Multi-Level Mixed-Effects Analysis of Stunting Among 6 to 59 Months Children in Ethiopia: Evidenced from Analysis of Health and Demographic Survey, 2000 to 2019.

Background. Stunting remains a major public health issue in developing countries like Ethiopia. It is termed as a chronic malnutrition which leads to morbidity and mortality among children. This study aimed to assess the prevalence and factors associated with stunting among 6 to 59 months children in Ethiopia. Methods. A total weighted sample of 34 930 children aged 6 to 59 months was included in this study. A Multilevel Mixed-Effect logistic regression was carried out. The Median Odds Ratio (MOR) and the Intra class Correlation Coefficient (ICC) were calculated. An adjusted odds ratio along with a 95% confidence interval was reported and statistical significance was declared at a P-value ≤ .05. Results. The weighted prevalence of stunting in Ethiopia was 48.3% (95% CI: 47.8%, 48.8%). Being male, increased in age, having multiple births (twin), having less than 2 years birth interval, history of diarrhea, anemia, lack of maternal and paternal formal education, having poor and middle-wealth status, and living in rural areas were significantly associated with stunting. Conclusions. The prevalence of stunting is high in Ethiopia. The risk factors mentioned above increase the likely hood of stunting among children. Therefore, we recommend that responsible bodies place a greater emphasis and priority on promoting parental education, awareness on the impact of the birth interval on child nutrition, the prevention of childhood diarrhea and anemia, improving household economic status, and reducing rural-urban disparities.

Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study.

OBJECTIVE: Investigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms. DESIGN: Cross-sectional survey of randomly selected households. SETTING: Haramaya Health and Demographic Surveillance site in Eastern Ethiopia, predominantly smallholder farming households. PARTICIPANTS: 678 preschool children (24-59 months) and their mothers. METHODS: The key outcome, the adequacy of dietary diversity of preschool children, was calculated using a 24-hour parental dietary recall. Binary logistic regression was then used to identify maternal and household factors associated with dietary adequacy versus inadequacy. RESULTS: The majority (80.53%) of surveyed children had low dietary diversity (mean Dietary Diversity (MDD)) score of 3.06±1.70 on a 7-point scale). Approximately 80% of households exhibited food insecurity. Households with greater food security (adjusted OR (AOR)=1.96, 95% CI 1.19 to 3.23), healthier maternal food choice (AOR=2.19, 95% CI 1.12 to 4.31) and broader maternal food preferences (AOR=4.95, 95% CI 1.11 to 21.95) were all associated with higher dietary diversity of their preschool children (p≤0.05). Other covariates associated with adequate child dietary diversity included improved household drinking water sources (AOR=1.84, 95% CI 1.16 to 2.92) and family planning use (AOR=1.69, 95% CI 1.00 to 2.86). Despite predictions, however, maternal depression and khat consumption were not identified as factors. CONCLUSIONS: The dietary diversity of preschool children is extremely low-a pattern observed in both food-secure and food-insecure households. Key factors include maternal selection of food for convenience and ease, preferences that do not include animal protein or healthier food choices, and lack of access to improved drinking water sources. Interventions around maternal food choice and preferences could improve preschool children's nutritional health.

Association between dietary protein intake, diet quality and diversity, and obesity among women of reproductive age in Kersa, Ethiopia.

Introduction: In Ethiopia, there is limited evidence on the effect of dietary protein intake on women's body mass index. Therefore, this study investigated the association between dietary protein intake, diet quality, and overweight and obesity. Methods: A cross-sectional study was conducted among 897 women of reproductive age. Food frequency questionnaires were used to assess 7-day dietary intake. It was converted into protein and other macro-nutrient intakes, Minimum Dietary Diversity for Women, and Global Dietary Quality Score. Body Mass Index (BMI) of overweight & obese women were defined as ≥25 kg/m2. An adjusted odds ratio with a 95% confidence interval (in a multivariate logistic regression model) was used to determine the strength of the association between BMI and dietary protein intake, adjusting for potential confounders. Results: The median dietary protein intake was 41.3 (32.9, 52.6) grams/day or 0.8 (0.6, 1.0) grams/kilogram of body weight/day. The prevalence of overweight and obesity was 7.5% (n = 67). Only 220 (24.5%) women could meet the recommended minimum dietary diversity of five or more food groups out of 10 per day. Furthermore, only 255 (28.4%) women were found to have a low risk for nutrient adequacy. Interestingly, women who consumed moderate dietary protein had a significantly lower likelihood of being overweight or obese, with AOR of 0.21 (95% CI 0.10-0.48). Similarly, those who consumed a high amount of protein had even lower odds, with AOR of 0.03 (95% CI 0.01-0.14), compared to those who consumed a low amount of dietary protein. Age of 40-49 years (AOR = 3.33, 95% CI 1.24-8.95) compared to 18-29 years, non-farmers (AOR = 3.21, 95% CI 1.55-6.62), higher consumption of food from unhealthy groups (AOR = 1.30, 95% CI 1.05-1.61), and high fat intake (AOR = 1.06, 95% CI 1.04-1.09) were associated with overweight and obesity. Conclusions and recommendations: The study indicated an inverse relationship between BMI and dietary protein intake. It also revealed that women who consumed foods from unhealthy or unhealthy when consumed in excessive amounts were more likely to be overweight or obese. Increasing dietary protein consumption can help reproductive-age women reduce the odds of obesity and overweight. Furthermore, community-based educational programs, policy changes, and healthcare services can support this effort.

