Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS: A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS: Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION: The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness.

Prevention and treatment of suspected pneumonia in Ethiopian children less than five years from household to primary care.

AIM: Ethiopia has implemented the integrated community case management to reduce mortality in childhood diseases. We analysed prevention, care seeking and treatment of suspected pneumonia from household to health facility in Ethiopia. METHODS: Analyses were based on a survey in four regions that included modules covering 5714 households, 169 health posts with 276 health extension workers and 155 health centres with 175 staff. Caregivers of children aged 2-59 months responded to questions on awareness of services and care seeking for suspected pneumonia. Pneumonia-related knowledge of health workers was assessed. RESULTS: When a child had suspected pneumonia, 46% (95% CI: 25,68) sought care at health facilities, and 27% (95% CI: 12,51) received antibiotics. Forty-one per cent had received full immunisation. One-fifth (21%, 95%: 19,22) of the caregivers were aware of pneumonia treatment. Sixty-four per cent of the health extension workers correctly mentioned fast or difficult breathing as signs of suspected pneumonia, and 88% suggested antibiotics treatment. CONCLUSION: The caregivers' awareness of suspected pneumonia treatment and the utilisation of these services were low. Some of the health extension workers were not knowledgeable about suspected pneumonia. Strengthening primary health care, including immunisation, and enhancing the utilisation of services are critical for further reduction of pneumonia mortality.

Undernutrition and Associated Factors Among School Adolescent Girls Attending Schools in Mirab-Armachiho District, Northwest Ethiopia.

Substantial proportions of adolescent girls are suffering from undernutrition; despite they are considered as future mothers. Undernourished mothers are more likely to give birth to an offspring with impaired growth and development. Hence, investigating adolescents' undernutrition had a pivotal role to tackle the problem. Therefore, this study aimed to assess undernutrition and associated factors among adolescent girls in Mirabarmacho district, Ethiopia. An institution-based cross-sectional study was conducted from March to April 20, 2018, in the Mirab Armachiho district, using the multistage cluster sampling method. A total of 706 adolescent girls was included in the study. The World Health Organization Anthro Plus software was used to calculate nutritional indices. A Binary Logistic Regression Analysis was used to check the effect of independent variables with adolescent wasting and stunting. The overall prevalence of wasting and stunting was 17.3% (95%CI: 14.6-20.1) and 10.3% (95%CI: 8.2-12.7), respectively. Being in the 10-14 years age group (AOR:2.47,95%CI:1.21-5.06), inadequate Dietary Diversity (Dietary Diversity Score) (AOR:2.46,95%CI:1.45-4.20),food-insecure households (Adjusted Odd Ratio:2.62,95%CI:1.33-5.16),middle wealth index(Adjusted Odd Ratio:1.94,95%CI:1.07-3.51), febrile illness (Adjusted Odd Ratio: 3.12,95%CI:1.94-5.03), diarrheal disease (AOR:3.61,95%CI:2.08-6.28), merchant fathers (Adjusted Odd Ratio:0.40, 95%CI:0.20-0.82),and government employee fathers (Adjusted Odd Ratio:0.27,95%CI:0.09-0.84) were factors significantly associated with thinness, while inadequate Dietary Diversity Score (Adjusted Odd Ratio: 8.07, 95%CI; 4.02-16.20) and febrile illness (Adjusted Odd Ratio; 2.49, 95%CI: 1.48-4.18) were factors relating to the adolescent stunting. Adolescent wasting and stunting are predominant problems in the survey region. Strengthening efforts to ensure household food security, diversified food intake, and prevention and control of infectious diseases are recommended to mitigate adolescent's undernutrition.

Anemia and Associated Factors among Pregnant Women Attending Prenatal Care in Rural Dembia District, North West Ethiopia: A cross-Sectional Study.

