Quantitative microbial risk assessment for Escherichia Coli O157: H7 via drinking water in the Gaza Strip, Palestine.

Introduction: Microbial contamination of drinking water, particularly by pathogens such as Escherichia coli O157: H7, is a significant public health concern worldwide, especially in regions with limited access to clean water like the Gaza Strip. However, few studies have quantified the disease burden associated with E. coli O157: H7 contamination in such challenging water management contexts. Objective: This study aimed to conduct a comprehensive Quantitative Microbial Risk Assessment to estimate the annual infection risk and disease burden attributed to E. coli O157: H7 in Gaza's drinking water. Methods: Applying the typical four steps of the Quantitative Microbial Risk Assessment technique-hazard identification, exposure assessment, dose-response analysis, and risk characterization-the study assessed the microbial risk associated with E. coli O157: H7 contamination in Gaza's drinking water supply. A total of 1317 water samples from various sources across Gaza were collected and analyzed for the presence of E. coli O157: H7. Using Microsoft ExcelTM and @RISKTM software, a Quantitative Microbial Risk Assessment model was constructed to quantify the risk of infection associated with E. coli O157: H7 contamination. Monte Carlo simulation techniques were employed to assess uncertainty surrounding input variables and generate probabilistic estimates of infection risk and disease burden. Results: Analysis of the water samples revealed the presence of E. coli O157: H7 in 6.9% of samples, with mean, standard deviation, and maximum values of 1.97, 9.74, and 112 MPN/100 ml, respectively. The risk model estimated a median infection risk of 3.21 × 10-01 per person per year and a median disease burden of 3.21 × 10-01 Disability-Adjusted Life Years per person per year, significantly exceeding acceptable thresholds set by the WHO. Conclusion: These findings emphasize the urgent need for proactive strategies to mitigate public health risks associated with waterborne pathogens in Gaza.

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis.

Background: As defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD). Methods: Observational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase. Results: Of 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15-1.27], I 2 = 0%), (1.53 [95% CI: 1.26-1.84], I 2 = 84%), and (2.24 [95% CI: 1.57-3.19], I 2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44-2.03], I 2 = 0%) and severe (aHR 2.66 [95% CI: 1.82-3.89], I 2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively. Conclusion: As defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

Effect of bariatric surgery on endogenous sex hormones and sex hormone-binding globulin levels: a systematic review and meta-analysis.

BACKGROUND: Most studies have shown beneficial effect of bariatric surgery (BS) on serum levels of sex hormones. OBJECTIVE: A systematic review and meta-analysis was conducted to examine the magnitude of possible changes in levels of sex hormones following BS. SETTINGS: Electronic databases were searched, including PubMed, Scopus, Web of Science, and Embase, for relevant studies. METHODS: The heterogeneity of the studies was examined by χ2 tests and the degree of heterogeneity was estimated using I2 statistic. RESULTS: The results of pooled analyses revealed that BS caused a significant increase in luteinizing hormone (LH), follicular stimulating hormone (FSH), total testosterone (TT), and sex hormone binding globulin (SHBG) levels and conversely, decreased dehydroepiandrosterone (DHEA) and estradiol (E2) levels in males. For females, BS significantly increased LH, FSH, and SHBG levels and conversely, decreased androstenedione (AE), E2 and TT levels. Additionally, the level of progesterone (P), prolactin (PRL), free testosterone (FT) and dehydroepiandrosterone sulfate (DHEA-S) showed no significant changes in patients who had undergone BS. CONCLUSION: BS changed most sex hormones levels including LH, FSH, TT, SHBG, AE, DHEA, and E2. It seems that BS is able to exert substantial impacts on sex hormones levels and as well as sexual function, however, larger, and more precise trials are required to specifically focus on these claims.

Sociodemographic Factors Predicting Exclusive Breastfeeding in Ethiopia: Evidence from a Meta-analysis of Studies Conducted in the Past 10 Years.

