Food Service Provision Status and Patients’ Satisfaction at Selected Government Hospitals in Ethiopia

The daily provision of hospital patients’ nutritional food dietary intake is still a major problem at the majority of government hospitals found in Ethiopia. this leads to increased recovery time, morbidity, and mortality of lives. This cross-sectional study was designed to investigate the current status and functioning of the health facility concerning daily dietary food provision for patients under health care treatments for various health reasons. The main objective of this assessment was to generate evidence-based information on the current status and functioning of the health facility concerning daily dietary food provision for patients under health treatments for various health problems. A cross-sectional design, with a mixed-method approach (both qualitative and quantitative methods), was conducted from February to May 2019. The qualitative data were collected from key informants and quantitative data were collected through a structured questionnaire. The mean age of the participants was 37.35 (±16.59) and overall, 74.75% of the targeted populations were not satisfied with the food prepared at hospitals and 13.00% of them had no idea about the food prepared for the patients. Insufficient budget allocation, unskilled manpower, and less attention to hospital nutritional foods were common problems among the 13 governmental hospitals. The nutritional food services offered to hospital patients should be improved

Chronic Energy Deficiency and Associated Factors among Lactating Mothers (15-49 years old) in Offa Woreda, Wolayita Zone, SNNPRs, Ethiopia

The lactating mothers in developing countries like Ethiopia are the first targeted and nutritionally vulnerable groups to under nutrition due to different socio demographic factors which influence the health and well being of mothers and children. During lactation periods, mothers need more nutritious food than the rests of the household members. The aim of this study was to determine the nutritional status, associated factors and dietary diversity of lactating mothers 15-49 years old in Offa woreda. A cross-sectional community based study was carried out to determine the Chronic Energy deficiency of lactating mothers in the studied woreda. The lactating mothers were randomly selected from four rural and two urban kebeles. A total of 422 households were visited and the required data were collected as scheduled in all selected kebeles. The prevalence of under nutrition among the lactating mothers in the studied area was determined using BMI by Anthropometric measurements and the blood sample test for hemoglobin (Hb) concentration was done using Haemocue methods. The collected data were analyzed using Stata version 14.2 software. Among the participated lactating mothers the values 15.8%, 74.2%, 8.3% and 1.7% were obtained for under weight, normal, over weight and obese in their BMI (kg/m2), respectively. The studied participants of 15.8% were in chronic energy deficiency according to WHO guidelines. The lactating mothers’ percentage value 36.4%, 59.3%, 4.3% were in age group of 15-24, 25-34 and 35-49 years, respectively. The blood test showed that among the lactating mothers 11.4% were found anemic which had got hemoglobin level less than normal level (12g/dl). The daily dietary diversity intake per day of lactating mothers was classified as high (>5 DDS) 1.2%, medium (4-5 DDS) 50.7% and low (<3 DDS) 47.4% among the nine food groups recommended for women dietary diversity score (WDDS). The independent variables: education, family size, marital status and occupation were significantly associated with nutritional status of the lactating mothers at P<0.05. In conclusion the majority of the lactating women in the study area had normal BMI. The researchers would like to recommend that the government and development agencies should focus on the risk factors identified, to ensure better health and nutrition for lactating mothers in this woreda

Factors associated with dietary diversity and length-for-age z-score in rural Ethiopian children aged 6-23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation.

Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership. LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership

Review of policies and frameworks on climate change, agriculture, food and nutrition security in Ethiopia

Agriculture is the mainstay of Ethiopia’s economy, contributing over 50% of the gross domestic product (GDP), accounting for more than 85% of the labor force and over 90% of the foreign exchange earnings (Alemu et al. 2010). Consequently, the sector receives considerable attention from the government, investing 15% of its total budget over the decade and meeting the commitments by Africa’s heads of states to the African Union Maputo 2003 Declaration on Agriculture and Food Security (CAADP 2003). On average, crop production makes up 60% of the sector’s outputs, livestock accounts for 27%, with other sub-sectors contributing 13% of the total value of agricultural production. The sector is dominated by small-scale farmers, practicing rain-fed mixed farming using traditional technologies, characterized with low levels of input use and low productivity

Effect of computer simulation and animation-integrated instruction on pre-service science teacher trainees conceptual understanding and retention of Acid-Base Chemistry and Stoichiometry

