Food insecurity and perinatal depression among pregnant women in BUNMAP cohort in Ethiopia: a structural equation modelling.

OBJECTIVE: To assess the effect of food insecurity on perinatal depression in rural Ethiopia. DESIGN: We used a prospective cohort in which food insecurity was considered as primary exposure and perinatal depression as an outcome. Food insecurity at baseline (in the period of 8-24 weeks of pregnancy) was measured using the Household Food Insecurity Access Scale (HFIAS), and perinatal depression at follow-up (in 32-36 weeks of pregnancy) was measured using a Patient Health Questionnaire (PHQ-9). We used multivariable regression to assess the effect of food insecurity on the prevalence of perinatal depression. We explored food insecurity's direct and indirect impacts on perinatal depression using structural equation modelling (SEM). SETTING: This paper used data from the Butajira Nutrition, Mental Health and Pregnancy (BUNMAP) cohort established under the Butajira Health and Demographic Surveillance Site (BHDSS). PARTICIPANTS: Seven hundred and fifty-five pregnant women. RESULTS: Among the study participants, 50 % were food-insecure, and about one-third were depressed at 32-36 follow-up. In SEM, higher values of baseline food insecurity, depressive symptoms and state-trait anxiety (STA) were positively and significantly associated with perinatal depression. The direct impact of food insecurity on perinatal depression accounts for 42 % of the total effect, and the rest accounted for the indirect effect through baseline depression (42 %) and STA (16 %). CONCLUSION: The significant effect of food insecurity at baseline on perinatal depression and the indirect effect of baseline food insecurity through baseline anxiety and depression in the current study implies the importance of tailored interventions for pregnant women that consider food insecurity and psychosocial problems.

The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity. DESIGN: Systematic review and meta-analysis. SETTING: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included. PARTICIPANTS: A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses. RESULTS: In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores. CONCLUSION: In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.

Determination of the level of heavy metals and assessment of their safety in cow's milk collected from Butajira and Meskan districts, south central Ethiopia.

Milk is a complete food useful to promote growth and development of the infant mammals as it contains vital nutrients (proteins, essential fats, vitamins, and minerals) in a balanced proportion. It is also a nutritious food for adults too. Milk can also contain hazardous chemicals and contaminants including heavy metals which can be a risk for health. This study was aimed at determining the level of heavy metals in cow's milk collected from Butajira and Meskan districts, south Ethiopia. Cows' milk was collected from 193 healthy lactating cows. Samples were digested by optimized microwave digestion method using HNO3 and H2O2. Analysis was done using ICP-OES for Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn levels. MP-AES was used for Ca, Mg, K, and Na. Ni was not detected in all samples. Concentrations of heavy metals in the studied samples were Cd (0.0-0.03), Cr (0.0-0.4), Cu (0.03-1.1), Fe (0.0-1.9), Mn (0.0-0.7), Pb (0.0-12.3), Zn (0.0-8.2), Ca (380.1-532.4), Mg (159.6-397.9), K (1114.2-1685.8), and Na (495.9-1298.3) ppm. These values were compared with permissible values prescribed by different international organizations and available literatures. Cd, Cr, Cu, Mn, Pb, Zn, and Mg levels were found above the permissible limits. Thus, special attention needs to be given to the level of heavy metals in cows' milk, as they are difficult to remove from the body. Their accumulation to a level greater than their permissible limit could be deleterious to the health of the user.

Mid-upper arm circumference as a screening tool for identifying adolescents with thinness.

OBJECTIVE: To evaluate the performance of mid-upper arm circumference (MUAC) to identify thinness in the late adolescence period (aged 15-19 years) in Ethiopia. DESIGN: We conducted a school-based cross-sectional study. The receiver operating characteristics curve was used to examine the validity of MUAC compared with BMI Z-score to identify adolescents with thinness (BMI Z-score <-2 sd). SETTINGS: Fifteen high schools (grade 9-12) located in Addis Ababa, Ethiopia. PARTICIPANTS: A total of 851 adolescent (456 males and 395 females) were included in the study. RESULTS: The prevalence of thinness and severe thinness among high-school adolescents in Addis Ababa was 9·5 % (95 % CI 7·7, 11·7 %). The overall AUC for MUAC against BMI Z-score <-2 SD was 0·91 (95 % CI 0·88, 0·93). The optimal MUAC cut-offs to identify thinness were 23·3 cm for males and 22·6 cm for females. These cut-off points give high sensitivity and specificity for both males (a sensitivity of 87·9 % and a specificity of 75·9 %) and females (a sensitivity of 100 % and a specificity 88·2 %). CONCLUSIONS: MUAC has a comparable level of accuracy with BMI Z-score to identify thinness in adolescents aged 15-19 years. Hence, MUAC could be used as an alternative tool for surveillance and screening of thinness among adolescents aged 15-19 years. The optimum cut-off proposed by this study may incorrectly include a large number of adolescents when used in a relatively well-nourished population. In this situation, it would be necessary to choose a cut-off with greater positive predictive value.