Introduction: About 22% of pregnant women are anemic in Ethiopia, but there is a large variation across the country. Hence, the aim of this study identifies the prevalence of anemia and associated factors among pregnant women attending prenatal appointments in Dembia District, northwest Ethiopia.Methods and materials: A facility-based, cross-sectional study was conducted among 713 pregnant women. A multi-stage, stratified sampling technique was used to select the study participants. A structured and pretested questionnaire, laboratory data, and chart review were used to collect data. Bivariate and multivariate logistic regression analyses were used to identify factors associated with anemia in pregnant women.Results: Prevalence of anemia was 32.4% with a majority of these having moderate anemia. Type of health center being rural/urban health center, water sources, days since fasting, 4 weeks of iron supplementation, craving unusual foods, mid-upper arm circumference scores, and decision power were significant predictors of anemia.Conclusion: The present study suggests anemia among pregnant women attending prenatal in Dembia district was high. Working to enhance adherence to iron supplementation and partner involvement for joint decision-making is recommended to avert prenatal anemia. Health-care providers and programmers are advised to pay special attention to rural and fasting pregnant mothers.Abbreviations: AOR: Adjusted Odd Ratio; CMHS: College of medicine and health sciences; CI: Confidence Interval; HFIAS: Household Food Insecurity Access Scale; RCSI: Reduced Coping Strategies Index; Hgb: Hemoglobin; MCMC: Marco Chain Monte Carlo; EPV: Events per variable; BMI: Body Mass Index; PPS: Population proportionate to size sampling; SRS: simple random sampling; DALYS: Disability-adjusted life years; MUAC: Mid-upper-arm-circumference; WHO: World Health Organization; EDHS: Ethiopian Demographic and Health Survey; SPSS: Statistical package for social science; ANC: Ante natal care; PCA: Principal component analysis; MASL: Meter above sea level; g/dl: gram per decilitre HALE: Health Action Leicester Ethiopia; WDDS: Women's Dietary Diversity Scale.

Prevalence and determinants of pre-adolescent (5-14 years) acute and chronic undernutrition in Lay Armachiho District, Ethiopia.

BACKGROUND: In Ethiopia it is documented that 16% of all grade repetitions in primary school and 33.9% childhood deaths are associated with undernutrition. School aged children are often omitted from public health research. Thus, the present study was carried out to find out the prevalence and determinants of pre-adolescent (5-14 years) acute and chronic undernutrition in Lay Armachiho District. METHODS: In this community based cross-sectional study, anthropometrics, individual and household characteristics data were collected from December, 2016 to January, 2017. A total of 848 school aged children (5-14 years) were included in the study. Z-scores for height-for-age (HAZ) and body-mass-index-for-age (BAZ) were calculated to illustrate stunting (chronic undernutrition) and thinness (acute undernutrition), respectively with Anthro Plus software version 1.0.4 using the WHO 2007 growth reference standard. Finally, backward stepwise multivariable logistic regression analysis was carried out to identify factors associated with stunting and thinness, individually. RESULTS: The overall prevalence of stunting and thinness was 35.5 and 9.9%, respectively. The multivariable analysis showed that child age 10-14 years [AOR = 1.58, 95% CI: 1.17, 2.12] and lack of availability of a latrine at home [AOR = 1.60; 95% CI: 1.17, 2.20)] were associated with increased likelihood of stunting. Nevertheless, child's hand washing practice before eating [AOR = 0.67; 95% CI: 0.49, 0.91] was protective against stunting. Children who consumed diversified foods [AOR = 0.64; 95% CI 0.39, 0.97] were protected from thinness. CONCLUSION: In Lay Armachiho district, one-third and one in every ten of school aged children were stunted and thin, respectively. Children age 10-14 years, lack of availability of a latrine at home and hand washing practices before eating were associated with stunting, while only dietary diversity was associated with thinness. Ensuring consistent hand washing practices before eating and ensuring availability of latrine should be improved in the region, which can assist in effectively tackling undernutrition. Finally, dietary diversification should be enhanced to rectify burden of acute undernutrition.

Clinical vitamin-A deficiency and associated factors among pregnant and lactating women in Northwest Ethiopia: a community-based cross-sectional study.

