The effect of UNIMMAP multiple micronutrient supplements versus iron-folic acid and placebo in anemia reduction among women of reproductive age in Kebribeyah Woreda, Somali Regional State, Ethiopia: a study protocol for a community-based individual RCT.

BACKGROUND: Women of reproductive age (WRA) in developing countries are often at risk of micronutrient deficiencies due to inadequate intakes and excessive losses. OBJECTIVE: The purpose of this trial is to assess the effectiveness of United Nations International Multiple Micronutrient Antenatal Preparation-Multiple Micronutrient Supplements (UNIMMAP-MMS) versus iron-folic acid (IFA) among WRA in reducing anemia. METHODS: Three parallel groups of WRA will participate in a community-based, individually randomized, double-blinded, placebo-controlled superiority trial. After consent, the sample of 375 mildly or moderately anemic women based on hemoglobin by Hemocue will be randomly assigned across two interventions and one control arm. Trial participants in intervention arms will receive UNIMMAP-MMS or IFA while those in the control arm will receive placebos twice a week for 17 weeks. The primary outcome will be a change in mean hemoglobin (Hb) concentrations. Outcome assessors and study participants will be blinded to the type of supplements and study arm. DISCUSSION: The World Health Organization (WHO) added UNIMMAP-MMS to its essential medicine lists in 2021 but recommended rigorous study. Several factors in addition to inadequate intakes of iron and folic acid contribute to the high prevalence of anemia among WRA in the Somali region. The findings of this study will provide evidence on the effect of UNIMMAP-MMS and IFA on Hb concentrations and anemia prevalence among anemic WRA. TRIAL REGISTRATION: ClinicalTrials.gov NCT05682261. Registered on January 12, 2023.

Examining energy and nutrient production across the different agroecological zones in rural Ethiopia using statistical methods.

Poor-quality diets are of huge concern in areas where consumption is dominated by locally sourced foods that provide inadequate nutrients. In agroecologically diverse countries like Ethiopia, food production is also likely to vary spatially. Yet, little is known about how nutrient production varies by agroecology. Our study looked at the adequacy of essential nutrients from local production in the midland, highland, and upper highland agroecological zones (AEZs). Data were collected at the village level from the kebele agriculture office and at the farm and household levels through surveys in rural districts of the South Wollo zone, Ethiopia. Household data were acquired from 478 households, and crop samples were collected from 120 plots during the 2020 production year. Annual crop and livestock production across the three AEZs was converted into energy and nutrient supply using locally developed crops' energy and nutrient composition data. The total produced energy (kcal) met significant proportions of per capita energy demand in the highland and upper highland, while the supply had a 50% energy deficit in the midland. Shortfalls in per capita vitamin A supply decreased across the agroecological gradient from midland (46%) to upper highland (31%). The estimated shortfall in folate supply was significantly higher in the upper highlands (63%) and negligible in the highlands (2%). The risk of deficient iron and zinc supply was relatively low across all AEZs (<10%), but the deficiency risk of calcium was unacceptably high. Agroecology determines the choice of crop produced and, in this way, affects the available supply of energy and nutrients. Therefore, agroecological variations should be a key consideration when designing food system interventions dedicated to improving diets.

Association between normal-weight obesity and cardiometabolic risk factors among adults in Addis Ababa, Ethiopia.

The relationship between normal-weight obesity (NWO)-high percent body fat (%BF) in individuals with normal body mass index (BMI)-and cardiometabolic abnormalities has not been explored in Africa. We determined the prevalence of the NWO and evaluated its association with hypertension, elevated blood sugar and dyslipidaemia among adults in Addis Ababa, Ethiopia. A cross-sectional study was conducted among adults 18-64 years (n = 600). Blood pressure, blood glucose, lipid profile, and anthropometric measurements were completed. As a function of skinfold thickness, body density and %BF were estimated using Durnin & Womersley and Siri Equations, respectively. The relationship between the NWO and the outcomes of interest, assessed using adjusted linear and logit models. The age- and sex-standardised prevalence of NWO was 18.9% (95% confidence interval (CI) 15.8, 22.2%). Comparison between normal-weight lean (normal %BF and BMI) and normal-weight obese individuals suggested no difference in systolic blood pressure (ß = 2.55; 95% CI - 0.82, 5.92); however, diastolic blood pressure (ß = 3.77: 95% CI 1.37, 6.18) and odds of hypertension (adjusted odds ratio (AOR) = 2.46: 95% CI 1.18, 5.13) were significantly raised in the latter. Similarly, adults with NWO had elevated blood glucose (ß = 2.30; 95% CI 1.23, 15.66) and increased odds of high blood sugar level (AOR = 1.68; 95% CI 1.05, 2.67). LDL (ß = 8.73: 1.56, 15.90), triglyceride (ß = 20.99: 0.78, 41.22), total cholesterol (ß = 10.47: 1.44, 19.50), and Cholesterol to HDL ratio (ß = 0.65: 0.27, 1.04) were also raised among adults with NWO. NWO is common among adults in Addis Ababa and is associated with cardiometabolic derangements.

