Correlates of Sedentary Time Among Children and Adolescents in Ethiopia: A Cross-Sectional Study.

PURPOSE: To assess the correlates of sedentary time among children and adolescents in Ethiopia. METHODS: The study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models were used to determine associations of sedentary time and predictor variables. RESULTS: The mean sedentary time was 4.61 (95% confidence interval [CI], 4.35-4.86) hours per day. Overall, the prevalence of high sedentary time (>3 h/d) was 68.2% (95% CI, 64.2-72.2). Results of multivariable logistic regression analyses showed a statistically significant association between high sedentary time and female household head (adjusted odds ratio [AOR] = 0.50; 95% CI, 0.32-0.80), literate mothers (AOR = 1.98; 95% CI, 1.26-3.11), child attending public school (AOR = 1.79; 95% CI, 1.12-2.85), children who belonged to the poor and rich household wealth tertiles compared with medium wealth tertile (AOR = 2.30; 95% CI, 1.42-3.72 and AOR = 2.04; 95% CI, 1.14-3.65, respectively), and those families that did not have adequate indoor play space for children (AOR = 0.45; 95% CI, 0.29-0.72). CONCLUSION: The study found that time spent sedentary was high in the study area as compared with other studies of similar settings. Several modifiable factors were identified that can be targeted in interventions to reduce sedentary time in the study setting.

Magnitude of urban household food insecurity in East Africa: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to determine the magnitude and determinants of urban household food insecurity in East Africa. DESIGN: Systematic review and meta-analysis. SETTING: Studies conducted in East Africa. PARTICIPANTS: Seventeen studies (fifteen cross-sectional and two cohort) that enrolled 156 996 households. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search electronic databases (PubMed, Cochrane Library, EMBASE, CINAHL, African Journals OnLine, Web of Science, Scopus and Google Scholar; date of last search: 10 June 2020) for studies reporting the prevalence and associated factors of urban household food insecurity. RESULTS: A total of 17 studies with 156 996 households from 8 countries were used for the analysis. The pooled prevalence of urban household food insecurity in East Africa was 60·91 % (95 % CI 47·72, 74·11; I2 = 100 %; P < 0·001) where the highest (91 %) and lowest (36·5 %) was observed in Sudan and Burundi, respectively. Household head educational status (illiterate) (AOR = 2·53; 95 % CI 2·11, 2·95, I2 = 90 %; P < 0·01), female as household head (AOR = 1·45; 95 % CI 1·16, 1·75; I2 = 0·0 %; P = 0·993), large family size (AOR = 1·43; 95 % CI 1·09, 1·76, I2 = 0·0 %; P = 0·863) and poorest wealth quantile (AOR = 3·95; 95 % CI 1·93, 5·98; I2 = 57·2 %, P = 0·053) were factors which significantly increased odds of urban household food insecurity in East Africa. CONCLUSIONS: The prevalence of urban household food insecurity in East Africa remains high. Therefore, policies and intervention programmes should be designed to reduce the high burden of food insecurity among urban households considering the identified factors.

Aflatoxin exposure among children of age 12-59 Months in Butajira District, South-Central Ethiopia: a community based cross-sectional study.