Dietary sodium and potassium intake: knowledge, attitude and behaviour towards dietary salt intake among adults in Addis Ababa, Ethiopia.

OBJECTIVE: The present study aimed to estimate the consumption of Na and K and to assess salt-related knowledge, attitude and behaviour among adults in Addis Ababa, Ethiopia. DESIGN: A community-based cross-sectional study was conducted. Estimates of Na and K intake were made using repeated multiple-pass 24-h dietary recall as well as using random urine. The usual intake of Na and K from the 24-h dietary recall was determined using the National Cancer Institute methodology. Estimated 24-h Na and K excretion was calculated using International Cooperative Study on Salt, Other Factors, and Blood Pressure and Tanaka formula. SETTINGS: Addis Ababa, the capital city of Ethiopia. PARTICIPANTS: Individuals aged 20 years and above residing in the city. RESULT: The mean Na and K intake estimated using the diet recall data was 3·0 (0·9) g/d and 1·9 (0·6) g/d, respectively. Based on the urine analysis, the estimated mean Na and K intakes were 3·3 (0·7) g/d and 1·9 (0·4) g/d, respectively. Moreover, the analysis showed that the mean Na:K ratio was 2·5 (1·4). The daily intake of K was below the recommended amount for all study participants. More than 98 % and 90 % of participants had an excess intake of Na and Na:K ratio, respectively. CONCLUSION: We found a high prevalence of inadequate K intake as well as excess intake of Na resulting in an increased prevalence of excess Na:K ratio. Thus, interventions targeting to decrease Na intake and to increase K intake are needed.

Spatial distribution of under immunization among children 12-23 months old in Butajira HDSS, southern Ethiopia.

BACKGROUND: Immunization is essential to prevent between 2 and 3 million deaths globally each year and it is widely accepted that it is one of the most cost-effective health interventions. Despite all its advantages, immunization in Ethiopia is still far from the target set by the United Nations Sustainable Development Goals to achieve universal immunization by all countries in 2030. The 2016 Ethiopian Demographic and Health Survey (EDHS) reported an overall full immunization rate of only 38.3%. The objective of this study was to evaluate the spatial distribution of under immunization in 12 to 23 months old children and further identify the determinants of under immunization clustering in the Butajira Health and Demographic Surveillance Site (HDSS). METHODS: We conducted a community based sectional survey from March to April, 2016 in Butajira HDSS. We collected data on immunization status from a total of 482 children between the age of 12 to 23 months. We randomly selected household and interviewed mothers and /or observed vaccination cards when available to collect data on child's immunization status. We also collected the geographic location of all villages within the ten Kebeles using a Handheld Global Positioning System (GPS) (Garmin GPSMAP®). We analyzed the spatial distribution of under immunization and clustering using the SatScan® software which employs a purely spatial Bernoulli's model. We also ran a logistic regression model to help evaluate the causes of clustering. RESULTS: We found that only 22.4% [95% CI: 18.9, 26.4%] of children were fully immunized. This study identified one significant cluster of under immunization among children 12-23 months of age within the Butajira HDSS (relative risk (RR) = 1.24,P < 0·01). We found that children residing in this cluster had more than 1.24 times risk of under immunization compared with children residing outside of the identified cluster. We found significant differences with regard to Maternal Tetanus Toxoid immunization status and place of delivery between cases found within a spatial cluster and cases found outside the cluster. For example, the odds of home delivery is more than two times [AOR 2.21: 95%CI; 1.06, 4.63] among children within an identified spatial cluster than the odds among children found outside the identified cluster. CONCLUSIONS: Under immunization of 12-23 months old children and under immunization with specific vaccines such as Polio, BCG, DPT (1-3) and Measles clustered geographically. Spatial studies could be effective in identifying geographic areas of under immunization for targeted intervention like in this study to gear health education to the specific locality.

