Assessing the influence of COVID-19 lockdown measures on cognition and behavior in school age children in Arba Minch Health and Demographic Surveillance site, Southern Ethiopia: A cross-sectional study.

Ethiopian schools were closed for nearly 40 weeks as a measure to control the COVID-19 pandemic. The objective of the study was to evaluate the role of COVID-19 pandemic's restrictive measures on cognition and behavioral difficulties of schoolchildren in Arba Minch Health and Demographic Surveillance Site. Two cross-sectional surveys were conducted in November 2019 (pre-COVID-19-lockdown) and November 2020 (post-COVID-19 lockdown). Data were collected both at the school and homes of the children. Cognitive development of the children was assessed using digit span, Raven's coloured progressive matrices (RCPM) and Visual search using cancellation task. Behavioral difficulties score of the children was assessed using Strengths and Difficulties Questionnaire. Analysis of covariance (ANCOVA) was used to compare between the cognition outcomes and behavioral difficulties score pre- and post-COVID-19-lockdown. In a sub-group of children who provided data in both surveys, the difference in cognitive and behavioral outcomes was tested using a mixed effect model. Compared to the pre-COVID-19-lockdown, schoolchildren post-COVID-19-lockdown scored lower in the standardized performance index for the visual search task, which measures attention (0.27 SD, 95% confidence intervals (95%CI): -0.40, -0.13). However, they scored higher by 0.26 SD (95%CI: 0.13, 0.40) and 0.36 SD (95%CI: 0.22, 0.49) in digit span and RCPM, respectively, measuring working memory and non-verbal intelligence. There was no significant difference in total difficulties score between pre- and post-COVID-19-lockdown (0.01 SD, 95%CI: -0.12, 0.15). The subgroup analysis showed a significant increase in digit span among children post-COVID-19-lockdown while the other domains did not show a significant change. Factors contributing to the improvement of children's cognitive domains while away from the school environment should be explored and utilized to enhance child development. This study was registered at clinicaltrials.gov as NCT04137354 on October 14, 2019.

Effectiveness of intermittent iron and high-dose vitamin A supplementation on cognitive development of school children in southern Ethiopia: a randomized placebo-controlled trial.

BACKGROUND: Iron is an essential mineral whose deficiency results in cognitive alteration, impaired emotional behaviors, and altered myelination and neurotransmission. In animal models, it has been shown that vitamin A (VA) could affect cognition. OBJECTIVES: The study aimed to evaluate the effectiveness of intermittent iron and VA supplementation on cognitive development of schoolchildren, and to assess the interaction between these supplementations. METHODS: Considering a 2 × 2 factorial design, 504 children were randomly assigned to 1 of the 4 arms: placebo VA and placebo iron supplement; high-dose vitamin VA and placebo iron supplement; iron supplement and placebo VA; and iron and high-dose vitamin VA supplements. Cognitive development was assessed using Raven's Coloured Progressive Matrices, digit span, Tower of London, and visual search tasks. RESULTS: The mean [± standard deviation (SD)] age of the enrolled children was 9.6 (±1.6) y. One-fifth of the children had iron deficiency or anemia, whereas 2.9%, 3.9%, and 12.1% of children had low iron stores, iron deficiency anemia, and VA deficiency, respectively. Intermittent iron supplementation did not result in any significant improvement of children's cognitive development and had a negative effect on the performance index of the visual search task compared with placebo (-0.17 SD, 95% confidence interval: -0.32, -0.02). Effects were evident among children with stunting, thinness, or children coming from understimulating home environments. High-dose VA supplementation resulted in a significant improvement of digit span z-score with a mean difference of 0.30 SD (95% confidence interval: 0.14, 0.46) compared with placebo VA. VA had a more beneficial impact for girls, children infected with helminths, and those from food secure households. CONCLUSION: In a population where the prevalence of iron deficiency is low, intermittent iron supplementation did not have any or negative effect on the child's cognitive development outcomes. Conversely, VA supplementation improved the child's working memory. TRIAL REGISTRATION NUMBER: The study is registered at clinicaltrials.gov as NCT04137354 (https://clinicaltrials.gov/study/NCT04137354).

