Time to complementary feeding initiation and its predictors among children aged 9–23 months in Meket District, Northeast Ethiopia: a Cox Weibull regression

.Globally and nationally, only 64⋅5 and 49⋅2 % of infants received solid or semi-solid foods, respectively. The available evidence indicates that the time to initiate complementary feeding practices is still poor and varies by region. The aim of the present study was to assess the time to initiation of complementary feeding and its predictors among children aged 9–23 months in Meket District, Amhara Region, Ethiopia. A community-based retrospective cohort study was conducted from June to July 2022 among 459 systematically selected mothers/caregivers with their children from 9 to 23 months of age. The result of descriptive statistics was reported by table, frequency, Kaplan-Meier curve and percent. The proportional hazard model assumption was checked, and a Weibull regression model was used to see the predictors of timely initiation of complementary feeding. An adjusted hazard ratio with a 95 % confidence interval and a P-value of 0⋅05 were used to declare the significant predictors. The median time of complementary feeding initiation was 6 months. Attending primary education (adjusted hazard ration (AHR) 1⋅8; 95 % CI 1⋅16, 2⋅78), occupation of the mother (AHR 1⋅43; 95 % CI 1⋅04, 1⋅95), home delivery (AHR 1⋅61; 95 % CI 1⋅09, 2⋅37) and birth preparedness (AHR 1⋅37; 95 % CI 1⋅03, 1⋅81) were the predictors of time to complementary feeding initiation. The median time to complementary feeding initiation was consistent with the WHO recommendation. Maternal education, maternal employment, place of delivery and birth preparedness were the predictors of time to initiation of complementary feeding. Therefore, working with the education sector, increasing the delivery rate in health facilities, strengthening counselling on birth preparation, increasing maternity leave until 6 months of age and initiating corner feeding should be part of the complementary feeding practices promotion agenda

Knowledge and practice of clients on preventive measures of COVID-19 pandemic among governmental health facilities in South Wollo, Ethiopia: A facility-based cross-sectional study

INTRODUCTION: Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client’s knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. METHODS: An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers’ knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client’s knowledge and preventive practices. RESULTS: Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. CONCLUSION: Our findings revealed that clients’ knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices

Timely Initiation of Complementary Feeding and its Associated Factors among Children 6-23 Months in Ethiopia: A Systematic Review and Meta-analysis

In Ethiopia, various studies have been done in order to determine the proportion of infants who had initiated complementary food timely and its  associated factors. The results of these studies were not consistent and had a big variability. Hence, the aim of this systematic review and meta-  analysis is to estimate the pooled prevalence of timely initiation of complementary feeding and its associated factors among children 6-23 months  in Ethiopia. Different databases were systematically searched. Studies reporting the proportion and associated factors of timely initiation of  complementary feeding in Ethiopia were considered. The Cochrane Q test statistic and I2 test were used to assess the heterogeneity between the  studies. A random effect model was computed to estimate the pooled prevalence of timely initiation of breastfeeding. In addition, the association  between timely initiation of complementary feeding and Antenatal Care follow-up, place of delivery, postnatal checkup, women’s education,  mother’s occupation, father’s education, marital status, child sex, place of residence was determined. Eighteen studies were finally included in this  meta-analysis. The findings of this meta-analysis revealed that, the pooled prevalence of timely initiation of complementary feeding in Ethiopia was  55.64% (95% Confidence interval: 50.35, 60.93%). In this study, timely initiation of complementary feeding in Ethiopia was significantly low compared  to the current global recommendation on complementary feeding. Women from rural area were less likely to initiate complementary  feeding at six months as compared with women from urban areas. Mothers who give birth at home were less likely to initiate complementary  feeding timely. &nbsp

Urban-rural disparity in stunting among Ethiopian children aged 6–59 months old: A multivariate decomposition analysis of 2019 Mini-EDHS

Background Childhood stunting is still a global public health challenge, including in Ethiopia. Over the past decade, in developing countries, stunting has been characterized by large rural and urban disparities. To design an effective intervention, it is necessary to understand the urban and rural disparities in stunting. Objective To assess the urban-rural disparities in stunting among Ethiopian children aged 6–59 months. Methods This study was done based on the data obtained from the 2019 mini-Ethiopian Demographic and Health Survey, conducted by the Central Statistical Agency of Ethiopia and ICF international. The result of descriptive statistics was reported using the mean with standard deviation, frequency, percentages, graphs, and tables. A multivariate decomposition analysis was used to decompose the urban-rural disparity in stunting into two components: one that is explained by residence differences in the level of the determinants (covariate effects), and the other component is explained by differences in the effect of the covariates on the outcome (coefficient effects). The results were robust to the different decomposition weighting schemes. Result The prevalence of stunting among Ethiopian children aged 6–59 months was 37.8% (95% CI: 36.8%, 39.6%). The difference in stunting prevalence between urban and rural residences was high (rural prevalence was 41.5%, while in urban areas it was 25.5%). Endowment and coefficient factors explained the urban-rural disparity in stunting with magnitudes of 35.26% and 64.74%, respectively. Maternal educational status, sex, and age of children were the determinants of the urban-rural disparity in stunting. Conclusion and recommendation There is a significant stunting disparity among urban and rural children in Ethiopia. A larger portion of the urban-rural stunting disparity was explained by coefficient effects (differences in behaviour). Maternal educational status, sex, and age of children were the determinants of the disparity. So, to narrow this disparity, emphasis should be given to both resource distribution and the appropriate utilization of available interventions, including improvement of maternal education and consideration of sex and age differences during child feeding practices

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model.