BACKGROUND: Vitamin A deficiency is known for its adverse health consequences, such as blindness, growth retardation and death. To curb the problem, Ethiopia has implemented various public health measures although little has been done to examine the deficiency among pregnant and lactating women. As a result, this study assessed the prevalence of Vitamin A deficiency and associated factors among pregnant and lactating women in Lay Armachiho district, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted on pregnant and lactating women in Lay Arimachiho district, northwest Ethiopia, using the multistage systematic sampling technique to select participants. The binary logistic regression model was fitted to test the effect of exposure variables, and the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were computed to identify the significance and the strength of the associations of variables with Vitamin A deficiency. RESULTS: The study revealed that 13.7% of the pregnant and lactating women had night blindness and 0.4% had also Bitot's Spot. Over 35 years of age of mothers (AOR = 2.74; 95%CI: 1.15,7.43), less than USD 22.7 household monthly income (AOR = 8.9; 95%CI: 4.54,21.73), and poor hand washing practices after toilets (AOR = 8.87; 95% CI: 4.43,18.68) were positively associated with VAD, while mothers' access to the media (AOR = 0.20; 95%CI:0.07, 0.59), formal education (AOR = 0.09; 95% CI: 0.03, 0.41), over 18 years of age at first marriage (AOR = 0.19; 95%CI: 0.08,0.36), and no fasting (AOR = 0.14; 95%CI: 0.04,0.46) were negatively associated. CONCLUSIONS: Maternal Vitamin A deficiency was the major public health problem in Lay Armachiho district. Over 35 years of age of mothers, less than USD 22.7 household monthly income and poor hand washing practices after toilets were high risks for VAD, while mothers' access to the media, formal education, over 18 years at first marriage, and no fasting were low risks. Therefore, community awareness about the risk of early marriage, poor hand hygiene practices after toilets, and fasting during pregnancy and lactating period were essential. Organizations working on maternal health need to focus on mothers with low incomes in order to reduce their deficiency in Vitamin A.

Sanitation predictors of childhood morbidities in Ethiopia: evidence from Dabat Health and Demographic Surveillance System.

BACKGROUND: Failure to provide adequate sanitation services to all people is perhaps the greatest development failure. Globally, billions of people have no access to improved sanitation facilities. Though the link between sanitation and childhood morbidities is established globally, the evidence is limited in rural parts of Ethiopia. This survey was, therefore, designed to determine the prevalence of common childhood morbidities and to identify sanitation predictors in rural parts of northwest Ethiopia. METHODS: A re-census reconciliation, which is a cross-sectional design, was employed from October to December 2014. All households found in the research and demographic sites were included as study subjects. A questionnaire and an observational checklist were used to collect data. Households' sanitation performances, house type, illumination, household energy sources, water supply, and waste management were assessed. The occurrence of childhood morbidities was determined from the occurrence of one or more water, sanitation, and hygiene (WASH) preventable diseases. Multivariable binary logistic regression analysis was done to identify the association of sanitation factors with childhood morbidities on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05. RESULTS: About 575 (7.00%) of under-five children had hygiene- and sanitation-related diseases. Gastrointestinal and respiratory health problems accounted for 287 (49.91%) and 288 (50.09%), respectively. Childhood morbidities among under-five children were associated with poor housing condition [AOR = 1.27, 95% CI = (1.04, 1.54)], dirty cooking energy sources [AOR = 1.52, 95% CI = (1.22, 1.89)], volume of water below 20 l/p/d [AOR = 1.95, 95% CI = (1.19, 3.18)], and narrow-mouthed water storage containers [AOR = 0.73, 95% CI = (0.56, 0.96)]. CONCLUSION: A significant proportion of under-five children had childhood morbidities in the study area. Housing condition, cooking energy sources, volume of water collected, and type of water storage containers were factors associated with the occurrence of childhood morbidities. Enabling the community to have the access to a safe and continuous supply of water and proper disposal of wastes, including excreta, is necessary with particular emphasis to the rural communities and semi-urban areas to reduce the occurrence of childhood morbidities.