Multilevel analysis of trends and predictors of concurrent wasting and stunting among children 6-59 months in Ethiopia from 2000 to 2019.

Introduction: Emerging evidence indicates that children can be concurrently wasted and stunted (WaSt), increasing their mortality risk. However, more is needed to know about WaSt in Ethiopia. Therefore, this study aimed to determine the trends and predictors of WaSt using Ethiopian Demographic and Health Survey datasets from 2000 and 2019. Methods: The study included a total weighted sample of 34,930 children aged 6-59 months. Descriptive and weighted multilevel mixed-effects (fixed and random effects) logistic regression analyses were carried out. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Results: The prevalence of WaSt was 1,682 (4.82%) with a significantly decreasing trend, yielding a percent change of -57.51% (-69.37% to -23.52%) from 2000 to 2019. In the adjusted model, the odds of WaSt increased in boys, children with a shorter preceding birth interval, small birth size, delayed initiation of complementary foods, diarrhea, fever, and anemia, mother's lack of formal education, and being a farmer, and poor/middle wealth index, and lack of mass media exposure. WaSt was inversely related to the child's age. Adjusted ICC and MOR were 31.16% and 3.20%, respectively. Conclusion and recommendations: The study highlights the importance of considering individual and community-level factors to address WaSt, such as timely initiation of complementary foods, improving access to health services, quality diet, and prevention of communicable diseases. Furthermore, programs that have positive impacts on formal education and employment opportunities for girls, as well as that increase access to mass media, are required.

Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia.

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07-3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09-3.38), literate in education (AOR 1.71, 95% CI 1.07-2.73), multigravida (AOR 1.96, 95% CI 1.12-3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93-0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF.

Antimicrobial resistance: A challenge awaiting the post-COVID-19 era.

Microbe exposure to pharmaceutical and non-pharmaceutical agents plays a role in the development of antibiotic resistance. The risks and consequences associated with extensive disinfectant use during the COVID-19 pandemic remain unclear. Some disinfectants, like sanitizers, contain genotoxic chemicals that damage microbial DNA, like phenol and hydrogen peroxide. This damage activates error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance. Public health priority programs that have faced drug-resistance challenges associated with diseases, such as tuberculosis, HIV, and malaria, have given less attention to risks attributable to the COVID-19 pandemic. Pathogen-specific programs, like the directly observed treatment strategy designed to fight resistance against anti-tuberculosis drugs, have become impractical because COVID-19 restrictions have limited in-person visits to health institutions. Here, we summarized the key findings of studies on the current state of antimicrobial resistance development from the perspective of current disinfectant use. Additionally, we provide a brief overview of the consequences of restricted access to health services due to COVID-19 precautions and their implications on drug resistance development.

Prevalence and determinants of concurrent wasting and stunting and other indicators of malnutrition among children 6-59 months old in Kersa, Ethiopia.

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6-59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross-sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height-for-age, weight-for-height and weight-for-age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6-17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12-2.75) compared with those aged 36-59 months, whereas children aged 18-35 months (aOR 2.4, 95% CI 1.65-3.47) and 36-59 months (aOR 1.6, 95% CI 1.07-2.37) had higher odds of stunting compared with those aged 6-17 months. Similarly, children aged 18-35 months (aOR 1.6, 95% CI 1.07-2.37) and 36-59 months (aOR 2.2, 95% CI 1.52-3.10) had higher odds of underweight compared with children aged 6-17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16-9.27) and stunting (aOR 1.9, 95% CI 1.31-2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m2 and maternal BMI between 18.5 and 25 kg/m2 were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point-of-use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community-based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended.

Retraction Note: Application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries: a systematic review and meta-analysis.

[This retracts the article DOI: 10.1186/s40748-019-0111-y.].