The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia.

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (ß = .23, p < .001), tend to emotionally overeat (ß = .09, p < .01), enjoy food more (ß = 0.23, p < .001) and have more desire to drink (ß = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (ß = .09, p < .001), were more satiety responsive (ß = .13, p < .001) and tended to eat slower (ß = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.

Anaemia among adolescent girls in three districts in Ethiopia.

BACKGROUND: Adolescence is characterized by rapid growth and development with a significantly increased need for macro and micronutrients. However, there is little empirical evidence on the burden of anaemia among adolescent girls in developing countries such as Ethiopia. This study aims to address this gap by evaluating the magnitude of anaemia with an aim to guide design of intervention modalities to address anaemia among adolescent girls. METHODS: The study employed a community based cross sectional design. The study was conducted on weekends to capture both in school and out of school adolescent girls. Data was collected from a total 1323 adolescent girls. From each district, we randomly selected villages and ensured that the sampled households had a range geographical spread (lowlands, highlands) within the larger category of rural and urban. We performed anaemia testing using HemoCue B-Haemoglobin analyser. We applied a complex survey data analysis method to estimate the level of anaemia. The hemoglobin level was adjusted for altitude and smoking status. We ran a logistic regression model to evaluate predictors of anaemia. RESULTS: The overall anaemia prevalence ranged from 24 to 38%, with an average rate of 29%. Less than half of the girls heard the term anaemia, and about one third knew the relationship between anaemia and the intake of iron rich foods. The risk of anaemia is higher among adolescent girls in their early adolescence period (10-14 years) (Adjusted Odds Ratio (AOR); 1.98; 95% CI; 1.03, 3.82] and among adolescent girls who lived in moderately food insecure households (AOR 1.48; 95% CI; 1.05-2.09). However, knowing the term "anaemia" was found to be protective against the risk of anaemia. CONCLUSIONS: The risk of anaemia was particularly high among adolescent girls in their early age and among those living in food insecure households. The prevalence of anaemia among adolescent girls is a moderate public health problem. According to the WHO set criteria, the districts could be candidates for intermittent iron and Folic acid supplementation program.

Good governance, public health expenditures, urbanization and child undernutrition Nexus in Ethiopia: an ecological analysis.

BACKGROUND: Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia. METHODS: This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations' World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition. RESULT: Government effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition. CONCLUSION: This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.

Ethiopian mothers' experiences with micronutrient powders: Perspectives from continuing and noncontinuing users.

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in-depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try "Desta," a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child ("continuing users," n = 14) or had stopped feeding Desta ("noncontinuing users," n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited "appropriate use" and "continued use." For "appropriate use," defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to "continued use," the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings.

Designing an ethnographic interview for evaluation of micronutrient powder trial: Challenges and opportunities for implementation science.

The evidence base for micronutrient powder (MNP) interventions predominantly consists of quantitative studies focused on measuring coverage, utilization, and/or biological outcomes. We need other types of studies to broaden the scope of our knowledge about determinants of MNP programme effectiveness. Addressing this knowledge gap, this paper focuses on the process of designing an ethnographic research protocol to obtain caregivers' perspectives on the factors that influenced their use of intervention delivery services and their adherence to MNP recommendations. The research was undertaken within the context of formative evaluations conducted in Mozambique and Ethiopia. Ethnography provides a means for acquiring and interpreting this knowledge and is an approach particularly well suited for formative evaluation to understand the response of a population to new interventions and programme delivery processes. We describe decisions made and challenges encountered in developing the protocol, and their implications for advancing methodology in implementation research science. In addition to a core team of three investigators, we added an "advisory group" of 10 experts to advise us as we developed the protocol. The advisory group reviewed multiple drafts of the interview protocol and participated in mock interviews. In the protocol development process, we faced the issues and made decisions about concerned gaps in content, cultural adaptations and comprehension, and interview guide structure and format. Differences between the core team and the advisory group in methodological approaches to the structure and content of questions call attention to the importance of establishing greater communication among implementation scientists working in nutrition interventions.

Maternal depression symptoms are highly prevalent among food-insecure households in Ethiopia.