Stunting and Its Determinants among Adolescent Girls: Findings from the Nutrition Surveillance Project, Northwest Ethiopia.

Under nutrition among adolescents is a major public health problem in Ethiopia and its causes are under investigated. Therefore, this study aimed to assess the prevalence of stunting and its determinants among adolescent girls in Dabat district. A total of 1556 adolescent girls were included in the study. The WHO's Anthro-plus software was used to generate the height for age z-scores. Variables having a p-value<0.2 in the simple logistic regression were entered into multiple logistic regression and a p-value < 0.05 were considered statistically significant. About 47.4%(95%CI; 45.0, 49.6%) of adolescent girls were stunted. Being in the early (AOR = 0.027, 95%CI: 0.08, 0.09) and middle age (AOR = 0.21, 95%CI: 0.06, 0.71) were less likely to be stunted compared with the late adolescent. The odds of stunting were found to be higher among adolescent of rural area (AOR = 1.45; 95%CI: 1.01, 2.10) and from household food in-secured (AOR = 1.33; 95%CI: 1.02, 1.73)families. Higher numbers of adolescent girls are stunted in Dabat district, suggesting severe public health importance of the problem. Age, residence and food security were associated with adolescent stunting. Thus, improving food security strategies targeting rural and food insecure households is recommended. Abbreviations: AOR= Adjusted Odd Ratio,CI= Confidence Interval, COR= Crude Odd Ratio, ENSSPI=Establishing Nutrition Surveillance System and Piloting Interventions HAZ=Height for Age, HDSS=Health and Demographic Surveillance System, HFSS=Household Food Security Status, INDEPTH=International Network of Demographic Evaluation of Population and Their Health, IQR=Inter Quartile Range, NNP=National Nutrition Program, NSHFP=National School Health and Feeding Program, SPSS=Statically Package for Social Science, WHO= World Health Organization.

Prevalence and determinants of contraceptive utilization among married women at Dabat Health and Demographic Surveillance System site, northwest Ethiopia.

BACKGROUND: Despite the enormous benefits of family planning services, the contraceptive utilization still remains low in Sub-Saharan Africa. There is regional variation in modern contraceptive utilization in Ethiopia. Therefore, this study was aimed to determine the prevalence of modern contraceptive utilization and determinants in Dabat demographic and health surveillance system site, northwest Ethiopia. METHODS: A re-census was carried out in Dabat Health and Demographic Surveillance System (HDSS) site from October to December 2014. Data of 8271 married women collected in the re-census was used. The outcome variable was current utilization of any modern contraceptive methods whereas socio demographic and economic variables were the potential determinants considered. Bi-variable and multivariable binary logistic regression along with odds ratio and 95% confidence interval were used to describe the strength of association. RESULTS: Prevalence of modern contraceptive utilization among married women in Dabat DHSS site was found to be 32.5% (95%CI: 31.5, 33.5%). After adjusting for covariates; the odds of using modern contraceptive were 2.35 times, 1.91 times, and 1.39 times higher among women of secondary and above educational level, urban residents, and women having six and above living children, respectively. CONCLUSION: Modern contraceptive utilization was found to be very low. Effort has to be applied to improve women's educational level that increases their understanding of reproductive health issues. It is also important to give special emphasis for rural residents, those aged 20-40 years, and those with six or more living children while serving for modern contraceptive methods.

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia.

BACKGROUND: Globally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia. METHODS: A school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant. RESULTS: In this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter. CONCLUSIONS: The prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.

Rural households at risk of malaria did not own sufficient insecticide treated nets at Dabat HDSS site: evidence from a cross sectional re-census.

