Prevalence of dental carries and its association with breastfeeding duration among young children in Addis Ababa, Ethiopia.

BACKGROUND: Breastfeeding is a crucial feeding practices that significantly contributes to the healthy development of children. However, the effect of breastfeeding duration on caries risk is unclear, as different studies have found different results. This study aims to assess the prevalence of dental caries and its association with breastfeeding duration among young children aged 12-36 months in selected health facilities of Addis Ababa, Ethiopia. METHODS: A cross-sectional study among 380 children aged 12-36 months from 11 health centers in Addis Ababa was conducted. Questionnaires and dental examinations were used to collect data. Dental caries was measured by the deft (decayed-extracted-filled teeth) index. Binary logistic regression was used to assess the association between dental caries and duration of breastfeeding, after adjusting for the confounders. RESULTS: The prevalence of dental caries was 53.4% (95% CI: 48.3, 58.5%), with 13.7% having high caries and 39.7% having low caries. Breastfeeding duration was not significantly associated with dental carries, after adjusting for confounders. However, sugar intake, older age, mothers' unemployment, and not being in marital union are risk factors for dental caries development. CONCLUSIONS: Promotion of healthy diet, especially limiting intake of sugar and sweets, and integration of oral health into primary health care programs are recommended. Further research using longitudinal design or meta-analysis is recommended to establish more concise evidence on the association between breastfeeding duration and dental caries.

Early childhood development and nutritional status in urban Ethiopia.

Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study.

BACKGROUND: The therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6-59 months admitted to the TFU in Ethiopia. METHODS: Health Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables. RESULTS: The median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62-7.38) compared to F-100 (10 days; 95% CI: 8.94-11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42-0.69), dehydrated (AHR = 1.34, 95% CI: 1.07-1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03-1.61), and anemic (AHR = 2.57, 95% CI: 1.90-3.48) during admission were associated with time to recovery. CONCLUSIONS: Children who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

Relapse of severe acute malnutrition among children discharged from outpatient therapeutic program in western Ethiopia.

BACKGROUND: Children with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia. METHODS: We conducted a facility-based cross-sectional study among 208 children aged 6-59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models. RESULTS: The prevalence of SAM relapse was 10.1% (95% CI: 5.8-14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3-12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8-23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1-12.8) than their counterparts. CONCLUSIONS: To reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators - weight-for-height/length z-score (WHZ) and MUAC - and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse.

Spatial farming systems diversity and micronutrient intakes of rural children in Ethiopia.

Own production contributes much of the food supply in smallholder production systems in low- and middle-income countries like Ethiopia. Understanding the potential as well as constraints of these production systems in terms of nutrient supplies is thus a critical step to design interventions to improve nutrient intakes. The objectives of this study were (1) to assess the usual total intakes of vitamin A, iron and zinc among rural children and (2) to investigate whether the intakes these nutrients are associated with differences in the dominant farming systems between spatial clusters. Using nationally representative intake data of 4,902 children 6-35 months of age, usual intake and the proportion of inadequate intakes of vitamin A, iron and zinc were calculated. A multi-level model was used to examine the association between individual-level and cluster-level variables with the usual total dietary intakes of these nutrients. The diet was dominated by starchy foods. Consumption of animal source foods, vitamin A-rich fruits and vegetables was low. We found a high prevalence of inadequate intake of vitamin A and zinc (85.4% and 49.5%, respectively). Relatively, low prevalence of inadequate intake of iron (8.4%) was reported. The spatial farming systems diversity across the rural clusters explained 48.2%, 57.2% and 26.7% of the observed variation in the usual total dietary intakes of vitamin A, iron and zinc, respectively. Our findings indicated the importance of farming system diversity at the landscape level as one of the determinant factors for individual usual total dietary intakes of vitamin A, iron and zinc.

Heat and emergency room admissions in the Netherlands.