OBJECTIVE: We aimed to evaluate the association between household food insecurity and maternal depression in Ethiopia. Design/Setting/Subjects In 2014, we conducted a cross-sectional study in southern Ethiopia, including 591 food-secure and 2500 food-insecure households. We measured depression status of women using the Patient Health Questionnaire-9 validated for Ethiopia, with a cut-off of ≥5. We evaluated household-level food insecurity using a validated Household Food Insecurity Access Scale. We applied Bayesian modelling to evaluate the relationship between food insecurity and maternal depression accounting for other observed characteristics. RESULTS: Among the analytic sample, 80·8 (95 % CI 79·4, 82·2) % of women were living in food-insecure households. The overall prevalence of probable depression (mild and moderate forms) was 4·7 (95 % CI 4·1, 5·6) %. All individual depressive symptoms had a significantly higher prevalence in the food-insecure group, except for suicidal ideation (but small numbers; P<0·001). In the Bayesian model adjusting for paternal characteristics, there was a significant dose-response linear relationship (trend) between household food insecurity and maternal depression (P<0·01). The adjusted OR (95 % Bayesian credible interval) for depression for differing levels of food insecurity were: mild food insecurity, 3·29 (1·63, 6·18); moderate, 3·82 (1·91, 7·45); severe, 12·50 (3·38, 32·70). CONCLUSIONS: The study documented a high burden of depression among women who lived in food-insecure households. Given this finding, we recommend integrating mental health in the livelihood programmes in areas suffering from food insecurity.

Estimating the spatial risk of tuberculosis distribution in Gurage zone, southern Ethiopia: a geostatistical kriging approach.

BACKGROUND: In low-income countries it is difficult to obtain complete data that show spatial heterogeneity in the risk of tuberculosis within-and-between smaller administrative units. This may contribute to the partial effectiveness of tuberculosis control programs. The aim of this study was to estimate the spatial risk of tuberculosis distribution in Gurage Zone, Southern Ethiopia using limited spatial datasets. METHODS: A total of 1601 patient data that were retrieved from unit tuberculosis registers were included in the final analyses. The population and geo-location data were obtained from the Central Statistical Agency of Ethiopia. Altitude data were extracted from ASTER Global Digital Elevation Model Version 2. Aggregated datasets from sample of 169(40%), 254(60%) and 338(80%) kebeles were used to estimate the spatial risk of TB distribution in the Gurage Zone by using a geostatistical kriging approach. The best set of input parameters were decided based on the lowest prediction error criteria of the cross-validation technique. ArcGIS 10.2 was used for the spatial data analyses. RESULTS: The best semivariogram models were the Pentaspherical, Rational Quadratic, and K-Bessel for the 40, 60 and 80% spatial datasets, respectively. The predictive accuracies of the models have improved with the true anisotropy, altitude and latitude covariates, the change in detrending pattern from local to global, and the increase in size of spatial dataset. The risk of tuberculosis was estimated to be higher at western, northwest, southwest and southeast parts of the study area, and crossed between high and low at west-central parts. CONCLUSION: This study has underlined that the geostatistical kriging approach can be applied to estimate the spatial risk of tuberculosis distribution in data limited settings. The estimation results may help local public health authorities measure burden of the disease at all locations, identify geographical areas that require more attention, and evaluate the impacts of intervention programs.

Dietary behaviour, food and nutrient intake of women do not change during pregnancy in Southern Ethiopia.

Although pregnant women are required to increase food and nutrient intake to accommodate for the increased nutritional demands, information on dietary behaviour and nutrient intake is limited. This study aimed to identify the adequacy and differences in intake between pregnant and non-pregnant women in a rural community of Butajira district, Southern Ethiopia. Simple random sampling was used to recruit 159 pregnant and 164 non-pregnant women. An interactive multiple pass 24-h recall survey was used to evaluate the food and nutrient intake of the study participants. Except for iron, vitamin A and C, intakes of macro and micronutrient were below the recommendations. Almost all study participants were deficient in energy, protein, calcium, folate and niacin intakes. There was no significant difference in the mean dietary intake of all nutrients between pregnant and non-pregnant women (p > 0.05). The prevalence of inadequacy was comparable between pregnant and non-pregnant women in all of the nutrient intakes except for Zn, where the prevalence of inadequacy was much higher among the pregnant women. Nearly all (99.0%) of the pregnant women were deficient in niacin, folate and calcium. Although all pregnant women considered it important to increase food intake during pregnancy, only a quarter of women reported to do so. In conclusion, pregnant women in the rural community of Butajira district do not make significant dietary intake adjustments to account for increased nutrient needs during pregnancy. In food insecure areas, such as ours, nutritional counselling complemented with supplementary feeding programmes could be key to ensure adequate dietary intake. © 2016 John Wiley & Sons Ltd.