Cereal-based fermented foods as a source of folate and cobalamin: The role of endogenous microbiota.

Folate (vitamin B9) and cobalamin (vitamin B12) deficiencies potentially affect millions of people worldwide, leading to different pathologies. In Ethiopia, the diet is characterized by high consumption of fermented cereal-based foods such as injera, a good source of folate but not of cobalamin, which is only found in foods of animal origin that are rarely consumed. Some of the bacteria responsible for the fermentation of cereals can synthesize cobalamin, but whether or not fermented cereal food products contain cobalamin remains underexplored. The objective of this study was to assess the folate and cobalamin content of injera collected from various households in Ethiopia at different stages of production. Global (16S rRNA gene sequencing) and specific (real-time PCR quantification of bacteria known for folate or cobalamin production) bacterial composition of these samples was assessed. UPLC-PDA was used to identify the cobalamin to see whether the active or inactive form was present. Surprisingly, teff flour contained 0.8 µg/100 g of cobalamin, most probably due to microbial contamination from the environment and the harvesting process. While fermentation increased the folate and cobalamin content in some households, their levels decreased in others. Conversely, cooking consistently reduced the level of the vitamins. Fresh injera contained, on average, 21.2 µg/100 g of folate and 2.1 µg/100 g of cobalamin, which is high, but with marked variation depending on the sample. However, the form of cobalamin was a corrinoid that is biologically inactive in humans. Injera fermentation was dominated by lactic acid bacteria, with significant correlations observed between certain bacterial species and folate and cobalamin levels. For example, a high proportion of Fructilactobacillus sanfranciscensis, a known folate consumer, was negatively correlated with the folate content of injera. On the contrary, Lactobacillus coryniformis, known for its cobalamin synthesis ability was present in high proportion in the cobalamin-rich samples. These findings highlight the complex interrelationship between microorganisms and suggest the involvement of specific bacteria in the production of folate and cobalamin during injera fermentation. Controlled fermentation using vitamin-producing bacteria is thus a promising tool to promote folate and cobalamin production in fermented food.

Effectiveness of Lactiplantibacillus plantarum in enhancing the folate content of injera made with different cereals.

Fermentation can contribute to the supply of essential vitamins like folate, but studies exploring this potential are scarce. Injera is an Ethiopian fermented pancake-like flatbread made from different cereals. The study aimed to investigate the effect of injera-making process using different cereals (tef, sorghum, wheat, and barley) on folate content and to evaluate the effectiveness of Lactiplantibacillus plantarum in enhancing folate of injera made with different cereals. Cereals were used alone or in combination (tef and sorghum (1:1), wheat and sorghum (3:1), sorghum (100%), and barley (100%)). L. plantarum previously isolated from tef dough and ersho (fermentation batch) collected from the households were used as starters. Folate content of the flour, dough, and injera was determined by microbiological assay. Contribution of consumption of injera made with different cereals to the folate requirement of children and women of reproductive age was evaluated. Among the studied cereals, the highest average folate content (49.9 µg/100 g) was observed in 100% sorghum flour and the least (32.2 µg/100 g) in 100% barley flour, on dry weight basis. After fermentation, the highest average folate content (60.1 µg/100 g) was observed in 100% sorghum dough fermented with L. plantarum. Highest average folate content (15.45 µg/100 g) per fresh weight was observed in wheat and sorghum (3:1)-blend injera fermented with L. plantarum. Consumption of L. plantarum-fermented injera made with different cereals contributed up to 8% of the recommended folate intake of women of reproductive age.

Association of fruit and vegetable intake with predicted 10-year cardiovascular disease risk among hypertensive patients in Addis Ababa, Ethiopia: a cross-sectional study.

