School feeding in Ethiopia: a scoping review.

INTRODUCTION: Undernutrition is a major public health problem in developing countries, especially in Sub-Saharan Africa. Undernourished children are smaller and have low weight. To solve this issue, school feeding (corn-soya blend, vegetable oil) started in 1994 in Ethiopia. Thus, this scoping review aims to map the evidence relating to school feeding programs and their potential role in managing children`s nutrition in Ethiopia. METHODS: This scoping review is informed by the methodological framework of Arksey & O'Malley for scoping reviews and recommendations on the framework by Levac and colleagues. The databases searched included the Education Resources Information Centre, International Initiative for Impact Evaluation, Cochrane Library, MEDLINE, and Google Scholar. To ensure its comprehensive search, grey literature sources were searched. The search was undertaken on 26 April 2023. Studies on school feeding, such as coverage, and studies that evaluate the educational and nutritional impacts of school feeding in Ethiopia, regardless of study designs, were included. Reports (publications) about school feeding without scientific methodology were excluded. RESULT: Twenty-seven studies were included in this review. It includes cross-sectional, prospective cohort, laboratory-based analysis, experimental, case study, and qualitative study designs. The school feeding program results were inconclusive, while some indicate a positive effect on body mass index, height, thinness, anemia, weight, dropout rate, class attendance, and enrollment. The others showed that the school feeding program did not affect stunting, thinness, weight, hemoglobin level, enrollment, attendance, dropout rate, and academic achievement. Factors affecting school feeding programs negatively include poor quality food and financial constraints. However, no literature on school feeding program coverage was found. CONCLUSION: School feeding programs improved nutritional status, and academic performance, although some studies show any effect. Poor-quality food provisions and financial constraints affect school feeding programs. There are mixed findings, and further research is required to determine the effect of school feeding programs conclusively. To ensure the program's sustainability, it should be supported by a national policy, and budget allocation is needed. In addition, more evidence should be generated to show the coverage of school feeding programs in Ethiopia.

Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia.

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0-5 months. In children aged 6-59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting.

Human resource capacity to effectively implement malaria elimination: a policy brief for Ethiopia.

OBJECTIVE: The aim of this study was to investigate malaria elimination in Ethiopia. Ethiopia has planned to eliminate malaria by 2015 in areas of unstable malaria transmission and in the entire country by 2020. However, there is a shortage and maldistribution of the health workforce in general and malaria experts in particular. Training, motivating, and retaining the health workforce involved in malaria control is one strategy to address the shortage and maldistribution of the health workforce to achieve the goal of elimination. METHODS: Policy options include the following: (i) in-service training (educational outreach visits, continuing education meetings and workshops, audit and feedback, tailored interventions, and guideline dissemination) may improve professional practice; (ii) recruiting and training malaria specialists together with academic support, career guidance, and social support may increase the number of malaria experts; and (iii) motivation and retention packages (such as financial, educational, personal, and professional support incentives) may help motivate and retain malaria professionals. RESULTS: Implementation strategies include the following: (i) massive training of health personnel involved in malaria elimination and malaria experts (requiring special training) at different levels (national, sub-national, District & community levels), and (ii) recruiting highly qualified health personnel and retention and motivation mechanisms are needed. CONCLUSIONS: The lack of adequately trained human resources and personnel attrition are major challenges to effectively implement the planned multi-faceted malaria elimination by 2020 strategy in Ethiopia. Although a reduction in malaria incidence has been observed in the last 3-4 years, maintaining this success and achieving the malaria elimination goal with the present human resource profile will be impossible. A clear strategy for developing the capacity of the health workers in general, and malaria experts in particular, and retaining and motivating staff are crucial for malaria control and elimination.

Effectiveness of conditional cash transfers for uptake and retention in HIV prevention of mother-to-child transmission services in low- and middle-income countries: a systematic review protocol.

OBJECTIVE: This systematic review will identify and synthesize evidence on the effectiveness of conditional cash transfers for the uptake and retention in prevention of mother-to-child transmission services in pregnant and/or breastfeeding women with HIV infection in low- and middle-income countries. INTRODUCTION: Regardless of the effectiveness of prevention of mother-to-child transmission services, uptake and retention in such services remains poor in low- and middle-income countries. This review intends to evaluate the effectiveness of conditional cash transfers in improving uptake and retention in such services for pregnant and/or breastfeeding women with HIV infection. INCLUSION CRITERIA: This review will consider studies that evaluate the impact of conditional cash transfers on uptake and retention in prevention of mother-to-child transmission services in pregnant and/or breastfeeding women with HIV. Studies will compare conditional cash transfers with no intervention or other interventions. Only studies carried out in low- and middle-income countries will be eligible for inclusion. METHODS: Eight databases will be searched. Publication status will not be considered as a criterion for inclusion. Studies published in English since 2000 will be considered, because prevention of mother-to-child transmission services were first introduced in that year. Following the search, two independent reviewers will screen titles and abstracts against the inclusion criteria, critically appraise eligible studies for methodological quality using JBI critical appraisal tools, and extract data from included studies using a standardized data extraction tool. Where possible, quantitative data will be pooled using statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021236729.

Susceptibility of Anopheles gambiae s.l. to DDT, malathion, permethrin and deltamethrin in Ethiopia.

