Search

The feeding experiment was conducted at Ofla district, southern Tigray, North Ethiopia, to investigate feed utilization, diet digestibility, and its economic feasibility under different supplementation options. Twenty-four yearling intact growing lambs were used in randomized complete block design with three treatments and eight replications. The treatment diets were T1 (molasses 15% + wheat bran 48% + cotton seed cake 35%), T2 (maize grain 20% + wheat bran 43% + noug seed cake 35%) and T3 (maize grain 20% + wheat bran 33% + dried brewers' grain 45%). The diet was formulated as iso-nitrogenous and each animal has taken daily nutrient requirements according to their body weight. The collected data were analyzed using SAS (2007) statistical software. Economic analysis was done using standard partial budget analysis guidelines of CIMMIT (1988). The crude protein contents of the three treatment rations were comparable across treatments. There was a higher total dry matter intake recorded in animals fed on T3 as compared to the other treatments. The barley straw intake was higher and significant (P < 0.05) for the animals' group in T3 than that of T1 and T2. Animals fed with T3 had significantly (P < 0.05) higher organic matter intake as compared to those fed with T1 and T2. However, there was no significant (P > 0.05) differences in crude protein intake between treatments. The apparent digestibility of dry matter, organic matter, and crude protein had no significant differences (P > 0.05) between treatments. Similarly, the apparent digestibility of neutral detergent fiber and acid detergent fiber was not significantly different (P > 0.05) among T1, T2, and T3. In general, animals that fed on T3 achieved better feed utilization and economic return as compared to the others.

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high‐impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron‐folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability. Key messages: Key barriers include lack of resources such as functional anthropometric equipment, high caseload, poor staff commitment and motivation, closed health posts, false reporting and lack of accountability, lack of priority for nutrition services, poor nutrition counselling, and poor leadership engagement and support.Improving implementation of nutrition services requires systematic identification of barriers and designing adaptable solutions.Our study highlights the need for separate growth monitoring and promotion (GMP) rooms and service providers. Service providers need adequate training to provide nutrition services. There is a need for improved monitoring supervision, leadership engagement and regular and improved carrier development and incentives. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, 12.5% of children below 5 years are wasted, and 9.7% are moderately wasted. The present strategy for the management of moderate acute malnutrition (MAM) is a supplementary feeding program; however, this is only provided to chronically food-insecure areas. This randomized controlled non-inferiority trial examines if Local ingredients-based supplement (LIBS) is as effective as corn-soya blends plus (CSB+) in treating moderate acute malnutrition among children aged 6-59 months., Methods: A randomized controlled non-inferiority trial will be conducted with moderately wasted children aged 6 to 59 months in Wolaita, Ethiopia. The calculated sample size is 324 (i.e. with 162 children in each of two arms, to be assigned by randomization). The daily ration will be: 100 g of LIBS plus 25.2 g of sugar with 8 ml oil in the intervention group, and 150 g of CSB+ with 16 ml of oil in the control group. These interventions will be provided for a maximum period of 12 weeks, with follow-up performed on a weekly basis. Data analysis will be done using SPSS and STATA software. Both intention-to-treat and per protocol analyses will be done. Hazard ratio and Kaplan-Meier (log rank) curves of survival analysis will be done to predict the probability of recovery rate. Logistic regression will be used to test for interactions between independent and dependent variables. Analysis of variances, t-tests, fisher's exact test and chi-square tests will be used to assess baseline characteristics., Conclusions: This paper will introduce to the existing research locally available nutritious foods which have the potential to enhance recovery from moderate acute malnutrition and to reduce the burden of malnutrition. The perceptions of mothers on feeding children with local ingredient-based supplementary food to assist recovery from moderate acute malnutrition will be the focus of in a qualitative study to follow; this will provide a further contribution in an evolving area of research., Trial Registration: Pan-African Clinical Trial Registration number: PACTR201809662822990, retrospectively registered on 11/09/2018.

The evidence base for micronutrient powder (MNP) interventions predominantly consists of quantitative studies focused on measuring coverage, utilization, and/or biological outcomes. We need other types of studies to broaden the scope of our knowledge about determinants of MNP programme effectiveness. Addressing this knowledge gap, this paper focuses on the process of designing an ethnographic research protocol to obtain caregivers' perspectives on the factors that influenced their use of intervention delivery services and their adherence to MNP recommendations. The research was undertaken within the context of formative evaluations conducted in Mozambique and Ethiopia. Ethnography provides a means for acquiring and interpreting this knowledge and is an approach particularly well suited for formative evaluation to understand the response of a population to new interventions and programme delivery processes. We describe decisions made and challenges encountered in developing the protocol, and their implications for advancing methodology in implementation research science. In addition to a core team of three investigators, we added an "advisory group" of 10 experts to advise us as we developed the protocol. The advisory group reviewed multiple drafts of the interview protocol and participated in mock interviews. In the protocol development process, we faced the issues and made decisions about concerned gaps in content, cultural adaptations and comprehension, and interview guide structure and format. Differences between the core team and the advisory group in methodological approaches to the structure and content of questions call attention to the importance of establishing greater communication among implementation scientists working in nutrition interventions., (© 2019 The Authors. Maternal & Child Nutrition Published by John Wiley & Sons Ltd.)

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in-depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try "Desta," a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child ("continuing users," n = 14) or had stopped feeding Desta ("noncontinuing users," n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited "appropriate use" and "continued use." For "appropriate use," defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to "continued use," the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings., (© 2019 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

Background: Wild edible plants (WEPs) are usually considered to constitute all plant resources that are neither cultivated nor domesticated but are used as nutritional supplements by local people. WEPs play a vital role in ensuring food and livelihood security for countless families and communities around the world. The objective of the study was to assess and document wild edible plants used by communities in the Arsi Robe district as food. Methods: Semi-structured interviews, market surveys, and guided field walks were employed as data collection tools. The data were analyzed using preference ranking, direct matrix ranking, and Jaccard's similarity index. Results: The present study revealed various types of wild edible plants consumed by local communities in the Arsi Robe district of the East Arsi Zone. This could be justified by the documentation of 36 different wild edible plants in the study area. These WEPs belong to 31 genera and 25 families. Most of the growth forms of the edible wild plants in the district were shrubs (16, 44.44%) and trees (14, 38.88%). Amaranthus caudatus and Bridelia micrantha are the most preferred WEPs in the study area. The finding of the study also revealed that Lepidotrichilia volkensii and Premna schimperi are among the novel WEPs that had not before been documented as food items in other areas. Olea europaea subsp. cuspidata, Ficus sycomorus, Cordia africana, and Ficus sur are species with multiple uses. Agricultural expansion, charcoal production, the construction of different materials, making agricultural tools, deforestation, and other factors were the top prioritized threats affecting the abundance and diversity of wild edible plants. Conclusion: Along with the sustainable utilization and conservation of the existing WEPs of the study district, priority should be given to the urgent collection, domestication, and cultivation of multiuse wild edible plant species such as Olea europaea subsp. cuspidata, Ficus sycomorus, Cordia africana, and Ficus sur in the study area. [ABSTRACT FROM AUTHOR]