OBJECTIVES: To investigate the association between EBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. METHODS: PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases were searched using key terms for all studies published in English between September 2009 and March 2019. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran's Q test, τ2, and I2 statistics. In addition, Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis were conducted. RESULTS: Out of 553 studies retrieved, 31 studies fulfilled our inclusion criteria. Almost all included studies were conducted among mothers with newborn less than 23 months old. Maternal primary school education (OR 1.39; 95% CI 1.03-1.89; I2 = 86.11%), medium household income (OR 1.27; 95% CI 1.05-1.55; I2 = 60.9%) and being married (OR 1.39; 95% CI 1.05-1.83; I2 = 76.96%) were found to be significantly associated with EBF. We also observed an inverse dose-response relationship of EBF with educational status and income. However, EBF was not significantly associated with parity, media exposure, and paternal educational status. CONCLUSIONS: In this meta-analysis, we showed the relevant effect of maternal education, income, and marital status on EBF. Therefore, multifaceted, effective, and evidence-based efforts are needed to increase the national level of exclusive breastfeeding in Ethiopia.

The state of child nutrition in Ethiopia: an umbrella review of systematic review and meta-analysis reports.

BACKGROUND: Malnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia. METHODS: PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models. RESULT: We included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI = 37-46%), 33% (95%CI = 27-39%), and 15% (95%CI = 12-19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65, 60, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors. CONCLUSION: Child malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only a few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children's feeding practices and reduce the high burden of malnutrition in the country.

Birth Weight and Risk of Cardiovascular Disease Incidence in Adulthood: a Dose-Response Meta-analysis.

PURPOSE OF REVIEW: Studies have revealed a relation between birth weight (BW) and later risk of cardiovascular diseases (CVDs). This meta-analysis aimed to report the dose-response relationship between BW and risk of CVDs. RECENT FINDINGS: The relation of BW to CVD subtypes was found to be U-shaped as BW below ~ 2500 g and above ~ 4000 g affected positively CVD risk (OR = 1.14 = 95%CI 1.03-1.27 and OR = 1.08; 95%CI 0.99-1.18, respectively). Regarding CVD subtypes, low BW was directly linked to greater risk of CHD (OR = 1.15; 95%CI 1.02-1.29) and stroke (OR = 1.28; 95% CI 1.05-1.55), while high BW was related to increased risk of arterial fibrillation in adulthood. A U-shaped nonlinear relationship was specifically demonstrated between BW and overall CVD and its subtypes. There is a U-shaped association between BW and all CVD subtypes.

Higher educational and economic status are key factors for the timely initiation of breastfeeding in Ethiopia: A review and meta-analysis.

AIM: To investigate the association between initiation of breastfeeding within 1 hour after birth (TIBF) and maternal educational status, paternal educational status, household income, marital status, media exposure and parity in Ethiopia. METHODS: We searched PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases. All studies were conducted in Ethiopia and published from 2000 to 2019 were included. To obtain the pooled odds ratio (OR), data were fitted in random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran's Q test, τ2 and I2 statistics. This meta-analytic review was reported in compliance with the PRISMA statement. RESULTS: Out of 553 studies retrieved, 25 fulfilled our inclusion criteria. High maternal educational status (P < .001), paternal educational status (P = .001) and household income (P = .002), being married (P = .001) and multiparity (P = .01) were significantly associated with TIBF. There was no significant publication bias. CONCLUSIONS: Our meta-analysis showed that TIBF was associated with high educational and economic status, being married and multiparity. This suggests that the meta-analysis detected small associations that many previous studies in Ethiopia have not been able to show. Our findings can be useful for comparisons with other countries.

Melatonin supplementation and pro-inflammatory mediators: a systematic review and meta-analysis of clinical trials.

BACKGROUND: Inflammatory processes are involved in chronic diseases. It has been suggested that melatonin reduces inflammation by its radical scavenging properties; however, the results of the previous studies are inconclusive. The objective of the present meta-analysis is to determine the direction and magnitude of melatonin supplementation effect on inflammatory biomarkers. METHODS: Databases including PubMed, Scopus, Cochran Library, Embase, and Google Scholar were searched up to April 2019. Meta-analysis was performed using random-effect model. Subgroup analysis, sensitivity analysis, and meta-regression were also carried out. RESULTS: Thirteen eligible studies with 22 datasets with total sample size of 749 participants were included in the meta-analysis. Melatonin supplementation significantly decreased TNF-α and IL-6 levels [(WMD = - 2.24 pg/ml; 95% CI - 3.45, - 1.03; P < 0.001; I2 = 96.7%, Pheterogeneity < 0.001) and (WMD = - 30.25 pg/ml; 95% CI - 41.45, - 19.06; P < 0.001, I2 = 99.0%; Pheterogeneity < 0.001)], respectively. The effect of melatonin on CRP levels was marginal (WMD = - 0.45 mg/L; 95% CI - 0.94, 0.03; P = 0.06; I2 = 96.6%, Pheterogeneity < 0.001). CONCLUSION: The results of the present meta-analysis support that melatonin supplementation could be effective on ameliorating of inflammatory mediators.

Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies.

OBJECTIVE: Low neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual's own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019. ELIGIBILITY CRITERIA: Epidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included. DATA EXTRACTION AND SYNTHESIS: Data extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran's Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger's regression test. RESULT: A total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001). CONCLUSION: NSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity. PROSPERO REGISTRATION NUMBER: CRD42017063889.

The contribution of dietary and non-dietary factors to socioeconomic inequality in childhood anemia in Ethiopia: a regression-based decomposition analysis.

OBJECTIVE: There is a scarcity of evidence on socioeconomic inequalities of childhood anemia in Ethiopia. We determined the magnitude of socioeconomic inequality in anemia and the contribution of dietary and non-dietary factors to the observed inequality, using a nationally representative data of 2902 children included in the 2016 Ethiopian demographic and health survey. The data were collected following a multistage, stratified cluster sampling strategy. We followed the Blinder-Oaxaca regression-based approach to decompose the inequality and determine the relative contribution (%) of the dietary and non-dietary factors to the observed inequality. RESULT: We found a significant pro-poor socioeconomic inequality in childhood anemia in Ethiopia. A third (~ 33%) of the inequality was attributable to compositional differences in the dietary determinants of anemia (dietary diversity, meal frequency, and breastfeeding factors). Non-dietary factors like residence place, maternal education, and birth weight) jointly explained ~ 36% of the inequality. Maternal education was the single most important factor, accounting alone for ~ 28% the inequality, followed by rural residence (~ 17%) and dietary diversity (~ 16%). Efforts to narrow socioeconomic gaps and/or designing equity sensitive interventions by prioritizing the poor in health/nutrition interventions stands worth of consideration to reduce the burden of childhood anemia in Ethiopia and beyond.

Household, maternal, and child related determinants of hemoglobin levels of Ethiopian children: hierarchical regression analysis.

BACKGROUND: Anemia remains a major public health problem among children under five years old in Ethiopia, rising unexpectedly from 44% national prevalence in 2011 to 57% in 2016. In this study, we investigated the household, maternal and child-related dietary and non-dietary factors associated with hemoglobin (Hb) level of infants and young children. METHOD: We analyzed data from a nationally representative sample of 2902 children aged 6-23 months, included in the 2016 Ethiopian demographic and health survey (EDHS). Hierarchical linear regression analysis was done to identify the factors associated with Hb level. We reported adjusted ß (aß) with 95% confidence interval (CI). RESULT: Overall, 72% of children under 2 years of age were anemic in Ethiopia in 2016. Household factors: rich household wealth category (aß = 0.48, 95%CI = 0.33-0.63, P < 0.001), and agrarian regions (aß = 0.64, 95%CI = 0.40-0.88, P < 0.001) were significantly associated with a higher mean Hb level. Maternal factors: secondary and above education level (aß = 0.69, 95%CI = 0.23-1.16, P = 0.004), and being not anemic (aß = 0.40, 95%CI = 0.26-0.53, P < 0.001) were significantly associated with a higher mean Hb level. Child factors: age below 12 months (aß = 0.72, 95%CI = 0.57-0.88, P < 0.001), female sex (aß = 0.16, 95%CI = 0.03-0.30, P = 0.019), being not underweight (aß = 0.22, 95%CI = 0.02-0.42, P = 0.031), average birth size (aß = 0.25, 95%CI = 0.08-0.42, P = 0.003), no history of recent infection (aß = 0.18, 95%CI = 0.02-0.33, P = 0.025), currently breastfeeding (aß = 0.28, 95%CI = 0.12-0.44, P = 0.002), vitamin A supplementation (aß = 0.17, 95%CI = 0.06-0.28, P = 0.021), and frequent meal feeding (aß = 0.11, 95%CI = 0.05-0.16, P = 0.034) were significantly associated with a higher mean Hb level. CONCLUSION: Hb level was associated with various dietary and non-dietary influences originating from household, maternal, and child levels. A comprehensive approach, addressing the multi-factorial nature of Hb status, might stand an important consideration to reverse the recent rise in anemia prevalence in Ethiopia.

Socioeconomic inequality in stunting among under-5 children in Ethiopia: a decomposition analysis.

