School feeding contributed valuable dietary energy and nutrients despite suboptimal supply to school-age children and adolescents at primary schools in Addis Ababa, Ethiopia.

OBJECTIVES: This study investigated the nutritional quality and adequacy of school meals served to school-age children and adolescents. METHODS: A total of 55 food samples were collected from 11 food types served for breakfast and lunch at 15 selected school kitchens. Each meal was weighed using a digital scale. The initial sample weights were recorded and dried in an oven at a temperature of 60°C to constant weight. The nutrient content and dietary energy of the meals were calculated using a conversion factor with reference to the national food composition table. RESULTS: School meals supplied 883 calories of average energy, representing 48% and 34% of the daily recommended nutrient intake (RNI) for early adolescents (ages 7-12 y) or late adolescents (ages 13-17 y), respectively. Late-adolescent boys acquired the least RNI (31%). The meals contributed protein (44%-66%; 31%-47%), carbohydrate (50%-68%; 35%-48%), fat (15%-26%; 10%-20%), and fiber (44%-110%; 31%-78%) for early and late adolescents, respectively. Micronutrients, such as ß-carotene (36%-51%; 26%-37%), thiamine (47%-78%; 33%-54%), riboflavin (35%-55%; 26%-38%), niacin (16%-27%; 12%-19%), phosphorous (27%-41%; 20%-29%), calcium (64%-103%; 46%-73%), and iron (188%; 133%) were served for early and late adolescents, respectively. The caloric and nutritional contributions were generally less than two-thirds of the daily RNIs required from school meals, except that of fiber, thiamine, and calcium (for early adolescents), and iron. CONCLUSIONS: Despite their benefit to alleviate hunger in schools, school meals contributed suboptimal energy and nutrients to deprived school-age children and adolescents. Inclusion of animal products, fruits, and vegetables may improve energy and nutritional values.

Impact of school meals on educational outcomes in Addis Ababa, Ethiopia.

OBJECTIVE: This study evaluated the impact of the Addis Ababa School Feeding Program (SFP) on educational outcomes. DESIGN: Single-group repeated measurement/longitudinal study design and multistage stratified sampling design were followed. Effect sizes estimates, repeated measures ANOVA, Chi-square, Generalised Additive Mixed Model and mixed effects negative binomial regression were used. Academic scores, attendance and dropout and height and weight of schoolchildren were collected. SETTING: School Feeding Programs in Addis Ababa, Ethiopia. PARTICIPANTS: Schoolchildren in primary schools and school directors and teachers in fifteen randomly selected schools for Key Informant Interview (KII). RESULTS: Anthropometric measurements of 4500 schoolchildren were taken from 50 schools. Academic scores of 3924 schoolchildren from 46 schools, class attendance records of 1584 schoolchildren from 18 schools and annual enrolment records of 50 schools were gathered. School meals achieved a minimum to large scale effects on educational outcomes with effect sizes (η2) of academic scores (boys = 0·023, girls = 0·04), enrolment (girls = 0·001, boys = 0·05) and attendance (Cramer's V = 0·2). The average scores of girls were significantly higher than that of boys (P < 0·0001). Height-for-age in all schoolchildren (P < 0·01) and BMI-for-age Z-scores in adolescent girls of 15-19 years (P < 0·0001) never had a significant positive relationship with average scores. Significant relation was observed between nutritional status and attendance (P = 0·021). KII showed that SFP created convenient teaching-learning environment and reduced hunger in schools, while boosting enrolment, attendance and academic performance among the schoolchildren. CONCLUSION: The Addis Ababa SFP has positively contributed to educational outcomes. Strengthening the program would enhance nutritional outcomes and diminish educational inequalities.

Use of modified composite index of anthropometric failure and MUAC-for-age to assess prevalence of malnutrition among school-age children and adolescents involved in the school feeding program in Addis Ababa, Ethiopia.

