Impact of weekly iron-folic acid supplementation on nutritional status and parasitic reinfection among school-age children and adolescents in Sub-Saharan Africa: a systematic review and meta-analysis.

Background: Two significant etiological factors contributing to iron deficiency anemia, and undernutrition posing substantial public health challenges in Sub-Saharan Africa, are soil-transmitted helminths and malaria. This study carried out the effect of weekly iron-folic acid supplementation (WIFAS) on the nutrition and general health of school-age children and adolescents in Sub-Saharan Africa, a systematic review and meta-analysis have been conducted. Methods: To find pertinent publications for this study, a thorough search was carried out on May 20, 2023, across five databases: Pubmed (MEDLINE), Web of Science, Scopus, Cochrane Library, and Google Scholar. In addition, a search was conducted on August 23, 2023, to capture any new records. The inclusion criteria for the studies were based on school-age children and adolescent populations, randomized controlled trials, and investigations into the effects of WIFAS. The outcomes of interest were measured through anthropometric changes, malaria, and helminthic reinfection. Results: A systematic review of 11 articles revealed that WIFAS significantly decreased the risk of schistosomiasis reinfection by 21% among adolescents (risk ratio = 0.79, 95%CI: 0.66, 0.97; heterogeneity I 2 = 0.00%, P = 0.02). However, no significant impact was observed on the risk of malaria reinfection (risk ratio = 1.02, 95%CI: 0.92, 1.13; heterogeneity I 2 = 0.00%, P = 0.67) or A. Lumbricoides reinfection (risk ratio = 0.95, 95%CI: 0.75, 1.19; heterogeneity I 2 = 0.00%, P = 0.65). Moreover, the analysis demonstrated that there is no significant effect of iron-folic acid supplementation in measured height and height for age Z-score (HAZ) of the school-age children (Hedge's g -0.05, 95%CI: -0.3, 0.2; test for heterogeneity I 2 = 0.00%, P = 0.7) and (Hedge's g 0.12, 95%CI: -0.13, 0.37; test for heterogeneity I 2 = 0.00%, P = 0.36) respectively. Conclusion: The effectiveness of WIFAS in reducing the risk of schistosomiasis reinfection in adolescents has been demonstrated to be greater than that of a placebo or no intervention. Additionally, the narrative synthesis of iron-folic acid supplementation has emerged as a potential public health intervention for promoting weight change. However, there was no significant association between WIFAS and Ascariasis, trichuriasis, and hookworm. Moreover, the certainty of the evidence for the effects of WIFAS on height and malaria is low and therefore inconclusive. Whereas, the certainty of the evidence for the effectiveness of WIFAS on Schistosomiasis is moderate. Even though the mechanisms need further research WIFAS may be implemented as part of a comprehensive public health strategy to address schistosomiasis in adolescents. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397898, PROSPERO (CRD42023397898).

Epidemiology of stunting in children aged 6-59 months, an unresolved chronic nutritional problem in Ethiopia: A systematic review and meta-analysis.

Background: In developing countries as well as Ethiopia, stunting continues to be a major public health burden. Thus, the aim of this systematic review and meta-analysis is to synthesize the updated pooled prevalence and its determinants of stunting in Ethiopia. Methods: This systematic review and meta-analysis follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The protocol has been registered with the International Prospective Register of Systematic Reviews, University of York Center for Reviews, and disseminated at https://www.crd.york.ac.uk/, with the registration number (CRD42024542984). A wide-ranging literature search was carried out using PubMed/Medline, Science Direct, Hinari, AJOL, and Google Scholar. All lists of qualified study references from 2013 to 2023 were recovered. The pooled estimate with a 95% CI was calculated using a random-effects model in STATA version 13 software. I 2 and meta-bias statistics were used to assess the heterogeneity of the incorporated studies. Results: This study included 29 articles with a total of 23,511 participants from 29 qualified studies. The current study found that the pooled prevalence of stunting among children aged 6-59 months was 43% (95% CI: 42-44). Children who were not exclusively breastfed (OR = 2.39; 95% CI: 1.61-3.54), male children (OR = 1.61; 95% CI: 1.13-2.31), children whose mothers had no antenatal care follow-up (OR = 3.03; 95% CI: 1.36-6.76), and women who had no formal education (OR = 4.55; 95% CI: 2.29-9.05) were significantly associated with stunting. Conclusions: In Ethiopia, nearly half of the children suffer from stunting, with those who are not breastfed, the sex of the child, children whose mothers had no antenatal care follow-up, and had no formal education having higher odds of stunting. To reduce the burden, strategies must be designed to intervene and improve maternal health literacy, focusing on children's nutrition and health-care utilization.

Nexus between postpartum depression and exclusive breastfeeding practices among lactating mothers in Assosa Town, West Ethiopia.