BACKGROUND: The continued provision of safe food, free of aflatoxin remains a huge challenge in developing countries. Despite several favourable climatic conditions that facilitate aflatoxin contamination in Ethiopia, there is little information showing aflatoxin exposure in children. Therefore, this study assessed aflatoxin exposure among young children in Butajira district, South-Central Ethiopia. METHODS: Community based cross-sectional study stratified by agro-ecology was employed in Health and Demographic Surveillance Site (HDSS) of Butajira. The study included 332 children aged 12-59 months and were selected by simple random sampling technique using the HDSS registration number as a sampling frame. We collected data on dietary practice and aflatoxin exposure. Aflatoxin M1 concentration in urine was measured by Enzyme-Linked Immunosorbent assay (ELISA). The data analysis was carried out using STATA. RESULTS: Detectable urinary Aflatoxin M1 was found in 62.4% (95% CI: 56.9 - 67.5%) of the children at a level ranging from 0.15 to 0.4 ng/ml. Children living in lowland agro-ecological zone had [AOR = 2.11 (95% CI; 1.15, 3.88] odds of being exposed to aflatoxin as compared to children living in highland agro-ecological zone. Children at lower socio-economic status [AOR = 0.27 (95% CI; 0.14, 0.50] and medium socio-economic status [AOR = 0.47 (95% CI; 0.25, 0.87] had 73% and 53% lower odds of being exposed to aflatoxin as compared to children in the higher socio-economic status, respectively. CONCLUSIONS: Aflatoxin exposure among young children was very high in South-Central Ethiopia. This high aflatoxin exposure might emphasize the need for aflatoxin exposure mitigation strategies in Ethiopia. Especially, raising awareness of the community towards aflatoxin exposure is very crucial. In addition, further research is required to assess long-term aflatoxin exposure and its association with child growth and development.

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.

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.

Health related quality of life of gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

BACKGROUND: Being diagnosed with gynaecologic malignancy certainly will have different sequelae which can hamper quality of life (QOL).This study aimed to assess health related quality of life (HRQOL) among gynaecologic cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Addis Ababa, Ethiopia. METHODS: This study employed facility-based cross-sectional study design on 153 gynaecological cancer patients attending TASH using the Amharic version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). We used descriptive statistics, independent t test and one way analysis of variance (ANOVA) in statistical analysis. RESULTS: The mean Global Health Status (GHS) was 40.95(SD ± 24.35) and of the functional scores, social function was most affected (42.26, SD ± 32.08), whereas cognitive function is the least affected domain (mean = 88.21, SD ± 18.49). The highest score on the symptom scores was found to be financial difficulties (mean = 64.76, SD ± 32.43) followed by pain (mean = 55.12, SD ± 29.64) and fatigue (mean = 53.97, SD ± 28.54); the lowest score on the contrary was scored for diarrhea (mean = 1.19, SD ± 7.38). As stage increases there was a statistically significant reduction in GHS (p = 0.005) and in all functional score domains except the physical and emotional function. Advancement in stage of the disease has also affected significantly the symptom score domains except financial difficulties, nausea /vomiting and diarrhea. Patients who never went to school have scored a statistically significant lower score in GHS, physical function, role function and social function (p < 0.05). CONCLUSION: GHS, social function, financial difficulties, pain and fatigue were the most affected domains; however, cognitive function and diarrhea were less affected components of HRQOL of gynaecologic cancer patients. Place of residence, educational status, marital status, payment type, cancer type and stage of the disease were associated with different quality of life scores.

Differences in spatial distributions of iron supplementation use among pregnant women and associated factors in Ethiopia: evidence from the 2011 national population based survey.

