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Milkessa Mebrate,1 Abdulhalik Workicho,2 Soresa Alemu,1 Ebsa Gelan3 1Mettu Health Science College, Mettu, Ethiopia; 2Department of Epidemiology, College of Health Science, Jimma University, Jimma, Ethiopia; 3Departement of Statistics, College of Natural Science, Mettu University, Mettu, EthiopiaCorrespondence: Soresa Alemu, Mettu, Oromia, Ethiopia, Tel +251 917273506, Email Sorealex6@gmail.comBackground: Globally, more than 19 million children have not received all of their vaccination benefits, resulting in an estimated one million deaths worldwide each year. Vaccine-preventable diseases are becoming more common in Ethiopia, despite the fact that official vaccination coverage is sufficient to develop herd immunity locally for some diseases such as measles. This mistrust of the official report prompted us to conduct a community survey and compare it to other areas where there have been no reports of vaccine-preventable disease.Methods: A community-based comparative cross-sectional study was conducted from 20/01– 20/02/2021 in Sinana and Mettu districts. Probability proportional to estimate size was used to select 23 clusters. We recruited 228 from Mettu and 436 from Sinana by systematic random sampling. We used a structured questionnaire to collected data from mother–child pair using card and history. We conducted independent t-tests to test coverage differences between districts. We identified determinants of full vaccination status by multivariate logistic regression analysis after bivariate candidate selection.Results: Fully vaccinated children accounted for 62.7% in Sinana and 91.6% in Mettu, demonstrating a significant coverage difference (p< 0.001). Being a resident of Mettu (AOR: 3.5, 95% CI [1.5, 6.9]), intended pregnancy (AOR 5.9, 95% CI [2.4, 11.3]), 4 or more antenatal care visits (AOR: 2.09, 95% CI [1.4, 3]), having postnatal care (AOR: 3.5, 95% CI [1.6, 7.9]), younger child age (AOR: 0.87, 95% CI [0.8, 0.9]), having up to three children (AOR 3, 95% CI [1.13, 8]) and good knowledge of vaccine schedule (AOR: 2.4, 95% CI [1.4, 4]) were associated positively with full vaccination status.Conclusion: Full vaccination status was 91.6% in Mettu and 62.7% in Sinana district. Place of residence, ANC, PNC, pregnancy intention, child number, age of child and knowledge of vaccination schedule were significantly associated with vaccination status of the children.Keywords: vaccination status, determinants, 12– 23 months children, Mettu district, Sinana district

Beniam Daniel,1 Liyew Agenagnew,1 Abdulhalik Workicho,2 Mubarek Abera1 1Department of Psychiatry, Jimma University, Jimma, Ethiopia; 2Department of Epidemiology, Jimma University, Jimma, EthiopiaCorrespondence: Beniam Daniel, Tel +251923289326, Email beni12dani@gmail.comBackground: Cognition is one of the most complex functions of the human brain, and major neurocognitive disorders affect this function causing a wide array of problems in an individual’s life. Screening for major neurocognitive disorders can be helpful in designing and implementing early interventions.Purpose: This study was designed to assess the reliability and validity of the Montreal Cognitive Assessment (MoCA) tool to detect major neurocognitive disorders among older people in Ethiopia.Methods: One hundred and sixteen randomly selected older adults in Ethiopia were involved in a cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders was used as a gold standard. Data were analyzed using STATA v16 statistical software. Receiver operating curve analysis was performed, and inter-rater, internal consistency reliabilities, content, criterion and construct validities were determined. Statistically significance was declared at a p-value of < 0.05.Results: The study had a 100% response rate. The mean age of the study participants was 69.87 ± 7.8. The inter-rater reliability value was 0.96, and Cronbach’s alpha was 0.79. The optimal cutoff value was ≤ 21, and Montreal Cognitive Assessment has an area under curve value of 0.89. The sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of MoCA are 87.18%, 74.03%, 3.35, 0.17, 63%, and 91.9%, respectively. The tool also has good concurrent and construct validities.Conclusion: The Montreal Cognitive Assessment tool was a reliable and valid tool to detect major neurocognitive disorder. It can be incorporated into the clinical and research practices in developing countries.Keywords: major neuro-cognitive disorder, validity and reliability, Montreal Cognitive Assessment, Ethiopia