Background: Across the globe, breastfeeding stands out as a highly effective strategy for reducing infant and child morbidity and mortality. Concurrently, postpartum depression (PPD) emerges as a notable public health issue, adversely affecting both exclusive breastfeeding (EBF) practices for infants and the fulfillment of parenting roles. Despite the lack of substantial evidence in Ethiopia and the specific study areas, indicating the association between PPD and EBF practices, this study endeavors to fill this gap. The primary objective is to examine the correlation between PPD and EBF practices, along with exploring other pertinent factors, in Assosa Town, West Ethiopia. Methods: A community-based cross-sectional study was carried out from 7 March to 5 April 2019. The study involved the recruitment of 462 participants through a systematic random sampling method. Data collection was facilitated by conducting a structured and pre-tested questionnaire. To screen for PPD, we used the Edinburgh Postnatal Depression Scale (EPDS) tool. This tool, EPDS, was used solely as a screening tool and not for diagnostic purposes. The collected data were entered into Epi-Data version 3.1 and subsequently exported to SPSS version 24 for comprehensive statistical analysis. Bivariate and multivariate logistic regression analyses were performed to assess the association between independent variables and dependent variables. Odds ratios, along with their 95% confidence intervals (CIs), were calculated to ascertain the presence and strength of any associations. Statistical significance was acknowledged at a p-value of <0.05. Results: The overall prevalence of EBF practices was found to be 58.2% (95% CI: 51.4-65.7), while the prevalence of PPD was 18.7% (95% CI: 15.94-26.7). Among mothers without PPD, the prevalence of EBF practices was notably higher at 62.4% (95% CI: 55.9-65.2%) compared to mothers experiencing PPD, where the prevalence was 31.3% (95% CI: 24.7-32.5%). Mothers who experienced PPD exhibited 51% reduced odds of practicing EBF compared to their counterparts (AOR = 0.49. 95% CI: 0.25-0.8). Furthermore, factors such as having a higher family monthly income (AOR = 8.7, 95% CI: 4.2-17.2), being multiparous (AOR = 5.8, 95% CI 4.9-10.8), attending antenatal care (ANC) visits (AOR = 4.9, 95% CI: 3.4-14.1), opting for vaginal delivery (AOR = 9.8, 95% CI: 5.6-17.4), and receiving husband's support (AOR = 5.3, 95% CI: 4.6-12.7) demonstrated a statistically significant positive association with EBF practices. Conclusion: In this study, a substantial number of mothers demonstrated suboptimal EBF practices during the first 6 months of their infants' lives. Consequently, the findings underscore a clear association between PPD and EBF. Thus, it is imperative to intensify efforts in the early detection and treatment of PPD, enhance household income, advocate for ANC, and encourage active husband involvement to bolster EBF practices.

Effects of blending ratio variation on macronutrient compositions and sensory acceptability of dabi teff-field pea-based novel composite complementary flours.

The response of a mixed system is determined by the proportions of the various ingredients that add up to one, not by the combination's total amount. This research aimed at examining the effects of blending ratio variation on the macro-composition and sensory acceptability of dabi teff-field pea-based novel composite complementary flours. Standard methods (AOAC, 2016, Official Methods of Analysis of the Association of Official Analytical Chemists) were used to determine macronutrients. The sensory attributes were evaluated using a 5-point hedonic scale. The ingredients were constrained at 0%-30% for field pea, 20%-35% for dabi teff, and 5%-20% for maize, while the remaining were set constant at 5% linseed, 15% oats, and 25% barley. D-optimal was used to examine the effects of blending ratio variation on the responses. All the responses were significantly different (p < .05) among the blends except for fat content, ranging from 14.58% to 17.21% for protein, 4.22% to 5.59% fat, 2.01% to 2.60% ash, 2.68% to 3.96% fiber, 68.08% to 70.76% utilizable carbohydrate, and 378.82 to 386.9 kcal/100 g gross energy. The sensory acceptability score ranged from 3.4 to 4.4. The linear model was significant (p < .05) and adequate to describe variation in moisture, protein, and ash contents. An increase in the ratio of field pea significantly increased (p < .05) protein, ash, fiber, and energy. The interactive effect between dabi teff and field pea significantly increased the sensory acceptability of the blends. These findings showed that varied proportions of the ingredients had a significant effect on the responses, and were used to develop a wholesome product to combat protein-energy malnutrition among children.

Experience of caregivers on the continuum of care and prevention of malnutrition among children with cholera in Ethiopia: a phenomenology study.