BACKGROUND: Iron supplementation during pregnancy prevents against low birth weight, incidence of prematurity and postpartum hemorrhage. However, the coverage of iron supplementation is still low in Ethiopia. This study aimed to investigate the spatial variations and associated factors of iron supplementation during pregnancy using the 2011 national demographic and health survey data. METHODS: This study used secondary data from the 2011 Ethiopian demographic and health survey. The survey was cross sectional and used a multistage cluster sampling procedure. A logistic regression statistical model using adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify the associated factors. Getis-Ord G-statistic was used to identify high and low hotspot areas of iron tablet supplementation during pregnancy. RESULTS: The coverage of iron tablet supplementation was 17.1% [95%CI: (16.3-17.9)] with the highest coverage of 38.9% [95%CI: (32.4--46.1)] in Addis Ababa followed by Tigray regional state with 33.8% [95%CI: (29.9-38.00)]. The lowest coverage was found in Oromiya regional state at 11.9% [95%CI: (10.7-13.0)]. Multivariable analysis showed that mothers who were aware of the Community Conversation Program had 20% [AOR = 1.2; 95% CI: (1.04-1.4)] higher odds of taking iron tablets. The odds of taking iron tablets was 2.9 times [AOR = 2.9; 95% CI: (2.3-3.7)] higher among those who took deworming tablets. Those mothers who attended the minimum four antenatal visits recommended by WHO were 3.9 times [AOR = 3.9; 95% CI: (3.3-4.6)] more likely and those mothers in the age group 31-49 years were 2.9 times [AOR = 2.9; 95% CI: (1.1-7.4)] more likely to use iron tablets as compared to those mothers who did not attend antenatal care and mothers in the age group less than 20 years. Mothers having a family size of 10 and above had 32% [AOR = 0.68; 95% CI: (0.49-0.97)] lower odds of taking iron tablets during pregnancy. The spatial analysis found that only northern, central and eastern parts of Ethiopia were identified as hotspots of iron supplementation. CONCLUSION: Iron supplementation use was not equally distributed in Ethiopia, with relatively higher prevalence in Tigray, Addis Ababa and Harari regional states. Attention should be given to younger age mothers, mothers with large family size and mothers who reside in areas with low coverage of iron tablet distribution. Promotion of antenatal care services based on the WHO standard can be used as an intervention for improving iron supplementation during pregnancy.

Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis.

BACKGROUND: Stunting reflects a failure to receive adequate nutrition over a long period of time. Stunting is associated with adverse functional consequences including poor cognition, low educational performance, low adult wages, and poor reproductive outcomes. The objective of the study was to investigate spatial variations and factors associated with childhood stunting in Ethiopia. METHODS: This study is a secondary data analysis of the 2011 Ethiopian Demographic and Health Survey (EDHS). A total of 9893 children aged 0-59 months were included in the analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of stunting. A multilevel multivariable logistic regression was used to identify factors associated with stunting. RESULTS: Statistically significant hotspots of stunting were found in northern parts of the country whereas low hotspots where there was less stunting than expected were found in the central, eastern, and western parts of the country. In the final model of multilevel logistic regression analysis, individual and community level factors accounted for 36.6 % of childhood stunting. Short birth interval [AOR = 1.68; 95%CI: (1.46-1.93)], being male [AOR = 1.20; 95%CI: (1.08-1.33)], and being from a male-headed household [AOR = 1.18; 95 % CI: (1.01-1.38)] were the factors that increased the odds of stunting at the individual level. Children in the age group between 24-35 months were more likely to be stunted than children whose age was less than one year [AOR = 6.61; 95 % CI: (5.17-8.44)]. The odds of stunting among children with severe anemia were higher than children with no anemia [AOR = 3.23; 95%CI: (2.35-4.43)]. Children with mothers who had completed higher education had lower odds of being stunted compared to children whose mothers had no formal education [AOR = 0.42; 95%CI: (0.18-0.94)]. The odds of being stunted were lower among children whose fathers completed higher education [AOR = 0.58; 95%CI: (0.38-0.89)] compared to children whose fathers had no formal education. Children whose mothers who had high a Body Mass Index (BMI) (≥25.0 kg/m(2)) were less likely to be stunted compared with children whose mothers had a normal BMI (18.5 kg/m(2)-24.9 kg/m(2))[AOR = 0.69; 95%CI: (0.52-0.90)]. Children from the poorest wealth quintile had higher odds of being stunted compared to children from the richest wealth quintiles [AOR = 1.43; 95 % CI: (1.08-1.88)]. Unavailability of improved latrine facilities and living in the northern parts of the country (Tigray, Affar, Amhara and Benishangul-Gumuzregions) were factors associated with higher odds of stunting from the community-level factors. CONCLUSION: Stunting in children under five years old is not random in Ethiopia, with hotspots of higher stunting in the northern part of Ethiopia. Both individual and community-level factors were significant determinants of childhood stunting. The regions with high hotspots of child stunting should be targeted with additional resources, and the identified factors should be considered for nutritional interventions.

Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian Demographic and Health Survey.

