Predictors of time to recovery from uncomplicated severe acute malnutrition among children in eastern Ethiopia.

Background: Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. Methods: A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan-Meir estimate along with the p-value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p-value below 0.05 was used to declare statistical significance. Results: A total of 402 records were reviewed, and the cure rate from SAM was 89.6% [95% confidence interval (CI), 87-93]. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, (p < 0.05). Edema at admission [adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33-2.29], without diarrhea (AHR = 1.51; 95% CI: 1.18-1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19-2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13-1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27-2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90-1.65), and new admission (AHR = 1.62; 95% CI: 0.84-3.10) were important predictors of recovery from SAM. Conclusion: Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.

Factors associated with compliance with weekly iron and folic acid supplementation among school adolescent girls in Debub Achefer district, northwest Ethiopia: school-based cross-sectional study.

Iron deficiency anemia is a public health problem among adolescents that could be addressed by weekly Iron Folic Acid Supplementation (IFAS). The Ethiopian government piloted weekly IFAS in schools, where its effectiveness depends on compliance. We assessed the determinants of compliance with the weekly IFAS in Ethiopia. A school-based survey was conducted in 506 adolescent girls on weekly IFAS. Compliance was considered when girls reported WIFAS for at least three months without discontinuation. Bivariable and multivariable logistic regression models were modeled, with odds ratios reported. Out of 506, 25.8% had limited access to educational resources, and 79.4% had no information on IFAS. Among these, 47.9% (95% CI: 45.5-49.9%) had poor compliance with weekly IFAS. Non-compliance was mainly due to school absenteeism (55.9%). Important predictors of poor compliance were adolescent girls' marital status (AOR = 5.21; 1.55-17.6), academic standing (AOR = 4.37; 2.20-8.70), family income (AOR = 1.85; 1.09-3.15), access to health education materials (AOR = 1.57; 1.02-2.40), problems with IFAS (AOR = 2.44; 1.26-4.74), a discouraging home environment for the program (AOR = 2.27; 1.54-3.34), and a lack of knowledge of the IFAS program (AOR = 1.40; 0.97-2.03). Compliance with weekly IFAS is optimal, which could be improved via strong adherence support and feasible supplementation schedules.

Digitalisation in the WFP fresh food voucher programme: a pilot study from rural Amhara region, Ethiopia.

Introduction: Malnutrition continues to pose a major challenge to human well-being around the world. In Ethiopia, 39% of children <5 years are stunted, with peaks in northern regions of the country such as Amhara (54.8%). Very few (2%) children in the region achieve the minimum dietary diversity and only a minority (27%) belong to households that can afford a nutritious diet. To tackle the high stunting rate, diets high in fruits and vegetables are widely recommended to improve dietary diversity. Programmes leveraging fresh food vouchers can be used to support vulnerable groups with malnutrition and limited affordability. Cash-based transfer (CBT) programmes have repeatedly been shown to improve child growth and increase household food security and dietary diversity. This study is part of the World Food Programme (WFP) intervention regarding a stunting reduction rural programme of restricted CBT for improving dietary diversity in households with children under 2 years of age and pregnant and lactating women. Methods: A community- based pilot study to assess the itemised foods purchased by beneficiaries was conducted in the four most accessible woredas of the Amhara region of Ethiopia. A total of 556 beneficiaries and 12 active retailers were selected randomly from 10 rural markets in the targeted woredas. A point of sale (POS) system was used to collect the itemised food prices and amounts of food procured by the beneficiaries. Results and Discussion: Approximately 51, 35, and 15% of the beneficiaries purchased vegetables, fruits, and eggs, respectively. Prices, taste preferences of children, and shelf life determine the purchase of certain food items. The average food expenditure was 49 Ethiopian Birr (ETB; US$ 0.94), representing the 63 and 37% daily and monthly requirements, respectively, for affordability. The higher increase in prices of some food items might be due to their seasonality. Almost half of the Fresh Food Voucher (FFV) beneficiaries were purchasing and consuming vegetables. The finding indicates that the WFP fresh food voucher programme contributes 63% (49 ETB, US$ 0.94) and 37% (837 ETB, US$ 16.1) of the daily and monthly needs of affordability, respectively, for a diversified nutritious diet. The use of Unstructured Supplementary Service Data (USSD) technology in the WFP digital voucher under the Fresh Food Voucher (FFV) project was effective at collecting itemised prices of foods purchased by the beneficiaries. The point of sale (POS) system can be scaled up under the Fresh Food Voucher (FFV) programme so that the digital voucher can contain the itemised food prices. Timely data from the point of sale could be used for timely Social Behaviour Change Communication (SBCC) development to improve dietary diversity.

Determinants of safe food handling practice among food handlers in food establishments, Yeka sub city, Addis Ababa, Ethiopia.