INTRODUCTION: Malnutrition is a public health problem in low- and middle-income countries among children. Although illnesses such as diarrhea are common immediate drivers of childhood malnutrition, their consequences could be averted through optimal sick child feeding and care to ensure the continuum of care. This study aimed to explore the lived experiences of mothers/caregivers on continuum of care to prevent malnutrition among children with cholera in Ethiopia. METHODS: A phenomenology study design was applied to explore experiences of mothers/caregivers in the Bale and Guji zones of the Oromia region, southeast Ethiopia, from November to December 2022 using an unstructured interview guide. The saturation of ideas was used to stop the in-depth interview. Translated data were cleaned and imported into ATLAS.ti7 software for analysis. Using an open coding system, the data were coded into a meaningful context. Deeper immersion into data with repeated reading, creating themes, subthemes, and family/category were carried out. In coding and categorization, multiple coders were involved. The finding was presented using well-spoken verbatim/quotes as illustrations and in narratives. RESULTS: In this qualitative study, ten participants were taken to explore their lived experience on the continuum of care for children with acute malnutrition and cholera. The study found that poverty, expensive cost of living, and poor utilization of diversified food were challenges. Moreover, health facilities did not provide any services to mothers whose child was admitted for malnutrition treatment. Children five years and above were excluded from both therapeutic food and screening for malnutrition program. Interruptions of supplies, low attention given to child feeding, inadequate knowledge, and lack of time to prepare diversified food were the main findings. CONCLUSION: Poverty, poor feeding habits, supplies interruption and non-inclusion of malnourished children five and above in screening for malnutrition and in the therapeutic feeding program is missed opportunities that lead to decreased early detection and treatment of malnutrition among children with cholera. Moreover, mothers/caregivers did not receive any service from health facilities when their child was admitted for treatment of malnutrition. This situation forces them to stop treatment before their child recovers from malnutrition, which has a negative impact on the continuum of care and prevention of malnutrition. Therefore, we strongly recommend strengthening emergency nutrition within the country's health system and revising the food and nutrition policy to incorporate emergency nutrition, with a particular focus on children under the age of fifteen. Additionally, it is important that the study's recommendations underscore the significance of a multi-sectoral approach that involves collaboration among the health sector, government agencies, and non-governmental organizations. Moreover, adaptive agricultural products be made easily accessible to the community which is crucial in effective preventing and reducing malnutrition in children in the study and similar settings.

Impact of indoor Air Pollution on the Linear growth of children in Jimma, Ethiopia.

BACKGROUND: Stunting in children is the term for reduced linear growth and development, which is frequently brought on by a persistently inadequate diet, recurrent infections and chronic diseases or poor health conditions. Apart from the classic covariates of stunting, which include diet and illness, the relative contribution of household air pollution to chronic nutrition conditions is least studied. Hence, this study is conducted to investigate the impact of household air pollution on the linear growth of under-five children in Jimma town, Ethiopia. METHODS: A prospective cohort study was employed to collect data from 280 under-five children who lived in households using solid fuel (exposed group, n = 140) and clean fuel (unexposed group, n = 140). Height-for-age Z scores were compared in both groups over a 12-month follow-up period. The difference in differences estimators were used for comparison of changes in the height-for-age Z scores from baseline to end line in exposed and non-exposed groups. The independent effect of the use of solid fuels on height-for-age Z scores was analyzed through a multivariable linear regression model. Statistical Significances were declared at P < 0.05 and 95% CI level. RESULTS: In an unadjusted model (Model 1), compared with the clean fuel type, the mean difference in the height-for-age Z score of children in households using solid fuel was lower by 0.54 (-0.54, 95% CI -0.97, -0.12, P = 0.011). The beta coefficient remained negative after adjusting for age and sex (Model 2 -0.543, 95% CI -1.373, -0.563) and sociodemographic variables (Model 3: -0.543, 95% CI -1.362, -0.575). In the final model (Model 4), which adjusted for wealth quantile, dietary practice, water, sanitation and hygiene status and household food insecurity access scale, the beta coefficient held the same and significant (beta: -0.543, 95% CI -1.357, -0.579, P < 0.001). Higher HAZ scores were observed among female child (ß: = 0.48, 95%CI: 0.28, 0.69), Child with father attended higher education (ß: = 0.304 95%CI: 0.304, 95% CI 0.19, 0.41) as compared to male gender and those who did not attend a formal education, respectively. In contrast, child living in households with poor hygiene practices had lower HAZ score (ß: -0.226, 95% CI: -0.449, -0.003), P < 0.001. CONCLUSIONS: Exposure to indoor air pollution was inversely related to linear growth. Furthermore, sex, educational status and hygiene were found relevant predictors of linear growth. In such a setting, there is a need to step up efforts to design and implement public education campaigns regarding the health risks associated with exposure to household air pollution. Promoting improvements to kitchen ventilation and the use of improved cooking stoves, which will help to mitigate the detrimental effects of indoor air pollution on child growth impairment and its long-term effects.