OBJECTIVE: Ethiopia bears a high stunting burden. However, there is a paucity of evidence on the socioeconomic inequalities of stunting in Ethiopia. Thus, this study was aimed to determine the degree of socioeconomic inequality in stunting and decompose it to the social determinants of stunting. We used a nationally representative sample of 8855 children, aged below 5 years, from the Ethiopian demographic and health survey, conducted in 2016. Subjects were recruited following a two-stage cluster sampling. The socioeconomic status was measured by the household wealth index, categorized into quantiles. The inequality in stunting between the poorest and the richest socioeconomic groups was decomposed into its contributing social factors following the Blinder-Oaxaca decomposition approach. RESULT: The overall prevalence of stunting was 38%, with a significant pro-poor socioeconomic inequality. The prevalence of stunting among the poorest and the richest socioeconomic categories was 45.1% and 26.9%, respectively. Caregivers education status was the main contributor, accounting alone for 33% of the socioeconomic inequality in stunting, followed by region of residence (11%) and birth size (6%). Equity sensitive interventions, which prioritize the vulnerable groups might help to narrow the socioeconomic inequality as well as fasten the progress towards the goal of stunting reduction.

Food taboo among pregnant Ethiopian women: magnitude, drivers, and association with anemia.

BACKGROUND: There are pervasive pregnancy-related food taboos and myths (PRFT) in Ethiopia. The evidence, however, is limited on whether PRFT contributes to the burden of maternal anemia. Thus, this study was aimed to determine the magnitude of PRFT, the reasons for adherence to PRFT, and the association of adherence to PRFT with anemia, among pregnant Ethiopian women. METHODS: The study was case-control in design and recruited a sample of 592 pregnant women attending antenatal care in four health facilities in Addis Ababa, Ethiopia. Participants were classified into anemic cases (n = 187) and non-anemic controls (n = 405) based on their hemoglobin level. PRFT was assessed by the participants' subjective reporting of avoidance of certain food items during the current pregnancy due to taboo reasons. The specific types of food items avoided and the underlying reasons for the avoidance were also assessed. The relation of PRFT with anemia was evaluated by multiple logistic regression analysis, controlling for covariate factors. RESULT: Almost a fifth of the study participants (18.2%) avoided one or more food items due to PRFT. Adherence to PRFT was 26.2 and 14.6% among the anemic and the non-anemic individuals, respectively. The food items most avoided due to adherence to PRFT were green chili pepper, organ meat, and dark green leafy vegetables like spinach, lettuce, kale, and broccoli. The underlying reasons for the adherence to PRFT were largely traditionally held beliefs and misconceptions. After controlling for covariates, PRFT was significantly and independently associated with a higher odds of anemia [adjusted odds ratio (AOR) = 2.12, 95% confidence interval (CI) = 1.32-3.42, P = 0.002]. CONCLUSION: PRFT might be contributing to the burden of maternal anemia in Ethiopia. It is time for public health authorities in Ethiopia to recognize PRFT as a public health risk, strengthen maternal nutrition counseling, and create public awareness of the consequences of PRFT. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03251664), 16 August 2017.

Biomedical and public health reviews and meta-analyses in Ethiopia had poor methodological quality: overview of evidence from 1970 to 2018.

OBJECTIVES: The aims of this overview are to assess the trend of narrative and systematic reviews in Ethiopia, examine their methodological quality, and suggest future directions for improvement. STUDY DESIGN AND SETTING: All narrative reviews and systematic reviews with or without a meta-analysis on topics associated with Ethiopia irrespective of the place of publication and authors' affiliation were included. The International Narrative Systematic Assessment for narrative reviews and A MeaSurement Tool to Assess Systematic Reviews for systematic reviews with or without a meta-analysis were used for quality appraisal. Fisher's exact test at the P-value threshold of 0.05 was used to investigate associated factors of methodological quality. RESULTS: Of 106 articles reviewed, 54 (50.9%) were narrative reviews, 17 (16%) were systematic reviews, and 35 (33.1%) were systematic reviews with meta-analyses. Among 48 systematic reviews with or without meta-analysis, only five (10.4%) registered their protocol, four (8.3%) justified the selection of the study design for inclusion, and none of them reported sources of funding for the primary studies. Overall, 55.3% of narrative reviews and 75% of systematic reviews with or without meta-analysis had poor methodological quality. CONCLUSIONS: Although publication rate of narrative and systematic reviews has risen in Ethiopia, half of the narrative reviews and three-quarters of the systematic reviews had poor methodological quality.

