Determinants of low birth weight among newborns delivered in public hospitals of North Shewa Zone, Amhara region, Ethiopia: A case-control study (2023).

BACKGROUND: Low birth weight (LBW), defined as a birth weight less than 2500 g, irrespective of gestational age, poses a significant health concern for newborns. Despite efforts, the incidence of LBW in sub-Saharan Africa has remained stagnant over the past decade, warranting attention from healthcare providers, policymakers, and researchers. OBJECTIVE: This study aimed to identify factors associated with LBW among newborns delivered in public hospitals of North Shewa Zone, Amhara Region, Ethiopia, from May 2 to June 10, 2023. METHODS AND MATERIALS: An unmatched case-control study was conducted from May 2 to June 10, 2023, involving 318 participants (106 cases and 212 controls). Data were collected using pretested interviewer-administered structured questionnaires, medical record reviews, and direct anthropometric measurements. Bivariate analyses were conducted, and variables with a p-value ≤ 0.25 were included in a multivariable logistic regression model to determine significant determinants of LBW. A significance level of p < 0.05 was used. RESULTS: A total of 309 newborns (103 cases and 206 controls) were included, yielding a response rate of 97.2%. Among the findings, females exhibited a higher risk of LBW (adjusted odds ratio [AOR]: 3.13, 95% CI: 1.34, 7.32, p = 0.008), as did mothers aged 20 or younger (AOR: 3.42, 95% CI: 1.35, 8.66, p = 0.009). Lack of formal education was associated with increased risk (AOR: 6.82, 95% CI: 2.94, 15.3, p < 0.001), as were unplanned pregnancies (AOR: 3.08, 95% CI: 1.38, 6.84, p = 0.006) and missed antenatal care visits (AOR: 2.74, 95% CI: 1.16, 6.49, p = 0.021). No significant associations were found with residency type or maternal age above 35. CONCLUSION: Mothers aged ≤ 20 years, with inadequate minimum dietary diversity, lack of antenatal care attendance, and unplanned pregnancies, faced heightened risks of LBW. Addressing these factors is vital for reducing LBW occurrences and improving newborn health outcomes in Ethiopia.

Effect of nutritional promotion intervention on dietary adherence among type II diabetes patients in North Shoa Zone Amhara Region: quasi-experimental study.

BACKGROUND: Diabetes is a major global public health problem that requires self-management behavior. However, this is difficult to implement in practice and requires new approaches. The purpose of this study was to evaluate nutritional promotion interventions for dietary adherence and lessons learned to improve self-management. METHODS: A quasi-experimental study was conducted from January 2020 to February 2021 in North Shoa Zone public hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Study participants were randomly assigned to intervention and control groups at an individual level. Data were measured twice (baseline and end line survey after six months using interviewer-administered questionnaires). Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t tests. A p-value less than 0.05 was considered significant for all statistical tests. RESULTS: A total of 216 type II diabetics participated in this study. Nutritional promotion intervention programs increased adherence to the mean number of days adhering to a healthy diet (p < 0.0001). Specifically, the nutrition promotion program improved daily intake of fruits and vegetables, low glycemic index foods, high fiber foods, healthy fish oils, low sugar foods, and healthy eating plans (p ≤ 0.050). Mean fasting blood glucose levels were significantly decreased after the educational intervention (p ≤ 0.05). CONCLUSION: This study demonstrates that a nutrition-promoting intervention can significantly change patients' adherence to healthy eating behaviors and effectively improve their glycemic control. Health care providers should integrate programs that promote nutrition education into existing health systems service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.

Sensitivity and specificity of mid-upper arm circumference for assessment of severe acute malnutrition among children ages 6 to 59 months: Systematic review and meta-analysis.