Prevalence of Stunting and Its Associated Factors Among Children Residing in Internally Displaced Persons (IDP) Camps in Hargeisa, Somaliland: A Community-Based Cross-Sectional Study.

Background: Stunting, a consequence of prolonged malnutrition, remains a critical global health issue affecting 165 million children under the age of five, with 10.6 million associated deaths. Its stunting prevalence is particularly pronounced in developing nations, notably Sub-Saharan Africa. Chronic protein-energy malnutrition, identified as a major cause of morbidity and mortality in displaced settings, underscores the urgency of understanding its impact in such contexts. Objective: This study aimed to assess the prevalence and associated factors of stunting among children aged 12-59 months and residing in IDP camps in Hargeisa, Somaliland. Methods: A community-based cross-sectional study was conducted in Hargeisa from May 5 to July 30, 2022, utilizing systematic random sampling, online mobile surveys, and caregiver interviews with anthropometric measurements. The SPSS version 25 was utilized in handled data entry, processing and analysis. Multivariable logistic regression, with p < 0.05 significance, included variables from bivariate analysis (p < 0.2). Stunting assessment utilized WHO AnthroPlus software, categorizing HAZ scores < -2.0 SD. Results: The prevalence of stunting among children living in IDP camps was found to be 21.1% [95% CI: 17.0-24.91%]. Vaccination status (adjusted odds ratio [aOR] = 0.19, 95% CI: 0.09-0.38), deworming practice (aOR = 6.5, 95% CI: 2.91-14.52), place of delivery (aOR = 0.14, 95% CI: 0.07-0.30), measles experience in the last year (aOR = 0.12, 95% CI: 0.04-0.34), ANC visits (aOR = 0.33, 95% CI: 0.14-0.81), and maternal insufficient extra food intake (aOR = 2.15, 95% CI: 1.11-4.15) were significantly associated with stunting. Conclusion: The observed stunting prevalence in IDP camps (21.1%) was substantial, highlighting the need for targeted interventions. Future efforts should aim to reduce stunting from the current rate to an estimated 5-10%, emphasizing comprehensive measures such as deworming, maternal nutrition, postnatal care improvement, robust immunization, and promoting healthcare facility deliveries.

Corrigendum: Effect of school feeding program on body mass index of primary school adolescents in Addis Ababa, Ethiopia: a prospective cohort study.

[This corrects the article DOI: 10.3389/fnut.2022.1026436.].

Effect of nutrition education intervention to improve dietary diversity practice and nutritional status of the older people: A cluster randomized controlled trial.

The growing aging population raises nutrition and health concerns, with malnutrition in the elderly linked to negative health outcomes. Our objective was to implement theory-based nutritional education interventions to improve the nutritional status of the elderly through diversified dietary practices. A cluster randomized controlled trial was conducted from December 1, 2021, to May 30, 2021, among 782 older persons randomly selected from two urban and 12 semi-urban areas in southwest Ethiopia. We used Social cognitive theory (SCT) in guiding the nutritional education intervention. Data were collected using an interviewer-administered questionnaire. The Mini Nutritional Assessment (MNA) tool was used to assess nutritional status, and a qualitative 24-h eating recall was used to evaluate dietary diversity. Difference-in-difference and generalized estimating equation models were used to assess the intervention effect. In total, 720 participants (361 in the intervention group and 359 in the control group) were included for analysis. The mean dietary diversity score differed significantly between the intervention group and the control group (p < .001). According to the multivariable generalized estimating equations model, the intervention group was 7.7 times (AOR = 7.746, 95% CI: 5.012, 11.973) more likely to consume a diverse diet than the control group. The nutrition status of the elderly in the intervention group improved significantly at the end of the intervention (p < .001). SCT-based nutritional education interventions can effectively improve healthy eating and nutritional status. For older adults, with its convenient approach and low cost, SCT should be considered an effective and efficient nutritional education approach for behavior change.

Optimization of a formula to develop iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio from dabi teff-field pea-based blends using a D-optimal mixture design.