Factors associated with long-acting family planning service utilization in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Even though the modern contraceptive use was improved in Ethiopia, the utilization of long-acting family planning services is still low because of numerous factors. The aim of this systematic review was to synthesize logical evidence about factors associated with long acting family planning service utilization in Ethiopia. METHODS: The participants of the study were married women of reproductive age in Ethiopia. This search included all published and unpublished observational studies written in the English language conducted before April 30, 2018, in Ethiopia. Electronic and non-electronic sources were used. PubMed, MEDLINE (EBSCO), CINHAL (EBSCO), Embase (EBSCO), POPLINE and the search engines like Google, Google Scholar Mednar and world cat log were used. The overall selected search results were 15 studies. Each study was evaluated using the Joanna Briggs Institute Quality Assessment Tool for Observational Studies. Data synthesis and statistical analysis were conducted using ReviewManagerVersion5.3.5. RESULTS: Women's inadequate knowledge level [OR, 0.29; 95% CI: 0.10, 0.83, P = 0.02], women's age between 15 and 34 [OR, 0.82; 95% CI: 0.53, 0.93, P = 0.01], not having electronic media [OR, 0.65; 95% CI: 0.53, 0.79, P < 0.0001] and women from rural area [OR = 0.65;95% CI:0.50, 0.81, P = 0.0009] were less likely associated in the use of long-acting family planning services. The odds of utilizing long acting family planning methods were high among non-government- employed women and husband [OR, 1.77; 95% CI: 1.29, 2.43, P = 0.0004], [OR, 1.69; 95% CI: 1.33, 2.15, P < 0.0001] respectively. Having no previous exposure to any modern family planning method [OR = 2.29; 95%CI: 1.83, 2.86, P < 0.00001] and women having no discussion with husband [OR = 1.92 (95%CI: 1.50, 2.45) P < 0.00001] were more likely associated in the utilization of long-acting family planning services. CONCLUSION: Lack of information and knowledge, having discussion with husband, being women of younger age, having less than five living children, being government-employed women and husband, not having electronic media, and being residents in rural area were significant barriers for underutilization of long acting family planning methods in Ethiopia. Hence, the investigators suggest that key stakeholders should design interventions strategies to avert attitudinal, cultural and informational barriers towards long-acting family planning methods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: 2018: CRD42018096373.The online version of this article (10.1186/s40834-019-0095-z) contains supplementary material, which is available to authorized users.

Application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries: a systematic review and meta-analysis.

ABSTRACT: There are conflicting results from large randomized controlled trials in different populations regarding the effectiveness of topical application of 4% chlorhexidine to the umbilical stump of newborn infants at reducing neonatal mortality. Meta-analysis and systematic review of trials performed in South Asia and Europe support 4% chlorhexidine application to reduce neonatal mortality, whereas trials performed in Sub-Saharan Africa do not. The aim of this review is to determine the effectiveness of 4% chlorhexidine application to the umbilical stump of newborn infants born in lower income countries in order to reduce neonatal mortality when compared with usual cord care.Our search strategy included randomized trials published between January1st 2000 and September 4th, 2018, that compared 4% chlorhexidine with usual cord care ("dry cord care"). The outcome variable of interest was neonatal mortality. Pooled relative risks (RR) with 95% confidence intervals (CIs) using a random-effects model were calculated. Nine trials were included, from six countries: Zambia, Tanzania, Bangladesh, Nepal, India and Pakistan, with a total of 257,153 participants. Five studies (N = 119,833) reported neonatal mortality. There was a 21% reduction in neonatal mortality among with 4% chlorhexidine application: pooled RR (95% CI) 0.79 (0.69-0.90), P = 0.0005. The incidence of omphalitis was decreased by 35% with 4% chlorhexidine (6 studies, N = 108,263): pooled RR (95% CI) 0.65 (0.56-0.75), P = 0.00001. Chlorhexidine application delayed the umbilical cord separation time (4 studies, N = 28,917): mean difference (95% CI) 2.71 (2.63-2.78) days.In conclusion, this systematic review found that topical application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries significantly reduces the incidence of neonatal mortality. Chlorhexidine also reduces the incidence of omphalitis, but prolongs umbilical cord separation time. TRIAL REGISTRATION: Systematic Review Registration: CRD42018109280.

Prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia.

