Local spatial clustering of stunting and wasting among children under the age of 5 years: implications for intervention strategies.

OBJECTIVE: The present study aimed to evaluate the clustering of undernutrition indicators of children under the age of 5 years in relation to different scales. DESIGN: A community-based cross-sectional study design was employed. We collected anthropometric data, geographic locations/elevations of households and other data from visited households. We used a retrospective purely spatial Poisson probability model to identify and locate clusters (high rates) of stunting and wasting using the software SaTScan™ version 9·1·1. We ran a logistic regression model to help evaluate the causes of clustering. Settings Six villages in the Meskane Mareko District (38·45763°E, 8·042144°N) of southern Ethiopia. SUBJECTS: We surveyed 2371 children aged <5 years, who were found in 1744 households. RESULTS: We found a micro-level variation in the risk of stunting and wasting within the studied district. We found the most likely significant clusters for wasting and severe wasting in two of the six villages. For stunting, a single large cluster size of 390 cases (304·19 expected) in 756 households was identified (relative risk=1·48, P<0·01). For severe stunting, a single cluster size of 106 cases (69·39 expected) in 364 households was identified (relative risk=1·69, P=0·035). CONCLUSIONS: We conclude that the distribution of wasting and stunting was partly spatially structured. We identified distinct areas within and between villages that have a higher risk than the underlying at-risk population. Our analysis identified the spatial locations of high-risk areas for stunting that could be an input for geographically targeting and optimizing nutritional interventions.

Climate change, crop production and child under nutrition in Ethiopia; a longitudinal panel study.

BACKGROUND: The amount and distribution of rainfall and temperature influences household food availability, thus increasing the risk of child under nutrition. However, few studies examined the local spatial variability and the impact of temperature and rainfall on child under nutrition at a smaller scale (resolution). We conducted this study to evaluate the effect of weather variables on child under nutrition and the variations in effects across the three agro ecologies of Ethiopia. METHODS: A longitudinal panel study was conducted. We used crop productions (cereals and oilseeds), livestock, monthly rainfall and temperature, and child under nutrition data for the period of 1996, 1998, 2000 and 2004. We applied panel regression fixed effects model. RESULTS: The study included 43 clusters (administrative zones) and 145 observations. We observed a spatio temporal variability of rainfall, stunting and underweight. We estimated that for a given zone, one standard deviation increase in rainfall leads to 0.242 standard deviations increase in moderate stunting. Additionally, a one standard deviation increase temperature leads to 0.216 standard deviations decrease in moderate stunting. However, wasting was found to be poorly related with rainfall and temperature. But severe wasting showed a positive relationship with the quadratic term of rainfall. CONCLUSIONS: We conclude that rainfall and temperature are partly predicting the variation in child stunting and underweight. Models vary in predicting stunting and underweight across the three agro ecologic zones. This could indicate that a single model for the three agro ecologies may not be not applicable.

Patterns of knowledge and condom use among population groups: results from the 2005 Ethiopian behavioral surveillance surveys on HIV.

BACKGROUND: Behavioral surveys help interpret the magnitude of HIV/AIDS. We analyzed indicators of knowledge on HIV/AIDS and condom use among sub populations selected for behavioral surveillance in Ethiopia. METHODS: We used 2005 HIV/AIDS behavioral data from ten target groups. These were female sex workers, defense forces, police force, pastoralists, truck drivers, intercity bus drivers, road construction workers, teachers, factory workers and people in ANC catchment areas. RESULTS: Data from 14,524 individuals were analyzed. The majority were males (63.6%). Overall, knowledge of the three preventive methods, misconceptions and comprehensive knowledge was 57%, 75% and 18.5%, respectively. Female sex workers and the defense force showed some behavioral change in using a condom during the most recent sexual encounter and consistently used a condom with non-regular sexual partners and paying partners. Women, pastoralists and the illiterate were less likely to use condom. CONCLUSION: Misconceptions about the transmission of HIV were high and comprehensive knowledge about HIV & AIDS was low, particularly among pastoralists. Consistent condom use and condom use during the last sexual encounter were high among both female sex workers and defense force employees, both with paying and non-regular sexual partners. This might be a positive sign, though a considerable proportion in each target group did not report using a condom during sex with non-regular partners.

Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia.

BACKGROUND: Endemic non-filarial elephantiasis or podoconiosis is a chronic and debilitating geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a major public health problem in countries in tropical Africa, Central America and North India. OBJECTIVE: To estimate the direct and the average productivity cost attributable to podoconiosis, and to compare the average productivity time of podoconiosis patients with non-patients. METHODS: Matched comparative cross sectional survey involving 702 study subjects (patients and non-patients) supplemented by interviews with key informants in Wolaita Zone, southern Ethiopia. RESULTS: Total direct costs of podoconiosis amounted to the equivalent of US$ 143 per patient per year. The total productivity loss for a patient amounted to 45% of the total working days per year, causing a monetary loss equivalent to US$ 63. In Wolaita zone, the overall cost of podoconiosis exceeds US$ 16 million per year. CONCLUSIONS: Podoconiosis has enormous economic impact in affected areas. Simple preventive measures (such as use of robust footwear) must be promoted by health policy makers.