Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study.

INTRODUCTION: Ethiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, the prevalence of household willingness to join the community-based health insurance (CBHI) program and its associated factors are less explored in urban area. Therefore, this study was aimed to assess the prevalence of willingness to join community-based health insurance program and its associated factors among households in Nekemte City, Ethiopia. METHODS: A community-based cross-sectional study was conducted on 422 randomly selected households in Nekemte City, Ethiopia. Bivariate and multivariable analyses were performed to see the association between the independent and outcome variables using binary logistic regression model. Association was described using an adjusted odd ratio (AOR) and a 95% confidence interval (CI). Finally, p-value < 0.05 was considered the cut-off point for declaring a significant. RESULTS: Among 422 study participants, 320 (75.83%) [95% CI = 71.5-79.8%)] of the households were willing to join community-based health insurance program. The willingness to join for community-based health insurance was 3.11 times more likely among households who were in the richest quintile (AOR = 3.11; 95% CI = 1.08-8.93), 3.4 times more likely among those who were merchants (AOR = 3.40;1.33, 8.69), 2.52 times more likely among those who had history of chronic illness in the household (AOR = 2.52; 95% CI = 1.43-4.45), 4.09 times more likely among those who had the awareness about the scheme (AOR = 4.09; 95% CI = 1.97-8.47) and 3.29 times more likely among those who had the experience of borrow for medical care (AOR = 3.29; 95% CI = 1.48-7.30). CONCLUSION: Nearly three fourth of the households were willing to join community-based health insurance program, however, about one fourth of households were not willing, which is a significant public health problem. Being merchant, having awareness about the scheme, being in the richest wealth quintile, having experience of borrowing for medical care, and having history of chronic illness in the household were factors found to be significantly associated with willingness to join community based health insurance in the study area. Therefore, strengthening awareness creation at community level about the benefit package and principle of the program would increase their demand for the community-based health insurance scheme.

Effect of enset (Ensete ventricosum) varieties and fermentation time on nutritional compositions, antinutritional factors, functional properties, and sensory acceptance of Bulla.

The effect of enset varieties and fermentation time on the nutritional composition, antinutritional content, functional properties, and sensory acceptance of bulla was assessed. Bulla samples were prepared from newly improved enset varieties yanbule, gewada, zereta, and messina and were fermented for 0, 15, and 30 days. The result revealed that bulla prepared from gewada had relatively better values of fat (0.3 g/100 g), fiber (1.04 g/100 g), carbohydrate (97.7 g/100 g), energy (394.2 Kcal), and Fe (2.54 mg/100 g). Yanbule had relatively higher ash content (1.05 g/100 g) and considerably higher Ca (317.9 mg/100 g) than bulla prepared from the other varieties. Mg (56.8 mg/100 g) and Zn (2.3 mg/100 g) were relatively higher in bulla prepared from Messina. A very low level of tannin was detected only for gewada, but high contents of phytate up to 112.5 mg/100 g were obtained. With respect to the functional properties of bulla fermented for 30 days, no significant differences were observed among the varieties except for water absorption capacity. In terms of sensory quality, bulla porridge prepared from yanbule had comparatively higher overall acceptability score (7.6).

Knowledge, Practice, and Availability of Iodized Salt and Associated Factors in Jibat Woreda, West Shoa Zone, Ethiopia.

Appropriate knowledge, practice, and availability of iodized salt are used to eliminate iodine deficiency disorders. However, little is known about the availability of adequately iodized salt in the western part of Ethiopia. Thus, the aim of this study was to assess knowledge, practice, and availability of iodized salt and associated factors at household level in Jibat woreda, Ethiopia. Community-based cross-sectional study was conducted using structured and pretested questionnaire interview. Sampling salt was tested by the iodometric titration method. The result showed that iodine content more than 90% was considered as adequately iodized salt. The result of this study shown that among the 357 salt samples, 191(53.5%) households had good knowledge on iodized salt while 166 (46.5%) had poor knowledge on iodized salt. In addition, the result of the study revealed that 162 (45.4%) had good practice of iodized salt, whereas 195 (54.6%) had poor practice of iodized salt. The result of this study also shown that 149 (41.7%) households were using adequately iodized salt while 208 (58.3%) were using inadequate iodized salt in study area. Residence area, education level, household job, and average monthly income were significantly associated with knowledge of iodized salt at household level. Residence area, educational level, average monthly income, and expose to sunlight were significantly associated with availability of adequately iodized salt. In this finding, the knowledge and practices of iodized salt at household level in Jibat woreda, Ethiopia, were poor, and the availability of iodine in iodized salt was inadequate. This is associated to residence area, education level of household, and average monthly income. Therefore, any concerned body/institution should have to work in the above gabs of the knowledge, practice, and availability of iodized salt.