BackgroundMaternal stress during pregnancy has been associated with adverse pregnancy and birth outcomes. Aiming to reduce maternal stress and to improve pregnancy and birth outcomes, different relaxation interventions have been tested during pregnancy. This systematic review and meta-analysis was conducted on studies that have tested relaxation interventions to improve maternal wellbeing, and pregnancy and birth outcomes in various settings.MethodA systematic search of PubMed, EMBASE Classic + EMBASE (Ovid), MEDLINE In-Process and Non-Indexed Citations, MEDLINE Daily, and MEDLINE (Ovid), Cumulative Index to Nursing & Allied Health Plus (CINAHL via EBSCO) and Cochrane library databases was conducted to identify studies on stress reduction relaxation interventions in pregnant women. The outcomes of interest were maternal mental health (stress, anxiety, and depression), pregnancy outcomes (gestational age, labor duration and mode of delivery) and birth outcomes (birth weight, APGAR score and term or preterm delivery). Randomized controlled trials or quasi-experimental studies with stress reduction relaxation interventions during pregnancy and ever published in English globally were eligible for inclusion. Studies with interventions in high-risk pregnancies, those including psychotropic medications, or interventions at the onset of labor and delivery were excluded. All studies were screened for quality and risk of bias. We conducted meta-analyses, using random-effects models, for three outcomes for which there was sufficient information: maternal depressive symptoms, perceived maternal stress; and birth weight.ResultNineteen studies were eligible for analysis. The studies sampled 2395 pregnant women, mostly aged between 18 and 39 years. The interventions applied were yoga therapy, music therapy, progressive muscular relaxation (PMR)/guided imagery/deep breathing exercises, mindfulness or hypnosis. The meta-analyses showed that the interventions were effective in improving maternal depressive symptoms (−2.5 points, [95% confidence interval (CI) -3.6, -1.3]) and stress symptoms (−4.1 points, [95% CI -8.1, -0.1]) during pregnancy. There was no effect of the interventions overall on birth weight (45 g, 95% CI -56, 146); however, PMR in two studies increased birth weight (181 g, 95% CI 25, 338) whereas music therapy and yoga had no benefit. Narrative syntheses of outcomes that were not amenable to meta-analysis indicated beneficial effects of music interventions on APGAR score (n=4 studies) and gestational age at birth (n=2 studies). Interventions were also reported to significantly increase spontaneous mode of delivery (n=3 studies) and decrease the rate of instrumental virginal delivery by 5%, caesarean section by 20% and duration of labor (n=2 study).DiscussionAdverse life experience during pregnancy impairs the normal adaptive changes supposed to maintain normal homeostasis during pregnancy and results in increased risk of stress, anxiety and depression. This imbalance results in increased stress hormone in the maternal-fetal circulation which is harmful to the mother and her fetus leading for adverse pregnancy and birth outcomes. Stress reduction relaxation intervention restores the normal homeostasis in pregnancy and improves normal biological and psychological wellbeing and consequently improves pregnancy and birth outcomes.ConclusionIn addition to benefits for mothers, relaxation interventions hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.

Background Poor nutritional status of women during prenatal and pregnancy increases the risk of maternal mortality and neonatal birth outcome complication. It is important to identifying factors affecting maternal undernutrition during pregnancy and evidence answering major determinant factors was limited in Ethiopia. This study was assessed to determinants of acute undernutrition among pregnant women attending primary health care unit in Chinaksen district, eastern Ethiopia. Method a facility-based case-control study was conducted on 226 (113 cases and 113 controls) pregnant women attended primary healthcare units in Chinaksen district from February 01 to March 30, 2017. Data entered using EpiData 3.1 and analyzed using SPSS version 24. Bivariable and multivariable logistic regression analyses applied to identify determinant factors acute undernutrition. A p value

Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10–19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47–49% of adolescents had marginal iron store ( 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P

Background Burden of caregivers of people with mental illness (PWMI) is considered to be a negative impact of the care provided by the family to the patient. However, little is known about the extent of the burden among caregivers of PWMI in Ethiopia. The aim of this study, therefore, is to assess the magnitude and associated factors of burden among caregivers of PWMI at Jimma University Medical Center, 2017. Methods Institution-based cross-sectional study design was employed among 406 conveniently selected caregivers of PWMI and interviewed using a structured questionnaire. Family burden interview schedule (FBIS) was used to assess burden of caregivers. Bivariate and multivariable linear regression analyses were performed to determine the predictors of burden among caregivers. Results Nearly two-thirds [264 (65.0%)] of the participants were male with a mean age of 38.45 ± 12.03 years. The mean score for burden among caregivers on family burden interview schedule was 23.00 ± 10.71. Age of the caregivers (β = 0.18, p

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.

Objective:To explore influences on adolescent diet and physical activity, from the perspectives of adolescents and their caregivers, in Jimma, Ethiopia.Design:Qualitative design, using focus group discussions (FGD).Setting:A low-income setting in Jimma, Ethiopia.Participants:Five FGD with adolescents aged 10–12 years and 15–17 years (n 41) and three FGD with parents (n 22) were conducted.Results:Adolescents displayed a holistic understanding of health comprising physical, social and psychological well-being. Social and cultural factors were perceived to be the main drivers of adolescent diet and physical activity. All participants indicated that caregivers dictated adolescents’ diet, as families shared food from the same plate. Meals were primarily determined by caregivers, whose choices were driven by food affordability and accessibility. Older adolescents, particularly boys, had opportunities to make independent food choices outside of the home which were driven by taste and appearance, rather than nutritional value. Many felt that adolescent physical activity was heavily influenced by gender. Girls’ activities included domestic work and family responsibilities, whereas boys had more free time to participate in outdoor games. Girls’ safety was reported to be a concern to caregivers, who were fearful of permitting their daughters to share overcrowded outdoor spaces with strangers.Conclusions:Adolescents and caregivers spoke a range of social, economic and cultural influences on adolescent diet and physical activity. Adolescents, parents and the wider community need to be involved in the development and delivery of effective interventions that will take into consideration these social, economic and cultural factors.