OBJECTIVE: In low-income countries, such as Ethiopia, few studies have evaluated the risk of cardiovascular disease (CVD) among hypertensive patients. We assessed the 10-year CVD risk of hypertensive patients. DESIGN: This cross-sectional study was part of a larger survey conducted in Addis Ababa. The 10-year CVD risk was calculated using the Framingham Risk Score (FRS) algorithm based on seven sex-specific risk factors as well as a country-specific Globorisk score. Fruits and vegetables (FV) consumption, salt intake and stress levels were measured with 24-hour dietary recall, INTERSALT equation and Cohen's Perceived Stress Scale, respectively. A multiple linear regression model was fitted to explore the association. SETTING: Addis Ababa, Ethiopia, 2021. PARTICIPANTS: A sample of 191 patients diagnosed with hypertension. OUTCOME MEASURES: Predicted 10-year cardiovascular risk of hypertensive patients. RESULTS: A total of 42.4%, 27.7% and 29.8% of hypertensive patients were at low, moderate and high CVD risks, respectively. The majority (80.1%) of patients consumed inadequate FV, 95.7% consumed salt >5 g/day and 58.1% had moderate to high-stress levels. There was a substantial agreement between the FRS and Globorisk prediction models (weighted kappa 0.77). In the unadjusted model, FV consumption (>450 g/day) and total fruit intake in the highest tertile were associated with 14.2% and 6.7% lower CVD risk, respectively. After adjusting for lifestyle factors, increasing FV intake from 120 to 450 g/day was significantly related to 11.1%-15.2% lower CVD risk in a dose-response manner. Additionally, total fruit, but not total vegetable intake in the highest tertile, was significantly associated with decreased CVD risk. CONCLUSION: We found a high prevalence of CVD risk among hypertensive patients. High FV consumption was inversely associated with CVD risk. This suggests that patients should be advised to increase FV intake to minimise CVD risk.

Multiscalar Evaluation of the Water Distribution System and Diarrheal Disease Risk in Addis Ababa, Ethiopia.

Despite growing urbanization, our understanding of the impacts of water and sanitation on human health has largely come from studies in rural sectors. To this end, we collected data at both regional (water quality measures from water treatment systems) and community (cross-sectional surveys) scales to examine determinants of enteric pathogen infection and diarrheal disease among infants in Addis Ababa, Ethiopia. Regionally, the Legedadi water treatment plant had significantly lower heterotrophic plate counts, total coliform counts, and fecal coliform counts compared with the Gefersa water treatment plant. The number of pathogen types in infant stool also differed by plant. Decreases in chlorine levels and increases in the relative abundance of Gammaproteobacteria with distance from treatment plants suggest a compromised water distribution system. In communities, infants in households that obtained water from yard pipes or public taps had significantly lower odds of diarrhea compared to households that had water piped into their dwellings (OR = 0.35, 95% CI 0.16, 0.76, and OR = 0.39, 95% CI 0.15, 1.00, respectively). Similarly, infants in households that boiled or filtered water had significantly lower odds of diarrhea compared to households that did not treat water (OR = 0.40, 95% CI 0.19, 0.86 and OR = 0.23, 95% CI 0.06, 0.84, respectively). Integrating multiscalar data better informs the health impacts of water in urban settings.

The influence of adolescents' nutrition knowledge and school food environment on adolescents' dietary behaviors in urban Ethiopia: A qualitative study.

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition-literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex-disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15-19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient-dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents.

Ethiopia National Food and Nutrition Survey to inform the Ethiopian National Food and Nutrition Strategy: a study protocol.