Effects of iron supplementation on cognitive development in school-age children: Systematic review and meta-analysis.

BACKGROUND: Iron deficiency is negatively associated with children's cognitive development. Evidence showed that iron supplementation improves cognitive development. Nearly 50% of anemia is caused by iron deficiency. Anemia affects more school-age children, at an age where their brain development continues. The aim of this systematic review and meta-analysis is to review the evidence from published randomized controlled trials to evaluate the effects of iron supplementation on cognitive development and function among school-age children. METHOD: Five databases including MEDLINE, EMBASE, Scopus, Web of Science and CENTRAL were used to search for articles on April 20th, 2021. The search was reconducted on October 13th, 2022 to retrieve new records. Studies were eligible if they included school children 6-12 years of age, were randomized controlled trials, and if they tested iron supplementation and measured cognitive development. RESULT: Thirteen articles were included in the systematic review. Overall, iron supplementation significantly improved intelligence (standardized mean difference, 95% confidence interval) (SMD 0.46, 95%CI: 0.19, 0.73, P<0.001), attention and concentration (SMD 0.44, 95%CI: 0.07, 0.81, P = 0.02) and memory (SMD 0.44, 95%CI: 0.21, 0.67, P <0.001) of school-age children. There was no significant effect of iron supplementation on school achievement of school-age children (SMD 0.06, 95%CI: -0.15, 0.26, P = 0.56). In a subgroup analysis, iron-supplemented children who were anemic at baseline had had better outcomes of intelligence (SMD 0.79, 95%CI: 0.41, 1.16, P = 0.001) and memory (SMD 0.47, 95%CI: 0.13, 0.81; P = 0.006). CONCLUSION: Iron supplementation has a significant positive effect on the intelligence, attention and concentration, and the memory of school-age children but there was no evidence on the effect of iron supplementation on their school achievement.

Colostrum avoidance practice and associated factors among mothers of infants less than six months in Chencha District: cross-sectional study.

BACKGROUND: Colostrum avoidance is failure to feed first breast milk to a newborn baby for the first 2 to 3 days after delivery. The problem of avoiding colostrum is prevalent in Ethiopia. But it is not adequately addressed yet. Therefore, the purpose of this study was to assess prevalence of colostrum avoidance practices and associated factors among mothers of infants aged less than six months; and to explore barriers for colostrum feeding in ChenchaZuria District. METHODS: A community-based cross-sectional study supplemented with a qualitative study was conducted in August 2020. The quantitative data were collected from 674 mothers selected by systematic sampling using a structured questionnaire. Both bi-variable and multi-variable binary logistic regression analysis was used to identify factors associated with the colostrum avoidance practices. The statistical significance was declared at a p-value < 0.05. The qualitative data were collected using in-depth interviews from breastfeeding mothers and thematic analysis was done manually. RESULT: The prevalence of the colostrum avoidance practice was 15.3% (95% CI: 11.4%- 18.2%). Late initiation of breastfeeding (AOR 4.15 95% CI 2.51-6.84), giving pre-lacteal feeding (AOR 3.16 95% CI 1.93-5.15), not using of postnatal care (PNC) service (AOR 1.79 95% CI 1.05-3.04), and having poor maternal knowledge regarding colostrum. (AOR 1.88 95% CI 1.14-3.08) were factors significantly associated with the colostrum avoidance practices. And in the qualitative part, cultural beliefs and misconceptions, community influence, and complementary feeding practices were found to be facilitators for the colostrum avoidance. CONCLUSION: About one in seven mothers practiced colostrum avoidance. Factors that contributed to the colostrum avoidance practices were breastfeeding initiation, pre-lacteal feeding, PNC utilization, and maternal knowledge regarding colostrum. Thus, efforts to prevent colostrum avoidance practices should focus on strengthening and promoting PNC services utilization, timely initiation of breastfeeding, and improving awareness creation activities on the importance of colostrum feeding and risks of pre-lacteal feeding.

Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study.

BACKGROUND: Broad and specific causes of adult mortalities are often neglected indicators of wellbeing in low-income countries like Ethiopia due to lack of strong vital statistics. Thus, this database study aimed to assess the causes of adult mortality using demographic surveillance data. METHODS: An 8-year (12 September 2009-11 September 2017) surveillance data from the Arba Minch Health and Demographic Surveillance Site was used for this study. Verbal autopsy methods and ICD codes were used to identify the causes of the adult deaths. The collected data were entered to the database by data clerks. We used Microsoft Excel and STATA version 16 software for data cleaning and analysis. Chi-squared test was used to see the significances of the trend analyses. RESULT: From the 943 adult deaths from 2009 to 2017 in the Health and Demographic Surveillance Site in southern Ethiopia, more than half of them were females. The specific leading cause of death in the adults were tuberculosis (16.8%), malaria (9.7%), and intestinal infectious diseases (9.6%). Communicable diseases (49.2%, 95% C.I 45.7, 52.7) accounted for about half of the deaths followed by non-communicable diseases (35%, 95% C.I 31.7, 38.4) where both categories showed an increasing trend. CONCLUSION: Although pieces of evidences are showing the shift from communicable diseases to non-communicable diseases as the major causes of adult death in developing countries, this study showed that communicable diseases are still the major causes of adult deaths. Efforts and emphasis should be given to control infectious diseases such as tuberculosis and malaria.

Prevalence of Undernutrition and Associated Factors among Lactating Mothers of Angecha District, Kembata Tembaro Zone, Southern Ethiopia.

BACKGROUND: Major reasons for malnutrition, particularly among those who live in low- and middle-income countries, are physiological vulnerability and inadequate intake. The objective of the study was to assess the prevalence of undernutrition and associated factors among lactating mothers of Angecha District, Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected lactating mothers in Angecha District from March to April 2017. A pretested structured questionnaire was used to assess the prevalence of undernutrition and associated factors among lactating mothers. Undernutrition was defined as the body mass index of less than 18.5 kg/m2. A multivariable logistic regression model was fitted, and the adjusted odds ratio (AOR) at a p value less than 0.05 was used to determine a statistically significant association between predictors and outcome variables. RESULT: The prevalence of undernutrition among lactating mothers was 21.2% (95% CI: 17.52, 25.46). The odds of undernutrition were higher among lactating mothers in the younger age group (AOR 4.12 (95% CI: 1.25-13.63), compared to 36-49 years group), dietary diversity less than five food groups (AOR 2.4, 95% CI: 1.35-4.36), and not attending antenatal care (ANC) (AOR 2.90 (95% CI: 1.43-5.86), compared to those who attended ANC for 4 or more times). The odds of undernutrition among lactating women from 3rd quantile wealth index households reduced by nearly half (AOR 0.47, 95% CI: 0.23-0.98) compared to lactating mothers from 1st quantile wealth index households. CONCLUSION: Nearly one in every five lactating mothers was undernourished. Age, dietary diversity score, ANC visit, and wealth index were found to be the associated factors of undernutrition. Therefore, due attention should have to be given to increase the use of ANC.

Tobacco use and associated factors among adults reside in Arba Minch health and demographic surveillance site, southern Ethiopia: a cross-sectional study.

BACKGROUND: Tobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS). METHODS: A community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables. RESULT: The prevalence of tobacco use among adults was 20.2% (95% CI: 18.9-21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8-18.4%) and 9.7% (95%CI: 8.8-10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42-0.68] compared to men), age group (35-44 [AOR 1.57; 95%CI: 1.14-2.17], 45-54 [AOR 1.99; 95%CI: 1.45-2.74], and 55-64 [AOR 3.26; 95%CI: 2.37-4.48] years old compared to 25-35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44-0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21-6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07-5.12), and Khat chewing (AOR 3.07(95%CI: 1.64-5.77) were also associated with the use of tobacco among the study participants. CONCLUSION: Nearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia.