BACKGROUND: Due to a global warming-related increase in heatwaves, it is important to obtain detailed understanding of the relationship between heat and health. We assessed the relationship between heat and urgent emergency room admissions in the Netherlands. METHODS: We collected daily maximum temperature and relative humidity data over the period 2002-2007. Daily urgent emergency room admissions were divided by sex, age group and disease category. We used distributed lag non-linear Poisson models, estimating temperature-admission associations. We estimated the relative risk (RR) for urgent hospital admissions for a range of temperatures compared to a baseline temperature of 21 °C. In addition, we compared the impact of three different temperature scenarios on admissions using the RR. RESULTS: There is a positive relationship between increasing temperatures above 21 °C and the RR for urgent emergency room admissions for the disease categories 'Potential heat-related diseases' and 'Respiratory diseases'. This relationship is strongest in the 85+ group. The RRs are strongest for lag 0. For admissions for 'circulatory diseases', there is only a small significant increase of RRs within the 85+ age group for moderate heat, but not for extreme heat. The RRs for a one-day event with extreme heat are comparable to the RRs for multiple-day events with moderate heat. CONCLUSIONS: Hospitals should adjust the capacity of their emergency departments on warm days, and the days immediately thereafter. The elderly in particular should be targeted through prevention programmes to reduce harmful effects of heat. The fact that this increase in admissions already occurs in temperatures above 21 °C is different from previous findings in warmer countries. Given the similar impact of three consecutive days of moderate heat and one day of extreme heat on admissions, criteria for activation of national heatwave plans need adjustments based on different temperature scenarios.

Drought, conflict and children's undernutrition in Ethiopia 2000-2013: a meta-analysis.

OBJECTIVE: To estimate the prevalence of childhood wasting and to investigate the effects of drought and conflict on wasting in crisis-affected areas within Ethiopia. METHODS: We searched the Complex Emergency Database for nutrition surveys carried out in Ethiopia over the period 2000-2013. We extracted data on the prevalence of wasting (weight-for-height z-scores below -2) among children aged 6-59 months for areas of Ethiopia that had sufficient data available. Data on any conflict events (irrespective of magnitude or impact) and episodes of seasonal drought affecting the survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesize the evidence from 231 small-scale surveys. FINDINGS: From the total sample of 175 607 children analysed, the pooled number of children wasted was 21 709. The posterior median prevalence of wasting was 11.0% (95% credible interval, CrI: 10.3-11.7) over the 14-year period. Compared with areas unaffected by drought, the estimated prevalence of wasting was higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05-1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68-1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82-1.26). CONCLUSION: Despite an overall declining trend, a wasting problem persists among children in Ethiopia. Conflict events did not have a major impact on childhood wasting. Nutrition interventions should go beyond severe drought-prone areas to incorporate areas where moderate droughts occur.

Barriers to surgical care in Nepal.

BACKGROUND: Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care. METHODS: A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care. RESULTS: Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54). CONCLUSIONS: More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.

Factors Associated with Stunting among Pre-school Children in Southern Highlands of Tanzania.

BACKGROUND: Stunting is a major public health problem in Africa and is associated with poor child survival and development. We investigate factors associated to child stunting in three Tanzanian regions. METHODS: A cross-sectional two-stage cluster sampling survey was conducted among children aged 6-59 months. The sample included 1360 children aged 6-23 months and 1904 children aged 24-59 months. Descriptive statistics and binary and multivariate logistic regression analyses were used. RESULTS: Our main results are: in the younger group, stunting was associated with male sex (adjusted odds ratio [AOR]: 2.17; confidence interval [CI]: 1.52-3.09), maternal absence (AOR: 1.93; CI: 1.21-3.07) and household diet diversity (AOR: 0.61; CI: 0.41-0.92). Among older children, stunting was associated with male sex (AOR: 1.28; CI: 1.00-1.64), age of 4 and 5 (AOR: 0.71; CI: 0.54-0.95; AOR: 0.60; CI: 0.44-0.83), access to improved water source (AOR: 0.70; CI: 0.52-0.93) and to a functioning water station (AOR: 0.63; CI: 0.40-0.98) and mother breastfeeding (AOR: 1.97; CI: 1.18-3.29). CONCLUSIONS: Interventions that increase household wealth and improve water and sanitation conditions should be implemented to reduce stunting. Family planning activities and programmes supporting mothers during pregnancy and lactation can positively affect both newborns and older siblings.

Food insecurity among low-income households in Addis Ababa, Ethiopia.