The study aimed to investigate the effect of computer simulation and animation-integrated instruction on pre-service science teacher trainees' conceptual understanding and retention of acid-base chemistry and stoichiometry. A quantitative approach with a pretest–posttest-delayed test quasi-experimental design was used. In the study area, there were only two sections of first-year trainees in the natural science department. So a comprehensive sampling technique of the two intact sections was employed. The two intact classes were randomly assigned to an intervention group (IG) and a comparison group (CG). Data was collected using Acid-Base Chemistry and Stoichiometry Conceptual Understanding of a two-tier multiple-choice Test (ABSCUT). Parametric statistics (independent sample t-test and ANCOVA) were used for the data analysis. The independent sample t-test was used for the pre-test analysis to examine the prerequisite experiences of trainees in the two groups and male and female trainees in the IG before the intervention. The result showed no significant difference between the mean score of the CG and IG. The result also showed no significant difference in the mean score of male and female trainees in the IG. The ANCOVA was used for post-test and delayed test analysis after the intervention. The result indicated that there was a statistically significant difference between the two groups on conceptual understanding, F (1, 49) =5.07, p=.029, partial eta squared=0.094, in favor of IG. This tends to imply the concepts of the trainees who received the intervention outperformed the comparison group. The ANCOVA result also indicated that gender difference has no statistically significant difference in the IG, F(1,24)=3.68, p=.067. The delayed-test analysis showed that the IG has higher retention than the CG. Based on the results, this study recommended that policymakers, chemistry curriculum experts, chemistry curricular material developers, and practitioners alike consider the application of computer simulation-integrated chemistry instruction to enhance learners’ conceptual understanding and retention

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia

BACKGROUND፡ Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia.METHODS: A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization’s case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected.RESULTS: Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%;164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria.CONCLUSION: Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia

The fidelity and dose of message delivery on infant and young child feeding practice and nutrition sensitive agriculture in Ethiopia: a qualitative study from the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme.

BACKGROUND: In Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers. METHODS: A qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes. RESULTS: SURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition. CONCLUSION: Despite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia.

INTRODUCTION: Improving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding and reduce stunting. The Federal Ministries of Health and Agriculture and Natural Resources implement the intervention. The evaluation aims to assess a range of processes, outcomes and impacts. METHODS AND ANALYSIS: The SURE evaluation study is a theory-based, mixed methods study comprising impact and process evaluations. We hypothesise that the package of SURE interventions, including integrated health and agriculture behaviour change communication for nutrition, systems strengthening and multisectoral coordination, will result in detectable differences in minimum acceptable diet in children 6-23 months and stunting in children 24-47 months between intervention and comparison groups. Repeated cross-sectional household surveys will be conducted at baseline and endline to assess impact. The process will be assessed using observations, key informant interviews and focus group discussions to investigate the fidelity and dose of programme implementation, behavioural pathways of impact and contextual factors interacting with the intervention. Pathways of impact will also be explored through statistical analyses. ETHICS AND DISSEMINATION: The study has received ethics approval from the scientific and ethical review committees at the Ethiopian Public Health Institute and the London School of Hygiene and Tropical Medicine. The findings will be disseminated collaboratively with stakeholders at specified time points and through peer-reviewed publications and presentations

Linkages between health and agriculture sectors in Ethiopia: a formative research study exploring barriers, facilitators and opportunities for local level coordination to deliver nutritional programmes and services.

BACKGROUND: In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Government has adopted the National Nutrition Programme that emphasizes the need for multi-sectoral collaboration to effectively deliver nutrition-sensitive and nutrition-specific interventions. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities. METHODS: Data were collected from eight districts in Ethiopia using 16 key informant interviews and eight focus group discussions conducted with district and community-level focal persons for nutrition including health and agriculture extension workers. A framework analysis approach was used to analyze data. RESULTS: Few respondents were aware of the National Nutrition Programme or of their own roles within the multi-sectoral coordination mechanism outlined by the government to deliver nutritional programmes and services. Lack of knowledge or commitment to nutrition, lack of resources and presence of competing priorities within individual sectors were identified as barriers to effective coordination between health and agriculture sectors. Strong central commitment to nutrition, increased involvement of other partners in nutrition and the presence of community development workers such as health and agriculture extension workers were identified as facilitators of effective coordination. CONCLUSIONS: Federal guidelines to implement the Ethiopian National Nutrition Programme have yet to be translated to district or community level administrative structures. Sustained political commitment and provision of resources will be necessary to achieve effective inter-sectoral collaboration to deliver nutritional services. The health and agriculture extension platforms may be used to link interventions for sustained nutrition impact

Scaling Preservice Training in Comprehensive Contraception and Abortion Care and Research across Ethiopia

This retrospective case study examines a five-year project scaling preservice training of comprehensive contraception and abortion care across nine Ethiopian schools of medicine and midwifery beginning in July 2014. It captures lessons learned from implementing the framework and share them with other schools and health ministries planning to strengthen contraception and abortion preservice training and research. The case study is based on semi-structured interviews conducted in July–December 2018 with 19 individuals who held faculty roles in the partner schools or staff roles with the Center for International Reproductive Health Training team in Ethiopia or Michigan. It also draws from document analysis of internal project files from across the full project period and participant observation by the case study authors, who were each involved in various stages of implementation. The case study is also available at http://hdl.handle.net/2027/spo.mpub11627346. This case study is shared under a Creative Commons Attribution Noncommercial No-Derivatives License: http://creativecommons.org/licenses/by-nc-nd/4.0/.https://deepblue.lib.umich.edu/bitstream/2027.42/150691/1/2019-scaling-preservice-training-in-comprehensive-contraception.pdfDescription of 2019-scaling-preservice-training-in-comprehensive-contraception.pdf : Case Stud