Iron deficiency anemia is one of the major public health problems in children associated with the inadequate intake of bioavailable iron. Thus, this research was aimed at incorporating dabi teff, an underutilized/forgotten crop, into other pre-processed local food crops, viz., germinated maize, roasted barley, roasted field pea, dehulled oats, and linseed, to develop optimized iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio. Nutrisurvey software was employed to define ranges, and they were constrained at 20-35% dabi teff, 0-30% field pea, and 5-20% maize, while the remaining were kept constant at 25% barley, 15% oats, and 5% linseed. Eleven experimental runs were generated from the six mixture components using Stat-Ease Design Expert® software version 11, D-optimal. Inductively coupled plasma-optical emission spectrometry was used to determine micronutrients. 'Scheffe' regression was used to fit and test the model's adequacy, and numerical multi-response optimization was performed using the Design Expert® to identify the optimal points. Dabi teff had a significantly higher (p < 0.05) iron content at 86.5 mg/100 g, iron density at 24.53 mg/100 kcal, and calcium content at 123.59 mg/100 g. The new formulations had a significantly higher iron content (3.31-4.36 times), iron density (3.25-4.27 times), and calcium content (1.49-1.58 times), as compared to the control flour, and fulfilled FAO/WHO recommendations. The optimal formula was identified at 34.66% dabi teff, 25% barley, 15% oats, 15.34% field pea, 5% linseed, and 5% maize flour ratios, with response values at the overall optimization as 32.21 mg/100 g iron, 77.51 mg/100 g calcium, 2.59 mg/100 g zinc, 0.233 phytate/iron molar ratio (Ph:Fe), 0.067 phytate/calcium molar ratio (Ph:Ca), 3.43 phytate/zinc molar ratio (Ph:Zn), and 6.63 phytate by calcium to zinc molar ratio (Ph*Ca:Zn). Furthermore, it contained iron at a level that is 2.01 times higher than the standard and 4.44 times higher than the control, as well as an iron density of 8.47 mg/100 kcal, which was 4.39 times higher than that of the control. These findings showed that the optimized dabi teff-field pea based iron-dense novel composite complementary flour with enhanced bioavailability can be developed and used as a sustainable food-based strategy to combat iron deficiency anemia among children in less developed countries, such as Ethiopia.

Optimization of dabi teff-field pea based energy and protein dense novel complementary food with improved sensory acceptability using D-optimal mixture design.

Protein-energy malnutrition is unacceptably high among children in developing countries due to inadequate required nutrients and poor quality of complementary foods characterized by low protein and energy density and often monotonous. Thus, this research was aimed at examining the potential of including dabi teff, the underutilized/forgotten crop into pre-processed local food crops viz., germinated maize, roasted barley, roasted field pea, dehulled oats and linseed to develop energy and protein-dense optimized novel complementary food with improved sensory acceptability. Nutrisurvey software was employed to define ranges and they were constrained at 20-35% dabi teff, 0-30% field pea and 5-20% maize, while the rest were set constant at 25% barley, 15% oats and 5% linseed. Eleven experimental runs were generated from the six mixture components using D-optimal mixture design, Stat-Ease Design Expert ® software version 11. A 5-point Hedonic scale was used to evaluate the sensory attributes. 'Scheffe' regression was used to fit and test model adequacy and numerical multi-response optimization was performed to identify optimal points using the Design expert. Field pea and linseed contained significantly higher (P < 0.05) protein at 20.95% and 20.57%. The newly formulated products contained significantly higher protein (1.4-1.6 times) and protein density (1.31-1.56 times) as compared to the control and fulfilled the recommended standard. The optimal was identified at 34.66% dabi teff, 25% barley, 15% oats, 15.34% field pea, 5% linseed and 5% maize flour ratios with response values at overall optimization to be 5.57% moisture, 15.74% protein, 5.09% fat, 2.26% ash, 2.88% fiber, 73.05% carbohydrate, 380.43 kcal/100 g energy and 4.12 sensory acceptability score and it contained an energy density of 1.27 kcal/g and protein density of 4.14 g/100kacl. These findings showed that optimized dabi teff-field pea based novel complementary food can be used as a sustainable food-based strategy to combat protein-energy malnutrition among children in developing countries.

Effect of school feeding program on academic performance of primary school adolescents: A prospective cohort study.

BACKGROUND: School Feeding Programs (SFPs) in low-income countries help vulnerable children learn better and maintain their health through the provision of nutritious food to school children. Ethiopia scaled up the implementation of SFP in Addis Ababa. AIMS: We aimed at evaluating the effect of the SFP on the school performance of primary school adolescents in Addis Ababa, Central Ethiopia. METHOD: A prospective cohort study design was employed on 322 SFP-beneficiary and equal-size non-beneficiary adolescents. SPSS version 24 and multivariable linear regression models were used. RESULT: In linear regression, unadjusted model (Model 1), compared with the non-school-fed adolescent, the mean difference in difference of average academic scores of school-fed adolescents was higher by 2.11 (ß 2.11, 95% CI 1.39-2.83). The beta coefficient remained positive after adjusted for age and sex (Model 2: ß 2.11, 95% CI 1.39-2.83), sociodemographic variable (Model 3: ß 2.16, 95% CI 1.45-2.88), health and lifestyle variable (Model 4: ß 2.21, 95% CI 1.38-3.04). In the final model, adjusted for model five, school absenteeism, there was a significant difference in favor of school-fed adolescents on GPA-score (Model 5: ß 2.32, 95% CI 1.47-3.17). Furthermore, being adolescents in middle tertile wealth index families decrease GPA by 1.22 (ß -1.22, 95% CI -2.19 to -0.26) as compared to high tertile wealth index. CONCLUSION: School feeding was positively associated with academic performance. However, these changes may not be meaningful to generate a firm conclusion on the utility of school feeding in improving the academic performance of adolescents.