BACKGROUND: Malaria is the leading cause of disease burden across the world, especially in African countries. Ethiopia has designed a five year (2011-2015) plan to cover 100% of the households in malarious areas with one insecticide treated net (ITN) for every two persons, and to raise consistent ITN utilization to at least 80%. However, evidence on ownership of ITN among malarious rural households in northwest Ethiopia is quite limited. Hence, the present study aimed at assessing ownership of ITN and associated factors among rural households at risk of malaria at Dabat Health and Demographic Surveillance System site, northwest Ethiopia. METHODS: A cross sectional re-census was carried out in Dabat Health and Demographic Surveillance System site during peak malaria seasons from October to December, 2014. Data for 15,088 households at Dabat Health and Demographic Surveillance System site were used for the analysis. Descriptive measures and binary logistic regression were carried out. RESULTS: Among those who owned at least one ITN, 53.4% were living at an altitude >2500 m above sea level. However, out of households living at an altitude <2000 m above sea level, 15.8% (95% CI 14.4%, 17.3%) owned ITN at an average of 4.3 ± 2.1 persons per ITN. Of these, 69.5% (95% CI 64.7%, 74.1%) used the ITN. Among utilizing households at malarious areas, 23.7% prioritized pregnant women and 31.4% children to use ITN. The availability of radio receiver/mobile (AOR 1.60, 95%CI 1.08, 2.35) and secondary/above educational status of household member (AOR 1.54, 95%CI 1.19, 2.04) were predictors of ownership of ITN. CONCLUSION: Rural households at risk of malaria did not own a sufficient number of ITN though the utilization is promising. Moreover, prioritizing children and pregnant women to sleep under ITN remains public health problems. Programmers, partners and implementers should consider tailored intervention strategy stratified by altitude in distributing ITN. ITN distribution should also be accompanied by using exhaustive promotion strategies that consider people without access to any source of information, and educating households to prioritize pregnant and under five children to sleep under ITN.

Prevalence of disability and associated factors in Dabat Health and Demographic Surveillance System site, northwest Ethiopia.

BACKGROUND: Despite the high burden of disability in Ethiopia, little is known about it, particularly in the study area. Hence, this study aimed to investigate the prevalence and factors associated with disability at Dabat Health and Demographic Surveillance System (HDSS) site, northwest Ethiopia. METHOD: A population-based study was conducted from October to December 2014 at Dabat HDSS site. A total of 67,395 people were included in the study. The multivariable binary logistic regression analysis was employed to identify factors associated with disability. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A p-value of <0.05 was used to declare statistical significance. RESULTS: One thousand two hundred twenty-eight individuals were reported to have a disability giving a prevalence rate of 1.82%, of which, about 39% was related to a vision disability. The high odds of disability were observed among the elderly (≥50 years) [AOR: 4.49; 95% CI: 1.95, 10.33], severely food in-secured [AOR: 2.11; 95% CI: 1.59, 2.80], and separated marital status [AOR: 7.52; 95% CI: 1.18, 47.84]. While having a paid job [AOR: 0.46; 95% CI: 0.28, 0.77], being in the richest quintile [AOR: 0.55; 95% CI: 0.41, 0.75], and high engagement in work-related physical activities [AOR: 0.36; 95% CI: 0.27, 0.49] were inversely associated with the disability. CONCLUSION: Disability is a major public health problem, and the burden is noticeable in the study area. Vision disability is the highest of all disabilities. Thus, efforts must be made on educating the public about disability and injury prevention. Measures that reduce disability should target the elderly, the poorer and the unemployed segment of the population.

Stunting, wasting and associated factors among children aged 6-24 months in Dabat health and demographic surveillance system site: A community based cross-sectional study in Ethiopia.