With the rapid urbanization in developing countries, poverty and food insecurity are becoming increasing prevalent, posing a major challenge to urban areas. The COVID-19 pandemic induced job losses and reduced income combined with inflation have further exacerbated the household food insecurity situation, particularly in cities of low-income countries. Our study aims to assess the extent of food insecurity and its determinants among low-income household in Addis Ababa, Ethiopia. We conducted a community-based cross-sectional study among a sample of 578 households in Addis Ababa. We estimated the household food insecurity status using the Household Food Insecurity Access Scale (HFIAS). An ordinal logistic regression model was used to assess the relationship between household food insecurity status and the socioeconomic and demographic covariates. The STATA 14 software package was used for data analysis. We found that household food insecurity was prevalent among low-income households in Addis Ababa, with a prevalence rate of 92.4 % (95 % CI: 90.2-94.6 %). Of these households, 33.6 % (95 % CI: 29.7-37.4 %) were severely food insecure. To cope with the food shortage, households were forced to reduce their food quantity and quality. We also found that respondent's education, engagement in income generating activities, and household wealth were independently associated with household food insecurity. We conclude that although supporting people living below the poverty line (pro-poor) remains the top priority for social protection programs, adapting the program to accommodate the working poor (informal sector employees and casual workers) is crucial, especially during shocks.

Effects of COVID-19 imposed school closure on school feeding program in Addis Ababa, Ethiopia.

The school feeding program in government schools in Addis Ababa was interrupted due to the COVID-19 pandemic. The study employed a qualitative research to explore the effects of the interruption on students' well-being. The study participants were recruited from seven primary schools within six sub-cities of Addis Ababa using convenience sampling. Fifty-three in-depth interviews were conducted with students, parents, teachers, school principals, and school feeding agency officials. Thematic analysis was then conducted. The study found that the school feeding program has indeed improved school attendance and in class concentration; helped decrease lateness and dropout; reduced child labour and abuse; and taken off parent's burden. The interruption of the program has dire consequences on students' well-being, and their parents. Some effects this study finds troubling are: food shortage; skipping meals; eating poor quality food; eating reduced portion size; and children being subject to child abuse and child labour for menial activities. Effective use of available resources through existing channels, such as the food banks and the urban safety net program, and encouraging innovative ideas, including the 'Each One Feed One' initiative, would help vulnerable children and families survive during the pandemic.

Drought and child mortality: a meta-analysis of small-scale surveys from Ethiopia.

Despite the intuitive connection between drought and mortality, we still lack a sound quantitative synthesis of evidence drawn from the available data. In this study, we estimate the pooled under-five death rates (U5DR) and assess the effect of drought on child death in Ethiopia. Small-scale mortality surveys were searched from the Complex Emergency Database and then aggregated spatially and temporally with drought exposure data from the Global Drought Monitor and food insecurity data from the Famine Early Warning Systems Network. A Bayesian Poisson meta-analysis was performed on 88 surveys conducted in Ethiopia between 2009 and 2014, consisting of 55,219 under-five children. The pooled U5DR was estimated at 0.323/10,000/day (95% credible interval, CrI: 0.254-0.397), which is below both the emergency and the baseline death rate thresholds of sub-Saharan Africa. We failed to find a plausible association between drought and U5DR. However, minimal food insecure areas showed elevated U5DR compared to stressed food insecure areas. Furthermore, the U5DR increases as the prevalence of acute malnutrition increases. Targeted interventions to improve the underlying causes of child malnutrition are crucial. Further, revising and updating the existing mortality thresholds, both the baseline and the emergency, is recommended.

Child Wasting in Emergency Pockets: A Meta-Analysis of Small-Scale Surveys from Ethiopia.