BACKGROUND: Tobacco is one of the leading preventable causes of non-communicable diseases. Previous studies gave due emphasis only for cigarette smoking with little attention given for other types of tobacco use. This study describes the prevalence of all common forms of tobacco use and identify associated factors among adults in Ethiopia. METHODS: The study used data from the 2011 Ethiopian demographic and health survey. An index was constructed from yes or no responses for common types of tobacco use. Bivariate and multivariate logistic regression statistical models were employed to determine associated factors with tobacco using adjusted odds ratios (AOR) and their 95 % confidence intervals (CI). RESULTS: The overall prevalence of tobacco use was 4.1 % [95 % CI: (3.93-4.37)]. The highest prevalence 16.9 % [95 % CI: (11.02-23.76)] in Gambella and the lowest 0.8 % [95 % CI: (0.48-1.29)] in Tigray regions were reported. The odds of tobacco use in the age group 20-24 and 45-49 years were [AOR = 2.3; 95 % CI: (1.60-3.21)] and [AOR = 9.1; 95 % CI: (6.06-13.54)] more likely to use tobacco, respectively, as compared to the age group 15-19 years. Traditional religion [AOR = 5.5; 95 % CI: (3.96-7.55)], Catholics [AOR = 3.40; 95 % CI: (2.03-5.69)] and Islamic followers [AOR = 2.8; 95 % CI: (2.31-3.32)] had higher odds of using tobacco as compared to Orthodox religion followers. Adults in the poorest wealth quintile were [AOR = 1.4; 95 % CI: (1.05-1.79)] more likely to use tobacco as compared to the richest wealth quintile. The odds of tobacco use among males were higher as compared to females [AOR = 13.08; 95 % CI: (10.24-16.72)]. Formerly married adults were [AOR = 1.71; 95 % CI: (1.20-2.34)] more likely to use tobacco as compared to never married. Adults who were professionally working [AOR = 0.49; 95 % CI: (0.29-0.85)] had less likely to use tobacco as compared to non-working adults. However, adults who were working in sales, skilled and unskilled occupations had [AOR = 1.6; 95 % CI: (1.18-2.24)], [AOR = 1.7, 95 % CI: (1.21-2.50)] and [AOR = 3.8 95 % CI: (2.27-6.23)] more likely to use tobacco, respectively, as compared to non-working adults. Individuals who had experience of child death were [AOR = 1.4; 95 % CI: (1.17-1.63)] more likely to use tobacco as compared to their counterparts. CONCLUSION: The overall prevalence of tobacco use seems low in Ethiopia. However, a significant regional variation of tobacco use was observed. A tailored public health interventions targeting regions with high prevalence of tobacco use is recommended.

Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross- sectional study.

BACKGROUND: Inadequate nutrition during the first two years of life may lead to childhood morbidity and mortality, as well as inadequate brain development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer sufficient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. Therefore this study aimed to identify the factors associated with nutritional status of infants and young children (6-23 months) in Filtu town, Somali Region, Ethiopia. METHODS: A cross-sectional community-based study was conducted. Simple random sampling was employed to select 214 infants for the study. Univariable and multivariable logistic regressions models were used in the statistical analysis. The strength of association was measured by odds ratios with 95% confidence intervals. Both the crude (COR) and adjusted odds ratios (AOR) are reported. RESULTS: The prevalence of wasting, stunting and underweight among infants and young children were 17.5% (95% CI: 12.91-23.22), 22.9% (95% CI: 17.6-28.9) and 19.5% (95% CI: 14.58-25.3) respectively. The multivariable logistic regression model showed that breastfeeding was independently associated with reduced odds of wasting (AOR = 0.38(95% CI: 0.14-0.99)). Diarrhea in the past 15 days (AOR = 2.13 (95% CI: 1.55-4.69)) was also associated with increased odds for wasting. The independent predictors of reduced odds for stunting were dietary diversity score ≥ 4 (AOR = 0.45(95% CI: 0.21-0.95)) and introduction of complementary feeding at 6 months (AOR = 0.25 (95% CI: 0.09-0.66)). Bottle feeding was associated with increased odds of stunting (AOR = 3.83 (95% CI: 1.69-8.67)). Breastfeeding was associated with reduced odds of underweight (AOR = 0.24 (95% CI: 0.1-0.59)), while diarrheal disease in the past 15 days was associated with increased odds of underweight (AOR = 3.54 (95% CI: 1.17-7.72)). CONCLUSION: Under nutrition is a public health problem among infants and young children in Filtu town, Somali region Ethiopia. Breastfeeding was associated with lower odds of wasting and underweight while diarrheal disease was associated with higher odds of wasting and underweight. Low dietary diversity scores, inappropriate age of complementary feeding initiation and bottle feeding were identified to be significant predictors of stunting. Those factors should be considered for any intervention aimed to reduce under nutrition among infants and young children in Filitu town, Somali region, Ethiopia.

Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: The World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. However, there is a paucity of studies which examined the associated factors of antenatal depression in low-income countries. This study aimed to determine the prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was employed among 393 pregnant women attending antenatal care service in Addis Ababa public health centers, Ethiopia from April 12-26, 2012. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms. Descriptive statistics and logistic regression were used in the statistical analysis. RESULTS: Prevalence of antenatal depression was 24.9 % (95 % CI: 20.85-29.30 %). In the final multivariable model, those pregnant women who have previous history of depression were nearly three times at higher odds of having antenatal depression as compared to pregnant women who have no history of depression [AOR = 2.57(95 % CI: 1.48-4.48 )]. Those pregnant women having unplanned pregnancy were nearly three times at higher odds to develop depression as compared to pregnant women whose pregnancy was planned [AOR = 2.78(95 % CI: 1.59-4.85)]. The odd of developing antenatal depression was 89 % higher in those pregnant women who experienced lack of baby's father support [AOR = 1.89(95 % CI: 1.06-3.36)]. Education level, community's support, and partner's feeling on current pregnancy were not significantly associated factors with antenatal depression in the final multivariable model. CONCLUSION: Although clinical confirmation for antenatal depression is not conducted, one quarter of the pregnant women attending antenatal care were depressed in Addis Ababa based on EPDS. Unplanned pregnancy, experiencing lack of baby's father support and previous history of depression were factors independently associated with antenatal depression. Promotion of family planning and integration of mental health service with existing maternal health care as well as strengthening the referral system among public health centers were the recalled interventions to prevent antenatal depression in Addis Ababa Public Health Centers.

Factors Associated with Colostrum Avoidance Among Mothers of Children Aged less than 24 Months in Raya Kobo district, North-eastern Ethiopia: Community-based Cross-sectional Study.

BACKGROUND: UNICEF and WHO recommend colostrum as newborns' perfect food that should be initiated within the first hour after birth. OBJECTIVE: To assess colostrum avoidance practices and associated factors among mothers of children aged <24 months in Raya Kobo district, North-eastern Ethiopia. METHODS: A quantitative community-based cross-sectional study supplemented by qualitative method was used. Descriptive statistics, binary and multivariable logistic regression analyses were used in the statistical analysis. RESULTS: Colostrum avoidance was practiced by 13.5% (95% confidence interval: 10.99-16.33) of mothers having children aged <24 months. In multivariable logistic regression analysis, giving birth at home, mother-heading households, lack of awareness on the advantages of colostrum and late initiation of breastfeeding remained statistically significant factors associated with colostrum avoidance practices. CONCLUSION: Promoting institutional delivery, timely initiation of breastfeeding and creating awareness on the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance.

Factors affecting healthcare service utilization of mothers who had children with diarrhea in Ethiopia: evidence from a population based national survey.

