Search

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents) and grandmothers (23 respondents) of children aged 6-23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notes before qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuits and lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored. This qualitative analysis explored patterns of complementary feeding and consumption of ultra-processed foods by infants and young children in poor rural households that are beneficiaries of the Productive Safety Net Program in Ethiopia. The evidence shows that t

PR, IFPRI3; DCA; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; ISI; IFPRIOA; SPIR, Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy, Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents) and grandmothers (23 respondents) of children aged 6–23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notes before qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuits and lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored.

Non-PR, IFPRI1; SPIR; DCA; 2 Promoting Healthy Diets and Nutrition for all, PHND, Since its inception in 2005, the Productive Safety Net Program (PSNP) has been a cornerstone of the Ethiopian government’s strategy for poverty alleviation, disaster risk management, and rural development. The PSNP provides food or cash transfers targeted to poor households in the form of payments for seasonal labor on public works or as direct support to households. It has played an important role in improving the lives of poor Ethiopian households by reducing household food insecurity, increasing asset holdings, and improving agricultural productivity (Berhane et al. 2014; Hoddinott et al. 2017).

A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed.

Currently, treatment of uncomplicated severe acute malnutrition is managed inthe integrated Community based Outpatient Therapeutic Program (C-OTP) using ready-to-usetherapeutic foods (RUTFs). The aim of this study was to determine challenges in implementingthe critical steps in C-OTP and caregivers’ perceptions of service provision in southern Ethiopia.A total of 1048 caregivers of children admitted to the OTP and 175 Health Extension Workers (HEWs)from 94 selected health posts were included in the study. Program admission, follow-up and exitinformation was collected from caregivers during home visits. HEWs were interviewed at theirrespective health posts. Only 46.6% (481/1032) were given the recommended amount of RUTF and19.3% (196/1015) were given antibiotics on admission. During C-OTP participation 34.9% (316/905)had uninterrupted provision of the recommended amount of RUTF. Of the children who left theprogram, 220/554 (39.7%) exited the program in line with the national recommendation. Caregivers(42.9% (394/918) and HEWs (37.1%, 62/167) perceive that RUTFs were being sold as a commodity.Inadequate provision and unintended usage of RUTFs, lack of antibiotics and inappropriate exitfrom the program were major constraints. For successful saving of lives, adequate resources must beallocated, and providers must be trained regularly, and supervised properly.

Caregivers’ autonomy is important for child nutritional status as it improves the availability of food and access to health resources necessary for children’s growth and recovery from illnesses. However, evidence on the extent of influence of caregivers’ autonomy during recovery from severe acute malnutrition (SAM) is limited. A cohort of children (n=788) aged 6-59 months admitted to community-based outpatient therapeutic programme (OTP) for SAM in rural southern Ethiopia were studied. Recovery from SAM was defined by MUAC ≥ 125 mm and absence of edema after treatment in OTP. A Kaplan Meier (KM) survival analysis was employed to estimate the recovery rates of the children treated for SAM for different level of caregivers’ autonomy and multivariable Cox proportional hazard regression analysis was used to control for confounding. Results from adjusted cox proportional hazard regression analysis indicated that children of caregivers with higher decision-making autonomy recovered more rapidly from SAM than children of caregivers with lower autonomy. Promotion of caregivers’ autonomy could augment effectiveness of a scaled up and integrated outpatient therapeutic feeding programme., COMSAM

Background: A scaled up and integrated outpatient therapeutic program (OTP) brings the treatment of severely malnourished children closer to the community. However, studies documenting program outcome and nutritional status beyond discharge from OTP are scarce. This study evaluated recovery from severe acute malnutrition (SAM), fatality and nutritional status up to 14 weeks after admission to the programme. Methods: In this cohort study, 1048 children admitted to 94 OTPs in southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Results: On admission 78.8% (826/1048) of the children had severe acute malnutrition. The mean length of admission to the programme was 7.1 weeks [95% CI 6.9 -7.3]. Only 37.8% (216/571) of children with SAM on admission fulfilled the programme recovery criteria (gained 15% in weight or oedema resolved, if present on admission) at discharge. However, of the children who achieved programme recovery criteria at discharge, 57.6% (121/210) were still acutely malnourished. Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely and 34.4% (348/928) were moderately malnourished, thus 69.0% were acutely malnourished. A total of 27/982 (2.7%) of the children had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). Conclusion: Despite children participating for the recommended duration of the programme, many were discharged without reaching programme criteria for recovery and acute malnutrition remained prevalent beyond discharge. Further research is needed to understand the factors constraining community management of acute malnutrition.

Background: The World Health Organization (WHO) recommends the community-based Outpatient Therapeutic Program (OTP) as a standard treatment protocol for the management of uncomplicated Severe Acute Malnutrition (SAM) at the community level. OTP has been scaled up and integrated into the existing grassroots level government health systems in several developing countries. The aim of this thesis was to assess the implementation and outcome of scaled-up and integrated OTP service provided at community level. Methods: One qualitative study and three quantitative studies were conducted in southern Ethiopia. Children admitted to 94 integrated OTPs, their caregivers and health extension workers providing primary health care services in the nearby health posts were included in this study. The quantitative studies were based on data generated from observation of a cohort of 1,048 children admitted to the integrated OTPs. Result: The majority (60.2%) of children with SAM on admission exited the program neither achieving program recovery criteria nor being transferred to inpatient care. Fourteen weeks after admission to OTP, 34.6% were severely malnourished and 34.4% were moderately malnourished, thus 69.0% were still acutely malnourished. Ready-to-use Therapeutic Foods (RUTFs) provided for SAM children were commonly shared with other children in the household and sold as a commodity for the collective benefit of the family thus admitted children received only a portion of the provided amount. Further, the program suffered a severe shortage of RUTFs, where only 46.6% of admitted children were given the recommended amount of RUTFs by providers on admission and only 34.9% of these had uninterrupted provision during the follow-up.