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.

Enhancing and promoting data management and systematic monitoring for an improved HIV/AIDS programs in Addis Ababa, Ethiopia.

BACKGROUND: Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). METHODS: AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50-74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time. RESULTS: After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23-46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03-77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01-33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38-65.6%] in September 2019. CONCLUSIONS: Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.

Unknown HIV status and the TB/HIV collaborative control program in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Ethiopia has shown significant efforts to address the burden of TB/HIV comorbidity through the TB/HIV collaborative program. However, these diseases are still the highest cause of death in the country. Therefore, this systematic review and meta-analysis evaluated this program by investigating the overall proportion of unknown HIV status among TB patients using published studies in Ethiopia. METHODS: We conducted a systematic review and meta-analysis of published studies in Ethiopia. We identified the original studies using the databases MEDLINE/PubMed, and Google Scholar. The heterogeneity across studies was assessed using Cochran's Q test and I 2 statistics. The Begg's rank correlation and the Egger weighted regression tests were assessed for the publication bias. We estimated the pooled proportion of unknown HIV status among TB patients using the random-effects model. RESULTS: Overall, we included 47 studies with 347,896 TB patients eligible for HIV test. The pooled proportion of unknown HIV status among TB patients was 27%(95% CI; 21-34%) and with a substantial heterogeneity (I2 = 99.9%). In the subgroup analysis, the pooled proportion of unknown HIV status was 39% (95% CI; 25-54%) among children and 20% (95% CI; 11-30%) among adults. In the region based analysis, the highest pooled proportion of unknown HIV status was in Gambella, 38% (95% CI; 16-60%) followed by Addis Ababa, 34%(95% CI; 12-55%), Amhara,30%(95% CI; 21-40%),and Oromia, 23%(95% CI; 9-38%). Regarding the study facilities, the pooled proportion of unknown HIV status was 33% (95% CI; 23-43%) in the health centers and 26%(95% CI; 17-35%) in the hospitals. We could not identify the high heterogeneity observed in this review and readers should interpret the results of the pooled proportion analysis with caution. CONCLUSION: In Ethiopia, about one-third of tuberculosis patients had unknown HIV status. This showed a gap to achieve the currently implemented 90-90-90 HIV/AIDS strategic plan in Ethiopia, by 2020. Therefore, Ethiopia should strengthen TB/HIV collaborative activities to mitigate the double burden of diseases.