Achieving equitable leadership in Global Health partnerships: barriers experienced and strategies to improve grant funding for early- and mid-career researchers.

Calls to decolonize global health have highlighted the continued existence of colonial structures in research into diseases of public health importance particularly in low- and middle-income countries (LMICs). A key step towards restructuring the system and shaping it to local needs is equitable leadership in global health partnerships. This requires ensuring that researchers in LMICs are given the opportunity to successfully secure grant funding to lead and drive their own research based on locally defined priorities. In February 2022, the London School of Hygiene and Tropical Medicine hosted a workshop aimed at bringing together funders and early- and mid-career researchers (EMCRs) to identify funder initiatives that have worked to improve equitable leadership, to better understand barriers faced by researchers, and collectively brainstorm approaches to overcome these barriers. The workshop transcript was analyzed using a deductive thematic approach based on the workshop topic to identify key emerging themes. Barriers identified were the lack of individual and institutional level support and flawed funding structures for EMCRs in LMIC settings. Strategies on how equitable leadership can be further facilitated include institutional reforms for funders to facilitate equity, diversity, and inclusion in their partners through consultative engagement and in addition, reshaping how research priorities are defined; diversified funding streams for research organizations, building partnerships and dedicated funding for capacity building of EMCRs. Intentional advances to overcome funding barriers in global health speak directly to its decolonization. Urgently required and complex changes in practice must be intentional and do require uncomfortable shifts which will take time. Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-024-00047-4.

Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia.

BACKGROUND: Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox. METHODS: Data were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level. RESULTS: Among 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RRa]:0.79; 95% confidence interval [CI]: 0.65, 0.96). In both evaluation periods (56-days and 168-days), HIV-positive status (RRa:1.29; 95%CI: 1.02, 1.63 and RRa:1.28; 95%CI: 1.07, 1.53), single/living independent (RRa:1.31; 95%CI: 1.03, 1.67 and RRa:1.38; 95%CI: 1.16, 1.64) and separated/widowed (RRa:1.40; 95%CI: 1.04, 1.90 and RRa:1.26; 95%CI: 1.00, 1.58) had higher rates of counts of days with no digital confirmation. CONCLUSION: Poorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment.

Health care seeking behaviors of pregnant women in rural Amhara, Ethiopia: a qualitative study of perceptions of pregnant women, community members, and health care providers.

Introduction: in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia. Methods: the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from October 3rd through October 14th, 2018. A phenomenological qualitative study design was used to understand participants' perceptions and experiences about pregnant women's health care seeking behaviors. Results: early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers. Conclusion: despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women's health care seeking practices.

Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia.

Adolescent diets may be influenced by the retail food environment around schools. However, international research to examine associations between the proximity of retail food outlets to schools and diet provides equivocal support for an association. This study aims to understand the school food environment and drivers for adolescents' consumption of unhealthy foods in Addis Ababa, Ethiopia. Mixed-methods research was conducted, 1200 adolescents (10-14 years) from randomly selected government schools were surveyed, along with vendors within 5-min' walk of the schools and focus group discussions (FGDs) with adolescent groups. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and the consumption of selected unhealthy foods. Thematic analysis was used to summarize findings from the FGDs. Consumption of sweets and sugar-sweetened beverages (S-SSB) and deep-fried foods (DFF) at least once a week was reported by 78.6% and 54.3% of the adolescents, respectively. Although all schools were surrounded by food vendors selling DFF and S-SSB, consumption was not associated with the number of vendors available around the school. However, adolescents' awareness and perception of healthy food, and their concerns about the safety of foods in the market, influenced their dietary choices and behaviours. Lack of financial resources to purchase food as desired also played a role in their selection of food and eating habits. Reported unhealthy food consumption is high among adolescents in Addis Ababa. Thus, further research is warranted to come up with school-based interventions that promote access and healthy food choices among adolescents.

Stunting and thinness in school-attending adolescents in Addis Ababa.

