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Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa (SSA), including Ethiopia. This study aimed to assess the effect of nutrition education on the nutritional status of pregnant women in urban settings in Southeast Ethiopia. A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control). We used a multistage cluster sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions. Women in the control group received standard care. A nonstretchable mid-upper arm circumference (MUAC) tape was used to measure the MUAC. A linear mixed effects model (LMM) was used to evaluate the effect of the intervention on MUAC, accounting for the clustering. The net mean ± standard error of MUAC between the intervention and control groups was 0.59 ± 0.05 (P < 0.0001). The multivariable LMM indicated that having received nutrition education interventions (β = 0.85, 95% CI 0.60, 1.12, P < 0.0001) improved the MUAC measurement of pregnant women. Thus, nutrition education during pregnancy will combat undernutrition among pregnant women. Trial Registration: Clinicaltrials.gov (PACTR202201731802989), retrospectively registered on 24/01/2022. [ABSTRACT FROM AUTHOR]

Background: Maternal anemia, miscarriage, low birth weight (LBW), preterm birth (PTB), intrauterine growth restriction (IUGR), prenatal and infant mortality, morbidity, and the risk of chronic disease later in life are all increased by a lack of dietary diversity during pregnancy. However, evidence for the effect of nutrition education on the dietary diversity score (DDS) among pregnant women was sparse in Ethiopia, particularly in the study areas. This study aimed to assess the effect of nutrition education on dietary diversity among pregnant women in urban settings in Southeast Ethiopia. Methods: A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention group and 223 control group) at health facilities from February to December 2021. A multistage cluster sampling technique, followed by systematic sampling, was used to select the pregnant women. Pregnant women who participated in the interventions were given nutrition education starting at 16 weeks of gestation and continuing for 6 months. We used a pre-tested, interviewer-administered, structured questionnaire to collect the data. A 24-hour qualitative dietary recall was used to calculate the dietary diversity score (DDS). A multivariable generalized estimating equation (GEE) model was conducted to evaluate the intervention effect. Results: After the intervention, the proportion of adequate dietary diversity was 14.15% higher in the intervention arm compared to the control group (45.09% versus 30.94%, P = 0.002). The overall difference in adequate dietary diversity between the two groups was 8.5%. After adjusting for background characteristics, the multivariable GEE binary logistic model revealed that having received intervention [(AOR = 1.89, 95% CI: 1.27, 2.79)], being literate [(AOR = 3.41, 95% CI: 1.13, 10.23)], and having high wealth [(AOR = 1.60, 95% CI: 1.09, 2.35)] significantly improved adequate dietary diversity. Conclusion: The findings indicated that having received the intervention, being literate, and having a high level of wealth significantly improved maternal dietary diversity. Efforts should be made to increase nutrition education using the health belief model (HBM) and the theory of planned behavior (TPB). Moreover, there is a need to improve literacy and economic empowerment through income-generating activities to enhance adequate dietary diversification during pregnancy. Trial registration: Clinicaltrials.gov (PACTR202201731802989, Retrospectively registered on 24 January 2022). [ABSTRACT FROM AUTHOR]

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle‐income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi‐sectoral initiative and the results of combined effects of community‐based and enhanced nutrition services, compared to community‐based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre‐ and post‐intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow‐up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow‐up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5‐year intervention, the use of standard community‐based nutrition services of growth monitoring and promotion increased (16%–46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%–77%). Women involved in home gardening significantly increased (73%–93%); however, household production of food decreased yet consumption of most own‐grown foods increased. Importantly, MAD and MDD increased four‐fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition‐sensitive practices can improve child feeding in young children. Key messages: Improved nutrition of young children can result from interventions that combine nutrition and agriculture through joint household visits by health and agriculture extension workers.Use of standard nutrition services increased over time when presented with other services that include enhancements that increase men's participation.Improvements in complementary feeding and diet quality of infant and young child feeding are achieved through enhancement of nutrition services over and above community‐based services. [ABSTRACT FROM AUTHOR]

Background: Despite varying serum levels of 25(OH)D among schoolchildren in Ethiopia, data are lacking whether this affects their muscle function as measured by handgrip strength of these children. Handgrip strength may be used as a proxy indicator of muscle strength and function. This study evaluated the association between serum levels of 25(OH)D and handgrip strength among schoolchildren in Ethiopia.Methods: The study used a data set from a school-based cross-sectional study conducted on a total of 174 randomly selected schoolchildren from urban (N = 89) and rural (N = 85) settings of Adama Town and Adama Woreda, respectively. Handgrip strength, serum 25(OH)D levels, and anthropometry were measured for each child following standard procedures, while data on demographic characteristics of children and their parents were collected using a structured interviewer-administered questionnaire. A multivariable linear regression model was used to determine the association between serum vitamin D level and handgrip strength after adjusting for other predictors.Results: The mean handgrip muscle strength of the students was 17.6 ± 6.9 kg. The average serum 25(OH)D for the group was 54.5 ± 15.8 nmol/L. On multivariable linear regression model, serum 25(OH)D level was significantly associated with handgrip strength (β = 0.06, P = .008) of the children after controlling for potential confounders. Other variables, female gender (β = -2.20, P = .004), age (β = 1.97, P < .001), height (β = .22, P < .001), weight (β = 0.33, P < .001), and triceps skinfold thickness (β = -0.19, P = .023), were identified to have significant association with handgrip strength of schoolchildren.Conclusion: Serum 25(OH)D levels had significant positive association with handgrip strength of Ethiopian schoolchildren. The results imply the need for incorporating school nutrition education on consumption of foods rich in important nutrients including vitamin D-rich foods in the school curricula and also enhancing behavioral change communication toward exposure to sunlight in the school to produce adequate vitamin D. Further longitudinal study involving a larger sample is recommended to confirm the findings. [ABSTRACT FROM AUTHOR]