Child undernutrition is a major public health concern in Ethiopia (stunting national prevalence: 44%; wasting: 10%), despite the overall improvement in child health status during the last decade. Hundreds of small-scale surveys are conducted in Ethiopia's emergency pockets under ENCU's supervision. We reviewed the evidence from small-scale surveys conducted between 2008 and 2013 with two objectives: to provide a summary estimate of wasting prevalence from emergency pockets and to examine reasons for variation in prevalence estimates. We created a dataset by combining data from the Complex Emergency Database, the Famine Early Warning System Network and the Armed Conflict Location Event Data. We conducted a meta-analysis of small-scale surveys using a random effects model with known within-study heterogeneity. The influence of survey covariates on estimated prevalence was investigated with meta-regression techniques. We included 158 surveys in the analysis. A high degree of heterogeneity among surveys was observed. The overall estimate of wasting prevalence was 10.6% (95% CI 9.8-11.4), with differences among regions and between residents and refugees. Meta-regression results showed that vaccination coverage, child mortality, diarrhea prevalence and food insecurity are significantly associated with wasting prevalence. Child care and displacement status were not. Aggregated analysis of small-scale surveys provides insights into the prevalence of wasting and factors explaining its variation. It can also guide survey planning towards areas with limited data availability.

Impact of disasters on child stunting in Nepal.

BACKGROUND: Stunting is a major public health problem that results from inadequate nutritional intake over a long period of time. Disasters have major implications in poor and vulnerable children. The aim of this study was, therefore, to assess the impact of disasters on child stunting in Nepal. METHOD: A sample consisting of 2,111 children aged 6-59 months was obtained from the 2011 Nepal Demographic and Health Survey. We used bivariate and multivariate analyses to examine moderate and severe stunting against disaster, controlling for all possible confounders. RESULT: Out of the total study sample, 43% were stunted (17.1% severely and 25.9% moderately). The final model, after adjusting for confounders, showed that epidemics have no impact on child stunting (adjusted odds ratio [OR] =1.14, 95% confidence interval [CI]: 0.66, 1.97 and adjusted OR =1.04, 95% CI: 0.66, 1.65 for severe and moderate stunting, respectively). Floods have impact on child stunting (adjusted OR =0.57, 95% CI: 0.31, 0.96 and adjusted OR =0.66, 95% CI: 0.41, 0.94 for severe and moderate stunting, respectively). However, children aged 6-11 months, nonvaccinated children, children of working women, children who live in mountainous areas, and children from the poorest households were more likely to be moderately stunted. Similarly, children aged 36-47 months, Dalit and other ethnic groups, children from rural settings, and children from the poorest households were more likely to be severely stunted. CONCLUSION: This article illustrates the need to rethink about child stunting in Nepal. This study suggests need for further research, integration of disaster data in the Nepal Demography Health Survey, educational interventions, public awareness, promotion of vaccination, and equity in health service delivery.

Health at the borders: Bayesian multilevel analysis of women's malnutrition determinants in Ethiopia.

BACKGROUND: Women's malnutrition, particularly undernutrition, remains an important public health challenge in Ethiopia. Although various studies examined the levels and determinants of women's nutritional status, the influence of living close to an international border on women's nutrition has not been investigated. Yet, Ethiopian borders are regularly affected by conflict and refugee flows, which might ultimately impact health. OBJECTIVE: To investigate the impact of living close to borders in the nutritional status of women in Ethiopia, while considering other important covariates. DESIGN: Our analysis was based on the body mass index (BMI) of 6,334 adult women aged 20-49 years, obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). A Bayesian multilevel multinomial logistic regression analysis was used to capture the clustered structure of the data and the possible correlation that may exist within and between clusters. RESULTS: After controlling for potential confounders, women living close to borders (i.e. ≤100 km) in Ethiopia were 59% more likely to be underweight (posterior odds ratio [OR]=1.59; 95% credible interval [CrI]: 1.32-1.90) than their counterparts living far from the borders. This result was robust to different choices of border delineation (i.e. ≤50, ≤75, ≤125, and ≤150 km). Women from poor families, those who have no access to improved toilets, reside in lowland areas, and are Muslim, were independently associated with underweight. In contrast, more wealth, higher education, older age, access to improved toilets, being married, and living in urban or lowlands were independently associated with overweight. CONCLUSIONS: The problem of undernutrition among women in Ethiopia is most worrisome in the border areas. Targeted interventions to improve nutritional status in these areas, such as improved access to sanitation, economic and livelihood support, are recommended.

Impact of Refugees on Local Health Systems: A Difference-in-Differences Analysis in Cameroon.

Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.