BACKGROUND: Malnutrition hampers educational performance of schoolchildren coming from low-income families. School feeding program was, thus, launched in public primary schools in Addis Ababa very recently. It is, thus, important to measure the initial nutritional status of participating students to see the effect of the program on their nutritional wellbeing. METHODS: The first-round survey was made at the initiation of the program. A multi-stage stratified sampling from 50 schools located in the ten sub cities of Addis Ababa yielded 4500 children and adolescents of ages five to 19 years. Data was collected on age, height, weight and MUAC of the schoolchildren. Nutritional status was evaluated using conventional anthropometric indicators, modified Composite Index of Anthropometric Failure (mCIAF), and MUAC-for-age. Receiver Operating Characteristic (ROC) curve was used to examine classification of malnourishment by MUAC-for-age versus BMI-for-age and mCIAF versus MUAC-for-age. Multilevel mixed effects model was applied to investigate variations in the prevalence of malnutrition across sub cities. FINDINGS: The area under the ROC curves (AUC) for MUAC-for-age against BMI-for-age z-scores was 0.68 and that of mCIAF against MUAC-for-age was 0.70, respectively, indicating an overall better classification of malnourishment. Mixed effects model showed significant variations in nutritional status of schoolchildren across sub cities. Conventional measures showed that prevalence of stunting, thinness, or underweight among the sample children and adolescents was 23.4, 18.4, and 16.5%, respectively. Assessment by mCIAF, instead, showed a higher prevalence of overall malnutrition (43.4%). MUAC-for-age indicated an acute malnutrition measurement of 33.4%. Significant differences (p < 0.0001) in nutritional status were seen between boys and girls, and among age groups as measured by mCIAF. INTERPRETATION: Conventional measures of nutritional status undermined level of malnutrition. Instead, mCIAF and MUAC-for-age gave higher estimates of the magnitude of the existing prevalence of malnutrition among the school children and adolescents.

Determinants of Ethiopian Women's Attitudes Toward Wife Beating.

The World Health Organization stipulated that intimate partner violence is one of the most common forms of violence against women and includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner. Opposition of women against any form of violence at home, beating by their husbands in particular, is a manifestation of readiness to assert their personal rights. This study used data from the 2011 Ethiopian Demographic and Health Survey to identify some predictors to determine attitudes of married Ethiopian women toward wife beating. The dataset used consisted of 5,818 married women of the reproductive age group 15 to 49 years. While 1,393 (24%) married women did not oppose wife beating, a total of 4,425 (76%) opposed the practice. In the binary multiple logistic regression analysis, age, economic status, level of education, employment status of a woman, number of children living in the household, region (federal administrative regions delineated on the basis of ethnicity), place of residence (urban vs. rural), religion, and husband's level of education have been included as possible socioeconomic and demographic determinants of women's attitudes toward wife beating. The findings showed that the predictors region, place of residence, number of living children in a household, and religion were significantly associated with women attitudes toward wife beating.

Spatial pattern and determinants of anaemia in Ethiopia.

Anaemia is a condition in which the haemoglobin concentration falls below an established cut-off value due to a decrease in the number and size of red blood cells. The current study aimed (i) to assess the spatial pattern and (ii) to identify determinants related to anaemia using the third Ethiopian demographic health survey. To achieve these objectives, this study took into account the sampling weight and the clustered nature of the data. As a result, multilevel modeling has been used in the statistical analysis. The analysis included complete cases from 15,909 females, and 13,903 males. Among all subjects who agreed for hemeoglobin test, 5.22% males, and 16.60% females were anemic. In both binary and ordinal outcome modeling approaches, educational level, age, wealth index, BMI and HIV status were found to be significant predictors of anaemia prevalence. Furthermore, this study applied spatial methods to generate maps at regional level which could be useful for policy makers where great efforts should be concentrated to reduce the prevalence of anaemia. As revealed by Moran's I test, significant spatial autocorrelation were noted across clusters. The risk of anaemia was found to vary across different regions, and higher prevalences were observed in Somali and Affar regions.