Background: Poor food handling practice is a key cause of foodborne diseases notably in developing countries like Ethiopia. This study aimed to assess food safety knowledge, attitude and practice of food handlers, establishments' status and determinants of safe food handling practice. Methods: The study utilized institution based cross-sectional study among food handlers working in Cafeterias, Restaurants and Hotels in Yeka sub city, Addis Ababa. A total of 284 food handlers: 69 from Cafeterias, 89 from Restaurants and 126 from non-stared Hotels were enrolled using stratified random sampling technique. Data were collected in observational checklist and through structured-questionnaire via face to face interview. A binary and multivariate logistic regression was used and adjusted for cofounders. A P-value of less than 0.05 was considered statistically significant. Result: The present study has indicated 42.6% of food handlers had good food handling practice. Food handling practice in the establishments were significantly associated with sex, monthly income, availability of functional pipe water supply, availability of soap and/or detergents and presence of insects or rodents. Conclusion: Food handlers in the study area were executing in a poor food handling practice, as most of them were not knowledgeable as needed. In fact, revising the salary of food handlers based on their work load could be valid, as there is existing worldwide economic inflation. Likewise enhancing pipe water availability in the food premises and dispatching sufficient soaps and detergents coupled with eradicating ubiquitous insects and rodents are key.

Dietary zinc intake and its determinants among Ethiopian children 6-35 months of age.

BACKGROUND: Adequate zinc intake is essential for the growth and neurobehavioral development of young children. Zinc deficiency in children is recognized as risk factor for stunting. In Ethiopia, 38% of children under five years of age are stunted. This analysis was conducted to measure dietary zinc intake and to identify its determinants among children 6-35 months of age to design appropriate intervention. METHODS: Nationally and regionally representative data available from 6752 children 6-35 months of age from the Ethiopian national food consumption survey were analyzed. A multivariate model was used to identify determinants of dietary zinc intake. RESULTS: We found low dietary zinc intake among children 6-35 month age. National average dietary zinc intake was 1.74 mg/day. Socio-economic status, maternal education, and maternal age were positively associated with dietary zinc intake, while the number of children under 5 years-of-age in a household was negatively associated with dietary zinc intake (p < 0.0001). Children reportedly sick in the previous 2 weeks were most likely to have low dietary zinc intake (p < 0.0001). CONCLUSION: The observed low dietary zinc intake in Ethiopian children has a significant association with health status of children, providing evidence for nutrition and health planners to emphasize on promoting consumption of zinc rich foods and preventing morbidity from common infections.

Linkages between health and agriculture sectors in Ethiopia: a formative research study exploring barriers, facilitators and opportunities for local level coordination to deliver nutritional programmes and services.

BACKGROUND: In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Government has adopted the National Nutrition Programme that emphasizes the need for multi-sectoral collaboration to effectively deliver nutrition-sensitive and nutrition-specific interventions. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities. METHODS: Data were collected from eight districts in Ethiopia using 16 key informant interviews and eight focus group discussions conducted with district and community-level focal persons for nutrition including health and agriculture extension workers. A framework analysis approach was used to analyze data. RESULTS: Few respondents were aware of the National Nutrition Programme or of their own roles within the multi-sectoral coordination mechanism outlined by the government to deliver nutritional programmes and services. Lack of knowledge or commitment to nutrition, lack of resources and presence of competing priorities within individual sectors were identified as barriers to effective coordination between health and agriculture sectors. Strong central commitment to nutrition, increased involvement of other partners in nutrition and the presence of community development workers such as health and agriculture extension workers were identified as facilitators of effective coordination. CONCLUSIONS: Federal guidelines to implement the Ethiopian National Nutrition Programme have yet to be translated to district or community level administrative structures. Sustained political commitment and provision of resources will be necessary to achieve effective inter-sectoral collaboration to deliver nutritional services. The health and agriculture extension platforms may be used to link interventions for sustained nutrition impact.

Dietary Fluoride Intake and Associated Skeletal and Dental Fluorosis in School Age Children in Rural Ethiopian Rift Valley.