Nutritional and antinutritional evaluation of complementary foods formulated from maize, pea, and anchote flours.

This study was aimed to evaluate nutritional and antinutritional contents of complementary foods from locally available and affordable raw materials (maize, pea, and anchote) grown in Western Ethiopia. The six formulated complementary diets analyzed for their proximate, mineral, and antinutritional continents were compared with Codex standards. The mineral ratios and molar ratios of the formulated diets were also evaluated and compared with each standard values. Six formulations were generated by d-optimal mixture design. The formulated ingredient ranges 45%-61% maize, 23%-31% pea, and 14%-28% anchote. Design-Expert® 6 (Stat-Ease) was used to constrain the three components. The formulated diets ranged from 14.92% to 20.99%, 5.95% to 9.94%, 2.75% to 3.41%, and 59.10% to 66.22% of protein, fat, fiber, and utilizable carbohydrate, respectively. Mineral contents (mg/100 g) of the formulated diet ranged from 225.45 to 261.32, 11.48 to 12.61, 2.73 to 3.00, 357.92 to 391.13, 298.55 to 332.63, 252.00 to 278.01, and 44.26 to 51.56 for calcium, iron, zinc, phosphorous, potassium, sodium and magnesium, respectively. The proximate and mineral contents of the formulated diet 5 meet the Codex standards, except the fat contents of the complementary food standards. The molar ratios of the formulated diets in this study were below standard reference and which show the high mineral bioavailability in all the formulated diets. The results of the study revealed that the formulated diets contain very low antinutritional factors and high mineral bioavailability. The paper's findings show that the complementary food formulated from maize, pea, and anchote flours particularly diet 5 may be suitable to alleviate protein energy malnutrition and it can be used as a substitute for the expensive commercial complementary food.

Nutritional and alcoholic contents of cheka: A traditional fermented beverage in Southwestern Ethiopia.

Cheka is a cereal and vegetable-based beverage which is consumed in Southwestern parts of Ethiopia particularly in Dirashe and Konso. In this study, nine cheka samples were collected from vending houses in Konso and Dirashe districts for the laboratory analysis of the nutritional profile and chemical properties of cheka. The pH and titratable acidity of the samples ranged from 3.53-3.99 and 0.80%-1.11%, respectively. The total solids, crude protein, crude fat, crude fiber, total ash, carbohydrate, and gross energy contents of the samples ranged from 21.05%-26.87%, 3.12-4.44 g/100 g, 1.17-1.81 g/100 g, 0.94-1.27, 0.65-0.93 g/100 g, 14.16-19.03 g/100 g, and 82.04-107.17 Kcal, respectively. The dietary Ca, Fe, and Zn content of the samples were ranged from 8.31-19.60 mg/100 g, 13.94-27.59 mg/100 g and 0.82-1.07 mg/100 g, respectively. The methanol and ethanol contents of the cheka samples ranged from 163.1-2,380 ppm and 3.04%-8.96% v/v, respectively. The findings of this study indicated that cheka has low nutrient content and thus, suggests that people in Konso and Dirashe should not rely on it without eating solid foods as it is almost always diluted with a significant amount of water. In conclusion, the longer fermentation time of cheka resulted in high methanol levels that can present adverse health effects to consumers.

Indigenous Ethiopian okra (Abelmoschus esculentus) mucilage: A novel ingredient with functional and antioxidant properties.

Functional and antioxidant properties of mucilage extracted from the pods of eight okra accessions grown in Benishangul-Gumuz region, Western Ethiopia, were evaluated. This study had shown that the mucilage contents of the pods of eight okra accessions ranged from 1.25 to 3.45 g/100 g. Functional properties of the mucilage of okra pods varied significantly (p < .05) and had respective ranges of bulk density of 0.58-0.64 g/ml; water absorption capacity of 2.45-4.60 ml/g; oil absorption capacity of 0.02-3.64 ml/g; emulsifying capacity of 42.22%-74.45%; emulsion stability of 42.22%-74.45%; foaming capacity of 50.51%-62.50%, and foam stability of 36.04%-54.35%. Total phenolic and flavonoid contents of the mucilage of the pods of okra accessions ranged from 4.66 to 49.93 mg GAE/g and 8.18-18.72 mg CE/g, respectively. The effective concentration (EC 50) values (mg/ml) of mucilage of okra pods varied from 3.15 to 6.60 and 1.10 to 1.85 for DPPH scavenging and metal-chelating activity, respectively. The study revealed that the mucilage of the pods of okra accessions was found to exhibit good functional properties and can offer a great potential in various food systems. Particularly, mucilage of the pods from OPA#5 and OPA#7 had desirable water and oil absorption capacities, whereas the mucilage of accession OPA#1 and OPA#6 had high emulsifying and foaming properties. The results also demonstrated that okra pod mucilage had potential sources of natural antioxidant.