BackgroundIn sub-Saharan countries, one in five children and one in three women experiences emotional and behavioural problems (EBPs) and depression, respectively. While various factors were reported to affect the mental health of children, little is known about the impact of maternal depression on the offspring. Moreover, the magnitude of children’s EBPs is barely known in Ethiopia.AimTo determine the magnitude of child EBPs and its association with maternal depression in Jimma town, southwest Ethiopia.MethodsA quantitative cross-sectional study was conducted among 734 mother–child pairs in Jimma town from January to June, 2019. EBP was assessed by using the parent version of Strengths and Difficulties Questionnaire (SDQ) with cut-off score of ≥14. Maternal depression was assessed using Patient Health Questionnaire-9 with a cut-off score of ≥10. Data were entered into Epidata V.3.1 and exported to SPSS V.24 for analysis. Multivariable logistic regression was fitted to identify the strength of association between exposure and outcome variables.ResultsOf the 734 participants, 146 (19.9%, 95% CI: 16.9% to 22.9%) met EBP criteria based on parent version of SDQ. Maternal depression had significant association with child EBP (adjusted OR=2.38, 95% CI: 1.55 to 3.66). In addition, children aged 7–10 years, family size categories of ≤3 and 4–6, maternal intimate partner violence and maternal khat use had significant association with child EBP.Conclusions and recommendationsA significant number of children suffer from EBP in Jimma town. Maternal depression is found to be a predictor of children’s EBPs. Thus, there is a need to design and implement an integrated maternal and child mental health programme. The maternal and child health section at the national level should integrate and cascade routine maternal and child mental health screening and intervention modalities down to the family healthcare system.

Background Undernutrition is one of the most common causes of morbidity and mortality among adolescent girls worldwide, especially in South-East Asia and Africa. Even though adolescence is a window of opportunity to break the intergenerational cycle of undernutrition, adolescent girls are a neglected group. The objective of this study was to assess the nutritional status and associated factors among adolescent girls in the Wolaita and Hadiya zones of Southern Ethiopia. Methods A community-based cross-sectional study was conducted, and a multistage random sampling method was used to select a sample of 843 adolescent girls. Anthropometric measurements were collected from all participants and entered in the WHO Anthro plus software for Z-score analysis. The data was analyzed using EPI-data 4.4.2 and SPSS version 21.0. The odds ratios for logistic regression along with a 95% confidence interval (CI) were generated. A P-value < 0.05 was declared as the level of statistical significance. Result Thinness (27.5%) and stunting (8.8%) are found to be public health problems in the study area. Age [AOR(adjusted odds ratio) (95% CI) = 2.91 (2.03–4.173)], large family size [AOR (95% CI) = 1.63(1.105–2.396)], low monthly income [AOR (95% CI) = 2.54(1.66–3.87)], not taking deworming tablets [AOR (95% CI) = 1.56(1.11–21)], low educational status of the father [AOR (95% CI) = 2.45(1.02–5.86)], the source of food for the family only from market [AOR (95% CI) = 5.14(2.1–12.8)], not visited by health extension workers [AOR (95% CI) = 1.72(1.7–2.4)], and not washing hand with soap before eating and after using the toilet [AOR (95% CI) = 2.25(1.079–4.675)] were positively associated with poor nutritional status of adolescent girls in the Wolaita and Hadiya zones, Southern Ethiopia. Conclusion Thinness and stunting were found to be high in the study area. Age, family size, monthly household income, regularly skipping meals, fathers’ educational status, visits by health extension workers, and nutrition services decision-making are the main predictors of thinness. Hand washing practice, visits by health extension workers, and nutrition services decision-making are the main predictors of stunting among adolescent girls. Multisectoral community-based, adolescent health and nutrition programs should be implemented.