Over the last two decades, great efforts and investments have been made in Ethiopia to ensure that all children have equal access to nutrition services in health facilities. While quality health systems are a prerequisite for quality nutrition services, little attention has been given to the evaluation of the supply and delivery services. The purpose of the study was to evaluate the coverage and quality of the nutrition‐specific interventions delivered through the health system. Using an end‐user monitoring (EUM) system, we monitored the delivery of nutrition‐specific interventions in 500 districts, having 2514 health facilities distributed throughout Ethiopia. Data were collected through third‐party monitors between August 2020 and 2021. Roughly 90% of health facilities were performing severe acute malnutrition management in line with the national guideline/protocol, and 2/3 of the assessed facilities were delivering iron and folic acid, vitamin A supplementation and deworming. A third of the messages on AMIYCN were retained by beneficiaries. Warehouse conditions were good in 64.3% of the facilities, but only 22% had good recording practices and about half had problems related to the quality and availability of nutrition supplies. Most beneficiaries were satisfied with the nutrition supplies and service delivered at the health facility level. This study also suggests the relevance of an EUM system to assess the quality of nutrition service delivery and its related supply management, as well as to improve the implementation of nutrition interventions as a decision‐making tool. Key messages: The main bottleneck identified in supply management was the recording system, while roughly 65% of warehouses are in good condition to store nutrition supplies at the health facility level.Roughly 90% of health facilities were performing severe acute malnutrition management in line with the national guideline, while 2/3 of the health facilities are delivering iron and folic acid, vitamin A supplementation and deworming.The knowledge and practices of the HW were above average and only a third of the messages delivered were retained by beneficiariesAlthough messages are being well delivered once counselling is implemented, many opportunities (contact points) are missed to deliver nutrition counselling. [ABSTRACT FROM AUTHOR]

Tef [Eragrostis tef (Zucc.) Trotter], an ancient cereal primarily grown in Ethiopia, is becoming increasingly popular worldwide due to its high iron content and gluten-free nature. However, it has been reported that injera produced only with tef flour lack certain vital nutrients. Therefore, this specific study was conducted to supplement tef injera with other food materials of better nutritional value and compensate its expensive market price with sorghum cereal flour. The effect of fermentation conditions, and the sorghum and carrot pulp blending ratio on the nutritional value and sensory quality of tef injera was investigated. The factorial approach of the experimental design was conducted considering the nutritional value and sensory quality of the injera made of three main blending ratios of tef, sorghum, and carrot (60% tef: 30% sorghum: 10% carrot pulp, 45% tef: 45% sorghum: 10% carrot pulp and 30% tef: 60% sorghum: 10% carrot pulp) as experiential variables. The raw materials and injera were characterised for their proximate composition, physicochemical property, mineral composition, microbial analysis, and sensory attributes, using standard methods. The results of the study show that fermentation conditions and blending ratios have a significant effect on the nutritional, anti-nutritional, mineral content, microbial quality, and sensory properties of blended injera products, where higher values of ash, crude protein, crude fat, Total titratable acidity (TTA), Fe, Zn, and Ca (2.30%, 11.34%, 2.62%, 3.53, 32.97 mg/100 g, 2.98 mg/100 g and 176.85 mg/100 g, respectively) were analyzed for the co-fermented injera sample. In addition, a lower microbial count was observed in co-fermented injera samples, whereas microbial counts in injera samples prepared from carrot pulp-supplemented dough after the co-fermentation of tef and sorghum flours were observed to be higher. The injera product made using blending ratio of 60% tef: 30%sorghum: 10% carrot co-fermented was found to be the optimum result due to its very good nutritional improvement (i.e., reduction of some anti-nutritional factors, microbial contents, pH and increased contents of some minerals, crude protein, crude fat, TTA and improved most of the sensory quality of the supplemented injera product). According to this study, sorghum and carrot supplementation on tef could improve the nutritional value of injera while also providing an instant remedy for the growing price of tef. [ABSTRACT FROM AUTHOR]

Background: From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months - about 500 days - is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. Objective and design: This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers. Results: The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron-folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries. Conclusions: This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay. [ABSTRACT FROM AUTHOR]

Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress. Key points: Delivering nutrition services to all pregnant women is essential for maternal and child health outcomes but remains a challenge.Nutrition gaps in antenatal care (ANC) include lack of specificity in national guidelines and protocols, bottlenecks in micronutrient supplies, low ANC provider knowledge and skills, inadequate supervision to reinforce counseling, and not engaging families to encourage key practices.National protocols for ANC should be more specific for the four nutrition interventions (micronutrient supplements, weight gain monitoring, counseling on diets and counseling on breastfeeding) and assign accountability for coverage and quality.Country models are needed for improving provision and utilisation of nutrition interventions through ANC that are based on comprehensive policy frameworks. [ABSTRACT FROM AUTHOR]

Abstract: Maternal and neonatal mortality are unacceptably high in developing countries. Essential nutrition interventions contribute to reducing this mortality burden, although nutrition is poorly integrated into health systems. Universal health coverage is an essential prerequisite to decreasing mortality indices. However, provision and utilization of nutrition and health services for pregnant women and their newborns are poor and the potential for improvement is limited where health systems are weak. The Community‐Based Maternal and Neonatal Health and Nutrition project was established as a set of demonstration projects in 4 countries in Africa with varied health system contexts where there were barriers to safe maternal health care at individual, community and facility levels. We selected project designs based on the need, context, and policies under consideration. A theory driven approach to programme implementation and evaluation was used involving developing of contextual project logic models that linked inputs to address gaps in quality and uptake of antenatal care; essential nutrition actions in antenatal care, delivery, and postnatal care; delivery with skilled and trained birth attendant; and postnatal care to outcomes related to improvements in maternal health service utilization and reduction in maternal and neonatal morbidity and mortality. Routine monitoring and impact evaluations were included in the design. The objective of this paper is to describe the rationale and methods used in setting up a multi‐country study that aimed at designing the key maternal and neonatal health interventions and identifying indicators related to inputs, outcomes, and impact that were measured to track change associated with our interventions. [ABSTRACT FROM AUTHOR]