BACKGROUND: In rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia. METHODS: A community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas. RESULTS: MWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization. CONCLUSIONS: A low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended.

Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study.

BACKGROUND: Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS). METHODS: A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered. RESULTS: The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6-14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR = 0.49; 95% C.I: 0.29-0.85] and housewives [AOR = 0.63; 95% C.I: 0.45-0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41-0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46-0.93] compared with 1st quintiles), and climatic zone (midland [AOR = 1.80;95% CI: 1.11-2.93), highland [AOR = 1.95;95% CI: 1.19-3.18] compared with lowland). In addition, tobacco use [AOR = 4.28;95% CI: 3.38-5.43], and khat use [AOR = 4.75; 95% CI: 2.66-8.50) were also associated with heavy episodic drinking among the study participants. CONCLUSIONS: More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.

Predictive capacity of obesity indices for high blood pressure among southern Ethiopian adult population: a WHO STEPS survey.

BACKGROUND: World Health Organization (WHO) consultation experts recommend countries to have guidance to identify public health action points suitable for their country. The objective of the study was to evaluate different obesity indices to predict high blood pressure and its optimal cutoff values among the adult population. METHOD: A total of 3368 individuals age from 25 to 64 years were included in this study. Data was collected based on the WHO Stepwise approach. Body mass index (BMI), waist circumference (WstC), waist to hip ratio (WHpR) and waist to height ratio (WHtR) were measured and calculated. High blood pressure was considered for those with systolic blood pressure above 135 mmHg, diastolic blood pressure above 85 mmHg or taking antihypertensive medications. To generate cutoff values, the receiver operator characteristic curve was generated with the maximum Youden index. RESULT: Women had a significantly higher hip circumference (P = 0.003), BMI (P = 0.036) and WHtR (P < 0.001) than men. Men had significantly higher WHpR (P = 0.027) than women. There were significantly higher BMI, WstC, WHpR, and WHtR among those with high blood pressure. The cutoff values for BMI, WstC, WHpR and WHtR were 22.86 kg/m2, 84.05 cm, 0.91 and 0.50 for men and 24.02 kg/m2, 79.50 cm, 0.91 and 0.51 for women, respectively. CONCLUSION: BMI, WstC, WHpR, and WHtR are a useful predictor of high blood pressure among adults' rural residents of southern Ethiopia. As the sensitivity for the cutoff values of most of indices were low, further surveys in different settings may need to be done before a conclusion can be drawn on whether or not to review the anthropometric cut offs for high blood pressure in Ethiopia.

Prevalence of hypertension and associated factors among adult residents in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia.

Hypertension is the leading risk factor for mortality and it is also one of the major risk factors for other non-communicable diseases (NCDs). The objective of the study was to assess the prevalence of hypertension and its associated factors among adults residing in Arba Minch health and demographic surveillance site (HDSS), Southern Ethiopia. A community-based cross-sectional survey was conducted in 2017 on the estimated sample size of 3,368 adults at Arba Minch Health and Demographic Surveillance site (HDSS). Data were collected using the WHO STEPS survey tools. Bivariate analysis was done to detect candidate variables at P-value less than 0.25 and entered into the final model to identify the independent predictors of hypertension. The prevalence of hypertension was 18.92% (95% CI: 17.63-20.28). The magnitude increase among respondents in the older age group [AOR 1.39 (95%CI: 1.05-1.84), 1.68 (95% CI: 1.26-2.23) and 2.67 (95%CI: 2.01-3.56) for age group 35-44, 45-54 and 55-64, respectively, compared to 25-34 years old group] and those with the higher wealth index [AOR 1.86 (95%CI: 1.33-2.59), 2.68 (95% CI: 1.91-3.75) and 2.97 (95%CI: 2.08-4.25) for 3rd quantile, 4th quantile and 5th quantile, respectively, compared to 1st quantile]. The odds of hypertension reduce among married participants (AOR 0.66, 95%CI: 0.51-0.85). Respondents with overweight (AOR 1.44, 95%CI: 1.02-2.02), khat chewing (AOR3.31, 95%CI: 1.94-5.64), low fruit and/or vegetable consumption (AOR 1.27, 95%CI: 1.05-1.53) and those who do not use coffee and tea (AOR 1.52, 95%CI: 1.03-2.24) had significantly higher likelihood of hypertension. Nearly one out of five participants have hypertension in this population. As hypertension is one of the silent killers, it is advisable to develop a system for enabling early detection and monitoring in the older age groups and overweight individuals.