INTRODUCTION: Appropriate healthcare-seeking practices of mothers are important to prevent child death. This study aimed to investigate factors associated with mothers' healthcare services utilization for managing childhood diarrhea (CDD) in Ethiopia. METHODS: A secondary data analysis was performed using data from the Ethiopian Demographic and Health Survey 2011. Binary and multivariable logistic regressions were carried out to identify factors associated with mothers' healthcare services utilization for CDD. RESULTS: About 35% (95% confidence interval (CI): 32.67-37.33%) of mothers visited healthcare institutions (HCIs) for CDD. Those mothers with children aged 6-11 months were 2.16 times more likely to use HCIs for CDD (adjusted odds ratio (AOR)=2.16, 95%CI: 1.32-3.53) compared to mothers who had children under 6 months of age. Urban mothers were 1.68 times more likely to use HCIs for CDD compared to rural mothers (AOR=1.68, 95%CI: 1.06-2.67). Those mothers who had information about oral rehydration salts (ORSs) were 2.66 times more likely to use HCIs for CDD compared to those mothers who had no information about ORS (AOR=2.66, 95%CI: 1.93-3.67). Mothers who attended antenatal care were 1.34 times more likely to use HCIs for CDD than mothers who never attended antenatal care (AOR=1.34, 95%CI: 1.04-1.74). Mothers who had postnatal checkups were 1.53 times more likely to use HCIs for CDD compared to mothers who had no postnatal checkups (AOR=1.53, 95%CI: 1.02-2.30). Those mothers who participated in community conversation were 1.67 times more likely to use HCIs for CDD than those mothers who had no information about community conversation (AOR=1.67, 95%CI: 1.15-2.39). CONCLUSIONS: Healthcare services utilization for CDD was found to be poor in Ethiopia. Urban residency, older age of the child, awareness of ORSs, antenatal care attendance, postnatal check and attending community conversation were factors associated with healthcare services utilization for CDD. Interventions to improve mothers' healthcare service utilization for CDD treatment should target rural households. Promotions of appropriate CDD treatment during ANC, postnatal checkup and community conversation are the recommended interventions.

Infant feeding practices among HIV exposed infants using summary index in Sidama Zone, Southern Ethiopia: a cross sectional study.

BACKGROUND: Combining various aspects of child feeding into an age-specific summary index provides a first answer to the question of how best to deal with recommended feeding practices in the context of HIV pandemic. The objective of this study is to assess feeding practices of HIV exposed infants using summary index and its association with nutritional status in Southern Ethiopia. METHODS: Facility based cross-sectional study design with cluster random sampling technique was conducted in Sidama Zone, Southern Ethiopia. Bivariate and multivariable linear regression analyses were performed to assess the association between summary index (infant and child feeding index) (CS-ICFI) and nutritional status. RESULTS: The mean (±standard deviation (SD)) cross-sectional infant and child feeding index (CS-ICFI) score of infants was 9.09 (±2.59), [95% CI: 8.69-9.49]). Thirty seven percent (36.6%) of HIV exposed infants fell in the high CS-ICFI category while 31.4% of them were found in poor feeding index tertile. About forty two percent (41.6%) of urban infants were found in the high index tertile but only 24% of the rural infants were found in high index tertile. Forty six percent (46%) of the rural infants were found in low (poor) feeding index category. The CS-ICFI has a statistically significant association with weight for age z score (WAZ) (ß = 0.168, p = 0.027) and length for age z score (LAZ) (ß = 0.183 p = 0.036). However CS-ICFI was not significantly associated with weight for height z score (WLZ) (p = 0.386). CONCLUSION: Majority of HIV exposed infants had no optimum complementary feeding practices according to cross-sectional infant and child feeding index. CS-ICFI was statistically associated especially with chronic indicators of nutritional status (LAZ and WAZ). More rural infants were found in poor index tertile than urban infants. This may suggest that rural infants need more attention than urban infants while designing and implementing complementary feeding interventions.

Modeled impacts of bouillon fortification with micronutrients on child mortality in Senegal, Burkina Faso, and Nigeria.

