Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Psychological problems and associated factors among high school students during COVID-19 pandemic in Sawla town, Gofa zone, southern Ethiopia

Background: Depression, anxiety, and stress (DAS) are common among high school students, and they have a negative impact on their academic performance and future lives. Pandemics, such as coronavirus disease 2019 (COVID-19), exacerbate these issues. Although psychological problems are studied in developed countries, they are overlooked in developing countries such as Ethiopia. Therefore, this study was aimed to assess the prevalence of psychological problems and associated factors among high school students during the COVID-19 pandemic in Sawla town, Gofa zone, southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 663 randomly selected high school students from March 1 to 31, 2021. The data was collected using the depression, anxiety, and stress scale (DASS-21) questionnaire and analyzed using SPSS version 26.0. Bivariable and multivariable analyses were computed to identify factors associated with DAS. An adjusted odds ratio with 95% CI was used to see the strength of the association and statistical significance was declared at p-value <0.05. Results: The overall prevalence of depression, anxiety, and stress were 52.1% [95% CI: 48.3, 55.98], 52.6% [95% CI: 48.8, 56.4], and 22.6% [95% CI: 19.4, 25], respectively. Being rural residence (AOR: 4.88, 95% CI: 3.02, 7.88), living in a prison house or with a husband (AOR: 5.94, 95% CI: 1.65, 21.3), having a lower academic level (AOR: 6.23, 95% CI: 3.42), having poor knowledge about COVID-19 (AOR: 1.75, 95% CI: 1.21, 2.53) and poor COVID-19 prevention practices (AOR: 1.74, 95% CI: 1.09, 2.79) were associated with depression. Similarly, being a rural resident (AOR: 3.73, 95% CI: 2.38, 5.84), being a lower academic level (AOR: 2.54, 95% CI: 1.50, 4.30), having poor knowledge about COVID-19 (AOR: 1.54, 95% CI: 1.08, 2.19), and poor COVID-19 prevention practices (AOR: 2.12, 95% CI: 1.36, 3.32) were associated with anxiety. Furthermore, stress was associated with rural residence (AOR: 2.24, 95% CI: 1.42, 3.53), lower academic level (AOR: 4.70, 95% CI: 2.12, 10.4), and poor knowledge of COVID-19 (AOR: 1.71, 95% CI: 1.13, 2.58). Conclusions: Depression, anxiety, and stress were all prevalent among high school students in the area. Rural residence, lower academic level, and poor knowledge about COVID-19, as well as poor COVID-19 prevention practices, all increase the likelihood of DAS. As a result, school-based psychological counseling interventions, particularly during pandemics, are critical

Pressure ulcer prevention practices and associated factors among nurses in public hospitals of Harari regional state and Dire Dawa city administration, Eastern Ethiopia.

IntroductionPressure ulcer is one of the major challenges in hospitals; which endanger patient safety, prolonging hospital stay and contributed to disability and death. Data regarding to pressure ulcer prevention practice are very important to take action. However in Ethiopia, there are limited researches that have been conducted and there is clearly paucity of information on this regard. Hence, this study aimed to assess pressure ulcer prevention practice and associated factors among nurses in public hospitals of Eastern Ethiopia.MethodsA cross-sectional study was conducted among randomly selected 422 nurses who were working in the public hospitals of Eastern Ethiopia. Data were collected from the 1st February to the 1st March 2018 using pretested structured self-administered questionnaire and observational checklist. The collected data were entered into EpiData version 3.1 and exported to SPSS version 22.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Pressure ulcer prevention was determined based on mean calculation; a result above the mean value was categorized as good pressure ulcer prevention practice, and a P-value of ResultsIn this study 51.9% (95% CI: 47.1%, 56.4%) of nurses were reported that they have good pressure ulcer prevention practice. On observation 45.2% of nurses were practicing proper pressure ulcer prevention activities. Pressure ulcer prevention practice were statistically associated with nurses with bachelor degree and above qualification level (AOR = 1.7, 95% CI: 1.02, 2.83), availability of pressure-relieving devices (AOR = 2.2, 95% CI: 1.34, 3.63), being satisfied with their job (AOR = 1.65, 95% CI: 1.09, 2.52) and good knowledge (AOR = 2.3, 95% CI: 1.48, 3.55).ConclusionsIn this study the self-reported practice and results from observation was substantially low. Continuing education and training should be considered for nurses to enhance their practice regarding pressure ulcer prevention practice

Comorbid anxiety and depression: Prevalence and associated factors among pregnant women in Arba Minch zuria district, Gamo zone, southern Ethiopia.