BACKGROUND: Though there is a marked decline in burden of undernutrition, about 44 and 10% of children under five are stunted and wasted, respectively in Ethiopia. The highest prevalence of wasting occurs in young children (6-23 months), however literature are limited in these population groups. Therefore, this study aimed to assess stunting, wasting and associated factors among children aged 6-24 months in Dabat Health and Demographic Surveillance System (HDSS) site, northwest Ethiopia. METHODS: A community based cross-sectional study was conducted in Dabat HDSS site from May 01 to June 29, 2015. A total of 587 mother-child pairs were included in the study. A multivariate logistic regression analysis was carried out to identify factors associated with stunting and wasting, separately. RESULTS: The prevalence of stunting and wasting among children aged 6-24 months were 58.1 and 17.0%, respectively. Poor wealth status [Adjusted Odds Ratio (AOR) = 2.20; 95% Confidence Interval (CI): 1.42, 3.40], unavailability of latrine [AOR = 1.76; 95% CI: 1.17, 2.66], child age: 12-24 months [AOR = 3.24; 95% CI: 2.24, 4.69], not receiving maternal postnatal vitamin-A supplementation [AOR = 1.54; 95%: 1.02, 2.33] and source of family food: own food production [AOR = 1.71; 95% CI: 1.14, 2.57] were significantly associated with higher odds of stunting. However, only history of diarrheal morbidity was significantly associated with wasting [AOR = 2.06; 95% CI: 1.29, 3.30]. CONCLUSIONS: In this community, the magnitude of stunting and wasting exists as a severe public health concern. Therefore, improving socio-economic status, latrine and maternal postnatal vitamin-supplementation coverage are essential to mitigate the high burden of stunting. Besides, reducing the childhood diarrheal morbidity as well as strengthening early diagnosis and management of the problem are crucial to curve the high prevalence of wasting.

Undernutrition and associated factors among children aged 6-59 months in East Belesa District, northwest Ethiopia: a community based cross-sectional study.

BACKGROUND: Undernutrition remains the major public health concern in Ethiopia and continues as the underlying cause of child mortality. However, there is a scarcity of information on the magnitude and determinant factors of undernutrition. Therefore, this study aimed to assess the prevalence of undernutrition and associated factors among children aged 6-59 months in East Belesa District, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April to May, 2014. A multistage stratified sampling technique was used to select 633 study participants. A structured interviewer-administered questionnaire was used to collect data. In order to identify factors associated with undernutrition (stunting and wasting) a multivariate logistic regression analysis was employed. The Adjusted Odds Ratio (AOR) with a 95 % Confidence Interval (CI) was computed to show the strength of the association. In the multivariate analysis, variables with a p-value of <0.05 were considered as statistically significant. RESULTS: In this study, about 57.7 and 16 % of the children were stunted and wasted, respectively. The odds of stunting were higher in children born to mothers who gave their first birth before 15 years of age (AOR = 2.4; 95 % CI: 1.19, 5.09) and gave prelacteal feeding to their child (AOR = 1.83; 95 % CI: 1.28, 2.61). However, lower odds of stunting were observed among children aged 36-47 months (AOR = 0.41; 95 % CI: 0.22, 0.78) and had higher family monthly income, Et. Br. 750-1000, (AOR = 0.61; 95 % CI: 0.39, 0.92). Moreover, the odds of wasting were higher among children who received butter as prelacteal food (AOR = 2.32; 95 % CI:1.82, 5.31). CONCLUSION: Child undernutrition is a critical public health problem in the study area. Advanced age of children (36-47 months) and higher family monthly income were inversely associated with stunting. However, higher odds of stunting were observed among children whose mothers delivered their first child before 15 years of age, and gave their children prelacteal feeding. Thus, delaying the first pregnancy and reducing prelacteal feeding is of a paramount significance in reducing the burden of undernutrition.

Determinants of timely initiation of complementary feeding among mothers with children aged 6-23 months in Lalibela District, Northeast Ethiopia, 2015.