BACKGROUND: Adolescent population Global Diet Quality Score (GDQS) is uncommon in low-income settings. Though Global Diet Quality Score is a good measure of dietary diversity, it has not been used in assessing nutritional outcomes among adolescents. Therefore, the aim of this study is to assess school-attending adolescents stunting and thinness status and associations with global diet quality scores in Addis Ababa. METHODS: A school-based cross-sectional study was conducted among school-attending adolescents in the age group of 10-14 years in urban settings in Ethiopia. A multi-stage stratified random sampling procedure was used to select schools and students. A total of 1200 adolescents were included in the study. Binary and Multinomial logistic regression analyses were used to determine the predictors of stunting and thinness respectively. RESULTS: The proportion of school-attending adolescents stunting was 8.17% (95% CI: 6.74%,9.85%) and their thinness status 12.66% (95% CI: 10.89%, 14.67%). The overall mean GDQS food groups for Seven days period consumed were 19.99 + 2.81 SD. Male adolescents were 1.95 times more likely to be stunted compared to female adolescents (1.95; 95%CI: 1.11,3.39). Frequent consumption of low-fat dairy increased the risk of thinness, while frequent consumption of citrus fruits and white root tubers decreased the risk of school-attending adolescents' thinness. CONCLUSION: The proportion of thin or stunted adolescents attending school was high still, about 1 in 10. Stunting and thinness have no association with the overall GDQS. Nutritional interventions need to consider frequent consumption of citrus fruits, low-fat dairy, and white roots and tubers in school adolescents' nutritional programs. Further studies should validate the GDQS for stunting and thinness of school adolescents.

Association between sexual and reproductive health education in peer group and comprehensive knowledge of HIV among adolescent girls in rural eastern Ethiopia: a community-based cross-sectional study.

OBJECTIVES: This study examined the association between sexual and reproductive health (SRH) education in peer-group discussion and comprehensive knowledge of HIV among young adolescent girls in rural eastern Ethiopia. DESIGN: The study analysed data from a large quasi-experimental study involving 3290 young adolescent girls aged 13-17 years. The intervention targeted adolescent girls aged 10-14 years. Data were collected using a comprehensive HIV knowledge tool adopted from the demographic and health survey questionnaire. Multi-level mixed-effect logistic regression analysis was employed to examine associations using STATA/SE V.14 statistical software. SETTING: West Hararghe, rural Ethiopia. PARTICIPANTS: 3290 adolescent girls. RESULTS: Magnitude of comprehensive knowledge of HIV among those who received SRH education and those who did not receive SRH education was 16.78% (95% CI 14.41% to 19.45%) and 14.01% (95% CI 12.38% to 15.81%), respectively. Overall, 14.84% (95% CI 13.4.% to 16.39%) of the adolescent girls aged 13-17 years had comprehensive knowledge of HIV. The odds of having comprehensive HIV knowledge were higher (1.36 times) among adolescent girls who received SRH education compared with those who did not receive SRH education (adjusted OR 1.36, 95% CI 1.01 to 1.84) after controlling for selected potential confounders. Odds of having comprehensive HIV knowledge were also higher (1.73 times) among older adolescent girls (adjusted OR 1.733 95% CI 1.098 to 2.735) and (3.89 times) among those who attended secondary school (adjusted OR=3.889 95% CI 1.836 to 8.235) compared with young adolescent girls and the uneducated, respectively. CONCLUSIONS: Comprehensive knowledge of HIV among young adolescent girls was very low. Providing SRH education for young adolescent girls improved their comprehensive knowledge of HIV in rural eastern Ethiopia. Initiating sexual education at an early age would benefit HIV prevention efforts.

Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study: protocol of a pragmatic clinical effectiveness study to improve birth outcomes in Ethiopia.

INTRODUCTION: The WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia. METHODS AND ANALYSIS: ENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at <24 weeks gestation are enrolled (n=2400). ANC quality is strengthened across all centres. Health centres are randomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised salt and iron-folate (IFA), enhanced nutrition counselling and those with mid-upper arm circumference of <23 cm receive a micronutrient fortified balanced energy protein supplement (corn soya blend) until delivery. In standard nutrition centres, women receive routine counselling and IFA. EIMP women have additional screening/treatment for urinary and sexual/reproductive tract infections and intensive deworming. Non-EIMP women are managed syndromically per Ministry of Health Guidelines. Participants are followed until 1-month post partum, and a subset until 6 months. The primary study outcomes are newborn weight and length measured at <72 hours of age. Secondary outcomes include preterm birth, low birth weight and stillbirth rates; newborn head circumference; infant weight and length for age z-scores at birth; maternal anaemia; and weight gain during pregnancy. ETHICS AND DISSEMINATION: ENAT is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (001-A1-2019) and Mass General Brigham (2018P002479). Results will be disseminated to local and international stakeholders. REGISTRATION NUMBER: ISRCTN15116516.