Micronutrient interventions can reduce child mortality. By applying Micronutrient Intervention Modeling methods in Senegal, Burkina Faso, and Nigeria, we estimated the impacts of bouillon fortification on apparent dietary adequacy of vitamin A and zinc among children and folate among women. We then used the Lives Saved Tool to predict the impacts of bouillon fortification with ranges of vitamin A, zinc, and folic acid concentrations on lives saved among children 6-59 months of age. Fortification at 250 µg vitamin A/g and 120 µg folic acid/g was predicted to substantially reduce vitamin A- and folate-attributable deaths: 65% for vitamin A and 92% for folate (Senegal), 36% for vitamin A and 74% for folate (Burkina Faso), and >95% for both (Nigeria). Zinc fortification at 5 mg/g would avert 48% (Senegal), 31% (Burkina Faso), and 63% (Nigeria) of zinc-attributable deaths. The addition of all three nutrients at 30% of Codex nutrient reference values in 2.5 g bouillon was predicted to save an annual average of 293 child lives in Senegal (3.5% of deaths from all causes among children 6-59 months of age), 933 (2.1%) in Burkina Faso, and 18,362 (3.7%) in Nigeria. These results, along with evidence on program feasibility and costs, can help inform fortification program design discussions.

Disordered eating behaviours and body shape dissatisfaction among adolescents with type 1 diabetes: a cross sectional study.

BACKGROUND: Disordered eating behaviours (DEBs) are variations in regular eating patterns and behaviours and might include symptoms and behaviours of eating disorder with lower level of severity. Such behaviours are common during adolescence at which time several physical and psychological changes occur favouring unhealthy dietary behaviours. Although the magnitude of DEBs is high among high-income countries, similar data are limited among adolescents with diabetes in low-income countries including Ethiopia. This study aimed to assess the magnitude of DEBs and its relationship with body shape dissatisfaction among adolescents with diabetes on follow-up at selected public hospitals in Addis Ababa, Ethiopia. METHODS: Hospital based cross sectional study was conducted among randomly selected 395 adolescents with diabetes attending public hospitals in Addis Ababa from January to December, 2021. Data were collected using structured pretested standard diabetes eating problem survey revised (DEPS-R) questionnaire, body part satisfaction scale of 8 items, and anthropometric measurements. Descriptive statistics such as median alongside interquartile range was used to describe the continuous variables. Binary bivariable and multivariable logistic regression was used for data analysis. Mann-Whitney U-test and Kruskal-Wallis test were used to evaluate the difference between median scores of independent variables. Adjusted odds ratios (AOR) alongside 95% confidence intervals (CIs) were estimated to measure the strength of association between variables of interest. RESULTS: The magnitude of disordered eating behaviours within the last 30 days was 43.3%, [95% CI: (38%, 48%)]. In multivariable analysis, body shape dissatisfaction [AOR = 2.21, 95% CI (1.28, 3.82, p = 0.0001)], family history of diabetes mellitus [AOR = 1.59, 95% CI (1.03, 2.47, p = 0.038)], late adolescence period [AOR = 2.10, 95% CI (1.33, 3.34, p = 0.002)], having diabetic complication[AOR = 2.32, 95% CI (1.43, 3.75, p = 0.001)],and being overweight [AOR = 2.25, 95% CI (1.32, 3.82, p = 0.003)] were significantly associated with DEBs. CONCLUSIONS: The magnitude of DEBs was high among the study participants. Body shape dissatisfaction, family history of diabetes mellitus, being in late adolescence period, diabetic complication, and nutritional status of adolescents were significantly associated with DEBs. Therefore, preventive interventions need to be designed by all relevant actors working on health promotion of young population to address factors influencing DEBs among adolescent population with diabetes.

