Body composition and associated factors among 5-7-year-old children with moderate acute malnutrition in Jimma town in southwest Ethiopia: A comparative cross-sectional study.

Acute malnutrition affects not only the growth and development but also the body composition of children. However, its specific effects have not yet been characterized. This study aims to compare the body composition of 5-7-year-old children with moderate acute malnutrition (MAM) to that of their well-nourished (WN) peers and identify associated factors. A school-based comparative cross-sectional study was conducted from June to July 2022 in Jimma town, southwest Ethiopia. The study participants were selected from eight kindergartens and eight primary schools using a simple random sampling technique based on the proportional allocation of the sample to the size of the population in the respective school. Descriptive statistics and multivariable linear regression analyses were used to assess the mean differences and associations between variables and isolate independent predictors of body composition, respectively. The statistical significance was determined using ß-coefficients with 95% confidence intervals and a p value of ≤ 0.05. Data were captured from 388 (194 MAM and 194 WN) children with a response rate of 97.9%. The mean fat-free mass of WN children was significantly higher compared with those with MAM (p < 0.001). The mean (SD) of fat mass of MAM children was 4.23 ± 0.72 kg, 4.36 ± 0.88 kg and 4.08 ± 0.89 kg for 5, 6 and 7-year-olds, respectively. For WN children, the mean (SD) of fat mass was 4.92 ± 0.88 kg for 5 years old, 5.64 ± 1.01 kg for 6 years old and 5.75 ± 1.26 kg for 7 years old (p < 0.001). On the multivariable linear regression analysis after controlling for background variables, WN children exhibited 1.51 times higher fat-free mass compared with MAM children (ß = 1.51, p = 0.003). A unit increase in age of the study participants was associated with a 1.37 increment in fat-free mass (ß = 1.37, p < 0.001). WN children had 1.07 times higher fat mass compared with children with MAM (ß = 1.07, p < 0.001). A unit increase in the age of the child resulted in 0.15 times increment in fat mass (ß = 0.15, p = 0.020), and being female was associated with a 0.37 increase in fat mass (ß = 0.37, p < 0.001). The results showed that the mean fat mass and fat-free mass were significantly lower among moderately acute malnourished children than in WN children showing the loss of both body compartments due to malnutrition. The body mass index for age, age of the child and sex of the child were significantly linked to both fat-free mass and fat mass.

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis.

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Development and validation of body fat percent prediction equation for screening obesity in adults.

BACKGROUND: In Ethiopia, use of advanced body composition measurement methods may not be feasible due cost and unavailability of the facilities. This study developed and validated body fat percent prediction equation for adults using locally appropriate data. METHODS: The study was conducted from February to April 2015 among 704 randomly selected adult employees of Jimma University. The total sample was spilt and randomly assigned to a training (n = 352) sample used for developing Ethiopian body fat percent (BF%) prediction equation and a testing (validation) sample (n = 352) used for determining the validity of the equation. A multivariable linear regression model was used to develop BF% prediction equation on the training sample using Air displacement Plethysmography (ADP) measured BF% as dependent variable and age, sex and body mass index as predictor variables. For the testing (validation) sample, BF% measured using ADP and the one predicted using the newly developed Ethiopian and Caucasian BF% prediction equations were compared using validity measures, Kappa statistics and agreement between the two measures was determined using Bland Altman plot. RESULTS: A multivariable linear regression model run on the testing population showed that age, sex and BMI were significant predictors of ADP measured BF%. Accordingly, the BF% prediction equation of Ethiopian adults was generated as follows: BF% = -8.601 + BMI (1.521) + Age (0.243) + Sex (-10.568), where sex = 1 for males and 0 for females. Comparison of measured and predicted BF% showed that there was no significant (P = 0.932) difference between ADP measured BF% and BF% predicted using Ethiopian equation with a mean (±SD) difference of 0.03 (±5.44). Conversely, there was a significant difference (<0.0001) between ADP measured BF% and the Caucasian Equation estimated BF% with a mean (±SD) of 6.83 (±5.57). In both males and females, the Ethiopian equation demonstrated a very good to excellent sensitivity, specificity, positive predictive value and negative predictive values. Conversely, the Caucasian equation had poor sensitivity and negative predictive values, while it demonstrated an excellent specificity and positive predictive value. Likewise, there was a substantial Kappa agreement for males (K = 0.741) and for females (K = 0.720) between Ethiopian equation and ADP in diagnosing obesity among males based on BF%, while there was a slight Kappa agreement for males (K = 0.156) and a fair Kappa agreement for females (K = 0.365) between Caucasian equation and ADP (P < 0.001). Bland Altman plot showed a good agreement between ADP measured BF% for the Ethiopian Equation and not for the Caucasian equation. It was observed that the Ethiopian equation has a better prediction of BF% when compared to the measured one, but the Caucasian equation consistently underestimated BF% for all samples with different levels BF%. CONCLUSION: The new Ethiopian BF% prediction equation performed very well in predicting BF% in the testing population in terms of validity measures, Kappa agreement and Bland Altman plot; while the Caucasian equation significantly underestimated body fat percent among Ethiopian adults. The results imply that the new Ethiopian equation can be used as a cost effective and user friendly screening method for early detection of obesity for the prevention of associated morbidity and mortality in Ethiopian adults.