Performance of three sheep breeds in the lowland areas of western Amhara, the Gumuz, Rutana and Begiet were evaluated using three levels of concentrate (400, 500 and 600 g head-1 day-1) having same Noug seed cake:Wheat bran ratio (75:25) under feedlot condition. The roughage was native grass hay which was offered adlibitum. Thirty two eight to nine old intact male sheep (12 breed-1) were randomly allotted to the dietary treatments, fed for 90 days and slaughtered at an age of approximately 12 months. Breed and diet (concentrate level) significantly affected average daily gain (ADG). Gumuz and Rutana sheep breeds achieved higher average daily gain (ADG) than Begiet. Sheep fed on concentrate L2 (500 g head-1 day-1) recorded significantly higher ADG than sheep fed on L1 and L3. As a result of better slaughter weight (SW) achieved higher hot carcass weight (HCW) was recorded by Gumuz and Begiet sheep breeds. Because of greater difference in proportion of non-carcass components and better HCW achieved relative to slaughter body weight, better dressing percentage (DP) was achieved by Gumuz. Breed and concentrate level did not improve main carcass components, edible and non-edible offal. Meat quality attributes were not influenced by breed. Among the concentrate levels L2 was optimum to improve major meat quality attributes like juiciness, flavor and over all acceptance. Sheep supplemented with concentrate L2 had the highest net return (855.06 ETB and highest MRR (14.12) compared to the other concentrate levels. Compared to other lowland breed Gumuz and Rutana sheep breeds recorded highest net return (733.42 and 531.67 ETB) and highest MRR (10.25 and 11.42 ETB), respectively. Thus, it is recommended that use of adaptive sheep breeds (Gumuz and Rutana) to that specific environment and use of concentrate level two (L2) are biologically efficient and potentially profitable in the feeding of growing lowland sheep to the area and other similar areas. [ABSTRACT FROM AUTHOR]

Simple Summary: Nutritional flushing has the potential to increase reproduction in small ruminants. Utilization of locally available feed resources is imperative if smallholder farmers are to adopt improved nutritional strategies for flushing sustainably. The current experiment investigated the effect of four isonitrogenous (14.7% crude protein) rations formulated to supply low (Lo-ME) or high (Hi-ME) metabolizable energy based on enset leaf (Ensete ventricosum) and commercial concentrate and the effects on local Doyogena ewes in Ethiopia. The current finding indicated the supplementation of both enset leaf and concentrate enhanced the performance of local ewes. The objective of the study was to establish the effect of appropriate supplementation days (days -21 to +7) using four isonitrogenous (14.7% CP) diets balanced to provide low (Lo-ME) or high (Hi-ME) metabolizable energy on the body condition score (BCS), body weight (BW) change, and reproductive performances of sheep. Thirty-five Doyogena ewes (27.71 ± 2.87 kg, 2–5 years of age, BCS of 2.0–2.5) grazing on natural pasture were randomly assigned to supplementary treatments consisting of combinations of enset leaf (EL) and commercial concentrate (CC): T0 (control), T1 (250 g EL + 500 g CC: Lo-ME), T2 (400 g EL + 500 g CC; Hi-ME), T3 (500 g EL + 400 g CC; Hi-ME), and T4 (500 g EL + 250 g CC; Lo-ME). The estrous cycle was synchronized with one intramuscular injection, 5 mg PGF2α, prior to artificial insemination. The dry matter (DM) from the pasture provided 1.10–1.46 kg/day, which corresponds to the DM requirements of the ewes until late gestation. However, the pasture provided a protein content of 9.52%, which was insufficient for breeding, mid-gestation, and gestation, requiring minimums of 16.1%, 13.1%, and 14.8%, respectively. The pasture could only provide enough energy for breeding ewes with a BW of up to 30 kg. The energy provided by pasture was insufficient for ewes weighing > 30 kg at mid-gestation and gestation, providing 6.9–9.2 MJ/day, below the requirement of 11.92–16.32 MJ/day required for mid-gestation and gestation. The energy was not sufficient for large ewes weighing > 40 kg. Supplementary diets T1–T4 provided DM in the range of 1.7–2.29 kg/day. This was sufficient for AI, mid-gestation, and gestation phases. Dietary supplements increased (p < 0.01) BW during breeding and mid-gestation. During lambing, T2 and T3 increased BW (p < 0.05) compared to T4 and T1. T4 had a similar effect (p > 0.05) on BW during lambing. T1, T2, and T3 significantly increased BCS (p < 0.05). T2 and T3 increased (p < 0.05) BCS at mid-gestation, but only T2 significantly increased BCD (p < 0.05) during lambing. All dietary supplements resulted in a shorter (p < 0.05) time to the resumption of estrous and the length of estrous (p < 0.05). T1, T2, and T3 resulted in a stronger estrous response (p < 0.05). Dietary supplements enhanced (p < 0.05) the conception rate and fecundity rate. The conception rate was highest in T2 and T3 at 85.7% and 83.3%, respectively. T2 had the highest fecundity rate at 151.7% (p < 0.05). Dietary supplementation increased the rate of lambing (LR), litter size (LS), and weight of lambs at birth (LBW). The LR for treatments T2, T3, and T4 was 100% versus 66.7% in the control. T1 and T2 significantly increased (p < 0.05) LS, but T4 had a similar LS to the control. Dietary supplements T1, T3, and T4 tended to increase (p < 0.05) LBW, but T2 increased LBW significantly (p < 0.05). Supplementation (T2, T3) with 400 g enset + 500 g CC and 500 g enset + 400 g CC are promising feed supplements to increase the reproductive capacities of Doyogena ewes in Ethiopia. Energy is as important to ewe flushing as protein. [ABSTRACT FROM AUTHOR]