Prevalence of Stunting and Its Associated Factors among Children of 6-59 Months in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia: A Community-Based Cross-Sectional Study.

Methods: The community-based cross sectional study was conducted in the Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. The simple random sampling method was used to recruit 656 mother-child pairs. Height for age Z score was computed using WHO Anthro version 3.2.2 software. Multivariable logistic regression model was fitted, and adjusted odds ratio (AOR) at p value <0.05 was used to determine statistically significant association between predictors and outcome variable. Result: The prevalence of stunting among children of 6-59 months in the study area was 47.9% (95% CI; 44.0-51.7). The likelihood of stunting was significantly higher among children who live in households with medium (AOR 2.20, 95% CI: 1.43-3.37) and poor (AOR 2.87, 95% CI: 1.72-4.81) wealth status. In addition, children who were not exclusively breast fed (AOR 1.55, 95% CI: 1.07-2.24), whose mothers had not participated in decision of major household purchases (AOR 2.27, 95% CI: 1.21-4.26), and whose mothers lacked decision on freedom of mobility (AOR 1.96, 95% CI: 1.05-3.66) were significantly stunted compared with counterparts. Conclusion: Stunting is a severe public health problem in the area. Therefore, efforts should be taken to enhance maternal empowerment, household wealth, and infant and young child feeding practice for reducing stunting among children.

The Burden of Malnutrition among Adults Residing in Arba Minch Health and Demographic Surveillance Site (HDSS): A WHO STEPS Survey.

BACKGROUND: Malnutrition is one of the main underlying risk factors for the deaths due to different diseases. The aim of this study was to assess the prevalence and factors associated with underweight and overweight among adults residing in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. METHODS: A community-based cross-sectional survey was conducted from April to June 2017. The data collection procedures and 3,368 calculated sample size were based on the World Health Organization (WHO) STEPwise approach to Surveillance guideline. Using the surveillance data of Arba Minch HDSS, simple random sampling technique was implemented to identify individuals for the study. To assess the presence of association, the multinomial logistic regression model was used. RESULTS: The mean (SD) body mass index of the participants was 21.5 4.90 kg/m2. From 3,346 participants, 23.3% of the study participants were affected by malnutrition (10.8% and 12.5% were overweight and underweight, respectively). The prevalence of underweight was increased significantly among individuals aged 45-54 years and 55-64 years (adjusted odds ratio (AOR) 1.70 and 1.93, respectively) compared with those who were 25-34 years old. Belonging to households with higher wealth index quintile (2nd quintile AOR is 0.58 and 4th quintile AOR is 0.66) has decreased the chance of adult individual to be underweight compared with the poorest households. On the other hand, the prevalence of overweight was significantly higher among females (AOR 1.60), urban residents (AOR 1.72), those with formal education (primary AOR 1.89 and secondary and above AOR 1.94), and higher wealth index (5th quintile AOR 1.87). CONCLUSION: One in five adult individuals was malnourished in the study area. The double burden of malnutrition at the population level is becoming a challenge for this community, as both underweight and overweight are becoming prevalent. Sex, age, residency, educational status, current tobacco use, occupation, and wealth index were identified as important determinates of under- and overweight.