Objective. The study is aimed to assess the determinants of low birth weight among term neonates born in the health facilities of Kambata Tembaro Zone, Ethiopia. Methods. An Institution-based case control study was conducted. Term neonates born with birth weight less than 2500.00 g (LBW) were grouped into cases, and those term neonates with weight greater or equal to 2500.00 g were grouped as controls. A total of 282 participants (57 cases and 225 controls) were included with controls to cases ratio of 4:1. Binary logistic regression was done to get candidate variables. An adjusted odd ratio (aOR) was estimated from multivariable analysis with corresponding confidence interval to assess the strength of the association and statistical significance between the independent and the outcome variable. Results. A total of 282 term neonates (57 cases and 225 controls) comprised the study participants. The mean birth weight of the neonates was 2041.23 g (standard deviation-SD 339.00) for cases and 376.00 g (438.572) for controls. Among mothers of neonates 38 (66.7%) cases' and 146 (64.9%) controls' were age > 24 years old. Household food insecu­rity (aOR=6.74; 95% confidence interval-CI 2.78-16.36), gen­der of neonates (aOR=2.74, 1.24-6.05), iron supplementation (aOR=9.71, 3.51-26.88), additional food during pregnancy (aOR=5.49, 2.49-12.11) and anemia (aOR=3.51, 1.56-7.85) were significantly associated with LBW at term. Conclusion. Neonatal, maternal and dietary factors are mu­tually associated with low birth weight among term neonates included in our study.

Background Unfortunately, despite an increase in medical knowledge, the treatment need of head and neck cancers (HNCs) have not been improved in Ethiopia. In addition, there is no published evidence in the epidemiology of head and neck cancer patients in the country. The present study aimed to describe the prevalence and pattern of HNCs among patients seen at Black Lion Hospital oncology center.

Derese Bekele Daba,1 Tamrat Shaweno,2 Kefyalew Taye Belete,1 Abdulhalik Workicho2 1Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia; 2Departement of Epidemiology, Faculty of Public Health, Jimma University, Jimma, EthiopiaCorrespondence: Kefyalew Taye BeleteDepartment of Public Health, College of Medicine and Health Science, Ambo University, P.O.Box 19, Ambo, EthiopiaTel +251 912 30 60 13Email kefyalewtaye24@gmail.comBackground: Undernutrition is the major health problem in developing countries especially among underprivileged populations. In Ethiopia there is no clear information regarding the magnitude and forms of undernutrition and their associated factors among adolescent street children. This study assessed the magnitude of undernutrition and its associated factors among adolescent street children at Jimma town from March 1– 31, 2019.Methods: A community based cross-sectional study was conducted among 312 street children. Pretested self-administered structured questions were used for data collection. Data were entered to EpiData version 3.1 and exported to SPSS version 20 for statistical analysis. WHO AnthroPlus software version 1.0.4 was used for computing standardized indicators of nutritional status. Independent variables with P-value ≤ 0.25 in bivariate analysis were included in multivariable logistic regression and variables with P-value < 0.05 in multivariable logistic regression were declared as statistically significant.Results: A community based cross-sectional study was conducted among 312 street children from March 1– 31, 2019. The study found 29.2% (95%CI: 24– 34.0) and 30.4% (95%CI: 24.6– 35.3) magnitude of thinness and stunting respectively. Being female (AOR: 2.55; 95%CI: 1.16– 5.63), Ever skipped one or more daily meal per day (AOR: 6.56; 95%CI: 2.25– 19.15), low dietary diversity score (AOR: 1.86; 95%CI: 1.05– 3.27) and using unprotected water source (AOR: 1.78; 95%CI: 1.03– 3.05) were statistically significant factors for thinness whereas being in age group 15– 18 (AOR: 5.78; 95%CI: 3.20− 10.40) and ever used substance (AOR: 3.01; 95%CI: 1.17– 7.77) were statistically significant factors for stunting.Conclusion: This study found that the magnitude of thinness and stunting was high among adolescent street children and a range of factors were observed that result in thinness and stunting. Service provisions targeting nutritional supply, personal and environmental sanitation should be given to these street children through intersectoral collaboration.Keywords: adolescent, street children, stunting, thinness, undernutrition

Background The migration of young Ethiopian men and women to the Middle East countries was mainly for economic reasons. The migration was largely irregular that posed a wide range of unfavorable life conditions for some of the migrants. The overall objective is to assess common mental disorders and its associated factors for Ethiopian migrants returned from the Middle East countries and to describe mental health care services targeting these migrants. Methods The study employed a mixed-methods approach. For the quantitative part, a systematic random sampling technique was used to select a sample of 517 returnees. An interviewer-administered questionnaire based on Self Report Questionnaire-20 was used to collect data from respondents. The qualitative study employed a phenomenological study design to describe mental health care services. Key informant interviews and non-participant observation techniques were used to collect qualitative data. Results The prevalence of common mental disorder among Ethiopian migrants returned from the Middle East countries was found to be 29.2%. education (AOR=2.90 95%CI: 1.21, 6.94), physical abuse (AOR=12.17 95%CI: 5.87, 25.22), not getting salary properly and timely (AOR=3.35 95%CI: 1.47, 7.63), history of mental illness in the family (AOR=6.75 95%CI: 1.03, 43.95), detention (AOR=4.74 95%CI: 2.60, 8.62), guilty feeling for not fulfilling goal (AOR=9.58 95%CI: 4.43, 20.71), and denial of access to health care (AOR=3.20 95%CI:1.53, 6.67) were significantly associated with a common mental disorder. Shelter based and hospital-based mental health care services were rendered for a few return migrants with mental disorders. The services were primarily targeted, female return migrants. Conclusion The prevalence of common mental disorder was high among migrants returned from the Middle East countries. Despite the high burden of mental distress, only a small proportion of return migrants with mental illness is getting mental health care services.