INTRODUCTION: Ethiopia has made significant progress in reducing malnutrition in the past two decades. Despite such improvements, a substantial segment of the country's population remains chronically undernourished and suffers from micronutrient deficiencies and from increasing diet-related non-communicable diseases such as diabetes, hypertension and cancer. This survey aims to assess anthropometric status, dietary intake and micronutrient status of Ethiopian children, women and adolescent girls. The study will also assess coverage of direct and indirect nutrition-related interventions and map agricultural soil nutrients. The survey will serve as a baseline for the recently developed Ethiopian Food System Transformation Plan and will inform the implementation of the National Food and Nutrition Strategy. METHODS AND ANALYSIS: As a population-based, cross-sectional survey, the study will collect data from the 10 regions and 2 city administrations of Ethiopia. The study population will be women of reproductive age, children aged 0-59 months, school-aged children and adolescent girls. A total of 16 596 households will be surveyed, allowing the generation of national and regional estimates. A two-stage stratified cluster sampling procedure will be used to select households. In the first stage, 639 enumeration areas (EAs) will be selected using probability-proportional-to-size allocation. In the second stage, 26 eligible households will be selected within each EA using systematic random selection. Primary outcomes include coverage of direct and indirect nutrition interventions, infant and young child feeding (IYCF) practices, food insecurity, dietary intakes, mental health, anthropometric status, micronutrient status and soil nutrient status. ETHICS AND DISSEMINATION: The protocol was fully reviewed and approved by the Institutional Review Board of the Ethiopian Public Health Institute (protocol no: EPHI-IRB-317-2020). The study is based on voluntary participation and written informed consent is required from study participants. The findings will be disseminated via forums and conferences and will be submitted for publication in peer-reviewed journals.

Ethiopian orthodox fasting is associated with weight reduction and body composition changes among healthy adults: a prospective cohort study.

The Ethiopian Orthodox Christian (EOC) fasts, although adopted for religious purposes, combines aspects of energy restriction, time-restricted feeding, and a vegan dietary pattern, all of which have been independently associated with weight loss and healthier body composition. However, combined effect of these practices as part of EOC fast remains unknown. This longitudinal study design evaluated the effect of EOC fasting on body weight and body composition. Information on socio-demographic characteristics, physical activity level, and fasting regimen followed was captured through an interviewer-administered questionnaire. Weight and body composition measurements were taken before and at the end of major fasting seasons. Body composition parameters were measured by bioelectrical impedance (BIA), Tanita® BC-418®, Japan). Significant changes in body weight and body composition were observed for both fasts. Significant decreases in body weight (14/44 day fast: - 0.45; P = 0.004/- 0.65; P = 0.004), FFM (- 0.82; P = 0.002/- 0.41; P < 0.0001), and trunk fat mass (- 0.68; P < 0.0001/- 0.82; P < 0.0001) were observed after adjusting for covariates including age, sex, and physical activity. The EOC fasting regimen leads to significant reductions of body weight and compositions. Longer fasting duration led to much higher effects in body weight and body composition and may be non-pharmacological strategy in prevention or treatment of chronic diseases.

Epidemiology of hypertension among adults in Addis Ababa, Ethiopia.

The public health significance of hypertension is increasing in low- and middle-income countries. However, there is limited epidemiological evidence in Ethiopia. We assessed the prevalence of hypertension and explored its predictors among adults in Addis Ababa, Ethiopia. A community-based cross-sectional study was conducted from April to May 2021 among randomly selected adults aged 18-64 years. A face-to-face interview using an adapted STEPwise Approach to NCD Risk Factor Surveillance (STEPS) questionnaire was conducted. Multilevel mixed-effects logistic regression model was fitted to determine factors associated with hypertension. The sample consisted of a total of 600 adults (mean age: 31.2 ± 11.4 years, 51.7% women). The overall age-standardized prevalence of hypertension was 22.1% and 47.8% according to the Seventh Joint National Commission (JNC7) and the 2017 American Heart Association (AHA) guidelines, respectively. About 25.6% were newly diagnosed with hypertension. The age groups of 40-54 years (AOR = 8.97; 95% CI: 2.35,34.23), and 55-64 years (AOR = 19.28; 95% CI: 3.96,93.83) as compared to the 18-24 age group, male sex (AOR = 2.90; 95% CI: 1.22,6.87), obesity (AOR = 1.92; 95% CI: 1.02,3.59), abdominal obesity (AOR = 4.26; 95% CI: 1.42,12.81), and very poor sleep quality (AOR = 3.35; 95% CI: 1.15,9.78) were independent predictors of hypertension. This study revealed that the burden of hypertension among adults is very high. Hypertension is independently associated with older age group, male sex, obesity, abdominal obesity, and poor sleep quality. Therefore, the study highlights the need to develop regular blood pressure surveillance programs, weight loss intervention, and improvement of sleep quality.

The Global Diet Quality Score predicts diet quality of women of reproductive age in Addis Ababa, Ethiopia.

Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption (P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS (P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.

Stool biomarkers as measures of enteric pathogen infection in infants from Addis Ababa informal settlements.