Background: Despite their paramount importance all over the globe in supporting food security, information about wild edible plants is generally patchy. In this study, we investigated the wild edible plants used by the local people in the Soro District of Hadiya Zone, southern Ethiopia. The main purpose of the study was to document and analyze the indigenous and local knowledge of the people on their abundance, diversity, use and management. Methods and materials: Purposive sampling and systematic random sampling were used to identify informants who can give information about the wild edible plants of the area. Data were collected by interviewing 26 purposively sampled key informants and 128 systematically randomly sampled general informants using semi-structured interviews. Guided observations and 13 focus group discussions (FGDs) consisting of 5–12 participants/discussants at each FGD session were also undertaken. Statistical analyses (mainly descriptive statistics approaches) and common analytical tools of ethnobotany including informant consensus, informant consensus factor, preference ranking, direct matrix ranking, paired comparison and index of fidelity level were applied to the data sets. Results: A total of 64 wild edible plant species belonging to 52 genera and 39 families were recorded. All of these species are indigenous, 16 are new additions to the database and seven of them, including Urtica simensis and Thymus schimperi, are endemic to Ethiopia. In about 82.81% of the species, the edible plant part is also used in the Ethiopian traditional herbal medicine. It is striking to see that almost all wild edible plants recorded from the study area are nutraceutical plant species, serving multiple roles as food and therapeutic sources for the local people. We recorded five growth habits of 34.38% trees, 32.81% herbs, 25% shrubs, 6.25% climbers, and 1.56% liana. We found the Flacourtiaceae, Solanaceae, and Moraceae to be families that represented more species (4 each), followed by Acanthaceae, Apocynaceae, Amaranthaceae, and Asteraceae, which accounted for 3 species each. Fruits (53.13%) and leaves (31.25%) were consumed in more proportions than other edible parts (15.63%); mostly the ripe, raw fruit is eaten upon simple processing, followed by leaves eaten after boiling, roasting and cooking. Conclusion: The frequency and intensity of consumption of these plants varied significantly (P < 0.05) with gender differences, key and general informants, and people's religious backgrounds. We postulate that priority setting for in situ and ex situ conservation of multipurpose wild edible plants in human-inhabited landscapes is essential to warrant sustainable use and conservation of the species as well as the use of new modes of application and valorization. [ABSTRACT FROM AUTHOR]

Previous attempts to increase the level of flaxseed in hens' diet for the production of n-3 polyunsaturated fatty acids (n-3 PUFAs)-enriched eggs have been commonly associated with undesirable effects on production efficiency, lipid health indices, and oxidative stability of eggs, requiring adequate research attention. This study investigated the effects of feeding a moderate level of flaxseed (FS) and plant polyphenol extracts (PPEs) on fatty acid content, oxidative stability, and lipid health indices in eggs of slow-growing Sasso T451A laying hens. One hundred and five hens were assigned to five groups (seven replicates of three) and fed on FS (75 g flaxseed and no antioxidants), VE8 (75 g flaxseed and 800 mg vitamin E), TS8 (75 g flaxseed and 800 mg Thymus schimperi), DA8 (75 g flaxseed and 800 mg Dodonaea angustifolia), and CD8 (75 g flaxseed and 800 mg Curcuma domestica) extract per kg diets. The egg yolk content of eicosapentaenoic acid (EPA, C20:5 n-3) in the DA8, TS8, and CD8 diets and docosahexaenoic acid (DHA, C22:6 n-3) in TS8 and CD8 diets significantly (p < 0.05) increased compared with the FS diet. The FS diet significantly increased the malondialdehyde (MDA) content in egg yolks, whereas the TS8 diet decreased it by 67% (p < 0.05). Little difference was observed in yolk fatty acid content between cooked and raw eggs. Production of n-3 PUFA-enriched eggs with favorable lipid health indices was possible through inclusion of PPEs extracted from local plant species grown in Ethiopia and a moderate dose of flaxseed in the diet of laying hens. [ABSTRACT FROM AUTHOR]

The paper presents the study on possibilities of using green coffee beans (GCB) from Ethiopia, Kenya, Brazil and Colombia as a functional additive. The dominant compound identified was 5-caffeoylquinic acid. Caffeine content was comparable in all samples and averaged from 4.36 mg/g dw to 4.99 mg/g dw. The grinding characteristics of GCB was studied and the sensory properties of bread enriched with GCB flour were evaluated. GCB was characterized by high grinding energy requirements. Phenolics released during simulated digestion were highly bioavailable in vitro. Simulated digestion released phytochemicals acting as chelating and reductive agents, free radical scavengers and lipid-preventers. Results of a preliminary study concerning the proposed functional product indicate that phenolic compounds from bread enriched with powdered GCB were highly mastication-extractable, which may predict their high bioaccessibility and bioavailability. The content of phenolics was strongly correlated with powdered GCB addition. The sensory characteristics linking results indicated that a partial replacement of wheat flour in bread with up to 3% ground GCB powder gives satisfactory overall consumer acceptability. Bread enriched with GCB possessed higher antiradical activity than control samples. The results of our study clearly show that powdered GCB may be used directly, without extract preparation, for food supplementation. [ABSTRACT FROM AUTHOR]

Background: Vitamin A is a nutrient that is required in a small amount for normal visual system function, growth and development, epithelia's cellular integrity, immune function, and reproduction. Vitamin A has a significant and clinically important effect since it has been associated with a reduction in all-cause and diarrhea mortality. The aim of this study was to determine factors associated with national vitamin A supplementation among children aged 6–35 months. Method: The data for this study was extracted from the 2019 Ethiopian Mini Demographic and Health Survey. A total weighted sample of 2242 women with children aged 6–35 months was included in the study. The analysis was performed using Stata version 14.2 software. Applying sampling weight for descriptive statistics and complex sample design for inferential statistics, a manual backward stepwise elimination approach was applied. Finally, statistical significance declared at the level of p value < 0.05. Result: The overall coverage of vitamin A supplementation among children aged 6–35 months for the survey included was 44.4 95% CI (40.15, 48.74). In the multivariable analysis, mothers who had four or more antenatal visits [AOR = 2.02 (95% CI: 1.34, 3.04)] were two times more likely to receive vitamin A capsules for their children than mothers who had no antenatal visits. Children from middle-wealth quintiles had higher odds of receiving vitamin A capsules in comparison to children from the poorest wealth quintile [AOR = 1.77 (95% CI: 1.14, 2.73)]. Older children had higher odds of receiving vitamin A capsules than the youngest ones. Other factors that were associated with vitamin A supplementation were mode of delivery and region. Conclusion: The coverage of vitamin A supplementation in Ethiopia remains low and it is strongly associated with antenatal visit, household wealth index and age of child. Expanding maternal health services like antenatal care visits should be prioritized. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Can three months’ intervention with a lipid based nutrient supplement containing either whey or soy protein improve regain of lean body mass, grip strength, physical activity, and immune recovery in patients with HIV starting antiretroviral treatment in a food insecure setting? SUMMARY ANSWER: Supplementation resulted in greater gains of lean body mass, grip strength, and immune recovery in Ethiopian patients with HIV, compared with patients initiating antiretroviral treatment without a nutrient supplement. No major differences between the two supplements were observed WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Poor nutritional status at initiation of antiretroviral treatment is associated with impaired treatment outcomes among African patients with HIV. This study shows that provision of a lipid based nutrient supplement during the initial phase of antiretroviral treatment has beneficial effects. [ABSTRACT FROM AUTHOR]