Associations of percentage energy intake from total, animal and plant protein with overweight/obesity and underweight among adults in Addis Ababa, Ethiopia.

OBJECTIVE: This study investigated associations between types and food sources of protein with overweight/obesity and underweight in Ethiopia. DESIGN: We conducted a cross-sectional dietary survey using a non-quantitative FFQ. Linear regression models were used to assess associations between percentage energy intake from total, animal and plant protein and BMI. Logistic regression models were used to examine the associations of percentage energy intake from total, animal and plant protein and specific protein food sources with underweight and overweight/obesity. SETTING: Addis Ababa, Ethiopia. PARTICIPANTS: 1624 Ethiopian adults (992 women and 632 men) aged 18-49 years in selected households sampled using multi-stage random sampling from five sub-cities of Addis Ababa. RESULTS: Of the surveyed adults, 31 % were overweight or obese. The majority of energy intake was from carbohydrate with only 3 % from animal protein. In multivariable-adjusted linear models, BMI was not associated with percentage energy from total, plant or animal protein. Total and animal protein intake were both associated with lower odds of overweight/obesity (OR per 1 % energy increment of total protein 0·92; 95 % CI: 0·86, 0·99; P = 0·02; OR per 1 % energy increment of animal protein 0·89; 95 % CI: 0·82, 0·96; P = 0·004) when substituted for carbohydrate and adjusted for socio-demographic covariates. CONCLUSION: Increasing proportion of energy intake from total protein or animal protein in place of carbohydrate could be a strategy to address overweight and obesity in Addis Ababa; longitudinal studies are needed to further examine this potential association.

Anemia Etiology in Ethiopia: Assessment of Nutritional, Infectious Disease, and Other Risk Factors in a Population-Based Cross-Sectional Survey of Women, Men, and Children.

BACKGROUND: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. OBJECTIVES: We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia. METHODS: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models. RESULTS: The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases. CONCLUSIONS: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.

Hair, serum and urine chromium levels in children with cognitive defects: A systematic review and meta-analysis of case control studies.

Environmental chromium exposure may cause impaired development of children. We conducted a systematic review and meta-analysis. Electronic databases including PubMed, Embase, Web of Science and CINAHL were searched to identify case-control studies that reported childhood Cr exposure and cognitive development. The Newcastle-Ottawa Scale (NOS) was used to ensure the quality of the included studies. Cr levels were compared in cases and controls, and a random effect meta-analysis was performed using Stata version 16. Twelve of 61 studies identified in the literature search were eligible for this analysis. Hair, serum and urine Cr measurements were reported by seven, two and one studies, respectively. In addition, one study reported both serum and hair Cr exposure and another reported urine and hair Cr exposure. The pooled standard mean differences (SMD) showed that hair Cr levels were non-significantly lower among children with cognitive defects (-0.01 µg/g, 95% CI: -0.04, 00, p = 0.27). In serum and urine, the pooled SMD was higher in children with cognitive deficits compared with healthy control children (0.32 µg/g, 95% CI: -0.78, 1.42, p = 0.56 and 0.64 µg/g, CI: -0.07,1.36, p = 0.08; respectively). In summary, this systematic review found no significant differences in hair, serum and urine Cr levels between children with cognitive deficits and healthy control children when all study data were pooled in the meta-analysis. Larger studies using standardized criteria and longitudinal assessment of cognitive development are needed to determine whether there is a dose response effect of childhood Cr exposure on cognitive development of children.

Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia.

BACKGROUND: Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country's health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. METHODS: We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the "hardware" (using the World Health Organization's building blocks) and the "software" (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. RESULTS: Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. CONCLUSIONS: Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country's health indicators and may promote sustained functionality of the health system.

Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia.

In an effort to address undernutrition among women and children in rural areas of low-income countries, nutrition-sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56-66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, 'dietary' and 'vitamin' knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men's engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes.

Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study.

BACKGROUND: In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). METHODS: We studied a retrospective cohort of 304 children aged 6-59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes. RESULT: From a total of 304 children 6-59 months with SAM, 133 (51.4%) were boys. Marasmus was the most common type (132 (51%)) of severe acute malnutrition. The recovery, death and defaulter rate were 70.4, 12.2 and 8.2% respectively. The main predictors of undesirable treatment outcomes were found to be the presence of HIV antibody (AHR = 3.208; 95% CI: [1.045-9.846]) and sepsis (AHR = 7.677, 95% CI: [2.320-25.404]). CONCLUSION: The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation. The main predictors of undesirable treatment outcomes among inpatient children treated for SAM were HIV and sepsis. Intervention to reduce undesirable treatment outcomes should focus on comorbidities, especially HIV and sepsis.