Dietary Practice among Type 2 Diabetic Ppatients in Southern Ethiopia.

BACKGROUND: Diabetic patients' dietary practice is critical to improve glycemic, lipid, and blood pressure control. However, a significant number of patients had poor dietary practice. In Ethiopia, more than half of diabetic patients were not practicing a healthy dietary approach. Therefore, this study assessed variables that were hardly addressed in previous studies. The aim of this study was to assess dietary practice and associated factors among patients with type 2 diabetes. METHODS: A facility-based cross-sectional study was performed among patients with type 2 diabetes in Arba Minch General Hospital from April 21 to May 20, 2020. A systematic sampling technique was used to select 352 patients. The data were entered into EpiData version 3.1 and exported to SPSS version 21 for cleaning and analysis. Descriptive statistics were performed. All variables in bivariate analysis with p-value <0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05. RESULTS: The prevalence of poor dietary practice was found to be 40.6% (95%CI (35.7-46.0)). After adjusting for other variables in multivariable analysis, not attending formal education (AOR = 3.0; 95%CI (1.6-5.5)), being at primary education level (AOR = 2.2; 95%CI (1.1-4.4)), being moderately food insecure (AOR = 5.3; 95%CI (2.8-9.9)), having depression (AOR = 5.9; 95%CI (3.0-11.4)), and not having nutrition education (AOR = 2.2; 95% (1.1-4.6)) were factors associated with poor dietary practice. CONCLUSIONS: A significant proportion of patients had poor dietary practice. The poor dietary practice was significantly higher among those with no formal education, at the primary education level, from the moderately food-insecure household, having depression, and not having nutrition education. The results imply the need for strengthening health information dissemination concerning healthy dietary practice in the form of a package.