A study was performed with the objective to assess nutrient biological performance and assess economic feasibility of Farta lambs fed wheat straw (WS) as a basal feed and supplemented with lentil screening (LS) in replacement for noug seed cake (NSC). The experimental sheep were blocked into five based on their initial body weight and randomly assigned to treatment diets within each block. The experimental design used for this study was randomized complete block design (RCBD) with five replications. Result indicated %CP contents of experimental feeds were 26.13, 25.00 and 5.66 for lentil screening, NSC and WS, respectively. There was significant difference in WS DM intake (p<0.05) in all treatment groups. The supplement DM intake increased significantly (p<0.001) as lentil screening level increased from 0, 29.4, 55.4, 78.8, and 100% from (T1-T5), respectively. Total DM intake was significantly different (p<0.01) among all treatment groups but CP intake was not significantly different among treatments (p>0.05). Average daily body weight gain (ADG) and feed conversion efficiency (FCE) were significantly different (p<0.01) among treatment groups. Among treatment groups, T5 had higher (p<0.01) daily body weight gain (76.44 g/d) as compared to T4 (72.1 g/d), T3 (69.8 g/d), T2 (62.89 g/d), T1 (58.28 g/d). T5 returned a higher net income (110.94 Ethiopian Birr (EB)/sheep) as compared to the other treatment groups. From biological performance and economic return T5 could be recommended as an alternative supplement for growing Farta sheep both in biological performance and better economic gain. [ABSTRACT FROM AUTHOR]

Background: Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6–23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6–23 months in the emerging regions of Ethiopia. Methods: Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6–23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors. Results: In this analysis, 37.3% (95% CI: 34.3–40.3) of children aged 6–23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4–2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3–3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2–2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3–4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0–3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1–0.9) was the community-level factors that decrease micronutrient intake. Conclusions: Micronutrient intake among children aged 6–23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6–23 months. [ABSTRACT FROM AUTHOR]

Background: Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Methods: A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. Results: Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. Conclusion: The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. [ABSTRACT FROM AUTHOR]

Background: For infants and young children in low-income settings, human milk (HM) is the main source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). However, the n-3 LCPs concentrations of HM show wide variability, largely depending on the maternal intake of marine foods. This may put children living far from coastal areas at risk of inadequate intake. We evaluated the efficacy of fish-oil (FO) supplementation of lactating mothers on HM n-3 LCPs concentrations in a rural setting from Ethiopia.Methods: Mothers (n = 360) with children 6-12 months old were randomized to receive either intervention FO capsules (215 mg DHA + 285 mg EPA) or control corn-oil capsules (without n-3 LCPs). In a random subsample of 154 participants, we analyzed LCPs in HM and child capillary blood using gas chromatography.Results: Compared to the control, FO supplementation increased HM concentrations of DHA by 39.0% (95% CI: 20.6, 57.5%; P < 0.001) and EPA by 36.2% (95% CI: 16.0, 56.4%; P < 0.001), whereas the arachidonic acid (AA)/(DHA + EPA) ratio decreased by 53.5% (95% CI: -70.2, -36.7%; P < 0.001). We also found statistically significant association between the changes in (DHA + EPA)/AA ratio in HM and child capillary blood (P < 0.001). However, HM DHA concentrations remained lower than international norms after FO supplementation.Conclusions: FO supplementation improves n-3 LCPs content of HM. Future studies should evaluate different doses of n-3 LCPs and consider potential effect modifiers such as genetic polymorphism and diet. This trial was registered at clinicaltrials.gov as NCT01817634. [ABSTRACT FROM AUTHOR]

Background: Breast milk is the ideal and complete form of nutrition for infants colostrum contains all the necessary nutrients for infants' growth and development and antibodies that can protect from many childhood illnesses. Understanding the extent of and barriers to colostrum avoidance in Ethiopia is important for learning how to best improve optimal breastfeeding. No single study has been conducted on primigavida mothers in the country. Therefore, this study aimed to assess the rate of colostrum avoidance practice and associated factors among primigavida mothers.Method: A community- based cross-sectional study was conducted from March to April 2016 among (n = 398) randomly selected primigavida mothers in Bahir Dar city, northwest Ethiopia. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version25. Bivariate and multivariate logistic regression analyses were carried out. Odds ratio with 95% confidence interval was used to measure the strength of association. Statistical significance was declared at P-value ≤0.05.Results: Out of 398 primipara mothers, 8.8% discarded colostrum. The most common reasons for discarding colostrum were; yellow and creamy (39.2%), bad for infant (35.2%), traditional/cultural reason (17.1%) and infant unable to feed (8.5%). Married mothers (AOR = 4.52, 95%CI: 1.13, 18.16), unemployed mothers (AOR = 3.46, 95%CI: 1.15, 10.51), mothers underwent normal delivery (AOR = 5.20, 95%CI: 1.87, 20.90) and mothers who initiated breastfeeding within 1 h (AOR = 2.79, 95%CI: 0.96, 8.16) were less likely to discard colostrum.Conclusion: The current study revealed that colostrum was discarded by 8.8% of primipara mothers. Primipara mothers who were married, unemployed, underwent normal delivery and initiated breastfeeding within 1 h were less likely to discard colostrum. These results suggest that multi-sectorial and multi-disciplinary approaches are needed to decrease colostrum avoidance among primipara mothers in Ethiopia. [ABSTRACT FROM AUTHOR]

In an effort to address undernutrition among women and children in rural areas of low‐income countries, nutrition‐sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56–66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, 'dietary' and 'vitamin' knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men's engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia.Methods: A cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6-59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI).Results: The coverage of VAS was 75.0% (95% CI: 72.1-77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02-2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34-2.72) than health professionals and being from households in the "rich" wealth tertile (AOR: 1.80, 95% CI: 1.07-3.03) were positively associated with uptake VAS.Conclusion: The VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community. [ABSTRACT FROM AUTHOR]