Effect of School Feeding Program on School Absenteeism of Primary School Adolescents in Addis Ababa, Ethiopia: A Prospective Cohort Study.

BACKGROUND: School feeding programs (SFP) in low-income countries are designed to provide food to vulnerable school children to create optimal educational and health conditions for learners. Ethiopia scaled up the implementation of SFP in Addis Ababa. Yet, the utility of this program in terms of school absenteeism has not been monitored thus far. Hence, we aimed at evaluating the effect of the SFP on school performance of primary school adolescents in Addis Ababa, Central Ethiopia. METHODS: A prospective cohort study was carried out from 2020 to 2021 on SFP-beneficiary (n = 322) and non-SFP beneficiary (n = 322). Logistic regression models were done using SPSS version 24. RESULTS: In logistic regression, unadjusted model (model 1), the school absenteeism of non-school-fed adolescents was higher by 1.84 (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 1.28-2.64) as compared to school-fed adolescents. The odds ratio remained positive after adjusting for age and sex (model 2: aOR 1.84, 95% CI 1.27-2.65), and sociodemographic (model 3: aOR 1.84, 95% CI 1.27-2.67). In the final model, adjusted model 4, health and lifestyle, there was a significant increase in absenteeism of non-school-fed adolescents (model 4: aOR 2.37, 95% CI 1.54-3.64). The likelihood of absenteeism in female increase by 2.03 (aOR 2.03, 95% CI 1.35-3.05), whereas being in a low tertile wealth index family decreases absenteeism by (aOR 0.51, 95% CI 0.32-0.82). School feeding was negatively associated with school absenteeism. CONCLUSIONS: The findings imply the need for strengthening school feeding programs.

Abdominal Pain of Functional Gastrointestinal Disorders in Dietary Diversity Patterns and Its Determinants among Healthy Adults in Jimma City, Southwest Ethiopia.

Background: Functional Gastrointestinal Disorders (FGIDs) and their risk factors vary from region to region. Therefore, this study aimed to determine the prevalence of abdominal pain of FGIDs in different dietary diversity score (DDS) and its determinant factors among adults in Jimma City, Southwest Ethiopia. Methods: A community-based cross-sectional study was conducted from July 17 to October 27, 2019. The study included systematically selected healthy adults aged ≥ 18years. Data were collected on gastrointestinal symptoms (Rome III), and DDS (24-dietary recall). Results: Of 865 healthy adults, the prevalence of abdominal pain symptoms co-occurrence was 168(19.4%), dyspepsia, 152(17.6%) and IBS, 133(15.4). Similarly, the co-occurrence was distributed as 81(9.4%) in middle, 64(7.4%) in high and 23(2.6%) in low DDS groups. Although this distribution was different in the DDS groups, it is not significantly associated. With potential confounders adjusted, the behavioral factors associated with the co-occurrence with an AOR (95% CI) were khat chewing: 7.37 (1.76 - 30.87), drinking alcohol: 3.24 (1.15 - 9.18), sedentary life: 12.28 (3.19 - 48.40) and less physical activity: 4.44 (1.43-13.75). Moreover, elevated TAG: 5.44 (2.78 - 8.10), elevated LDL: 4.26 (1.61-11.29), central obesity: 2.78 (1.08 -7), low HDL 5.89 (2.22-15.60), positive H.pylori stool test: 2.7 (1.86 -7.72), being diabetic: 2.7 (1.79 -7.79) and hypertensive: 2.79 (1.08 - 7.14) were associated with the co-occurrence. Conclusion: Abdominal pain and FGIDs had significant distribution among adults in Jimma City. Therefore, early screening and managing FGIDs in the community is recommendable.

Early life exposure to famine and risk of dyslipidemia in adults: a systematic review and Meta-analysis.