Anemia and its associated factors among school-age children living in different climatic zones of Arba Minch Zuria District, Southern Ethiopia.

BACKGROUND: Anemia, defined as a low blood hemoglobin concentration, has been shown to be a major public health concern in low-income countries like Ethiopia. School-age children are the most vulnerable population groups for anemia. The aim of this study was to assess the prevalence of anemia, with consideration of altitudinal variations, and to identify factors associated with anemia among school-age children. METHODS: A community-based cross-sectional study was conducted from April to May 2017 among randomly selected 391 school-age children (6 to 14 years) in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. Hemoglobin concentration was measured on the spot using portable hemoglobinometer (HemoCue Hb 201). The hemoglobin cut off values, adjusted for child age and altitude, were used to define anemia. Stool microscopic examination was done for investigation of intestinal parasites. A binary logistic regression model was used to assess the possible association of independent and outcome variables. RESULTS: The overall prevalence of anemia was 37.3% (146); (95% CI: 32.5, 42.2). Among those who were anemic, 110 (28.1%) and 35 (9%) had mild (Hb 11-11.4 g/dl for children age from 6 to 11 years and 11-11.9 g/dl for children age from 12 to 14 years) and moderate (Hb 8-10.9 g/dl) anemia respectively. A single case of severe (Hb < 8 g/dl) anemia was identified. Fifty-seven (46.3%) of children living in an altitude ≥ 2500 m above sea level were anemic. Anemia was higher among children who were positive for intestinal parasitic infections (AOR = 3.30, 95% CI: 2.04, 5.35) and children not-enrolled to schools (AOR = 2.05, 95%CI: 1.26, 3.32). Anemia was less common among children who had no habit of eating vegetables in the last week prior to the survey (AOR = 0.35, 95%CI: 0.14, 0.84). CONCLUSIONS: More than one-third of school-age children were suffering from anemia. Intestinal parasitic infections and school non-enrollment were among the major factors associated with anemia among school-age children in the study area. Interventions, focusing on identified contributing factors need to be implemented by integrating with other school or community-based health programs.

Prevalence and factors associated with stunting and thinness among school-age children in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia.

INTRODUCTION: Despite consistent economic growth in the country, malnutrition remains one of the major public health problems in Ethiopia. The prevalence of malnutrition and its associated factors are well studied among under-five children. However, there is a paucity of evidence among older children in developing countries including Ethiopia. The aim of the study was to assess the prevalence of stunting and thinness and their associated factors among school-age children. METHODS: A community-based cross-sectional study was conducted among randomly selected 389 school-age children in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia, during April and May 2017. Height for age and body mass index for age z scores were calculated using WHO Anthro Plus software as indicators of stunting and thinness respectively. A binary logistic regression model was used to assess the association between independent and outcome variables. RESULTS: The prevalence of stunting and thinness were 41.9% (95% CI: 37-47) and 8.0% (95% CI: 5.4-10.8) respectively. The likelihood of stunting was significantly higher among children within the age group of 12-14 years old (AOR = 2.97, 95% CI: 1.78-4.95); children who were male (AOR = 1.94, 95% CI: 1.21-3.10); children living in households with medium wealth terciles (AOR = 2.90, 95%CI: 1.39-6.04); and children who were non-enrolled in schools (AOR = 2.25, 95% CI: (1.37-3.70). Moreover, thinness was 63% less common among children who had a dietary diversity score of <4 food groups (AOR = 0.37, 95%CI: 0.16-0.89). CONCLUSION: The prevalence of thinness is low when compared to the prevalence reported by a single national school health and nutrition survey in Ethiopia. Stunting is a major public health concern. Therefore, this finding warrants the need to implement school health and nutrition programs to improve the nutritional status of school-age children in the study area. The interventions should focus towards both gender and special emphasis should also be given to increase the enrollment of children in schools. In addition, effort should be taken by stakeholders in different hierarchies to improve the family wealth status.