Frequent enteric infections in children may be an important cause of growth faltering; however, we do not fully understand the mechanisms by which pathogen infections and the physiological responses to these infections result in poorer growth. Commonly used protein fecal biomarkers (anti-alpha trypsin, neopterin, and myeloperoxidase) provide broad immunological information on an inflammatory response; however, they do not provide information on non-immune processes (e.g., gut integrity) that may be important indicators of chronic end states such as environmental enteric dysfunction (EED). To explore how additional biomarkers will better inform which physiological pathways (both immune and non-immune) are impacted by pathogen exposure we added to the traditional panel of 3 protein fecal biomarkers 4 novel fecal mRNA transcript biomarkers (sucrase isomaltase, caudal homeobox 1, S100A8, and mucin 12) and analyzed stool samples from infants living in informal settlements in Addis Ababa, Ethiopia. To test how this expanded biomarker panel captures distinct pathogen exposure processes we used two different scoring systems. First, we used a theory-based approach to assign each biomarker to specific physiological attributes based on prior understanding of each biomarker. Second, we used data reduction methods to categorize biomarkers and then assign physiological attributes to those categories. We used linear models to examine the association between the derived biomarker scores (based on mRNA and protein levels) and stool pathogen gene counts to determine pathogen specific effects on gut physiology and immune responses. Inflammation scores were positively associated with Shigella and enteropathogenic E.Coli (EPEC) infection, while gut integrity scores were negatively associated with Shigella, EPEC and, shigatoxigenic E.coli (STEC) infection. Our expanded panel of biomarkers hold promise as tools to measure systemic outcomes of enteric pathogen infection. mRNA biomarkers complement established protein biomarkers by providing important cell-specific physiological and immunological consequences of pathogen carriage that can lead to chronic end states such as EED.

The influence of dough kneading time and flour particle size distribution on white bread structure, glycemic response and aspects of appetite.

BACKGROUND & AIMS: White bread is widely consumed in many countries despite being a high-glycemic index (GI) food. It has been shown that the "food matrix effect" may help with diabetes and obesity management through lowering GI and appetite. This study aimed at investigating the effects of dough kneading time and flour particle size on white bread structure, glycemic response, and aspects of appetite. METHODS: A two-phase randomized cross-over design was used in 10 healthy subjects over the course of 2 h. In phase 1, Texture Profile Analysis (TPA) attributes, Scanning Electron Microscope (SEM) image, glycemic response, and appetite aspects of white bread made with a 15-min dough kneading time (K15) were compared with white bread made with a 10-min dough kneading time (K10). In phase 2, TPA, SEM image, glycemic response, and satiety score of white bread made with coarse flour (CF) were compared to white bread made with fine flour (FF). RESULT: With increasing hardness (force required to compress a food between the molars to a given deformation), total blood glucose IAUC in K15 (IAUC = 119 ± 12; GI = 66) was significantly (p < 0.05) lower than in K10 (IAUC = 154 ± 10; GI = 81). No marked difference was observed between K15 and K10 on aspects of appetite except for hunger. There was no significant (p > 0.05) difference in glycemic response between CF (IAUC = 126 ± 18; GI = 64) and FF (IAUC = 147 ± 12; GI = 81). Similarly, no discernible difference in satiety between CF and FF. CONCLUSION: Changes in processing conditions can improve blood glucose response relalated to white bread consumption.

Co-coverage of reproductive, maternal, newborn and child health interventions shows wide inequalities and is associated with child nutritional outcomes in Ethiopia (2005-2019).

The health system is the primary vehicle for the delivery of nutrition-specific interventions that aim to reduce maternal and child malnutrition. The integration of nutrition interventions into existing health interventions is promising, but to ensure that no one is left behind requires that access to essential health services is equitably distributed. This study aims to assess trends and socioeconomic inequalities in coverage of reproductive, maternal, newborn and child health (RMNCH) and assess its association with child nutritional outcomes in Ethiopia. Using the Ethiopian Demographic and Health Survey (2005, 2011, 2016, and 2019), we estimated the coverage of RMNCH interventions in Ethiopia using the co-coverage index, which is a count of the number of interventions accessed. We assessed the trend and inequalities in co-coverage and evaluated its association with child nutritional outcomes like stunting, wasting, and minimum dietary diversity (MDD). The national co-coverage index has shown a significant increase over the 2005-2019 period. However, all of the RMNCH interventions constituting the co-coverage index showed a pro-rich and pro-urban distribution (p < 0.05). The highest inequality, based on the slope index of inequality (SII), was observed for skilled assistance during delivery (SII: 80.4%), followed by access to an improved source of drinking water (SII: 62.6%), and antenatal care visits (SII: 55.5%). The low coverage in RMNCH and the observed inequality were associated with stunting, wasting, and MDD. Reducing socioeconomic inequality in RMNCH is key to achieve the health, nutrition and equity-related goals of the Sustainable Development Goals.