BackgroundTimely initiating antenatal care (ANC) is crucial in the countries that have high maternal morbidity and mortality. However, in developing countries including Ethiopia, pregnant mother's time to initiate antenatal care was not well-studied. Therefore, this study aimed to assess time to first ANC and its predictors among pregnant women in Ethiopia.MethodsA community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data. A two-stage stratified cluster sampling was employed. The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit. Cox-gamma shared frailty model was applied to determine predictors. Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size. Model adequacy was assessed by using the Cox-Snell residual plot. Statistical significance was considered at p value ResultsThe median time to first ANC was 5 months with IQR (3,-). The independent predictors of time to first ANC visit were primary education [AHR: 1.24 (95%CI, 1.13-1.35)], secondary education [AHR: 1.28(95% CI, 1.11-1.47)], higher education [AHR: 1.43 (1.19-1.72)] as compared to women with no formal education. Having media exposure [AHR: 1.13 (95% CI, 1.03-1.24)], early initiation of ANC increases by 25% [AHR: 1.25 (95% CI, 1.12-1.40)] in poorer, 32% [AHR: 1.32 (95% CI, 1.17-1.49)] in middle, 37% [AHR: 1.37 (95% CI, 1.20-1.56)] in richer and 41% [AHR: 1.41 (95%CI, 1.1.19-1.67)] in richest households as compared to poorest household wealth index. Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit.ConclusionsThe current study revealed that women's time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO). The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility. It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women. Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases

Urban-rural disparity in stunting among Ethiopian children aged 6-59 months old: A multivariate decomposition analysis of 2019 Mini-EDHS.

BackgroundChildhood stunting is still a global public health challenge, including in Ethiopia. Over the past decade, in developing countries, stunting has been characterized by large rural and urban disparities. To design an effective intervention, it is necessary to understand the urban and rural disparities in stunting.ObjectiveTo assess the urban-rural disparities in stunting among Ethiopian children aged 6-59 months.MethodsThis study was done based on the data obtained from the 2019 mini-Ethiopian Demographic and Health Survey, conducted by the Central Statistical Agency of Ethiopia and ICF international. The result of descriptive statistics was reported using the mean with standard deviation, frequency, percentages, graphs, and tables. A multivariate decomposition analysis was used to decompose the urban-rural disparity in stunting into two components: one that is explained by residence differences in the level of the determinants (covariate effects), and the other component is explained by differences in the effect of the covariates on the outcome (coefficient effects). The results were robust to the different decomposition weighting schemes.ResultThe prevalence of stunting among Ethiopian children aged 6-59 months was 37.8% (95% CI: 36.8%, 39.6%). The difference in stunting prevalence between urban and rural residences was high (rural prevalence was 41.5%, while in urban areas it was 25.5%). Endowment and coefficient factors explained the urban-rural disparity in stunting with magnitudes of 35.26% and 64.74%, respectively. Maternal educational status, sex, and age of children were the determinants of the urban-rural disparity in stunting.Conclusion and recommendationThere is a significant stunting disparity among urban and rural children in Ethiopia. A larger portion of the urban-rural stunting disparity was explained by coefficient effects (differences in behaviour). Maternal educational status, sex, and age of children were the determinants of the disparity. So, to narrow this disparity, emphasis should be given to both resource distribution and the appropriate utilization of available interventions, including improvement of maternal education and consideration of sex and age differences during child feeding practices

The effects of ANC follow up on essential newborn care practices in east Africa: a systematic review and meta-analysis

Abstract In the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa

Water, sanitation, and hygiene conditions and prevalence of intestinal parasitosis among primary school children in Dessie City, Ethiopia.

BackgroundIntestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps.MethodsA school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children.Main findingsThe overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5-19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother's education (illiterate) (AOR = 3.3; 95% CI: 1.20-9.37), father's education (illiterate) (AOR = 3.9; 95% CI: 1.40-10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25-7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11-4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17-16.70) were statistically associated with presence of intestinal parasitic infections.ConclusionWe concluded that the prevalence of intestinal parasitosis in the study area among Grades 4-8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children's were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students' WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures

Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis

Abstract Background Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. Methods A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. Results Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. Conclusions Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women’s education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government