Background Evidences indicate that the risk of linear growth faltering is higher among children born from young mothers. Although such findings have been documented in various studies, they mainly originate from cross-sectional data and demographic and health surveys which are not designed to capture the growth trajectories of the same group of children. This study aimed to assess the association between young maternal age and linear growth of infants using data from a birth cohort study in Ethiopia. Methods A total of 1423 mother-infant pairs, from a birth cohort study in rural Ethiopia were included in this study. They were followed for five time points, with three months interval until the infants were 12 months old. However, the analysis was based on 1378 subjects with at least one additional follow-up measurement to the baseline. A team of data collectors including nurses collected questionnaire based data and anthropometric measurements from the dyads. We fitted linear mixed-effects model with random intercept and random slope to determine associations of young maternal age and linear growth of infants over the follow-up period after adjusting for potential confounders. Results Overall, 27.2% of the mothers were adolescents (15–19 years) and the mean ± SD age of the mothers was 20 ± 2 years. Infant Length for Age Z score (LAZ) at birth was negatively associated with maternal age of 15–19 years (β = − 0.24, P = 0.032). However, young maternal age had no significant association with linear growth of the infants over the follow-up time (P = 0.105). Linear growth of infants was associated positively with improved maternal education and iron-folate intake during pregnancy and negatively with infant illness (P

STROBE-nut check list. (DOCX 66 kb)

Estimates table for the linear, quadratic and cubic-spline models. (DOCX 16 kb)

Undernutrition is a major public health concern due to its association with the mortality and disease burden of women and children. This study aimed at identifying the extent and determinants of undernutrition among young pregnant women in Ethiopia. A multivariable regression analysis was fitted to identify determinants of undernutrition and anaemia in a sample of 1,393 pregnant women. Risk ratios (RRs) with 95% confidence interval (CI) were estimated. All the analyses were performed using STATA version 14 and adjusted for clustering. The study revealed that 38% of the women were undernourished and 22% were anaemic. Improved maternal education, RR = 0.94, 95% CI [0.89, 0.98]; higher wealth status, RR = 0.72, 95% CI [0.47, 0.95]; higher minimum dietary diversity for women, RR = 0.87, 95% CI [0.77, 0.98]; increased maternal height, RR = 0.96, 95% CI [0.94, 0.98]; and protected water source, RR = 0.93, 95% CI [0.86, 0.96], have decreased the risk of undernutrition while using unimproved toilet, RR = 1.31, 95% CI [1.06, 1.63], and depression, RR = 1.33, 95% CI [1.14, 1.55], increased the risk of anaemia. Animal source food consumption decreased both the risk of undernutrition, RR = 0.85, 95% CI [0.77, 0.94], and anaemia, RR = 0.91, 95% CI [0.85, 0.95]. The burden of undernutrition is still high. Although improved socio-economic status and dietary practices decreased the risk of undernutrition, poor health and environmental conditions were still significant risk factors. These findings suggest the need to target this set of important determinants to significantly decrease the burden of undernutrition among young pregnant women.

The world has faced a public health emergency due to the emergence of the COVID-19 pandemic. A cross-sectional study with mixed methods was conducted to review the status of maternal and child health care and nutrition service delivery during the early months of the pandemic in woredas (districts) targeted by the Growth through Nutrition Activity, a multi-sectoral nutrition project, in Ethiopia. Comparison to the previous year showed some decline in key maternal and child health and nutrition services, with more pronounced effects during the early months of March and April before coordinated effort and standard guidance were well established. A recovery of most services was likely due in no small part to a range of mitigation interventions implemented by respective health workers and institutions, supervising government organizations, and through support from non-governmental organizations., Findings from a crossectional, mixed method study reviewing status of maternal and child health and nutrition service delivery in select areas of Ethiopia during the COVID-19 pandemic.