Suboptimal feeding practices and impaired growth among children in largely food insecure areas of north Wollo, Ethiopia.

In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.

Determinants of depressive symptoms among postpartum mothers: a cross-sectional study in Ethiopia.

OBJECTIVE: This study aims to assess the determinants of depressive symptoms among postpartum mothers. DESIGN: A community-based cross-sectional study was conducted. SETTING: Ten randomly selected rural kebeles of Meket district of Ethiopia. PARTICIPANTS: A random sample of 232 mothers with infants 5-10 months was included in this study. DATA ANALYSIS: Forward multivariable logistic regression analysis. RESULTS: The factors significantly associated with increased odds of maternal postpartum depressive symptoms were: moderate (adjusted OR (AOR) 4.44, 95% CI 1.34 to 14.72) and severe (AOR 12.98, 95% CI 5.24 to 32.14) household food insecurity; infant underweight (AOR 2.99, 95% CI: 1.21 to 7.37) and infant acute respiratory infection (ARI) (AOR 7.0, 95% CI: 3.09 to 15.99). Maternal education, workload and age, household socioeconomic status, distance to the health facility, and child stunting, diarrhoea and fever were not significantly associated with postpartum depressive symptoms in adjusted logistic regression. CONCLUSION: Household food insecurity, infant ARI and infant underweight had significant associations with postpartum depressive symptoms. Therefore, interventions that address infant nutrition and health and household food insecurity within the framework of the productive safety net programmes (PSNPs) as well as programmes focused on preventing, detecting and solving maternal mental health challenges may be helpful to improve maternal mental well-being and promote graduation from the PSNP.

Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis.

OBJECTIVE: Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks. SETTING: Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES: We analysed intentions and plans of the government to act, using policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008 and 2020. Our coding framework was guided by the policy component (n=7 domains) of the Healthy Food-Environment Policy Index, which was modified to include food quality and safety as an eighth domain. RESULTS: From the 127 policy outputs identified, 38 were retained, published by 9 different government ministries and institutions. Our results show that eight food environment domains have been addressed to some extent, but gaps remain compared with global best practice, especially in food promotion, processing, retail, price and trade. From 2018, policy began to embrace the wider food system, with more explicit food environment interventions becoming apparent. CONCLUSIONS: Policy efforts achieved in food safety, food processing, marketing and labelling are important stepping stones to building future policy actions addressing the food environment domains of food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in the context of multiple forms of malnutrition.

Pregnant Mothers Diversified Dietary Intake and Associated Factors in Southwest Ethiopia: A Cross-Sectional Study.

Background: Dietary diversity is very critical for fetal growth and development, as well as for the health and wellbeing of the mother. In Ethiopia, 41% of pregnant mothers consume diversified diets. There has been no study assessing whether pregnant women in southwest Ethiopia consume a varied diet. Objective: To estimate the proportion of adequate diversified dietary intake and to determine whether there is an association between diversified dietary intake and mothers' social capital. Design: A community-based cross-sectional study was conducted on 367 pregnant women in South West Ethiopia. A 24-hour multiple-pass dietary recall method was used to measure dietary intake and the 10 food groups of FANTA/FAO 2016 were used to analyze dietary diversity. Social capital was assessed based on the number of social networks in which a mother participated. Result: The proportion of diversified dietary intake was 14.7% (95% CI: 11.1, 18.3). Pregnant mothers who had social capital, had their own income, had emotional support from their husbands, were from a rich family, and had a frequent dietary intake were statistically associated with a diversified dietary intake, with an AOR of 7.8 (95% CI 1.02, 2.3 (95% CI 1.12, 4.44), 4.0, (95% CI 1.16, 13.7), 59.19), 2.3 (95% CI 1.04, 5.26), and 1.5 (95% CI 1.04, 2.07), respectively. Conclusion: Diversified dietary intake was found to be lower than previously reported, and it was associated with social capital. Methodologically rigorous studies are required to verify the association between social capital and adequate diversified dietary intake.