Protein-Energy Wasting and Associated Factors Among Chronic Kidney Disease Patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: Protein-energy wasting is a major issue in patients with chronic kidney disease (CKD), adversely affecting morbidity, mortality, functional activity, and quality of life. Assessment of nutritional status in CKD patients is important to ensure patient's normal protein stores and avoid metabolic complications. However, in Ethiopia, there were very few studies done to assess the prevalence of protein-energy wasting (PEW) and its associated factors among CKD patients. OBJECTIVE: To assess protein-energy wasting and associated factors among chronic kidney disease patients at adult OPD St. Paulo's Hospital Millennium Medical College, Addis Ababa Ethiopia. MATERIALS AND METHODS: An institution-based cross-sectional study was conducted from March to April 2019. Data were collected using a structured interviewer-administered questionnaire and anthropometric measurements, and laboratory data were collected from patient files. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were performed to identify associated factors. P values <0.05 were considered to declare statistical significance. RESULTS: In this study, 274 respondents were interviewed with a response rate of 100%. The prevalence of protein-energy wasting in CKD patients was 23.4%. Chronic kidney disease patients at age ≥65 years were seven times more likely to have protein-energy wasting as compared to patients aged 18-34 years [AOR=7.0, 95% (CI: 2.4, 20.5)]. Patients who had a history of anorexia were 5.2 times more likely to have protein-energy wasting as compared to those who had no history of anorexia [(AOR=5.2, 95% (CI: 2.7, 10.3)] and were significantly associated with the risk of having CKD. CONCLUSION: The prevalence of protein-energy wasting among CKD patients was high and associated with age, physical activity, history of anorexia, and CKD stages. Interventions that address nutritional problems and lifestyle factors in CKD patients need to be implemented together with medical treatment.

Determinants of Anemia Among Pregnant Women Attending Antenatal Care Clinic at Public Health Facilities in Kacha Birra District, Southern Ethiopia.

BACKGROUND: Anemia is accountable for 20% of maternal death globally, and it is associated with premature birth, low birth weight, and infant death. According to the WHO report of 2008, 57.1% of pregnant women were anemic in Africa. In Ethiopia, anemia among pregnant women is 62.7%. There were no data in the study area that identified the determinants of anemia. OBJECTIVE: To identify the determinants of anemia among pregnant mothers attending ANC clinic in public health facilities in Kacha Birra District, Southern Ethiopia. METHODS: An institutional-based unmatched case-control study was conducted among pregnant women attending antenatal care clinics in public health facilities in Kacha Birra District, Southern Ethiopia, from February 1/2019-May 30/2019. An aggregate of 117 cases and 227 controls were involved in the study. Data were collected using interviewer-administered questionnaires. Controls were pregnant ladies whose blood hemoglobin level was 11 g/dl and above at their first antenatal care clinic, and cases were pregnant ladies whose hemoglobin level less than 11 g/dl. Both bivariate and multivariable logistic regression models were used to isolate independent predictors of anemia. RESULTS: An overall of 344 respondents (117 cases and 227controls) were included in this study with a response rate of 100%. On multivariable logistic regression models, significant predictors of anemia were: rural residence [AOR= 2.9,95% CI:1.18-5.84], previous history of heavy menstrual blood flow [AOR=2.75, 95% CI: 2.66-28.53], age of mother [AOR=4.013, 95% CI: 1.08-14.90], parasitic infection [AOR=6.39, 95% CI: 1.226-33.362], food taboo (aversion) [AOR= 3.92, CI: 95% 2.08-7.35], drinking tea/coffee instantly after meal [AOR=18.49, 95% CI:6.89-40.64]. CONCLUSION: Residence, previous heavy menstrual flow, age, parasitic infection, food taboo, and tea/coffee consumption immediately after meals were significant predictors of anemia among pregnant women. So, anemia prevention and control policy should include the promotion of counseling on the consumption of diversified and iron-enriched foods during pregnancy, prevention of parasitic infection as well as mass deworming, awareness creation on cultural norms that makes food aversion during pregnancy.