Normal growth and development of adolescent girls need a healthy diet which includes a variety of foods from different food groups. The dietary practice of adolescent girls in the study area was not assessed. The objective of this study was to assess the dietary diversity score and associated factors among adolescent girls. A community-based cross-sectional study was conducted from 30 April 2019 to 30 May 2019 in Wolaita Zone Southern Ethiopia. A multistage sampling method was used to select 843 adolescent girls. A structured 24-h dietary recall (24 HR) interview was conducted to capture detailed information about all foods and beverages consumed by the respondent in the past 24 hours, most commonly, from “sun raise on the day before interview to sunrise on the date of interview”. Dietary diversity scores were calculated by summing the number of food groups consumed by the adolescent girl over the 24-h recall period. Socio-demographic, health, and sanitation-related data were collected using a structured interviewer-administered questionnaire which was developed based on a thorough reviewing of different literature. Data were entered into EPI-data version 4.4.2 and exported to SPSS for windows version 21.0 for further analysis. Multivariable logistic regression model was used to isolate independent predictors of adequate dietary diversity. P-value of less than 0.05 was considered as the level of statistical significance. The mean dietary diversity score of the study participants is 3.56 (±1.2). Overall 72.4% of the study participants had a low dietary diversity score. A low dietary diversity score is found to be a public health problem in the study area. Family monthly income [AOR (95%CI) = 15.5 (8.6–28.1)], fathers [AOR (95%CI) = 4.3 (1.8–10.6)] and mothers’ educational status [AOR (95%CI) = 3.2 (1.5–6.8)], not taking nutrition education [AOR (95%CI) = 2.1 (1.4–3.1)] and decision-making power [AOR (95%CI) = 2.2 (1.5–3.3)], were the main predictors of low dietary diversity among adolescent girls in southern Ethiopia. Family monthly income and education, providing nutrition education, and decision-making power should be improved. The results imply the need for promoting maternal education, nutrition education, and empowering women to have decision-making power to improve the dietary diversity of girls in the study area. [AOR (95% CI) = 2.45(1.02–5.86)].

Purpose: The purpose of this article was to assess the pattern of supplement use and associated factors among pregnant women in Ethiopia. Methods: A facility-based cross-sectional study was conducted. A total of 339 pregnant women were included in the study, 63 (18.3%) and 23 (6.8%) of whom used at least 1 supplement during pregnancy and 2 to 4 weeks prior to pregnancy, respectively. Only 3 women were prescribed folic acid during pregnancy. The pregnant women were interviewed to collect supplements use and pregnancy-related information through a pretested semistructured questionnaire. Subsequent charts of prescribed supplements were reviewed using a pretested data collection format. Results: The majority (76.4%) of the women claimed no awareness about the benefits of early supplementation. Supplement use was about 8 times higher among women with > 3 children (adjusted odds ratio, 7.85; 95% confidence interval, 1.69-36.28; P ¼ .008) than among nulliparous women, and about 6 times higher among women in their second trimester (adjusted odds ratio, 6.26; 95% confidence interval, 1.91-20.55; P ¼ .03) of pregnancy compared to those women in their first trimester. Conclusion: Overall supplement use, particularly folic acid intake, was found to be negligible during the prenatal as well as antenatal periods. The majority of the women in the study lacked awareness about the benefits of supplementation and potential risks associated with the absence of folic acid during pregnancy. Information by the media and health care personnel given to childbearing women about the need to take folic acid to prevent neural tube defects seems to improve the intake of folic acid during the protective period.