BACKGROUND: Optimal complementary feeding alone prevents six percent of child mortality, but it has continued to be considered as sub-optimal in Ethiopia. Therefore, this study aimed to assess timely initiation of complementary feeding and associated factors among mothers with children aged 6-23 months in Lalibela District. METHODS: A community-based cross-sectional study was conducted from March 01 to April 29, 2015. Four hundred twenty-one mother-child pairs were selected by the systematic random sampling technique. An interviewer-administered questionnaire was used to collect data. A multivariable logistic regression analysis was employed to identify factors associated with timely initiation of complementary feeding. The Adjusted Odds Ratio (AOR) with a 95 % Confidence Interval (CI) was computed to assess the strength of association, and variables with a P-value of <0.05 were considered as statistically significant in the multivariable analysis. RESULTS: The study demonstrated that, the prevalence of timely initiation of complementary feeding was 63 %. In addition, mother's education [AOR = 4.33, 95 % CI: 1.99, 9.40], antenatal care follow up [AOR = 5.90, 95 % CI: 2.45, 14.21], and institutional delivery [AOR = 2.54, 95 % CI: 1.33, 4.82] were found key determinants of timely initiation of complementary feeding. CONCLUSION: In this community, timely initiation of complementary feeding was lower than the World Health Organization cut-off point for good practice of complementary feeding. Therefore, intensifying utilization of antenatal care and institutional delivery helps to improve the coverage of timely initiation of complementary feeding. Furthermore, the focus needs to be on uneducated women.

Associated factors of safe child feces disposal in sub-Saharan Africa: Evidence from recent demographic and health surveys of 34 sub-Saharan countries.

INTRODUCTION: Children's feces are thought to pose a greater public health risk than those of adults' due to higher concentrations of pathogens. The aim of this study was to determine the associated factors of safe child feces disposal among children under two years of age in Sub-Saharan Africa. METHODS: The most recent demographic and health survey datasets of 34 sub-Saharan countries were used. A total weighted sample of 78, 151 mothers/caregivers of under two children were included in the study. Both bivariable and multivariable multilevel logistic regression were done. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for each independent variables included in the model. RESULTS: Those mothers/caregivers from urban residence (AOR = 1.42; CI: 1.36, 1.48), mothers with primary education (AOR = 1.49; CI: 1.44, 1.56), richer (AOR = 1.78; CI: 1.69, 1.88) and richest wealth quintiles (AOR = 2.17; CI: 2.01, 2.31), family size <5 (AOR = 1.06; CI: 1.02-1.09), access to improved water source (AOR = 1.29; CI: 1.25, 1.34), mothers who owned toilet (AOR = 3.09; 2.99-3.19) and who had media exposure (AOR = 1.19; CI: 1.15, 1.24) had higher odds of practicing safe child feces disposal than their counter parts. However, mothers/care givers who are not currently working (AOR = 0.83; CI: 0.80, 0.86), higher education (AOR = 0.85; CI: 0.76-0.94) and from Western region of Africa (AOR = 0.82; CI: 0.79-0.86) had reduced chance of safe child feces disposal as compared to their counter parts. CONCLUSION: Residence, mothers' level of education, wealth index, water source, toilet ownership and media exposure were factors associated with safe child feces disposal. It is advisable to implement health promotion and behavioral change intervention measures especially for those women /caregivers from rural residence, poor economic status, who cannot access improved water and for those with no media exposure to improve the practice of safe child feces disposal.

Health postservice readiness and use of preventive and curative services for suspected childhood pneumonia in Ethiopia: a cross-sectional study.

OBJECTIVE: Pneumonia is the single-leading cause of infectious disease deaths in children under-5. Despite this challenge, the utilisation of preventive and curative child health services remains low in Ethiopia. We investigated the association between health post service readiness and caregivers' awareness of pneumonia services, care-seeking and utilisation of pneumonia-relevant immunisation in four Ethiopian regions. DESIGN AND SETTING: This cross-sectional study was conducted in 52 districts of four regions of Ethiopia from December 2018 to February 2019. The health posts preparedness for sick child care was assessed using the WHO Health Service Availability and Readiness Assessment tool. Multilevel analyses were employed to examine the associations between health post readiness and household-level awareness and utilisation of services. PARTICIPANTS: We included 165 health posts, 274 health extension workers (community health workers) and 4729 caregivers with 5787 children 2-59 months. OUTCOME MEASURES: Awareness of pneumonia treatment, care-seeking behaviour and coverage of pentavalent-3 immunisation. RESULTS: Only 62.8% of health posts were ready to provide sick child care services. One-quarter of caregivers were aware of pneumonia services, and 56.8% sought an appropriate care provider for suspected pneumonia. Nearly half (49.3%) of children (12-23 months) had received pentavalent-3 immunisation. General health post readiness was not associated with caregivers' awareness of pneumonia treatment (adjusted OR, AOR 0.9, 95% CI 0.7 to 1.1) and utilisation of pentavalent-3 immunisation (AOR=1.2, 95% CI 0.8 to 1.6), but negatively associated with care-seeking for childhood illnesses (AOR=0.6, 95% CI 0.4 to 0.8). CONCLUSION: We found no association between facility readiness and awareness or utilisation of child health services. There were significant deficiencies in health post preparedness for services. Caregivers had low awareness and utilisation of pneumonia-related services. The results underline the importance of enhancing facility preparedness, providing high-quality care and intensifying demand generation efforts to prevent and treat pneumonia.