Dyslipidemia and Associated Factors Among Adult Patients on Antiretroviral Therapy in Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The development of antiretroviral drugs and subsequent access to combined antiretroviral therapy contributed to the decline in morbidity and mortality rates associated with acquired immune deficiency syndrome, resulting in an increased life expectancy and improved quality of life for people living with human immunodeficiency virus. However, a cluster of metabolic derangements such as dyslipidemia is increasing, especially for those on antiretroviral therapy. Limited studies were done on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Ethiopia which demand the conduct of the present investigation entitled on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Armed Force Comprehensive and Specialized Hospital Addis Ababa, Ethiopia, 2018. METHODS: Institution-based cross-sectional study design was employed between March and April 2018. Systematic sampling method was used to select 353 study participants. Pretested stepwise approach of the World Health Organization questionnaire (WHO Stepwise), document review, anthropometric measurements, and laboratory analysis were used to collect data on different variables under the study. Collected data were entered in Epidata version 3 and analyzed by SPSS version 21. RESULTS: The prevalence of dyslipidemia among study participants was 74.8%. Female participants were twice and half at risk of developing dyslipidemia compared to males (AOR= 2.38; 95% CI: 1.15, 3.66). Similarly, compared to those attended college level of education, not attended formal education (AOR=0.19; 95% CI: 0.05, 0.66), and having primary/secondary educational level (AOR= 0.33; 95% CI: 0.16, 0.66) showed lower odds to develop dyslipidemia. Furthermore, WHO clinical stage II (AOR= 0.35; 95% CI: 0.14,0.92), stage III (AOR=0.25; 95% CI:0.10,0.64), duration on ART (AOR= 1.01; 95% CI: 1.001,1.02), and BMI (AOR =1.13; 95% CI: 1.06,1.23) were significantly associated with dyslipidemia. CONCLUSION: There exists a high prevalence of dyslipidemia among study participants. Sex, educational status, WHO clinical stage, duration on ART, and BMI were significantly associated factors for dyslipidemia. Intervention strategies including the identified factors are demanded in the setting.

Metabolic Effects of Fasting and Animal Source Food Avoidance in an Ethiopian Adult Cohort.

Fasting is a religious practice to which the faithful comply strictly. The longest period of fasting in Orthodox religion is the lent (in Ethiopia known as "Hudade"). According to the doctrine of Ethiopian Orthodox Christianity, fasters should strictly avoid all animal source foods (ASF) and skip breakfast at least up to lunch time. This can be taken as a well-controlled natural experiment to evaluate the effect of breakfast skipping and avoidance of ASF for 55 days. However, there is no study that evaluated the effect of ASF fasting (avoidance of animal source foods  and breakfast skipping) on lipid profiles, fasting blood sugar and body composition in Ethiopian set up. A retrospective cohort study was carried out among 704 employees of Jimma University (253 fasters and 451 non-fasters) from February 2015 to April 2015. Data on socio-demographic, anthropometry, blood pressure and blood samples were collected according to WHO STEPS procedure. Descriptive statistics and multivariable linear regression models were used to compare the effect of fasting on outcome variables. There was a significant difference in the body fat percent (mean ± sd) between non-fasters (32.35 ± 11.12) and fasters (30.59 ± 11.22, P = 0.045). Similarly, the mean ± sd waist circumference was higher among non-fasters (84.96 ± 11.43 cm) compared to fasters (83.04 ± 11.43 cm, P < 0.033). High density lipoprotein was significantly (P = 0.001) high among fasters (68.29 mg/dl) compared to non-fasters (57.24 mg/dl). Total cholesterol (T.chol) was also higher among non- fasters (181.01 mg/dl) than fasters (173.80 mg/dl, P = 0.035). The mean Triglyceride level was significantly (P = 0.035) high among non-fasters (142.76 mg/dl) compared to fasters (129.39 mg/dl). Similarly, fasting blood sugar was high among non-fasters (100.14 mg/dl) compared to fasters (95.11 mg/dl), P = 0.009. On multivariable linear regression analyses after adjusting for different variables, fasters had a significantly high mean HDL and lower mean T.chol, Triglycerides, FBS and LDL levels. Similarly, fasters had a significantly low mean waist circumference and low mean body fat percent (P < 0.05). In conclusion, animal source food avoidanceand breakfast skipping has a significant desirable health effects on lipid profiles, fasting blood sugar and body composition. The findings imply the need for considering such a dietary practice as a basis for public health promotion. Future research should investigate the effect of ASF fasting and breakfast skipping on micronutrient intake and determine the minimum number of days of fasting required to generate clinically significant effects.