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97.1 (95% UI 95.8-98.1) in Iceland, followed by 96.6 (94.9-97.9) in Norway and 96.1 (94.5-97.3) in the Netherlands, to values as low as 18.6 (13.1-24.4) in the Central African Republic, 19.0 (14.3-23.7) in Somalia, and 23.4 (20.2-26.8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1-936) in Beijing to 48.0 (43.4-53.2) in Tibet (a 43.5-point difference), while India saw a 30.8-point disparity, from 64.8 (59.6-68.8) in Goa to 34.0 (30.3-38.1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4.8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20.9-point to 17.0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17.2-point to 20.4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view and subsequent provision of quality health care for all populations., Bill & Melinda Gates Foundation. Barbora de Courten is supported by a National Heart Foundation Future Leader Fellowship (100864). Ai Koyanagi’s work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII —General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Alberto Ortiz was supported by Spanish Government (Instituto de Salud Carlos III RETIC REDINREN RD16/0019 FEDER funds). Ashish Awasthi acknowledges funding support from Department of Science and Technology, Government of India through INSPIRE Faculty scheme Boris Bikbov has received funding from the European Union’s Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No. 703226. Boris Bikbov acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Panniyammakal Jeemon acknowledges support from the clinical and public health intermediate fellowship from the Wellcome Trust and Department of Biotechnology, India Alliance (2015–20). Job F M van Boven was supported by the Department of Clinical Pharmacy & Pharmacology of the University Medical Center Groningen, University of Groningen, Netherlands. Olanrewaju Oladimeji is an African Research Fellow hosted by Human Sciences Research Council (HSRC), South Africa and he also has honorary affiliations with Walter Sisulu University (WSU), Eastern Cape, South Africa and School of Public Health, University of Namibia (UNAM), Namibia. He is indeed grateful for support from HSRC, WSU and UNAM. EUI is supported in part by the South African National Research Foundation (NRF UID: 86003). Ulrich Mueller acknowledges funding by the German National Cohort Study grant No 01ER1511/D, Gabrielle B Britton is supported by Secretaría Nacional de Ciencia, Tecnología e Innovación and Sistema Nacional de Investigación de Panamá. Giuseppe Remuzzi acknowledges that the work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Behzad Heibati would like to acknowledge Air pollution Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Syed Aljunid acknowledges the National University of Malaysia for providing the approval to participate in this GBD Project. Azeem Majeed and Imperial College London are grateful for support from the Northwest London National Insititute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care. Tambe Ayuk acknowledges the Institute of Medical Research and Medicinal Plant Studies for office space provided. José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). João Fernandes gratefully acknowledges funding from FCT–Fundação para a Ciência e a Tecnologia (grant number UID/Multi/50016/2013). Jan-Walter De Neve was supported by the Alexander von Humboldt Foundation. Kebede Deribe is funded by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (201900). Kazem Rahimi was supported by grants from the Oxford Martin School, the NIHR Oxford BRC and the RCUK Global Challenges Research Fund. Laith J Abu-Raddad acknowledges the support of Qatar National Research Fund (NPRP 9-040-3-008) who provided the main funding for generating the data provided to the GBD-IHME effort. Liesl Zuhlke is funded by the national research foundation of South Africa and the Medical Research Council of South Africa. Monica Cortinovis acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Chuanhua Yu acknowleges support from the National Natural Science Foundation of China (grant number 81773552 and grant number 81273179) Norberto Perico acknowledges that work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Charles Shey Wiysonge’s work is supported by the South African Medical Research Council and the National Research Foundation of South Africa (grant numbers 106035 and 108571). John J McGrath is supported by grant APP1056929 from the John Cade Fellowship from the National Health and Medical Research Council and the Danish National Research Foundation (Niels Bohr Professorship). Quique Bassat is an ICREA (Catalan Institution for Research and Advanced Studies) research professor at ISGlobal. Richard G White is funded by the UK MRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 programme supported by the European Union (MR/P002404/1), the Bill & Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, CORTIS: OPP1137034/OPP1151915, Vaccines: OPP1160830), and UNITAID (4214-LSHTM-Sept15; PO 8477-0-600). Rafael Tabarés-Seisdedos was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIII-FEDER. Mihajlo Jakovljevic acknowleges contribution from the Serbian Ministry of Education Science and Technological Development of the Republic of Serbia (grant OI 175 014). Shariful Islam is funded by a Senior Fellowship from Institute for Physical Activity and Nutrition, Deakin University and received career transition grants from High Blood Pressure Research Council of Australia. Sonia Saxena is funded by various grants from the NIHR. Stefanos Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral program (reference number CD15/00019 from the Instituto de Salud Carlos III (ISCIII–Spain) and the Fondos Europeo de Desarrollo Regional. Stefanos was awarded with a 6 months visiting fellowship funding at IHME from M-AES (reference no. MV16/00035 from the Instituto de Salud Carlos III). S Vittal Katikreddi was funded by a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the MRC (MC_UU_12017/13 & MC_ UU_12017/15) and the Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15). Traolach S Brugha has received funding from NHS Digital UK to collect data used in this study. The work of Hamid Badali was financially supported by Mazandaran University of Medical Sciences, Sari, Iran. The work of Stefan Lorkowski is funded by the German Federal Ministry of Education and Research (nutriCARD, Grant agreement number 01EA1411A). Mariam Molokhia’s research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We also thank the countless individuals who have contributed to GBD 2016 in various capacities.

Abdulhalik Workicho,Wondwosen Kassahun,Fessahaye Alemseged Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia Background: Multidrug-resistant tuberculosis (MDR-TB) did not receive major attention until recently in sub-Saharan Africa where the tuberculosis incidence and risk factors are highest. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programs. The objective of this study was to identify the risk factors for MDR-TB among tuberculosis patients. Methods: A case-control study was conducted to assess sociodemographic, behavioral and clinical risk factors using a structured questionnaire and clinical record reviewing. The data were entered and analyzed using SPSS windows version 16. Descriptive analysis was done to generate summary values for the variables and those significant variables in the bivariate analysis at p-value less than 0.25 were entered to multivariable logistic regression to identify independent determinants. Statistical significance was declared at p-value less than or equal to 0.05. Results: A total of 90 cases and 90 controls were included in the study. Age of respondents (adjusted odds ratio [AOR] =7; 95% confidence interval [CI]: 2.6–24.5), living in a household with only one room (AOR=5; 95%CI: 1.68–15.38), history of previous treatment (AOR=21; 95% CI: 17.8–28) and being HIV infected (AOR=3.1; 95%CI: 1.02–9.4) were found to be independent predictors of MDR-TB. Conclusion: In light of these findings, the strategies in controlling MDR-TB should emphasize on patients with HIV coinfection, young patients, those who have a history of previous treatment, and those living in crowded places. Keywords: MDR-TB, risk factors, case-control study, St. Peter’s TB Specialized Hospital, Ethiopia