IntroductionPrenatal anxiety and depression are major health problems all over the world. The negative sequela of prenatal comorbid anxiety and depression (CAD) has been suggested to be higher than that of anxiety or depression alone. CAD increases the odds of preterm birth, low birth weight, prolonged labor, operative deliveries, postpartum psychiatric disorders and long term cognitive impairment for the newborn. Despite its significant ill consequences, there is a dearth of studies in low-and middle-income countries. So far, to the best of our knowledge, no study assessed the prevalence of CAD in Ethiopia. Hence, the purpose of this study was to assess CAD and associated factors among pregnant women in Arba Minch Zuria district, Gamo zone, southern Ethiopia.MethodsA community-based cross-sectional study was conducted among 676 pregnant women from January 01 to November 30, 2019. Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales were used to assess depression and anxiety respectively. The data were collected electronically using an open data kit (ODK) collect android application and analyzed using Stata version 15.0. Bivariate and multivariable analyses were carried out to identify factors associated with CAD using binary logistic regression. Statistical significance was set at p-value ResultsA total of 667 women were involved. The prevalence of CAD was 10.04% [95% confidence interval (CI): 7.76, 12.33]. Being married [adjusted odds ratio (AOR): 0.16, 95% CI: 0.05, 0.56], categorized in the highest wealth quintile [AOR: 2.83, 95% CI: 1.17, 6.84], having medical illness [AOR: 3.56, 95% CI: 1.68, 7.54], encountering pregnancy danger signs [AOR: 2.66, 95% CI: 1.06, 6.67], experiencing life-threatening events [AOR: 2.11, 95% CI: 1.15, 3.92] and household food insecurity [AOR: 3.51, 95% CI: 1.85, 6.64] were significantly associated with CAD.ConclusionsIn general, one in every ten women faced CAD in the study area. Nutritional interventions, early identification and treatment of pregnancy-related illness and medical ailments, prenatal mental health problems screening and interventions are imperative to minimize the risk of CAD in pregnant women

Minimum Dietary Diversity and Associated Factors among Lactating Mothers in Ataye District, North Shoa Zone, Central Ethiopia: A Community-Based Cross-Sectional Study

Background. Low dietary diversity superimposed with poor-quality monotonous diets is a major problem that often results in undernutrition, mainly micronutrient deficiencies. However, there is limited evidence on minimum dietary diversity and associated factors among lactating mothers in resource-poor settings, including the study area. Therefore, the objective of the study is to assess the prevalence of minimum dietary diversity and associated factors among lactating mothers in Ataye District, Ethiopia. Methods. A community-based cross-sectional study design was used among 652 lactating mothers aged 15–49 years from January 25 to April 30, 2018. Dietary diversity was measured by the minimum dietary diversity indicator for women (MDD-W) using the 24-hour dietary recall method. Data were entered into EpiData version 4.2.0.0 and exported to the statistical package for social science (SPSS) version 24 for analysis using the logistic regression model. Results. The prevalence of minimum dietary diversity among lactating mothers was 48.8% (95% CI: (44.7%, 52.9%). Having formal education ((AOR = 2.16, 95% CL: (1.14, 4.09)), a final say on household purchases ((AOR = 5.39, 95% CI: (2.34, 12.42)), home gardening practices ((AOR = 2.67, 95% CI: (1.49, 4.81)), a history of illness ((AOR = 0.47, 95% CI: (0.26, 0.85)), good knowledge of nutrition ((AOR = 5.11, 95% CI: (2.68, 9.78)), being from food-secure households ((AOR = 2.96, 95% CI: (1.45, 6.07)), and medium ((AOR = 5.94, 95% CI: (2.82, 12.87)) and rich wealth indices ((AOR = 3.55, 95% CI: (1.76, 7.13)) were significantly associated with minimum dietary diversity. Conclusion. The prevalence of minimum dietary diversity among lactating mothers was low in the study area. It was significantly associated with mothers having a formal education, final say on the household purchase, home garden, good knowledge of nutrition, history of illness, food-secure households, and belonging to medium and rich household wealth indices. Therefore, efforts should be made to improve the mother’s decision-making autonomy, nutrition knowledge, household food security, and wealth status

Minimum acceptable diet and associated factors among infants and young children aged 6–23 months in Amhara region, Central Ethiopia: community-based cross-sectional study

Objective The main objective of this study was to assess the prevalence of a minimum acceptable diet (MAD) and associated factors.Design Community-based cross-sectional studySetting Debre Berhan Town, Ethiopia.Participants An aggregate of 531 infants and young children mother/caregiver pairs participated in this study. A one-stage cluster sampling method was used to select study participants and clusters were selected using a lottery method. Descriptive statistics were calculated for all study variables. Statistical analysis was performed on data to determine which variables are associated with MAD and the results of the adjusted OR with 95% CI. P value of &lt;0.05 considered statistically significant.Primary outcome Prevalence of MAD and associated factorsResults The overall prevalence of MAD was 31.6% (95% CI: 27.7 to 35.2). Having mother attending secondary (adjusted OR, AOR=4.9, 95% CI: 1.3 to 18.9) and college education (AOR=6.4, 95% CI: 1.5 to 26.6), paternal primary education (AOR=1.3, 95% CI: 1.5 to 2.4), grouped in the aged group of 12–17 months (AOR=1.8, 95% CI: (1.0 to 3.4) and 18–23 months (AOR=2.2, 95% CI: 1.2 to 3.9), having four antenatal care (ANC) visits (AOR=2.0, 95% CI: 1.0 to 3.9), utilising growth monitoring (AOR=1.8, 95% CI: 1.1 to 2.9), no history of illness 2 weeks before the survey (AOR=2.9, 95% CI: 1.5 to 6.0) and living in the household with home garden (AOR=2.5, 95% CI: 1.5 to 4.3) were positively associated with increase the odds of MAD.Conclusion Generally, the result of this study showed that the prevalence of minimum acceptable was very low. Parent educational status, ANC visits, infant and young child feeding advice, child growth monitoring practice, age of a child, a child has no history of illness 2 weeks before the survey, and home gardening practice were the predictors of MAD. Therefore, comprehensive intervention strategies suitable to the local context are required to improve the provision of MAD