Local spatial clustering of stunting and wasting among children under the age of 5 years: implications for intervention strategies.

OBJECTIVE: The present study aimed to evaluate the clustering of undernutrition indicators of children under the age of 5 years in relation to different scales. DESIGN: A community-based cross-sectional study design was employed. We collected anthropometric data, geographic locations/elevations of households and other data from visited households. We used a retrospective purely spatial Poisson probability model to identify and locate clusters (high rates) of stunting and wasting using the software SaTScan™ version 9·1·1. We ran a logistic regression model to help evaluate the causes of clustering. Settings Six villages in the Meskane Mareko District (38·45763°E, 8·042144°N) of southern Ethiopia. SUBJECTS: We surveyed 2371 children aged <5 years, who were found in 1744 households. RESULTS: We found a micro-level variation in the risk of stunting and wasting within the studied district. We found the most likely significant clusters for wasting and severe wasting in two of the six villages. For stunting, a single large cluster size of 390 cases (304·19 expected) in 756 households was identified (relative risk=1·48, P<0·01). For severe stunting, a single cluster size of 106 cases (69·39 expected) in 364 households was identified (relative risk=1·69, P=0·035). CONCLUSIONS: We conclude that the distribution of wasting and stunting was partly spatially structured. We identified distinct areas within and between villages that have a higher risk than the underlying at-risk population. Our analysis identified the spatial locations of high-risk areas for stunting that could be an input for geographically targeting and optimizing nutritional interventions.

Development and validation of a simplified risk prediction model for preterm birth: a prospective cohort study in rural Ethiopia.

Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer-Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the "Youden index" to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer-Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications.

Mycotoxins Exposure of Lactating Women and Its Relationship with Dietary and Pre/Post-Harvest Practices in Rural Ethiopia.

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future.

Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems.

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.

Diagnostic ability of mid-upper arm circumference-to-length ratio in detecting wasting among infants aged 1-6 months in Ethiopia.

Mid-upper arm circumference (MUAC) is an age-sensitive anthropometric measurement in infants. However, exact age is difficult to know, particularly in low-income countries. We evaluated the diagnostic accuracy of an age-independent mid-upper arm circumference-to-length (MUAC/L) ratio measurement in detecting wasting among infants aged 1-6 months in Ethiopia. A facility-based diagnostic accuracy study was conducted on 467 in-patient infants aged 1-6 months from March to May 2019. The receiver operating characteristic (ROC) curve was used to evaluate the ability of MUAC/L to detect wasting. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive and negative predictive values were calculated. The magnitude of severe wasting was 21⋅6 % and moderate wasting was 13⋅0 %. The area under the ROC curve (AUC) of MUAC/L was 0⋅77 (95 % CI 0⋅73, 0⋅81) for detecting moderate wasting and 0⋅92 (95 % CI 0⋅89, 0⋅94) for detecting severe wasting. MUAC/L had a sensitivity of 91⋅1 % (95 % CI 81⋅3, 94⋅4), a specificity of 84⋅7 % (95 % CI 80⋅6, 88⋅2), a positive likelihood ratio of 5⋅82 (95 % CI 4⋅53, 7⋅48) and a negative likelihood ratio of 0⋅13 (95 % CI 0⋅07, 0⋅22) in total infants. The optimal MUAC/L cut-off was <0⋅190 for boys and <0⋅185 for girls. MUAC/L had an AUC of 0⋅77 and 0⋅92 in predicting moderate and severe wasting in infants aged 1-6 months, respectively. Using MUAC/L to treat Ethiopian infants with severe wasting and infants with similar characteristics in other countries could improve treatment coverage.

Iodine status, household salt iodine content, knowledge and practice assessment among pregnant women in Butajira, South Central Ethiopia.

BACKGROUND: Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019. METHODS: In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data. RESULTS: The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 µg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg). CONCLUSIONS: The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 µg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 µg/L. Because our study population's median level is 151.2 µg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 µg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.