Prevalence and factors associated with exclusive breastfeeding among rural mothers of infants less than six months of age in Southern Nations, Nationalities, Peoples (SNNP) and Tigray regions, Ethiopia: a cross-sectional study.

BACKGROUND: Exclusive breastfeeding (EBF) is the global recommended nutrition for infants less than 6 months of age. The prevalence of exclusive breastfeeding in Ethiopia is much lower than the recommendations of World Health Organization (WHO). This study aimed to assess the prevalence and associated factors of EBF among rural mothers of infants less than 6 months of age in two regions, Southern Nations, Nationalities and Peoples (SNNP) and Tigray Regions, of Ethiopia. METHODS: The research was based on the secondary data analysis of community-based cross-sectional study conducted in 56 rural woredas (districts) in two regions of Ethiopia for impact evaluation of Alive & Thrive multi-year project. The 24-h recall dietary data were collected from 600 mother-infant dyads where the infant was less than 6 month of age, using multistage cluster sampling technique and 584 dyads were found eligible for analysis. Bivariate and multivariable logistic regressions were applied to identify the associated factors of exclusive breastfeeding. RESULTS: The prevalence of EBF of infants less than 6 months of age was 88.0% (95% CI 84.9, 90.4%). The odds of practicing EBF were significantly higher among infants less than 2 months of age (AOR 4.47, 95% CI 2.41, 8.27), married mothers (AOR 4.35, 95% CI 1.50, 12.67), mothers who gave birth in health facilities (AOR 2.07, 95% CI 1.15, 3.73) and mothers who received breastfeeding counseling during pregnancy (AOR 2.23, 95% CI 1.26, 3.96). CONCLUSIONS: The prevalence of EBF was relatively high when compared with previous studies in Ethiopia but close to the WHO recommendations of 90 %. Infant age, marital status of mothers, delivery place and breastfeeding counseling during pregnancy were identified as factors associated with EBF practices in 24 h preceding the survey. Devising appropriate strategies on breastfeeding messaging/counseling and support in addressing poor breastfeeding practices through existing government-led health intervention packages are recommended.

Anemia prevalence and etiology among women, men, and children in Ethiopia: a study protocol for a national population-based survey.

BACKGROUND: Anemia remains a public health challenge in Ethiopia, affecting an estimated 56% of children under age 5 years, 23% of women of reproductive age and 18% of adult men. However, anemia etiology and the relative contribution of underlying risk factors for anemia remains unclear and has hindered implementation of anemia control programs. METHODS/DESIGN: Anemia Etiology in Ethiopia (AnemEE) is a population-based cross-sectional survey of six regions of Ethiopia that includes children, women of reproductive age, and men from regionally representative households. The survey will include detailed assessment of anemia, iron, inflammatory and nutritional biomarkers, diet, comorbidities, and other factors. The objectives of AnemEE are 1) to generate evidence for decision-making on the etiology of anemia in Ethiopia among men, women and children and 2) to simulate the potential effect of iron fortification and other interventions on the prevalence of anemia and risk of iron overload. DISCUSSION: AnemEE will provide the most comprehensive evaluation of anemia etiology in Ethiopia to date due to its detailed assessment of diet, biomarkers, infections and other risk factors in a population-based sample. By generating evidence and simulating potential interventions, AnemEE will inform the development of high-impact anemia control programs and policies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04002466 . Registered on 28 June 2019. Retrospectively registered.

Food Insecurity and Mental Distress among Mothers in Rural Tigray and SNNP Regions, Ethiopia.

Access to safe and adequate food is a basic human right under Article 25 of the Universal Declaration of Human Rights. Globally, more than 870 million people consume less calories than they require, which can lead to disabling physical and mental health outcomes. This study was designed to investigate the association between household food insecurity and mental distress among mothers in the Tigray and SNNP regions of Ethiopia. A community based cross-sectional survey was completed on a total of 2,992 households. A linear multiple regression model was used to study the association between food insecurity and mental distress. More than half of the study participants, 57.9%, were experiencing food insecurity. The prevalence of mental distress among the mothers was 39%. Food insecurity was significantly associated with mental distress after controlling for socioeconomic covariates. Integrating screening and management of mental distress would result in a better health status of the mothers and those under their care.