Background Diabetic nephropathy is the most serious complication of diabetes which leads to end-stage renal failure and other complication of diabetes mellitus. Determinants of Diabetic nephropathy are not consistent in different studies and associated factors to chronic complications of diabetes are not specific and there are limited studies specific to diabetic nephropathy. Thus, the aim of this study is to identify determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia. Methods A case-control study was conducted from February 14 to May 8 2016. Diabetic patients who developed nephropathy in the last two years were the cases and diabetic patients free of nephropathy were controls. Cases and controls were identified detailed review of the chronic care follow up chart. Then simple random sampling was used to select sample of 420 (with control to case ratio of 4:1) resulting in 84 cases and 336 controls. Record review and interviewer administered questionnaire were used to collect data. Data was coded and entered in to Epi-Data version 3.1 and then exported to STATA 12 for analysis. Variables with P-values< 0.25 in Bivariate logistic regression were selected for multiple logistic regressions to determine independent determinants of diabetic nephropathy. OR was calculated with 95% CI to show strength of association. Result The mean age (±Standard deviation) for the cases and the controls were 52(SD: ±1.34) and 42.4(SD: ±0.8) respectively. In multiple logistic regressions age of patient (AOR: 1.037 95%CI: 1.01–1.064), duration of diabetes after diagnosis (AOR for one year increase: 1.09 95%CI: 1.036–1.15), not-adhered to blood glucose measurement at home (AOR: 6.81 95%CI: 1.15–40.24), having Systolic Hypertension (AOR;2.13 (1.002–4.51), poor glycemic control (AOR;2.71 95%CI: (1.49–4.95), being overweight(AOR;2.7(1.47–4.96) were the independent predictors of diabetic nephropathy. Conclusion In the light of these findings, targeted interventions should be designed at the follow up clinic to address the risk of developing diabetic nephropathy among the risk groups.

Background: Peripheral arterial disease (PAD) is defined as an ankle-brachial index (ABI) ≤ 0.90 in individuals aged 40 years or over. So far, the prevalence of PAD in Ethiopia is not known. We assessed the prevalence of PAD among Ethiopians using ABI and thus evaluated its applicability as a screening tool at the community level. Methods: A cross-sectional community based survey was conducted on 178 sampled individuals aged 40 years and above in Jimma town, Southwest Ethiopia from June 15 to July 15, 2011. Conventional cardiovascular risk factors and intermittent claudication (with Edinburgh Claudication assessment tool) were assessed using a structured questionnaire. Blood pressure was measured using a mercury sphygmomanometer and a hand held Doppler flow detector at arm and ankle respectively. The ABI was calculated from the ratio of higher ankle systolic blood pressure and the higher of the two brachial systolic pressure measurements. Descriptive statistics and chi-square or Fischer’s exact test, were used for data analysis and interpretation. Predictors of PAD were estimated using univariate and multivariate regression models. Results: The overall prevalence of peripheral arterial disease was 10.8%. But, none of the participants with peripheral arterial disease fulfilled the criteria for claudication. The traditional risk factors identified were; hypertension, diabetes mellitus, and current cigarette smoking accounting for 29.5%, 6.8% and 12.5% of participants respectively. Female sex, current smoking and diabetes mellitus were significantly associated with increased risk of PAD. Conclusion: Peripheral arterial disease is common among Ethiopians aged 40 years and above. Intermittent claudication was found to be insensitive in the detection of peripheral arterial disease. Female sex, current smoking and diabetes mellitus were predictors of PAD.

Background It is imperative to track dietary quality and progress in nutritional outcomes in a population to develop timely interventions. Dietary diversity is a commonly used proxy to assess dietary quality in low-income countries. This study identified predictors of household dietary diversity in Ethiopia and pattern of consumption of animal source food (ASF) among households. Methods Secondary data were analyzed from the 2011 Ethiopian Welfare Monitoring Survey (WMS). This survey used a structured questionnaire to collect socio-demographic and economic data. Dietary data were collected using a dietary diversity questionnaire measuring dietary diversity over the past 1 week. A Household Dietary Diversity Score (HDDS) was constructed according to the Food and Agricultural Organization (FAO) guidelines. Consumption of ASFs is described by its distribution among the regions and by HDDS. Multiple logistic regression analysis was fitted to identify independent predictors for HDDS. Results A total of 27,995 households were included in the analyses. A little over half of the study households (52.2%) had more than four household members, and 75% of households were male headed. The mean HHDS was five food groups. Cereals were the most commonly (96%) consumed food groups. Fish, egg and fruits, on the other hand, were the least consumed food groups. ASFs were consumed in greater proportion among households with higher HDDS. Being part of the higher and middle socio economic strata (P