Demand and Supply Side Barriers that Limit the Uptake of Nutrition Services among Pregnant Women from Rural Ethiopia: An Exploratory Qualitative Study.

Despite poverty reduction and increased promotion of improved nutrition practices in the community, undernutrition in Ethiopia remains a concern. The present study aimed to explore the demand and supply side barriers that limit the uptake of nutrition services among pregnant women from the rural communities of the Tigray Region, Northern Ethiopia. A community-based qualitative study was conducted in December through January 2017. A total of 90 key informant in-depth interviews and 14 focus group discussions were undertaken. Study participants were purposively selected for specific characteristics, along with health professionals deployed at various levels of the health system, including health posts, health centers, woreda health offices, and the regional health bureau. Study participants were asked to identify the barriers and implementation challenges that limit access to nutrition services for pregnant women. Participants' responses were transcribed verbatim, without editing the grammar, to avoid losing meaning. The data were imported to ATLAS.ti 7 (qualitative data analysis software) for coding and analyzed using a thematic content analysis approach. The study findings indicated that the dietary quality of pregnant women in the study area remains poor and in some cases, poorer quality than pre-pregnancy. Across study sites, heavy workloads, food taboos and avoidances, low husband support, lack of economic resources, lack of awareness, low educational level of women, poor dietary habits, increased expenditure for cultural and religious festivities, "dependency syndrome", low physical access to health facilities, poorly equipped health facilities, focus on child health and nutrition, poor coordination among nutrition specific and sensitive sectors, and limited sources of nutrition information were identified as the demand and supply side barriers limiting the uptake of nutrition services during pregnancy. In conclusion, the community would benefit from improved social behavior change communication on nutrition during pregnancy and multi-sectoral coordination among nutrition-specific and nutrition-sensitive sectors.

Scale up of nutrition and health programs in Ethiopia and their overlap with reductions in child stunting.

The prevalence of stunting in Sub-Saharan Africa has changed little since 2000, and the number of stunted children has increased. In contrast, Ethiopia is an example where the national stunting prevalence and number of stunted children have decreased consistently. We compare regional differences and temporal patterns in stunting with large-scale program coverage to identify where and when programs may have led to reductions in stunting. Data from three national demographic and health surveys and population statistics illustrate, at the regional level, where and when the prevalence and number of stunted children changed since 2000. Reports from large-scale nutrition and health programs were used to identify ecologic associations between geographic program coverage and reductions in stunting. From 2000 to 2005, the decline in the national stunting prevalence was mainly a result of reductions in Oromiya, SNNP and Tigray. Few nutrition programs had high coverage during this time, and economic growth may have contributed to stunting reduction by increasing household wealth and investments in sanitation. From 2005 to 2011, declines in stunting prevalence in Amhara, SNNP, Somali and Oromiya were largely responsible for national reductions. Numerous programs were implemented at scale and could have plausibly improved stunting. While ecologic relationships suggest that economic growth and large-scale programs may have contributed to the reduction in stunting in Ethiopia, stunting did not decrease in all regions despite increased program coverage expansion of the health system. Additional impact evaluations are needed identify the most effective programs to accelerate the reduction in the prevalence and number of stunted children. © 2016 John Wiley & Sons Ltd.

Prevalence of goiter in children 6 to 12 years of age in Ethiopia.

BACKGROUND: Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established. OBJECTIVE: To investigate the distribution and degree of severity of iodine-deficiency disorders in terms of goiter prevalence, urinary iodine excretion (UIE) levels, and proportion of households with iodated salt in Ethiopia. METHODS: A nationwide, community-based, cross-sectional study was conducted from February to May 2005 among 10,965 children aged 6 to 12 years. A multistage, proportional-to-population-size sampling method was used. Goiters were classified by the method recommended by the World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (WHO/UNICEF/ICCIDD), in which the thyroid gland is graded as 0 (normal), 1 (palpable goiter), or 2 (visible goiter); urinary iodine was determined by the wet digestion method; and salt samples were analyzed by a rapid test kit. RESULTS: The national total goiter weighted prevalence rate among children aged 6 to 12 years was 39.9% (95% confidence interval, 38.6% to 41.2%), representing more than 4 million children. The median UIE was 2.45 microg/ dL; 45.8% of children had UIE values of 2 microg/dL or less, and 22.8% had UIE values of 2.01 to 5.0 pg/dL. Only 4.2% of the households had iodated salt. CONCLUSIONS: According to the WHO/UNICEF/ ICCIDD classification, both goiter prevalence and UIE levels indicate that the whole country appears to be severely affected by iodine deficiency. Furthermore, the virtual absence of iodated salt in the households shows that currently there is no salt iodization program in the country. Dietary sources of iodine in Ethiopia are not dependable, and hence a sustainable universal salt iodization program needs to be implemented without delay.

Breastfeeding in Tigray and Gonder, Ethiopia, with special reference to exclusive/almost exclusive breastfeeding beyond six months.

This study assesses the initiation and duration of exclusive/almost exclusive breastfeeding (Ex/AEx-BF) versus partial breastfeeding (P-BF) and its relationship to infant growth and maternal body mass index (BMI) in Ethiopian infants up to 12 months of age (Tigray n = 471; Gonder n =596). Initiation of breastfeeding within 1 hr after birth was 1.7 times more common in Tigray. In Gonder 19% of the mothers started breastfeeding on the third day of delivery and consequently, a significant higher proportion of newborns were offered prelacteal feeds (P<0.001). At six months, 52.2% and 61.5% of mothers in Tigray and Gonder respectively practised Ex/AEx-BF. Perceived lack of breastmilk was a major factor for offering complementary foods before six months. More than 25% of infants in both regions were Ex/AEx-BF up to the eighth month and 16.4% and 15.7% of infants in Tigray and Gonder were still Ex/AEx-BF at the end of the first year. Growth faltered before six months of age but less frequently in Ex/AEx-BF compared to P-BF infants. Malnutrition became obvious after eight months in both groups. Malnourished mothers (BMI < 18.5) offering mixed feeding to their malnourished children (<-2 z-score) below six months of age was higher in both regions compared to the Ex/AEx-BF group (in Gonder 25% vs 5.9%; in Tigray 42.9% vs 33.3%). Nutrition education to raise awareness of mothers regarding initiation of exclusive breastfeeding directly after birth, the value of colostrum and avoidance of pre-postlacteal feeds, needs to be implemented. A new health package to be implemented could be a proper vehicle to reach the rural population, which doesn't have access to health services. The relationship between infant growth, mode of feeding and mothers nutritional status should be further investigated, particularly in populations with a high prevalence of maternal and infant nutrition and where long term breastfeeding is practiced.