OBJECTIVES: Sensitivity is the proportion of people classified as diseased (i.e., no false negatives). A test with low sensitivity can be thought of as being too cautious in finding a positive result. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed for this systematic review and meta-analysis. The databases used were PubMed, Google Scholar, Jane, and African Journals Online. The search terms used were "sensitivity" and "specificity of and mid-upper arm circumference" (MUAC). A Joanna Briggs Institute meta-analysis and checklist for diagnostic test accuracy studies was used for the critical appraisal of the studies. The meta-analysis was conducted using STATA, version 14, software. The pooled sensitivity was computed to present the pooled sensitivity at a 95% confidence interval (CI). RESULTS: A total of 11 individual studies were included in the meta-analysis. The lowest sensitivity of MUAC with the detection of severe acute malnutrition (SAM) was 5% in Vietnam, and the highest sensitivity was at 43.2% in India. The pooled sensitivity of MUAC among children aged <5 y to determine SAM was 20.7% (range, 13.24%-28.25%; P = 0.001). Based on the pooled specificity of MUAC, the detection of SAM was 97.636% (95% CI, 96.339%-98.932%; P = 0.001), and the pooled optimal cutoff point to diagnose SAM was 13.23 cm (95% CI, 12.692-13.763 cm; P = 0.001). CONCLUSIONS: The sensitivity of MUAC is lower compared with the specificity to detect SAM, and varies from area to area.

Utilization of mid-upper arm circumference as discharge tool for children in outpatient therapeutic program, Ethiopia.

Mid-upper arm circumference (MUAC) is simple to use and inexpensive in Ethiopia; both MUAC and target weight are employed, although the time to cure for MUAC is not indicated. The present study is aimed to determine cure time of MUAC for children in outpatient therapeutic program. A prospective cohort study was conducted among 414 severe acute malnourished under-five children admitted to selected health twenty-two posts from 1 February to 30 July 2021, in Oromia, Ethiopia. Data were coded, entered to Ep-data version 4.2 software, and transferred to SPSS for windows version 25 software for analysis. The Multivariate Cox Proportional Hazards model was used to fit independent determinants of time to cure. All tests were two-sided and statistical implications at P-values < 0⋅05. In the present study, the minimum week for a cure was 4 weeks, the maximum was 16 weeks and the overall time to cure severe acute malnutrition as measured by MUAC is judged to be 10 at 95 % CI (9⋅65-10⋅35). Families with six or more members are 2⋅16 times more at risk, children from homes with the lowest wealth index are at 1⋅4 times more risk, and children from food insecure families were 2⋅61 times more likely to require long-term treatment for MUAC. In the present study, the time to cure severe acute malnutrition by MUAC is determined as 10 weeks. Moreover, family size, low wealth index, and household food insecurity were risks to delay in cure time MUAC.

Validating the diagnostic performance of MUAC in screening moderate acute malnutrition and developing an optimal cut-off for under five children of different regions in Ethiopia.

BACKGROUND: Valid and reliable anthropometric indicator is useful for early detection and treatment for under nutrition. Although, mid upper arm circumference (MUAC) is used for screening of children with moderate acute malnutrition in Ethiopia, its performance for the different ethnic groups has not been evaluated. OBJECTIVE: To determine the diagnostic performance of MUAC for determination of moderate wasting among children of different ethnic background and develop optimal cut-off. METHODS: A community based cross-sectional study was conducted among under five children of the three regions namely: Somalia, Amhara and Gambella Regions. The diagnostic performance of MUAC was validated using weight for height Z-score< -2 as a gold standard binary classifier. Test variable is mid upper arm circumference (MUAC< 12.5cm) and weight for height Z-Score (WHZ) is standard variable. ROC analysis performed based on the assumptions of MUAC value lower the cut-off point indicates the undernutrition. Area under the curve and validity measures (sensitivity and specificity) was generated as parameter estimated. The results were presented using tables and ROC curves. RESULTS: Except in the Gambella region, there was fair agreement between MUC<12.5cm and Weight for Height Z score<-2 in diagnosing wasting in Somali (Sensitivity = 29.3%, Kappa = 0.325, P<0.001) and in Gambella regions (Sensitivity = 16.7%, Kappa = 0.19, P<0.001). In Amhara region there was fair agreement between the two measures in diagnosing moderate acute malnutrition (MAM) (Sensitivity = 16%, Kappa = 0.216). For the Overall sample, the sensitivity of MUAC<12.5cm was 20.6% (Kappa = 0.245, P<0.001. Based on ROC analysis, the optimal cutoff value of MUAC for diagnosing moderate acute malnutrition for the two regions namely for Gambella and Amhara was 13.85cm with sensitivity of 0.99 and 1.00, respectively. However, for Somali Region the optimal cut was 13.75cm (Sensitivity = 0.98 cm and specificity = 0.71). CONCLUSION: Findings revealed that the inter reliability of measurement for MUAC< 12.5cm and WHZ<-2 for diagnosing MAM was low among different ethnic groups with the cut-off varying in each region. The existing cutoff point is less sensitive for diagnosis of MAM. As Ethiopia is home of diverse ethnic groups with different body frame and environmental conditions, the new cut off points developed for each region recommended to be used for screening moderate acute malnutrition to prevent relapse of MAM and reduce chronic malnutrition.