Household food insecurity and coping strategies among pensioners in Jimma Town, South West Ethiopia.

BACKGROUND: Ethiopia is currently facing new challenges related to food insecurity among the urban poor. Pensioners are segments of the population with reduced income and working capacity because of advancement of age and other related problems. There is no empirical evidence on Jimma Town pensioner's household food insecurity and coping strategies. METHODS: A cross-sectional study was conducted among households in Jimma Town living on an income obtained from a pension from March 01-28, 2017. Data were collected from 399 randomly selected participants. Data were entered into EPi-Data version 3.1 and analyzed using SPSS Version 20.0. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression model to control for confounding variables. RESULTS: Nearly, 83.5% of households were food insecure. The odds of food insecurity among households with heads attending secondary school and above was 78% lower when compared to that of households with uneducated household heads (AOR = 0.22, 95% CI: 0.97 to 0.49). The odds of food insecurity among households headed by merchants was 91% lower when compared to that of households headed by guards (AOR = 0.09, 95% CI: 0.03, 0.29). Food insecure households were using coping strategies such as changing consumption patterns (44%), eating inexpensive foods (72.4%), reducing meal frequency (62.4%) and selling household assets, such as household food utensils (30.8%). The odds of food insecurity among households having large family size (≥ 7) was 3.74 times higher when compared to that of households with family size less than three (AOR = 3.74(1.27, 10.99). CONCLUSIONS: Household food insecurity was associated with having households headed by uneducated, widowed and guard household heads and having large family size. Food insecure households used both consumption and asset-based coping strategies such as eating less preferred, lower quality or less expensive foods and receiving donation from relatives or friends. Government policies should consider revising the current social protection scheme for pensioners. Special attention should be given to widow pensioners and pensioners with low educational status and with large family sizes.

Anemia and associated factors among children aged 6-23 months in Damot Sore District, Wolaita Zone, South Ethiopia.

BACKGROUND: Anemia affects a significant part of the population in nearly every country in the globe. Iron requirements are greatest at ages 6-23 months when growth is extremely rapid and critically essential in critical times of life. Even though infants and toddlers are highly at risk, they are not considered as separate populations in the estimation of anemia. Despite this, the prevalence of anemia among under 24 months of age is still at its highest point of severity to be a public health problem in Ethiopia. There is no study that documented the magnitude of the problem and associated factors in the study area. The main aim of this study was to assess the prevalence of anemia and to identify associated factors among children 6-23 months of age. METHODS: A community-based cross-sectional study was carried out among 485 children of Damot Sore, South Ethiopia from March to April 2017. Data on socio-demographic, dietary, blood samples for hemoglobin level and malaria infection were collected. Both descriptive and bivariate analyses were done and all variables having a p-value of 0.25 were selected for multivariable analyses. A multivariable logistic regression model was used to isolate independent predictors of anemia at a p-value less than 0.05. A principal component analysis was used to generate household wealth score, dietary diversity score. RESULTS: Out of 522 sampled children, complete data were captured from 485 giving a response rate of 92.91%. For altitude and persons smoking in the house adjusted prevalence of anemia was 255(52.6%). The larger proportion, 128(26.4%) of children had moderate anemia. On multivariable logistic regression analyses, household food insecurity (AOR = 2.74(95% CI: 1.62-4.65)), poor dietary diversity (AOR = 2.86(95% CI: 1.73-4.7)), early or late initiation of complementary feeding (AOR = 2.0(95% CI: 1.23-3.60)), poor breastfeeding practice (AOR = 2.6(95% CI: 1.41-4.62)), and poor utilization of folic acid by mothers (AOR = 2.75(95% CI: 1.42-5.36)) were significantly associated with anemia. CONCLUSION: Prevalence of anemia among children (6-23 months) was a severe public health problem in the study area. Most important predictors are suboptimal child feeding practices, household food insecurity, and poor diet. Multi-sectoral efforts are needed to improve health and interventions targeting nutrition security are recommended.