The World Health Organization (WHO) defined adolescents as individuals in the age bracket of 10­19 years. Biologically, adolescence is a period of development that stretches from the onset of puberty through the termination of growth. This period is a critical link between childhood and adulthood, characterized by significant physical, psychological, and social transitions which carry new risks including the development of disordered eating behaviors among adolescents and opportunities that influence the immediate and future health of young people. This cross-sectional study aimed at assessing the magnitude of disordered eating behaviors and its relationship with body shape dissatisfaction among adolescents with diabetes on follow-up at selected public health facilities. The results showed that the magnitude of disordered eating behaviors is high. Body shape dissatisfaction was found to be statistically significantly associated with disorder eating behaviors during adjusted analysis alongside other attributes which have been identified to have an influence on adolescents' eating behaviours. A better understanding of the link between individual level attributes and DEBs could help adolescents' health programmers to launch more conducive interventions targeting the identified risks and researchers to more understand other aspects that could influence the adolescents' eating behaviors.

Comparison of Published Estimates of the National Prevalence of Iron, Vitamin A, and Zinc Deficiency and Sources of Inconsistencies.

Micronutrient deficiencies result in a broad range of adverse health and functional consequences, but the true prevalence of specific deficiencies remains uncertain because limited information is available from nationally representative surveys using recommended biomarkers. The present review compares various reported national deficiency prevalence estimates for nutrients and years where the estimates overlap for individual countries that conducted nationally representative surveys and explores possible reasons for any discrepancies discovered. Nationally representative micronutrient status surveys that were conducted since 2000 among preschool-aged children or women of reproductive age and included assessment of iron, vitamin A, or zinc status based on recognized biomarkers were considered eligible for inclusion, along with any modeled deficiency prevalence estimates for these same countries and years. There was considerable variation across different published prevalence estimates, with larger inconsistencies when the prevalence estimate was based on proxies, such as hemoglobin for iron deficiency and dietary zinc availability for zinc deficiency. Numerous additional methodological issues affected the prevalence estimates, such as which biomarker and what cutoff was used to define deficiency, whether the biomarker was adjusted for inflammation, and what adjustment method was used. For some country-years, the various approaches resulted in fairly consistent prevalence estimates. For other country-years, however, the results differed markedly and changed the conclusions regarding the existence and severity of the micronutrient deficiency as a public health concern. In conclusion, to determine micronutrient status, we consider the assessment of one of the recommended biomarkers in a population representative survey as the best available information. If indicated, results should be adjusted for inflammation and generally acceptable cutoffs should be applied to facilitate comparisons, although individual countries may also apply nationally defined cutoffs to determine when and where to intervene. Global consensus is needed on best practices for presenting survey results and defining the prevalence of deficiency.

Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon.

Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.

Population vitamin D status might be related to COVID-19 mortality but not with infection rate in Africa: evidence from ecological analysis.

Introduction: there is a large body of literature that has linked vitamin D status in the population with COVID-19 infection risk and disease severity. However, there is paucity of evidence in African context. Hence, this study aimed to conduct an ecological analysis to explore correlation between population level vitamin D status, COVID-19 infection, and mortality in Africa. Methods: an ecological study was conducted using data from different open sources, published literatures and organizational databases. In the final analysis, we included 23 African countries which had data on prevalence of vitamin D deficiency, population level mean serum 25 (OH) D concentrations and COVID-19 data. We employed spearman correlation and linear regression. All tests were two-sided, and P- value <0.05 was considered statistically significant. Results: based on our analysis, the prevalence of vitamin D deficiency is positively correlated (r=0.6265; p= 0.0094) while mean 25(OH) D concentration is negatively correlated (r=-0.4941; p= 0.0194) with COVID-19 mortality. In addition, the median age of the national population (r=0.7015; p= 0.0003), prevalence of current use of tobacco (r=0.6071; p= 0.0075) and prevalence of obesity among adult population (r=0.7143; p= 0.0003) were positively correlated with both COVID-19 infection and mortality in Africa. Nonetheless, vitamin D status was not positively correlated with observed case fatality rate and COVID-19 infection rate. Conclusion: population vitamin D status might be related to COVID-19 mortality but not with infection rate in Africa. Due to the increasing weight of evidence that shows a link between COVID-19 and vitamin D, we strongly recommend well-designed controlled studies to explore causality and clinical trials to find out the effect of vitamin-D supplementation in the treatment and prevention of COVID-19 in African settings.