BACKGROUND: Depression among tuberculosis patients, especially in settings with low economic status is common. Screening for depression in all levels of health facilities can identify patients who need support and treatment for depression. OBJECTIVE: The aim of this study was to assess the prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia. METHODS: An institutional based cross-sectional study was conducted among 403 tuberculosis patients attending in eleven tuberculosis treatment centers in eastern Ethiopia from February to July 2017. Depression was measured using the Patient Health Questionnaire. Data was collected consecutively until the required sample size was obtained. Tuberclusis  patients who were under anti tuberculosis treatments for more than one month were included. Data were analyzed with Statistical Package for Social Sciences (SPSS) version 20. Bivariate and multivariate logistic regression models were applied to identify independent factors for dependent variable depression and P-values < 0.05 considered statistically significant. RESULTS: A total of 403 tuberculosis patients were included in the study. The prevalence of depression among tuberculosis patients was 51.9% (95%CI = 42.7, 62.2%) with 34.2% were mild cases. In our logistic regression analysis, odds of developing depression among tuberculosis patients with age less than 25 years were 0.5(50% protective effect) [AOR = 0.5, 95% CI 0.26-0.99] where as patients with a monthly income within the 25thpercentile were four times higher odds to have depression [AOR = 3.98, 95% CI: 2.15-7.39]. CONCLUSION: The prevalence of depression was high in this study. Age, low monthly income, the category of patients as "new tuberculosis treatment" and the first 3 months of treatment was associated with depression among tuberculosis patients. Health facilities should integrating mental health services with tuberculosis clinics, especially assessing and treating TB patients for depression, is vital.

Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia.

INTRODUCTION: Pulmonary tuberculosis (TB) impairs respiratory physiology and functional ability, resulting in economic and social dependence upon others. Patients with tuberculosis especially multi drug resistant (MDR-TB) suffer from social isolation, stigma, lack of support and economic constraints. In Ethiopia, the trend of MDR TB is increasing and becoming a serious public health problem. However, little is known about patients except treatment outcomes, financial burden and psychological distress with serious deficiency of data on Health Related Quality of Life (HRQOL). Hence, the aim of this study was to assess HRQOL of MDR TB patients in comparison with drug sensitive pulmonary TB (DSTB) patients. METHODS: We included 100 cases of MDR and 300 controls with DSTB who were matched by sex. Data were collected using SF- 36v2 TM questionnaire and analysed with SPSS version 20. Independent t-test and conditional logistic regression analysis was done considering P-values of less than 0.05 statistically significant. Eight in-depth interviews were also conducted with both groups and represented with verbatim quotations and narrative texts. RESULTS: There were no statistically significant differences in mean scores for health related quality of life between cases and controls (57.61±16.42 and 59.13±22.10) nor were there significant differences in physical functioning, role disruption due to physical problems, vitality, social functioning, role disruption due to emotional distress, or overall mental health. Individuals with MDR-TB were significantly more likely to be single, a current student, and with lower education and families with more than 5 people than individuals with Drug sensitive TB, all of which were significantly associated with poorer HRQOL (p<0.05). There was good internal consistency of the scale scores, with a Cronbach's alpha value of 0.73. CONCLUSION: Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with Drug sensitive TB. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households and students about pulmonary tuberculosis, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB.

Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study.

OBJECTIVES: The aim of this study was to assess the level and factors associated with caregivers' disclosure of perinatally HIV-infected (PHIV+) children's seropositive status. DESIGN: We conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05. RESULTS: The study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children's HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74). CONCLUSION: Only half of the caregivers disclosed their child's PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children's frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.

Acceptability of donor breast milk banking, its use for feeding infants, and associated factors among mothers in eastern Ethiopia.

BACKGROUND: The first priority for infant feeding is to encourage the use of infant's mother's breast milk, but when this is not possible, donated breast milk is the second best option. In developing countries, very few studies have been conducted on the acceptance of donor breast milk. Hence, this study was planned to discover the acceptability of donor breast milk banking, its use for feeding infants, and associated factors among mothers in eastern Ethiopia. METHODS: A mixed method study was conducted in eastern Ethiopia from December 2015 to February 2016. Data were collected through a pre-tested structured interview based questionnaire. A total of 1085 mothers participated in the survey and six focus group discussions were held with 33 mothers. Descriptive statistics have been used to report results from the survey and qualitative data were analyzed using the thematic data analysis approach. RESULTS: The study revealed that 119 (11%) of participants were willing to donate breast milk for banking and 165 (15.2%) of mothers were willing to use for feeding infants. The acceptance of donor milk banking was 5.8 times more likely among the mothers who had heard about donor milk banking previously (Adjusted Odds Ratio [AOR] 5.8; 95% Confidence Interval [CI] 3.1, 10.72), 4.2 times more likely among the mothers who heard about wet-nurses (AOR 4.2; 95% CI 2.5, 6.99) and 2 times more likely among mothers who had visited a neonatal intensive care unit (AOR 2; 95% CI 1.1, 3.73). CONCLUSIONS: Generally, this study showed that the acceptance of breast milk donation for banking and its use for feeding infants was very low, due to lack of information and misconceptions about the safety of breast milk. Therefore, before initiation of any donor milk banking program awareness should be created about donor breast milk and its safety.