Background: Anemia is the most common hematologic disorder of children in the globe. There are fragmented and inconclusive study findings on under-five anemia in Ethiopia. Understanding the distribution of anemia is an important step for program planners and policymakers. Therefore, this systematic review was aimed to assess the pooled prevalence of anemia and associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia. Methods: We searched through African journals of online, Google Scholar, CINHAL, PubMed, Web of Science, Cochrane library, and Scopus. Reviewers used standardized format to extract the data. The data was exported to Stata version 11 software for analysis after extracted by Microsoft excel. The DerSimonian-Laird random-effect model was used to assess the pooled prevalence of under-five anemia. Variation between studies (heterogeneity) was assessed by I2 statistic test. Publication bias was assessed by the Egger test. Result: From 561 studies, 16 articles were included in this review. The pooled prevalence of under-five anemia in Ethiopia was 44.83%. In subgroup analysis, the higher pooled prevalence of anemia was observed from children's age less than 2 years old (50.36%) (95% CI 39.53, 61.18). Poor dietary diversity OR = 1.71 (1.10, 2.68), stunting OR = 2.59 (2.04, 3.28), food insecurity OR = 2.87 (1.25, 6.61), and not dewormed OR = 2.34 (1.77, 3.09) were predictors of under-five anemia. Conclusion: The magnitude of under-five anemia in this study was extremely high. Therefore, increased coverage of supplementation and fortification programs, periodic deworming, feeding diversified food, supplement food for those who are stunted, and securing food in the households may all alleviate under-five anemia. [ABSTRACT FROM AUTHOR]

Background: Community-based management of acute malnutrition has been reported effective in terms of recovery rate, but recovered children may be at increased risk of developing acute malnutrition after returning to the same household (HH) environment. Objective: Compare the magnitude and factors associated with acute malnutrition among recovered and never treated children in South Gondar Zone, Amhara Region, Ethiopia. Method: A comparative cross-sectional study was conducted in three districts of South Gondar Zone by tracing 720 recovered and an equal number of age matched children who were never treated for acute malnutrition. Parents were asked to bring children to health post for survey data collection, anthropometric measurements, and edema assessment. Data were collected using a survey questionnaire, entered in to EpiData and analyzed using SPSS v20. Anthropometric indices were generated according to the WHO's 2006 Child Growth Standards using WHO Anthro software version 3.2.2. Bivariate and multivariable logistic regression was utilized. Values with P < 0.05 were considered statistically significant and Odds Ratio with 95% CI was used to measure strength of association. Result: A total of 1,440 parents were invited, of which 1,414 participated (98.2% response rate). Mean age in months of children (±SD) was 23.7 (±10.4) for recovered and 23.3 (±10.8) for comparison group. About 49% of recovered and 46% of comparison children were females. A significant difference was observed on magnitude of acute malnutrition between recovered (34.2% (95% CI [30.9-38.0]) and comparison groups (26.7% (95% CI [23.5-30.2]), P = 0.002. Factors associated with acute malnutrition among recovered were district of Ebnat (AOR = 3.7; 95% CI [1.9-7.2]), Tach-Gayint (AOR = 2.4; 95% CI [1.2-4.7]); male child (AOR = 1.4; 95% CI [1.0-2.0]); prelactal feeding (AOR = 2.6; 95% CI [1.3 -5.1]); not feeding colostrum (AOR = 1.5; 95% CI [1.1-2.3]); not consuming additional food during pregnancy/lactation (AOR = 1.6; 95% CI [1.1-2.3]); not given Vitamin A supplement (AOR = 2.1; 95% CI [1.4-3.2]); and safe child feces disposal practice (AOR = 1.7; 95% CI [1.2-2.5]) while district of Tach-Gayint (AOR = 2.5; 95% CI [1.3-4.8]); male child (AOR = 1.5; 95% CI [1.1-2.1]), not feeding colostrum (AOR = 1.7; 95% CI [1.2-2.5]), poor hand washing practice (AOR = 1.6; 95% CI [1.1-2.2]); food insecure HH (AOR = 1.6; 95% CI [1.1-2.4]), birth interval <24 months (AOR = 1.9; 95% CI [1.2-3.2]), and poor access to health facility (AOR = 1.7; 95% CI [1.2-2.4]) were factors associated with acute malnutrition among comparison group. Conclusion: Recovered children were more at risk of acute malnutrition than the comparison group. Nutrition programs should invest in improving nutrition counseling and education; as well as the hygienic practices to protect children against post-discharge relapse of acute malnutrition. [ABSTRACT FROM AUTHOR]

Introduction: Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6–23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6–23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6–23 months in districts covered and not covered by SURE program in West Gojjam zone. Methods: A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score. Result: The overall proportion of adequate dietary diversity among children aged 6–23 months was 29.9% (95% CI: 27.0–33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0–38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI:1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity. Conclusion: The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity. [ABSTRACT FROM AUTHOR]

Background: Maternal undernutrition is highly prevalent in resource-poor settings. Hence, this study was intended to determine factors associated with the dietary practice and nutritional status of pregnant women in Dessie town, northeastern Ethiopia.Methods: Community-based cross-sectional study design was employed. Six hundred four (604) pregnant women have participated. A two-stage sampling method was applied to select participants. Socio-demographic and socio-economic data were collected using a structured interviewer-administered questionnaire. The dietary practice was measured using 13 dietary practice questions. Mid upper arm circumference (MUAC) was measured by standard nonstretchable MUAC tape. Data were entered into Epi-Info 7 and exported to SPSS version 20. Binary and multiple logistic regression analysis was conducted. Variables with P < 0.2 in bivariate analysis were entered for multiple logistic regression. At a 95% confidence interval, variable with 푃< 0.05 in multiple logistic regression analysis was considered statistically significant.Result: About 54.8% of the pregnant women had poor dietary practice and 19.5% were undernourished. First trimester of pregnancy (AOR = 0.46; 95% CI: 0.26, 0.80), no history of illness 2 weeks before data collection date (AOR = 0.42; 95% CI: 0.22, 0.80), poor perceived severity (AOR = 1.64; 95% CI: 1.15, 2.33), poor perceived benefits (AOR = 1.63; 95% CI: 1.14, 2.32) and poor self efficacy (AOR = 4.74; 95% CI: 2.94, 7.65) were significantly associated with poor dietary practice. Not attending antenatal care (ANC) (AOR = 3.46; 95% CI: 2.07, 5.78), illness (AOR = 1.93; 95% CI: 1.10, 3.5), poor dietary diversity (AOR = 5.92; 95% CI: 3.59, 9.76), poor nutrition knowledge (AOR = 3.03; 95% CI: 1.87, 4.92), poor dietary practice (AOR = 3.25; 95% CI: 1.91, 5.54) and poor perceived self efficacy (AOR = 5.59; 95% CI: 3.56, 8.79) were significantly associated (P < 0.05) with undernutrition.Conclusion: The dietary practice of pregnant women was suboptimal and nutritional status was relatively high. Being in the first trimester of pregnancy and no history illness were negatively associated while poorly perceived severity to malnutrition, poor perceived benefits, and poor self-efficacy were positively associated with the poor dietary practice. Not attending ANC, history of illness, poor dietary diversity, poor nutritional knowledge, poor dietary practice, poorly perceived self-efficacy were positively associated with undernutrition. Government, health extension workers and other concerned bodies should encourage pregnant women to attend ANC, promote health during pregnancy, strength and counsel to improve dietary diversity and practice of good nutrition. They should focus on the perceived belief of dietary behaviors. [ABSTRACT FROM AUTHOR]