Meeting the World Health Organization Maternal Antenatal Care Guidelines Is Associated with Improved Early and Middle Childhood Cognition in Ethiopia.

OBJECTIVE: To assess the association between meeting the World Health Organization (WHO) maternal antenatal care attendance guidelines and early and middle childhood cognition among impoverished Ethiopian children. STUDY DESIGN: A total of 1914 impoverished Ethiopian children from the Young Lives longitudinal cohort study were included. Childhood cognition was assessed via the Cognitive Development Assessment (CDA) and Peabody Picture Vocabulary Test (PPVT) at ages 4-5 years; PPVT, Early Grade Reading Assessment (EGRA), and Math Test at ages 7-8 years; and PPVT, Math Test, and Reading Test at ages 11-12 years. Linear regression models were used to examine the association between maternal antenatal care attendance and childhood academic achievement test scores. RESULTS: In the univariable analysis, children of mothers who received the WHO recommended 4+ antenatal care visits or received the WHO recommended first antenatal care visit during the first trimester scored higher on all academic achievement tests. In the multivariable analysis, children of mothers who received 4+ antenatal care visits scored significantly higher on the CDA at ages 4-5 years and Math Test at ages 7-8 years. Children of mothers who received antenatal care in the first trimester scored higher on the CDA at ages 4-5 years and Math Test scores at ages 11-12 years. Children of mothers who received both antenatal care in the first trimester and 4+ antenatal care visits scored significantly higher on the CDA at ages 4-5 years and Math Test at both ages 7-8 and 11-12 years. CONCLUSIONS: Children of mothers who received the WHO recommended number and timing of antenatal care visits had significantly higher academic achievement scores across multiple domains during early and middle childhood. Promotion of antenatal care visit attendance may improve cognition through middle childhood.

Market food diversity mitigates the effect of environment on women's dietary diversity in the Agriculture to Nutrition (ATONU) study, Ethiopia.

OBJECTIVE: In Ethiopia, women's dietary diversity is low, primarily due to poor food availability and access, both at home and market level. The present study aimed to describe market access using a new definition called market food diversity (MFD) and estimate the impact of MFD, crop and livestock diversity on dietary diversity among women enrolled in the Agriculture to Nutrition (ATONU) trial. DESIGN: Baseline cross-sectional data collected from November 2016 to January 2017 were used for the analysis. Availability of foods in markets was assessed at the village level and categorized into nine food groups similar to the dietary diversity index for women. Bivariate and multivariate mixed-effects regression analyses were conducted, adjusted for clustering at the village level. SETTING: Chicken-producing farmers in rural Ethiopia.ParticipantsWomen (n 2117) aged 15-49 years. RESULTS: Overall, less than 6 % of women met the minimum dietary diversity (≥5 food groups) and the most commonly consumed food groups were staples and legumes. Median MFD was 4 food groups (interquartile range: 2-8). Multivariate models indicated that women's dietary diversity differed by livestock diversity, food crop diversity and agroecology, with significant interaction effects between agroecology and MFD. CONCLUSIONS: Women's dietary diversity is poor in Ethiopia. Local markets are variable in food availability across seasons and agroecological zones. The MFD indicator captures this variability, and women who have access to higher MFD in the highland agroecological zone have better dietary diversity. Thus, MFD has the potential to mitigate the effects of environment on women's dietary diversity.

Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia.

Weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC) are two independent anthropometric indicators for diagnosing and admitting children with severe acute malnutrition (SAM) for treatment. While severely wasted children are at high risk of mortality, MUAC and WHZ do not always identify the same population of children as having SAM. Understanding how this discrepancy relates to age and sex may provide valuable information for care programmes for children with SAM. Age and sex distribution for differences between children identified as SAM by MUAC and WHZ were examined and the degree of agreement calculated. Children (n = 4297) aged 6-59 months with validated anthropometric measures were recruited from a population-based survey conducted in rural southern Ethiopia. MUAC < 115 mm and WHZ < -3 were used to define severe wasting as per the World Health Organization (WHO) classification. The kappa coefficient (κ) was calculated. There was fair agreement between the MUAC and WHZ definitions of severe wasting in boys (κ = 0.37) and children younger than 24 months (κ = 0.32) but poor agreement in girls (κ = 0.15) and children aged 24 months and above (κ = 0.13). More research is needed on response to treatment and prediction of mortality using different anthropometric measurements in relation to ages and sex of children.