Concurrent anemia and stunting in young children: prevalence, dietary and non-dietary associated factors.

BACKGROUND: The existing evidence is limited and contradicting on the co-occurrence of anemia and stunting (CAS) at individual level, despite a great overlap in their risk factors. We aimed to determine the prevalence of CAS, and the dietary and non-dietary factors associated with it, among infants and young children in Ethiopia. METHOD: We used a nationally representative sample of 2902 children aged 6-23 months from the Ethiopian demographic and health survey, conducted in 2016. The study was cross-sectional in design. Samples were selected by two-stage clustering sampling method. CAS prevalence was estimated by various sociodemographic factors. To identify the dietary and non-dietary factors associated with CAS, we conducted hierarchical logistic regression analyses. RESULT: The overall prevalence of CAS was 23.9%. The dietary factors found significantly linked to lower odds of CAS were use of vitamin A supplement [adjusted odds ratio (AOR) = 1.19, 95%CI = 1.06-1.33, P = 0.003], consumption of vitamin A rich fruit and vegetables (AOR = 1.15, 95%CI = 1.04-1.27, P = 0.006), meat (AOR = 1.55, 95%CI = 1.17-2.05, P = 0.002), legumes (AOR = 1.38, 95%CI = 1.05-1.81, P = 0.021), and meal frequency > 3 (AOR = 1.22, 95%CI = 1.04-1.37, P = 0.020). The non-dietary household and child factors found significantly linked to higher odds of CAS were rural residence (AOR = 1.29, 95%CI = 1.18-1.41, P < 0.001), low household wealth (AOR = 1.91, 95%CI = 1.53-2.39, P < 0.001), low caregivers' education level (AOR = 2.14, 95%CI = 1.33-3.44, P < 0.001), male sex (AOR = 1.25, 95%CI = 1.04-1.50, P = 0.015), age 12-23 months (AOR = 1.65, 95%CI = 1.57-1.73, P < 0.001), history of infection (AOR = 1.14, 95%CI = 1.00-1.30, P = 0.048), and small birth size (AOR = 1.99, 95%CI = 1.58-2.51, P < 0.001). CONCLUSION: Among infants and young children in Ethiopia, there was a concerning high level of CAS, which was associated with various dietary and non-dietary factors. Enhanced public health/nutrition interventions, with due emphasis on the multifactorial nature of CAS, might stand an important consideration to reduce the burden of CAS in Ethiopia and beyond.

Dietary and non-dietary determinants of linear growth status of infants and young children in Ethiopia: Hierarchical regression analysis.

INTRODUCTION: Childhood growth faltering remains a major public health problem in developing countries. We aimed to identify the distal, underlying, and proximal dietary and non-dietary factors associated with length-for-age (LFA) of infants and young children in Ethiopia. METHODS: We used a nationally representative sample of 2,932 children aged 6-23 months from the Ethiopian demographic and health survey (EDHS) conducted in 2016. Hierarchical regression analysis was done to identify the factors associated with LFA. FINDINGS: Pastoral residence (adjusted ß (aß) = -0.56, 95%CI = -0.82, -0.31, P<0.001) and poorest household wealth category (aß = -0.57, 95%CI = -0.66, -0.48, P<0.001) were the basic factors negatively associated with LFA. Among underlying factors, maternal wasting (aß = -0.43, 95%CI = -0.58, -0.28, P<0.001), and unimproved toilet facility (aß = -0.48, 95%CI = -0.73, -0.23, P<0.001) were negatively associated with LFA. Proximal factors found positively associated with LFA were dietary diversity (aß = 0.09, 95%CI = 0.043, 0.136, P<0.001), meal frequency (aß = 0.04, 95%CI = 0.00, 0.08, P = 0.042), and vitamin A supplementation (aß = 0.16, 95%CI = 0.03, 0.29, P = 0.020). Male sex (aß = -0.26, 95%CI = -0.39, -0.14, P<0.001), age (aß = -0.12, 95%CI = -0.13, -0.10, P = 0.001), small birth size (aß = -0.45, 95%CI = -0.62, -0.29, P<0.001), and not currently breastfeeding (aß = -0.29, 95%CI = -0.47, -0.11, P = 0.003) were negatively associated with LFA. CONCLUSION: LFA was associated with various influences at distal, underlying, and proximal levels. A multi-pronged approach, addressing the various factors comprehensively, would represent an important consideration to promote linear growth in early childhood in Ethiopia.

Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: Evidence from a meta-analysis on 10,603,067 subjects from 57 studies.

BACKGROUND & AIM: Previous studies have explored the relation of metabolic syndrome (MetS), its components and the risk of albuminuria/proteinuria but their results are inconsistent. Then, we aimed to conduct a meta-analysis in order to resolve these controversies. METHOD: PubMed and Scopus were systematically searched from their inception to 1 march 2018. Risk estimates and their 95% confidence intervals were extracted and pooled using the random-effects approach. RESULT: A total of 57 studies, 44 studies on albuminuria and 13 studies on proteinuria, with a total sample size of 10,603,067 participants, were included in this meta-analysis. Overall, MetS was contributed to higher risks of proteinuria (OR = 2.08, 95%CI = 1.85-2.34) and albuminuria (OR = 1.92, 95%CI = 1.71-2.15), independent of diabetes status; although, this relationship was more noticeable in studies that used the WHO definition of MetS and in non-East Asian populations. Also, the relationship between MetS and proteinuria was sex independent, while, for albuminuria was significant only in men. MetS components such as obesity, impaired fasting glucose, elevated blood pressure and hypertriglyceridemia were associated with significant increases in proteinuria and albuminuria risk, while lower HDL-Cholesterol was only linked to greater risk of proteinuria. Moreover, the total impact of MetS on proteinuria was more remarkable than each component of the syndrome and an escalating dose-response association was found between the number of MetS components and albuminuria risk. CONCLUSION: MetS and its components are potential risk factors for albuminuria and proteinuria.

Breast and complementary feeding in Ethiopia: new national evidence from systematic review and meta-analyses of studies in the past 10 years.

PURPOSE: The aim of this systematic review and meta-analysis was to provide a national estimate of breast and complementary feeding practices and its predictors in Ethiopia. METHODS: PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases were searched for all available literature published until April 2018. Observational studies including cross-sectional, case-control and cohort studies were included. Newcastle-Ottawa Scale was used to assess the quality of studies. Heterogeneity of studies was quantified using Cochran's Q χ2 statistic and Higgins's method (I2). A meta-analysis using a weighted inverse variance method was performed. Subgroup analysis was carried out based on region and study area. RESULTS: In total, 70 studies that involved > 55,000 women from nine regions and two chartered cities in Ethiopia were included. The pooled national prevalence for timely initiation of breastfeeding (TIBF), exclusive breastfeeding (EBF) and timely initiation of complementary feeding was 66.5%, 60.1% and 62.5%, respectively. Guidance and counselling on breastfeeding, vaginal delivery and health institution delivery significantly increased the odds of TIBF and EBF. In addition, TIBF significantly associated with high EBF practice. Maternal occupational status significantly associated with low EBF practice, but not TIBF. CONCLUSIONS: Based on the WHO standard, the current breast and complementary feeding practice in Ethiopia is good and improving. Integrated intervention is still required for further improvement and minimizing the effect of occupational status.

Teff consumption and anemia in pregnant Ethiopian women: a case-control study.

PURPOSE: Teff, an iron-rich staple grain in Ethiopia, is consumed mainly in the form of teff injera (TI). Studies on the association of TI consumption with anemia are limited. We aimed to determine the association of frequencies of TI consumption with anemia, in Addis Ababa, Ethiopia. METHODS: We conducted a hospital-based case-control study involving 592 pregnant women: 187 anemic cases, and 405 non-anemic controls. TI consumption was assessed by a food frequency questionnaire (FFQ). Multiple logistic regression, adjusted for dietary and non-dietary covariates, was performed to determine the relation of TI consumption to anemia status. RESULTS: We found that a decrease in frequency of TI consumption was significantly associated with an increase in the likelihood of anemia (p-trend = 0.009). Compared with everyday TI consumption, the adjusted odds ratios (AORs) of anemia associated with the other frequencies of teff consumption were 1.50 [95% confidence interval (CI) 0.71, 3.23; p = 0.285] for every other day, 2.13 (95% CI 1.03, 4.41; p = 0.04) for 1-2 times a week, and 3.17 (95% CI 1.62, 6.22; p < 0.001) for once in 2 weeks. CONCLUSIONS: Teff consumption was associated with reduced odds of anemia in pregnant women. Further studies are warranted, including determining the feasibility and effectiveness of TI use for anemia prevention. REGISTRATION: The study was registered as https://clinicaltrials.gov/ct2/show/NCT03251664 .