Background: Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. Methods: This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. Results: Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. Conclusions: More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory. [ABSTRACT FROM AUTHOR]

Objective: To simulate impact of Ca supplementation on estimated total Ca intakes among women in a population with low dietary Ca intakes, using WHO recommendations: 1·5-2·0 g elemental Ca/d during pregnancy to prevent pre-eclampsia.Design: Single cross-sectional 24 h dietary recall data were adjusted using IMAPP software to simulate proportions of women who would meet or exceed the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) assuming full or partial adherence to WHO guidelines.Setting: Nationally and regionally representative data, Ethiopia's 'lean' season 2011.Subjects: Women 15-45 years (n 7908, of whom 492 pregnant).Results: National mean usual Ca intake was 501 (sd 244) mg/d. Approximately 89, 91 and 96 % of all women, pregnant women and 15-18 years, respectively, had dietary Ca intakes below the EAR. Simulating 100 % adherence to 1·0, 1·5 and 2·0 g/d estimated nearly all women (>99 %) would meet the EAR, regardless of dosage. Nationally, supplementation with 1·5 and 2·0 g/d would result in intake exceeding the UL in 3·7 and 43·2 % of women, respectively, while at 1·0 g/d those exceeding the UL would be <1 % (0·74 %) except in one region (4·95 %).Conclusions: Most Ethiopian women consume insufficient Ca, increasing risk of pre-eclampsia. Providing Ca supplements of 1·5-2·0 g/d could result in high proportions of women exceeding the UL, while universal consumption of 1·0 g/d would meet requirements with minimal risk of excess. Appropriately tested screening tools could identify and reduce risk to high Ca consumers. Research on minimum effective Ca supplementation to prevent pre-eclampsia is also needed to determine whether lower doses could be recommended. [ABSTRACT FROM AUTHOR]

Abstract: Ethiopia's targeted supplementary feeding (TSF) programme aims to rehabilitate moderately malnourished children and pregnant and lactating women in selected chronically food‐insecure districts. Screening for malnutrition is made by health extension workers through the quarterly community health days (CHD) events based on mid‐upper arm circumference (MUAC) thresholds. This validation study examined the extent of targeting errors of inclusion (providing aid to the nonneedy) and exclusion (failure to reach the needy) in the TSF programme, among preschool children in 6 TSF districts. The study was conducted within 7 days after the completion of the CHD event. Multistage cluster sampling was employed to recruit 1,104 children. Data were collected using interviewer‐administered questionnaire and by reviewing CHD registers. A paired t test was used to compare the MUAC measurements taken during the CHD and during the survey. The study found a global acute malnutrition prevalence of 13.0%. During the CHD, only 54.8% of the children were screened for malnutrition. The overall inclusion and exclusion errors of the TSF were 16.5% and 40.3%, respectively. The reasons for the exclusion errors were low coverage of the screening programme (67.2%) and MUAC measurement errors (32.8%). The mean including standard deviation (M ± SD) of the MUAC measured by health extension workers (11.8 ± 0.9 cm) was significantly lower than the measurements made by fieldworkers in the survey (12.1 ± 1.0 cm; p < .001). The study concluded that high targeting errors are committed in the TSF programme of Ethiopia. Targeting can be enhanced through accurate measurement of MUAC and maximization of the coverage of the screening programme. [ABSTRACT FROM AUTHOR]

Abstract: Antenatal care (ANC) offers remarkable opportunities to reach a large number of women with effective nutrition and health interventions, including iron (Fe) supplementation. However, all women do not equally seek nor benefit from ANC. We aimed to identify characteristics associated with ANC and Fe use among women in hard‐to‐reach areas in Afar, Ethiopia; Sedhiou and Kolda, Senegal; and Kakamega, Kenya. Women who gave birth within 1 year preceding the survey (n = 4,575) from 15 different sub‐regions were randomly selected and surveyed. Multivariable logistic regression was used to identify associations of socio‐demographic characteristics with ANC and Fe use. Factors that showed positive associations with ANC uptake included education, income, possession of a mobile phone, and the occupation of the mother or another household member. Beginning ANC in the first trimester associated positively with achievement of 4 or more ANC visits, and having any ANC visits related positively with Fe intake. Distance to the nearest health facility was negatively associated, and type of nearest facility and counselling and health education were positively associated with some outcomes. The results from these surveys demonstrate the need to ensure access of services across all population groups and can help identify ANC programming needs. [ABSTRACT FROM AUTHOR]

Background: The delivery of vitamin A supplements in Ethiopia has been shifting from Child Health Days (campaigns) to routine delivery via the community health services.Objective: The objective of this study was to compare the cost and effectiveness of these 2 delivery methods. No previous studies have done this.Methods: A mixed method approach was used. Quantitative data on costs were collected from interviews with key staff and coverage data from health facility records. Qualitative data on the 2 modalities were collected from key informants and community members from purposefully sampled communities using the 2 modalities.Results: Communities appreciated the provision of vitamin A supplements to their under 5-year-old children. The small drop in coverage that occurred as a result of the change in modality can be attributed to normal changes that occur with any system change. Advantages of campaigns included greater ease of mobilization and better coverage of older children from more remote communities. Advantages of routine delivery included not omitting children who happened to miss the 1 day per round that supplementation occurred and not disrupting the availability of other health services for the 5 to 6 days each campaign requires. The cost of routine delivery is not easy to measure nor is the cost of disruption to normal services entailed by campaigns.Conclusion: Cost-effectiveness likely depends more on effectiveness than on cost. Overall, the routine approach can achieve good coverage and is sustainable in the long run, as long as the transition is well planned and implemented. [ABSTRACT FROM AUTHOR]