Perceived Quality of Healthcare and Availability of Supplies Determine Household-Level Willingness to Join a Community-Based Health Insurance Scheme in Amhara Region, Ethiopia.

PURPOSE: The Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households' willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia. PATIENTS AND METHODS: Using a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest. RESULTS: Out of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households' occupation (AOR=2.26; 95% CI:=1.12-5.07), perceived good (AOR=2.21; 95% CI:=1.53-3.21), and medium (AOR=1.44; 95% CI=1.22-2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08-2.73) were associated with higher odds of willingness to join the scheme. CONCLUSION: As The study revealed that level of willingness to join is lower compared to other studies. Therefore, social protection activities for the low-income population and enhancement of the capacity of health facilities are crucial.

Dietary diversity practice and associated factors among adolescent girls in Dembia district, northwest Ethiopia, 2017.

BACKGROUND: Dietary diversity is defined as the number of food groups or items consumed over a reference period, and usually, it is a problem in developing countries including Ethiopia. Inadequate dietary diversity is one of a major public health problem and can result in physical, emotional, and psychological changes among adolescents. However, studies on dietary diversity among school children were very limited. Hence, this study aimed at determining dietary diversity practices and factors among adolescents in Dembia district. METHODS: A school-based cross-sectional study was conducted from March 1 to April 15, 2017, at Dembia district, northwest Ethiopia. A total of 474 study subjects were selected using the multi-stage sampling technique. A structured and pre-tested questionnaire was used to collect the data. Dietary diversity was measured through standard tool adopted from Food and Nutrition Technical Assistance (FANTA) 2016 using the 24-h recall method. A multivariable binary logistic regression model was employed to identify factors associated with a diversified diet. RESULT: This study illustrated that 32.3% (95% CI 27.9-36.8) of the adolescents had adequate dietary diversity. Inadequate dietary diversity was significantly associated with being Muslim (AOR = 0.3; 95% CI 0.1-0.7), self-employment (AOR = 0.3; 95% CI 0.1-0.9), middle (AOR = 0.5; 95% CI 0.3-0.8) and high wealth category (AOR = 0.3; 95% CI 0.2-0.6), and underweight (AOR = 3.5; 95% CI 1.3-9.5). CONCLUSION: The findings of this study showed that only one-third of adolescent girls have adequate dietary diversity. Low level of dietary diversification suggested points to the need for strengthening efforts targeting to improve the healthy dietary practice of adolescents by giving due attention to poor households and undernourished adolescents.

Status of perceived social support and its associated factors among inmate prisoners in Northwest Amhara, Ethiopia.

OBJECTIVE: The objective of this study was to determine the level of social support and associated factors in selected prison institutions in Amhara region, Ethiopia. RESULT: Prisoners that had good social support from their family, friends, and significant others were 64.7%, (95% CI 60.9%, 68.4%). The odds of social support was higher among those educated and rural prisoners. However, it was found to be lower among non-Orthodox Christian prisoners and prisoners who were discriminated. Social support is buffering tool for social difficulties and hardships faced by prisoners while they are in prison and very helpful to reduce mental health morbidities and their consequences, hence should be strengthened.