Effect of conventional milling on the nutritional value and antioxidant capacity of wheat types common in Ethiopia and a recovery attempt with bran supplementation in bread.

The effect of wheat flour refined milling on nutritional and antioxidant quality of hard and soft grown in Ethiopia was evaluated. Bread was prepared with the supplementation of the white wheat flour with different levels (0%, 10%, 20%, and 25%) of wheat bran. Whole (100% extraction) and white wheat (68% extraction) flours were analyzed for proximates, minerals, and antioxidants. Results indicated that at a low extraction rate (68%), the protein, fat, fiber, ash, iron, zinc, phosphorous, and antioxidant contents of the samples significantly (P < 0.05) decreased by milling. The TPC (total phenolic content) of the white wheat flours, which ranged from 3.34 to 3.49 mg GAE (gallic acid equivalent)/g, was significantly (P < 0.005) lower than those of the whole wheat flours, whose TPC ranged from 7.66 to 8.20 GAE/g). At 50 mg/mL, the DPPH (2-diphenyl-1-picrylhydrazyl) scavenging effect of the wheat extracts decreased in the order of soft whole, hard whole, soft white, and hard white wheat flour, which was 90.39, 89.89, 75.80, and 57.57%, respectively. Moreover, the proximate and mineral contents of the bran-supplemented breads increased significantly (P < 0.05) with the bran level of the bread, and the highest values (protein, 12.0 g/100 g; fat, 2.6 g/100 g; fiber, 2.5 g/100 g; ash, 3.3 g/100 g; iron, 4.8 mg/100 g and zinc, 2.33 mg/100 g) were found in 25% bran supplemented bread. The sensory evaluation of bread showed that all the supplementation levels had a mean score above 4 for all preferences on a 7- point hedonic scale. The results indicated that refined milling at 68% extraction significantly reduces the nutritional and antioxidant activity of the wheat flours. Bread of good nutritional and sensory qualities can be produced from 10% and 20% bran supplementations.

Proximate, mineral, and antinutrient compositions of indigenous Okra (Abelmoschus esculentus) pod accessions: implications for mineral bioavailability.

The promotion and consumption of indigenous vegetables could help to mitigate food insecurity and alleviate malnutrition in developing countries. Nutrient and antinutrient compositions of eight accessions of Okra Pods were investigated. Molar ratios and mineral bioavailability of Okra pod accessions were also calculated and compared to the critical values to predict the implications for mineral bioavailability. Proximate and mineral composition of Okra pod accessions were determined using standard methods of Association of Official Analytical Chemists. The result of the study revealed that the proximate composition (g/100 g) in dry weight basis was significantly (P < 0.05) varied and ranged: moisture/dry matter 9.69-13.33, crude protein 10.25-26.16, crude fat 0.56-2.49, crude fiber 11.97-29.93, crude ash 5.37-11.30, utilizable carbohydrate 36.66-50.97, and gross energy 197.26-245.55 kcal/100 g. The mineral concentrations (mg/100 g) were also significantly (P < 0.05) varied and ranged: calcium (111.11-311.95), Iron (18.30-36.68), potassium (122.59-318.20), zinc (3.83-6.31), phosphorus (25.62-59.72), and sodium (3.33-8.31) on dry weight bases. The Okra Pods of "OPA#6" accession contained significantly higher amounts of crude protein, total ash, crude fat, calcium, iron, and zinc than all other accessions evaluated in this study. The results of antinutrients analysis showed that, except phytate, tannin, and oxalate contents of all the accessions were significantly (P < 0.05) varied. The range of phytate, tannin, and oxalate contents (mg/100 g) for Okra pod accessions studied were as follows: 0.83-0.87, 4.93-9.90, and 0.04-0.53, respectively. The calculated molar ratios of phytate: calcium, phytate: iron, phytate: zinc, oxalate: calcium and [Phytate][Calcium]/[Zinc] were below the critical value and this indicate that the bioavailability of calcium, iron, and zinc in these accessions could be high. The results of the study revealed that Okra pod contain appreciable amount of vital nutrients like protein, fiber, calcium, iron, and zinc and low in antinutrient contents with high mineral bioavailability. Therefore, increase in the production and consumption of these nutrient-rich indigenous Okra pods will help to supplement/formulate the diets and alleviate the problems associated with malnutrition in the country.