OBJECTIVE: To assess the susceptibility/resistance level of Anopheles gambiae s.l. to DDT, malathion, permethrin and deltamethrin in different parts of Ethiopia. METHODS: Field collected female An.gambiae s.l. was exposed for 1 h to discriminating dosage of 4% DDT, 5% malathion, 0.75% permethrin and 0.05% deltamethrin using WHO insecticide susceptibility test kits and procedures. Knockdown and mortality rates were recorded at 10, 15, 20, 30, 40, 50 and 60 min and 24 h post-exposure respectively. RESULTS: Anopheles gambiae s.l. was sensitive to DDT only in 2 of 16 localities where susceptibility studies were carried out in northern Ethiopia; it was resistant in 11 sites and potentially resistant in three. To malathion, the test population was sensitive in four of the six study sites in southern Ethiopia and potentially resistant in the other two sites. In northern Ethiopia, the population was resistant in five localities and sensitive in three. Of the six localities in northern Ethiopia where permethrin was tested, populations were sensitive in three, resistant in one and potentially resistant in two. In southern Ethiopia, the populations were resistant in five of the six sites. Against deltamethrin, the population was sensitive in five of 13 localities, three in northern and two in southern Ethiopia. It was resistant only in two localities, one in northern and one in southern Ethiopia, and potentially resistant in five localities. In eastern Ethiopia at Sabure, the population was sensitive to all insecticides but DDT to which it was potentially resistant. CONCLUSION: The existence of high level of DDT and pyrethroid resistance with the possibility of cross-resistance to each other and other classes of agricultural pesticides could seriously jeopardise the efficacy of both ITNs and IRS in the country in the future. Insecticide resistance monitoring and surveillance systems as part of a malaria control programme are mandatory for proper management of resistance. The use of a mixture of unrelated insecticides for impregnating nets and rotational use of insecticides for IRS is suggested as a way forward.

Socio-cultural Beliefs and Practices Influencing Institutional Delivery Service Utilization in Three Communities of Ethiopia: A Qualitative Study.

BACKGROUND: The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services. METHODS: A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically. RESULTS: The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility. CONCLUSIONS: Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth.

Biting behavior and Plasmodium infection rates of Anopheles arabiensis from Sille, Ethiopia.

The man-biting behavior and Plasmodium infection rates of anopheline mosquitoes were investigated in Sille, a hyperendemic malarious area in southern Ethiopia. Seven Anopheles species were identified from all night landing collections, conducted from 18:00 to 06:00h between October 2001 and August 2002. The predominant species was Anopheles arabiensis (55.8%), followed by Anopheles coustani (31.5%), Anopheles pharoensis (9.5%), Anopheles funestus (2.2%), Anopheles nili (0.5%), Anopheles marshallii (0.4%) and Anopheles demeilloni (0.2%). Dissection of A. arabiensis showed an average parous rate of 73.2%. A large proportion of the parous mosquitoes were caught biting in the latter part of the night. Malaria sporozoite rates were determined by ELISA for A. arabiensis, with 0.5% (4/796) infective with Plasmodium falciparum and 1.76% (14/796) with Plasmodium vivax; there were no mixed infections. From our small sample of sporozoite positives we found no association between biting behavior and sporozoite infection status.

Socio-cultural beliefs and practices influencing institutional delivery service utilization in three communities of Ethiopia: a qualitative study

BACKGROUND: The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services. METHODS: A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically. RESULTS: The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility. CONCLUSIONS: Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth

Field trials on the repellent activity of four plant products against mainly Mansonia population in western Ethiopia.

The repellent activity of essential oils of lemon eucalyptus (Eucalyptus maculata citrodion), rue (Ruta chalepensis), oleoresin of pyrethrum (Chrysanthemum cinerariaefolium) and neem (Azadiracta indica) have been field tested as 40%, 50% and 75% solutions in coconut oil against populations of mosquitoes consisting mainly of Mansonia in Gambella, western Ethiopia. A latin square design was used to randomize the test subjects for possible individual differences for mosquito attraction. Repellency was evaluated as the percentage protection. Deet was included in the study for comparison. All the plant products manifested repellency. At 50% concentration at which the highest repellency was recorded the protection was 91.6%, 87.0%, 96.0%, 97.9% for rue, neem, pyrethrum and deet, respectively. The essential oil of lemon eucalyptus was not tried at this concentration. At a 40% concentration deet, lemon eucalyptus and pyrethrum were significantly (p < 0.05) more effective than rue and neem. At a 50% concentration, deet and pyrethrum were significantly better (p < 0.05) than rue and neem. At a 75% concentration concentration, deet and lemon eucalypus performed significantly better (p < 0.05) than pyrethrum and neem. The difference between pyrethrum and neem was also significant (p < 0.01).

Prevention of postpartum hemorrhage in rural Ethiopia

The Problem: Lack of access to uterotonics to prevent PPH in rural Ethiopia - Ethiopia?s maternal mortality rate is among the highest in the world with 470 deaths per 100,000 live births. Postpartum hemorrhage (PPH) remains to be the leading cause of maternal mortality in developing countries like Ethiopia. The problem is worse in the rural setting where there are not proper facilities and trained health workers to administer injectable uterotonics, which are the standard treatment for PPH. Using community health (health extension) workers (HEWs) or traditional birth attendants (TBAs) trained in the use of easier- to-use technologies could prevent PPH in rural Ethiopia. Policy options: 1- Community-based delivery of misoprostol by HEWs or TBAs trained in its use; 2- Delivery of oxytocin in Uniject TM injection by HEWs or TBAs trained in its use.