Background: Dyslipidemia is the major contributor to the global disease burden. Earlier epidemiologic research has linked early-life famine exposure to dyslipidemia and altered lipid profiles in adulthood, but a uniform perspective has yet to be established. In response, this systematic review and meta-analysis is aimed to investigate the association of early life famine exposure and dyslipidemia in adults. Methods: Scopus, Medline and Google scholar databases were searched for articles published until October 2020. Studies of famine exposure during prenatal and early postnatal life and their association with dyslipidemia and lipid profiles in adults were included. Random effect model in the Meta-analysis and Mantel- Haenszel model was used to calculate odds ratios and their 95% confidence intervals to evaluate the strength of association between famine exposure and dyslipidemia. The lipid profiles of the exposed and non-exposed groups were compared using the standardized mean difference (SMD). Heterogeneity between studies were assessed using I2 values. Results: We identified 17 studies for assessing the association between early life famine exposure and risk of dyslipidemia in adults. About 11 studies were included for meta-analysis. Prenatal exposure to famine was associated with increased risk of dyslipidemia [OR = 1.74 (95% CI: 1.31, 2.31)], total cholesterol [SMD = 2.07 (95% CI: 1.40, 2.74)], LDL-cholesterol [SMD = 1.16 (95% CI: 0.25, 0.26)] and decreased HDL-cholesterol [SMD = -0.05 (95% CI: -0.10, -0.01)]. Likewise, famine exposure during early postnatal period was associated with increased risk of total cholesterol [SMD = 0.18 (95% CI: 0.11, 0.25), I 2 = 29%] and LDL-cholesterol [SMD = 0.15 (95% CI: 0.07, 0.23), I 2 = 61%]. Conclusions: Famine exposure in early life was found to have an association with increased risk of dyslipidemia and altered lipide profile during adulthood. Our findings highlight the need for promoting better nutrition during pregnancy and infancy to prevent dyslipidemia during adulthood. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01062-8.

Anaemia and associated factors among children aged 6-23 months in agrarian community of Bale zone: a cross-sectional study.

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children <5 years of age are anaemic. In the early stages of life, it leads to poor cognitive performance, delay psychomotor development and decreases working capacity in later life. The present study aimed to assess the prevalence and associated factors of anaemia among children aged 6-23 months in the Bale zone. A community-based cross-sectional study was conducted from 1 to 30 June 2021. Multistage stratified sampling and simple random sampling techniques were employed to select 770 samples. An interviewer-administered questionnaire was used to collect data on socio-demographic, child health and feeding practices. Haemoglobin levels were estimated using a portable Hemosmart machine. Children with haemoglobin values below 11 g/dl were considered anaemic. Binary logistic regression analysis was performed to identify factors associated with anaemia. Statistical significance was set at P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6-11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6-23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

Differential effect of prenatal exposure to the Great Ethiopian Famine (1983-85) on the risk of adulthood hypertension based on sex: a historical cohort study.

BACKGROUND: The consequence of the Great Ethiopian Famine (1983-1985) on mortality had been well documented. However, the long term assaults of the famine on adulthood health, particularly on the risk of hypertension, has never been documented. The aim of this study was twofold: to examine the association of prenatal-exposure to the Great Ethiopian Famine and hypertension in adulthood and investigate if there existed sex difference in the risk estimate. METHODS: Participants were recruited using multistage stratified random sampling and grouped as prenatal famine exposed and non-exposed cohorts based on their reported date of birth and current age. Independent sample T test was employed to compare continuous outcomes between the groups. A multivariable logistic regression was used to examine the association between prenatal famine exposure and risk of hypertension in adults. RESULTS: Compared to the non-exposed groups, prenatal famine exposed cohorts had higher systolic blood pressure by 1.05 mmHg, (95% CI 0.29, 4.42) and diastolic by 2.47 mmHg (95% CI 1.01, 3.95). In multivariable logistic regression analysis, both unadjusted (COR = 2.50; 1.575, 3.989) and adjusted model for covariates (OR: 2.306 95% CI (1.426, 3.72) indicated a positive association between prenatal famine exposure and the risk of adult hypertension. However, in sex disaggregated analysis, the positive association was only significant in females (AOR = 3.95 95% CI 1.76, 8.85) indicating nearly four folds of odds of hypertension among females, while the corresponding figure for males was not significant (AOR = 1.201 (0.69, 2.07). CONCLUSIONS: Famine exposure during prenatal period could have differential impact on the development of hypertension based on sex, where adult exposed females had higher risk of hypertension as compared to males. Contextualized primary prevention programs with special focus on gender is critical undertaking in hunger spots and regions with historical famine.

Early life famine exposure and anthropometric profile in adulthood: a systematic review and Meta-analysis.