Frequency of relapse for severe acute malnutrition and associated factors among under five children admitted to health facilities in Hadiya Zone, South Ethiopia.

BACKGROUND: Severe acute malnutrition is a common cause of morbidity and mortality among under five children in Ethiopia. A child may experience more than one episode of SAM depending on the improvement of the underlying factors. However, there is no study that determined the frequency of relapse of SAM cases after discharge in Ethiopia. OBJECTIVE: To identify the frequency of relapse and associated factors among children discharged after undergoing treatment for SAM in Hadiya Zone, South, Ethiopia. METHODS: An institution based retrospective cohort study was done among children admitted to health posts for treatment of SAM from 2014/2015-2019/2020 under-five children's after discharge in health post for severe acute malnutrition in the last five years in Hadiya zone, SNNPR, Ethiopia. Both first admission data and relapse data were abstracted from the records of the SAM children from Aguste 1-30 /2020 Using a data collection format. Data were coded and edited manually, then doubly entered into Epi-Data statistical software version 3.1 and then exported to SPSS for windows version 26. After checking all the assumptions finally Negative binomial regression for poison has been used. All tests were two sided and P values <0.05 were used to declare statistical significance. RESULTS: In the last five year there were the proportion of relapsed cases were 9.6%, 95% CI: (7.7%, 11.7%) On multivariable negative binomial regression model, after adjusting for background variables relapse of severe acute undernutrition was significantly associated with having edema during admission with (IRR = 2.21, 95% CI:1.303-3.732), being in the age group of 6-11 months (IRR = 4.74,95% CI:1.79-12.53), discharge MUAC for the first admission (P = 0.001, IRR = 0.37, 95% CI:0.270-0.50) increase the risk of incidence rate ratio(IRR) relapse case of severe acute under nutrition. CONCLUSION: Frequency of SAM relapse was positively associated with age, having edema during admission, while it was negatively associated with discharge MUAC. The results imply the need for reviewing the discharge criteria taking into account the recovery of MUAC as a marker for lean tissue accretion, especially in edematous children and those in the younger age.

Time to relapse of severe acute malnutrition and risk factors among under-five children treated in the health posts of Hadiya Zone, Southern Ethiopia.

Relapse/repeated episodes are defined as the admission of a child with a diagnosis of severe acute malnutrition (SAM) after being discharged with a status of recovery. However, there is a lack of study that documented the time to relapse of SAM and its risk factors. The present study aimed to identify the time of relapse and its risk factor among under-five children discharged after undergoing treatment for SAM in health facilities of Hadiya Zone, South Ethiopia. An institution-based retrospective cohort study was carried out in the Hadiya Zone of Southern Ethiopia among under-five children. Data were collected from 760 cards of severe acute malnourished children over the past 5 years spanning from 2014/15 to 2019/20. Both first admission and relapse data were abstracted from the records of the SAM children from 1 August to 30 August 2020 and cards of children that were admitted to program by transferee with complete records were included. After checking all the assumptions, multivariable Cox Proportional Hazards model was fitted to isolate independent determinants of time to cure. All tests were two-sided and statistical significance at P-values < 0⋅05. The mean(±sd) time for relapse of SAM among under-five children was 22(±9⋅9) weeks from discharge to relapse time. On multivariable Cox Proportional Hazards model, the hazard of relapse for SAM was significantly higher for children who had oedema (AHR 2⋅02, 95 % CI 1⋅17, 3⋅50), age of 6-11 months (AHR 5⋅2, 95 % CI 1⋅95, 13⋅87) had discharge MUAC not cured (AHR12, 95% CI 7⋅90, 19⋅52). The finding showed that children discharged from SAM are likely to have relapse in 3 weeks time.