Childhood and adolescent obesity is an international public health problem leading to an increased risk of adulthood obesity, mortality and morbidity. Its prevalence is increasing in low-income populations, and we hypothesized it may be associated with vitamin D deficiency. Low vitamin D status is a worldwide public health issue including in Ethiopia; however, no one has examined overweight/obesity in Ethiopian schoolchildren with regard to vitamin D status. The Analyses of a data set from a school-based cross-sectional study conducted in Adama Town (n = 89) and in rural Adama Woreda (n = 85) was carried out to determine vitamin D deficiency and its association with overweight and/or obesity. Data on a total of 174 schoolchildren aged 11-18 years was used for these analyses. The overall prevalence of overweight and/or obesity was 10.3%, with 8.5% overweight and 2.3% obese; the prevalence of underweight was 19%. In the multivariable logistic regression model, vitamin D deficiency, being in the higher age group, female sex and urban residence of students, their mothers' occupation of being employed and their households' high and middle socioeconomic status were significantly associated with overweight and/or obesity. We concluded that vitamin D deficiency is an independent predictor significantly associated with overweight and/or obesity among schoolchildren from rural and urban settings in Ethiopia. The results imply the need for behavior change communications on the importance of exposure to sunlight to produce adequate vitamin D to curb this emerging health problem of overweight/obesity following economic growth and globalization in Ethiopia. As this study only highlighted the association, prospective studies and randomized controlled trials are required to establish causality. [ABSTRACT FROM AUTHOR]

Background. Nutritious complementary foods are needed in countries where undernutrition and stunting are major problems, but mothers may be reluctant to change from traditional gruels. Objective. To test whether a recipe-based complementary feeding education intervention would improve knowledge and practice of mothers with young children in Hula, Ethiopia. Methods. A baseline survey of 200 eligible, randomly selected mother-child pairs gathered data on sociodemographic characteristics, food security status, knowledge and practices concerning complementary feeding, food group intakes of children aged 6 to 23 months by 24-hour recalls, and children's anthropometric measurements. Twice a month for 6 months, women in the intervention group received an education session consisting of eight specific messages using Alive and Thrive posters and a demonstration and tasting of a local barley and maize porridge recipe containing 30% broad beans. The control group lived in a different area and had no intervention. Results. At 6 months, knowledge and practice scores regarding complementary feeding were significantly improved (p < .001) in the intervention group but not in the control group. The intervention resulted in improvement of children's dietary diversity, as well as mean intake of energy and selected nutrients, compared with children in the control group. Changes in height and weight did not differ between the two groups. Conclusions. Community-based nutrition education over 6 months that included demonstration of a local porridge recipe with broad beans added improved the complementary feeding practices of caregivers and the nutritional status of their young children. [ABSTRACT FROM AUTHOR]

Dietary calcium binds Fluoride (F), thus preventing excess F absorption. We aimed to assess the efficacy of supplementing calcium-containing Eggshell Powder (ESP) on F absorption using urine F excretion and on fluorosis symptoms. In total, 82 women (41 Intervention Group, IG; 41 Control Group, CG) were recruited; overall, 39 in each group completed the trial. Morning spot urine was collected before (baseline, BL) and after (endline, EL) the intervention that was 6-months daily supplementation with 2.4 g ESP (providing ~1000 mg of calcium). Dental, skeletal, and non-skeletal fluorosis assessments was carried out at BL and, except for dental, at EL. Relative risk (RR) and linear generalized estimating equation were used to compare outcomes between groups. At BL, urinary F excretion in the IG and CG groups was similar, ~10 mg/L. At EL, urinary F excretion in IG women was six-fold lower (β = −6.1 (95% CI: −7.1, −5.1)) compared to CG. The risk of developing skeletal and non-skeletal fluorosis were significantly (p < 0.001) reduced in the intervention group. A significant reduction in urinary F excretion and reduction in many fluorosis symptoms were observed among women supplemented with calcium-containing ESP, thus providing evidence for using this dietary calcium source for mitigation of fluorosis. Clinical trials registration: NCT03355222. [ABSTRACT FROM AUTHOR]