLUSION AND RECOMMENDATION: There was high magnitude of chronic energy deficiency among PSNP and non-PSNP households, at 27.3 and 20.2%, respectively, and it was associated with economic status and health care utilization, suggesting the need to promote profitable income-generating activities and nudging for minimum health care as a condition for transfer.