Malnutrition in children under 5 years of age is pervasive in Ethiopia across all wealth quintiles. The objective of this study was to determine the willingness to pay (WTP) for a week's supply of Nutributter® (a lipid‐based nutrient supplement, or LNS) through typical urban Ethiopian retail channels. In February, 2012, 128 respondents from 108 households with 6–24‐month‐old children had the opportunity to sample Nutributter® for 2 days in their homes as a complementary food. Respondents were asked directly and indirectly what they were willing to pay for the product, and then participated in market simulation where they could demonstrate their WTP through an exchange of real money for real product. Nearly all (96%) of the respondents had a positive WTP, and 25% were willing to pay the equivalent of at least $1.05, which we calculated as the likely minimum, unsubsidised Ethiopian retail price of Nutributter® for 1 week for one child. Respondents willing to pay at least $1.05 included urban men and women with children 6–24 months old from low‐, middle‐ and high‐wealth groups from four study sites across three cities. Additionally, we estimated the initial annual market size for Nutributter® in the cities where the study took place to be around $500 000. The study has important implications for retail distribution of LNS in Ethiopia, showing who the most likely customers could be, and also suggesting why the initial market may be too small to be of interest to food manufacturers seeking profit maximisation. [ABSTRACT FROM AUTHOR]

Objectives: Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia. Methods: The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF. Results: Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to "rebuild the body," and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with "medicinal qualities," which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences. Conclusion: HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13–17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates. Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys. Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia. [ABSTRACT FROM AUTHOR]

Evidence on infant weaning processes provided by field research in Addis Ababa, Ethiopia, and among a refugee population of Eritreans in the Sudan is presented. The study in Addis Ababa, where households were economically disadvantaged but the situation was nutritionally stable, allowed the identification of factors constraining weaning, which includes both the introduction of supplementary foods and the termination of breastfeeding. While the timing of each aspect of weaning was the outcome of the interaction between mother and infant factors, ‘infant-centred’ factors were more important in the commencement and ‘mother-centred’ factors in the completion of weaning. The refugee population had in normal times a similar weaning regime, but under the unstable conditions of flight and life in a refugee camp the process had been significantly altered. Investigation of the factors which have led to altered weaning processes elaborates and confirms the model derived from the Addis Ababa study. [ABSTRACT FROM PUBLISHER]

Background: Mothers in low socio-economic conditions frequently have low birth weight infants. Inaddition Physically demanding work during pregnancy also contributes to poor fetal growth. During gestation a woman needs balanced nutrition for a healthy outcome. Women with inadequate nutritional status at conception are at greater risk of aquiring disease; their health usually depends on the availability and consumption of balanced diet, and therefore they are unlikely to be able to resist with their high nutrient needs during pregnancy. Therefore, the main purpose of this study was to assess the maternal risk factors associated low birth weight in public hospitals of Mekelle city, Tigray North Ethiopia, 2017/2018. Methods: Un-matched case-control study design was conducted among women who delivered in public hospitals of Mekelle city. Data was collected using a structured questionnaire through interview, direct physical assessment and medical record review of mothers. Sample size was calculated by Epi-info version 7.0 to get a final sample size of 381(cases = 127 and controls = 254). SPSS version 20 was used for analysis. Bivariate and multivariate logistic regression analysis was used to determine the effect of the independent variables on birth weight. Presence of significant association was determined using OR with its 95%CI. A P value of less than 0.05 was considered to declare statistical significance. Table, graphs and texts were used to present the data. Result: Most of the mothers (70.1% cases and 43.7% controls) were housewives. This study showed that maternal age ≤ 20 years (AOR = 6.42(95% CI = (1.93–21.42)), ANC follow up (AOR = 3.73(95%CI (1.5–9.24)), History of medical illness (AOR = 14.56(95% CI (3.69–57.45), Iron folate intake (AOR = 21.56(95%CI (6.54–71.14)), Maternal height less than 150 cm (AOR = 9.27(95%CI 3.45–24.89)) and Pregnancy weight gain (AOR = 4.93(95%CI = 1.8–13.48) were significant predictors of low birth weight. Conclusion: The study suggests that inadequate ANC follow-up, preterm birth and history of chronic medical illness, maternal height, pregnancy weight gain, and Iron intake were. Were significant predictors of low birth weight. Health professionals should screen and consulate pregnant mothers who are at risk of having infants with LBW and ensure that women have access to essential health information on the causes of low birth weight. [ABSTRACT FROM AUTHOR]

A theory‐driven evaluation was conducted to assess performance of a trial to deliver micronutrient powder (MNP) through the Ethiopian Ministry of Health. We adapted an approach to coverage assessment, originally developed to identify bottlenecks in health service delivery, to examine sequential program outcomes and their correlates using cross‐sectional survey data of caregivers of children 6–23 months (N = 1915). Separate multivariable Poisson regression models were used to estimate adjusted risk ratios of conceptually relevant determinants of coverage and adherence. Caregivers of children >11 months were more likely to have received MNP than caregivers of younger infants, yet children 12–17 months were 32% (P < 0.001) and children 18–23 months 38% (P < 0.001) less likely to have been fed MNP in the 14 days preceding the survey than children 6–11 months. Among caregivers who initiated feeding MNP, the most frequently reported reasons for discontinuing use were not obtaining additional supply (36.1%) and perceived child rejection of food with MNP (22.9%). For each additional time a caregiver met with frontline workers in the 3 months preceding the survey, they were 13% more likely to have recently fed MNP (P < 0.001). Caregivers' perception that MNP produced positive changes in children was associated with a 14% increase in the likelihood of having recently fed it (P < 0.001). These results emphasize the importance of counselling for MNP and infant and young child feeding for initial use and the importance of multiple contacts with frontline workers for continued use. [ABSTRACT FROM AUTHOR]

Antenatal calcium and iron-folic acid (IFA) supplementation can reduce maternal mortality and morbidity. Yet, even when pregnant women have a stable supply of supplements, forgetting is often a barrier to adherence. We assessed the acceptability of adherence partners to support calcium and IFA supplementation among pregnant women in Kenya and Ethiopia. Adherence partners are a behaviour change strategy to improve adherence, where pregnant women are counselled to select a partner (e.g. spouse, relative) to remind them to take their supplements. We conducted trials of improved practices, a formative research method that follows participants over time as they try a new behaviour. We provided pregnant women in Ethiopia ( n = 50) and Kenya ( n = 35) with calcium and IFA supplements and counselling, and suggested selecting an adherence partner. For each participant, we conducted semi-structured interviews about acceptability and adherence during four interviews over six weeks. We analysed interview transcripts thematically and tallied numerical data. In Kenya, 28 of 35 women agreed to try an adherence partner; almost all selected their husbands. In Ethiopia, 42 of 50 women agreed to try an adherence partner; half asked their husbands, others asked children or relatives. Most women who did not select adherence partners reported not needing help or not having anyone to ask. Participants reported adherence partners reminded and encouraged them, brought supplements, provided food and helped address side-effects. Almost all women with adherence partners would recommend this strategy to others. Adherence partners are an acceptable, low-cost strategy with the potential to support antenatal micronutrient supplementation adherence. [ABSTRACT FROM AUTHOR]