BACKGROUND: Previous famine studies reported the association between early life famine exposure and adulthood anthropometric profile. However, the findings were variable. Thus, a systematic review and meta-analysis was conducted to clarify the association of famine exposure in early life with the anthropometric profiles in adults. METHODS: Potentially relevant studies were searched through Scopus, Medline, Google Scholar and Google for gray literature and reference lists of previous studies. The random effects model (REM) and I2 test was used to adapt the pooling method and assess heterogeneity, respectively. RESULTS: Prenatal famine exposure was associated with increased risk of body mass index [SMD = 0.10 (95% CI: 0.02, 0.18)], waist circumference [SMD = 0.21 (95% CI: 0.11, 0.31)] in adults. Likewise, famine exposure during prenatal life was associated with decreased adult height [SMD) = - 0.26 (95% CI: - 0.44, - 0.09)]. Moreover, famine exposure during early childhood was associated with increased risk of waist circumference [SMD = 0.09 (95% CI: 0.01, 0.16)] and decreased adult height [SMD = - 0.16 (95% CI: - 0.27, - 0.04)]. CONCLUSION: Our finding indicates that exposure to famine during early life was associated with the anthropometric profile of adults. In terms of public health significance, the results of the study further underscore the importance of improving the nutritional status of mothers and children to prevent adulthood diseases in the long run. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168424.

Impact of prenatal famine exposure on adulthood fasting blood glucose level.

In the past decade, in low-income countries, there have been a rapid rise in prevalence of diabetes among adult population. Hence, understanding the context specific drivers of this change including the impacts of childhood nutrition adversaries on adult metabolic conditions is critical undertaking. This study investigates the potential effects of prenatal famine exposure to the Ethiopian great famine (1983-1985) on adulthood blood glucose level of survivors. A total of 441 adults (222 exposed and 219 controls) were included in the study. Self-reported place of birth and, date of birth and/or age were used to identify participants. A multivariable linear regression analysis was used to analyze the impact of prenatal famine exposure on the level of fasting blood glucose. In linear regression, unadjusted model (Model 1), fasting blood glucose level was increased by 4.13 (ß = 4.13; 95% CI .41, 7.42) points in prenatal famine exposed groups, compared with non-exposed. Similarly, the positive association of prenatal famine exposure and fasting blood glucose level was maintained after adjusted for sex (Model 2) (ß = . 4.08 95% CI .056, 7.50). Further adjusted for age, residence, educational status, wealth index and family size (Model 3) resulted in 4.10 (ß = . 4.10 95% CI .45, 7.56) points increases in fasting blood glucose level. In model 4 adjusting for dietary pattern, physical activity level and family history of diabetes, alcohol and cigarette smoking resulted in 3.90 (ß = 3.90, 95% CI 039, 7.52) points increase in fasting glucose level. In the he full adjusted model (Model 5) prenatal exposure to famine was resulted in 3.78 (ß = 3.78, 95% CI .22, 7.34) increases in fasting blood glucose level after adjusted for BMI and waist to height ratio. There existed a positive association of prenatal famine exposure and adulthood blood glucose levels. In this population, establishing effective overweight/obesity prevention programs to minimize the co-impact of early famine exposure on blood glucose control are important.

Effect of school feeding program on body mass index of primary school adolescents in Addis Ababa, Ethiopia: A prospective cohort study.

Background: Governments and developmental organizations are encouraged to devote adequate resources to the establishment of free school meals to low-income children in developing countries. In Ethiopia, the school feeding program (SFP) is implemented in a few regions including the capital, Addis Ababa. However, the nutritional benefit of the program was not monitored and reported thus far. In this study, we evaluated the effect of the SFP on the body mass index (BMI) of primary school adolescents in Addis Ababa, Central Ethiopia. Method: A prospective cohort study was employed to collect data from 644 SFP-beneficiary adolescents (n = 322) and non-SFP (n = 322). Nutritional outcomes were measured following 6 months of follow-up. WHO Anthroplus were used to convert anthropometric data into body-mass-index-for-age Z scores. The independent effect of school feeding is analyzed through a multivariable linear regression model. Result: In linear regression, unadjusted model (Model 1), compared with the non-school-fed adolescents, the mean difference in difference of BAZ-score of school-fed adolescent was higher by 0.36 (ß 0.36, 95% CI 0.17, 0.55). The beta coefficient remained positive after adjusted for age and sex (Model 2: ß 0.35, 95% CI 0.16, 0.54) and sociodemographic variable (Model 3: ß 0.35, 95% CI 0.16, 0.54). In the final model, adjusted for model four, lifestyle and health status there was a significant difference in favor of school-fed adolescents on BAZ-score indices (Model 4: ß 0.4, 95% CI 0.18-0.62). On the contrary, for a unit increase in family size, the BAZ score will decrease by 0.06 (ß 0.06, 95% CI -0.12--0.01). Similarly, adolescents with a middle tertile wealth index decreased their BAZ score by 0.30 (ß 0.30, 95% CI -0.55--0.05) as compared to the higher tertile wealth index. Conclusion: School feeding was positively associated with a change in BAZ score whereas family size and middle tertile wealth index were negatively associated. This implies that school feeding can serve as an optimal strategy for addressing the nutrition needs of adolescents.