An observational study was conducted to determine dietary fluoride intake, diet, and prevalence of dental and skeletal fluorosis of school age children in three fluorosis endemic districts of the Ethiopian Rift Valley having similar concentrations of fluoride (F) in drinking water (~5 mg F/L). The duplicate plate method was used to collect foods consumed by children over 24 h from 20 households in each community (n = 60) and the foods, along with water and beverages, were analyzed for fluoride (F) content. Prevalence of dental and skeletal fluorosis was determined using presence of clinical symptoms in children (n = 220). Daily dietary fluoride intake was at or above tolerable upper intake level (UL) of 10 mg F/day and the dietary sources (water, prepared food and beverages) all contributed to the daily fluoride burden. Urinary fluoride in children from Fentale and Adamitulu was almost twice (>5 mg/L) the concentration found in urine from children from Alaba, where rain water harvesting was most common. Severe and moderate dental fluorosis was found in Alaba and Adamitulu, the highest severity and prevalence being in the latter district where staple foods were lowest in calcium. Children in all three areas showed evidence of both skeletal and non-skeletal fluorosis. Our data support the hypothesis that intake of calcium rich foods in addition to using rain water for household consumption and preparation of food, may help in reducing risk of fluorosis in Ethiopia, but prospective studies are needed.

Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia.

BACKGROUND: Iron deficiency is the most prevalent nutritional deficiency in adolescent girls from the developing world. One of the recommended interventions to improve iron status in adolescent girls is iron supplementation. Yet the provision of iron supplements to adolescent girls proved to be a challenging task for the health systems across the developing world. OBJECTIVE: The objective of the study was to examine means of reaching adolescent girls for iron supplementation in Northern Ethiopia. METHODOLOGY: Analytical cross-sectional study consisting of both quantitative and qualitative approaches to data collection and analysis was used in this study. Stratified multi-stage systematic random sampling technique was adopted and primary quantitative data were collected from 828 (578 school attending and 250 non school attending) adolescent girls recruited from nine districts of Tigray. The primary quantitative data were analyzed using SPSS version 20 software. The qualitative data collected through key informant interviews and focus group discussions were transcribed verbatim and qualitatively analyzed. RESULTS: The mean (SD) age of the girls was 16.7 (1.4) years. Four hundred forty seven (54%), 355 (42.9%) and 26 (3.1%) of the adolescent girls had low, medium and high diet diversity scores, respectively. More than half, 467 (56%), of the adolescent girls believed that adolescent girls were overloaded with household jobs everyday compared to boys from their respective communities. Key informants said that, there is no adolescent nutrition message promoted in the study area. Low community awareness, perceiving iron tablet as a contraceptive, religious and cultural influences, and lack of confidence in supplementation value of iron tablets, are some of the potential barriers mentioned by the key informant and focus group discussion participants. Schools (45%), health centers (27%) and health posts (26%) were the preferred public facilities for provision of iron supplements to student adolescent girls whereas schools (11%), health centers (47%) and health posts (41%) were the preferred public facilities for provision of iron supplements to adolescent girls who were not attending schools from the study communities. CONCLUSION: The health posts and health centers were the preferred health facilities for iron supplementation to adolescent girls who were not attending schools while the school was the preferred facility for iron supplementation of student adolescent girls.

Iron, folate and vitamin B12 status of Ethiopian professional runners.

BACKGROUND: Better macro and micro nutrient status and their adequate intake by the athletes have great role in balancing losses associated with strenuous exercise, then for better performance. The objective of this study was to determine iron, folate and vitamin B12 status of Ethiopian professional athletes. METHODS: A cross sectional study was conducted using a point time convenient sample of 101 male and female Ethiopian professional athletes of different distance categories in the period of February to April 2014. Biochemical samples, detail health and exercise related interview, performance data, 24 h dietary diversity and weekly food frequency were collected. RESULTS: The low, medium and high dietary diversity terciles were 36.1, 60.9 and 3.3 % respectively. The mean ± Sd of dietary diversity was 5.44 ± 1.8. Prevalence of iron overload (Serum ferritin >200 µg/L) was 11 %, whereas that of anemia (Hb < 12 g/dL), iron deficiency (ferritin < 12 µg/L) and moderate folate deficiency (<5.9 ng/mL) was 3, 2 and 20.8 % respectively. There was no iron deficiency anemia case in the study. In this study, the mean serum vitamin B12 concentration was 561 ± 231 pg/ml with a minimum and maximum value of 210 and 1736 pg/ml respectively, and there was no deficiency for this nutrient (>210 pg/ml). The iron status of male athletes was significantly different by running-distance categories. In contrast, such difference was absent for female athletes. Performance of the athletes was associated with their red blood cell count (RBC) at p = 0.03. The high performer athletes exhibited high mean value of micronutrient status and hematological variables than their counter parts. However, the RBC of the athletes was the only parameter whose association was statistically significant. CONCLUSIONS: The observed gender difference in the association of running-distance category with iron and folate in this study needs further investigation. Given the 11 % iron overload in the present study; there is a need of awarance creation activities and diet intervention in the athletics federation, the athletes and the coaches in order not aggravate the present overload. Prescription of supplements such as iron-folate, multivitamins and minerals should not be based on broad spectrum rather it should be based on recent history of confirmed deficiency, clinical signs and/or laboratory testing to prevent trace element toxicity.