Diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar zone, Northwest Ethiopia

Published 3 June 2018Background. Diarrheal disease remains one of the principal causes of morbidity and mortality in infants and children in developing countries, including Ethiopia. Risk factors for diarrhea vary by settings and have important implications for developing intervention strategies to reduce the burden of the disease. Thus, the aim of this study was to assess diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar Zone. Methods. A community-based cross-sectional study was conducted from April to June 2016 among 736 randomly selected households with one child under five years old. A structured questionnaire was used for collecting information on sociodemographic characteristics and diarrheal occurrence. Data was analyzed using SPSS version 20. The bivariate and multivariable logistic regression analysis were used to determine the association between risk factors and diarrheal occurrence, and a p value < 0.05 was taken as statistically significant. Results. A total of 736 under-five children and their respondents were enrolled during the study period. Almost all respondents were biological mothers 96.4% (709/736), married 94.2% (693/736), and house wives 86% (632/736). The overall prevalence of diarrheal disease among under-five children was 22.1% (163/743). Of these, children with age group of less than one year old, 7.7 % (57/736), were commonly infected with diarrheal diseases. Children less than or equal to one year [AOR=1.82, 95% CI= (1.39, 4.63)], guardians [AOR=4.37, 95% CI= (1.73, 11.1)], and children with no breast feeding practice [AOR=3.13, 95% CI= (1.62, 6.03)] were the major risk factors for the occurrence of diarrhea. Conclusion. Childhood diarrhea remains an important health concern in the study area. Occurrence of diarrhea was statistically associated with child age less than or equal to one year, educational status of mother/guardians, and breast feeding. To minimize the magnitude childhood diarrhea, various designing and implementing strategies, such as health education, child care, breast feeding, and weaning practice, integrated with the existing national health extension are quite essential.Atalay Getachew, Tadesse Guadu, Alebachew Tadie, Zemichael Gizaw, Mulat Gebrehiwot, Daniel Haile Cherkos, Martha Alemayehu Menberu, and Teklay Gebrecherko

Birthweight data completeness and quality in population-based surveys: EN-INDEPTH study.

BACKGROUND: Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight. RESULTS: Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02-0.03), neonatal deaths (aOR 0.19(95%CI 0.16-0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33-0.58), aOR 0.30(95%CI 0.22-0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37-19.55) and Dabat (aOR 14.25(95%CI 10.13-20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11-3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight. CONCLUSIONS: Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality

People who once had 40 cattle are left only with fences: Coping with persistent drought in Awash, Ethiopia

How to support those responding to environmental change in resource-constrained environments is central to literature on climate change adaption. Our research explores a gap in this literature relating to the negotiation of intra-household relations and resource access across different types of household in contexts of social and environmental transition. Using the example of the semi-arid Awash region in North-Eastern Ethiopia, which has experienced drought and alien plant invasion over the past decade, we explore how men and women use changes in household structures and relationships to adapt more effectively. We draw evidence from life histories with 35 pastoralists across three rural, peri-urban and urban communities. Using Dorward et al’s taxonomy, we find Afar people are not only ‘stepping up’, but also ‘stepping out’: shifting from pastoralism into agriculture and salaried employment. As this often involves splitting households across multiple locations, we look at how these reconfigured households support pastoralists’ wellbeing

Foodborne disease hazards and burden in Ethiopia: A systematic literature review, 1990–2019

Objective(s): To summarize literature on foodborne hazards and their associated burden in Ethiopia, identify research gaps and intervention targets. Materials and methods: A systematic literature review was performed according to Cochrane and PRISMA guidelines. Searches were performed on PubMed and CAB Direct for relevant publications between 1990 and 2019 (inclusive). Observational studies, secondary data analyses, reviews and grey literature were included. Titles and abstracts were screened, and selected publications reviewed in full for quality and data extraction. A metanalysis was not conducted as studies were varied in focus with few similar studies estimating the same parameter. Results: In total 142 articles met the inclusion criteria. Most studies focused on identification and prevalence of biological and chemical hazards in food. High levels of microbial contamination in different food value chains were often found by the typically small, ad hoc, observational studies. Dairy products, beef, poultry, and eggs were the most commonly studied food products. Raw beef and raw milk were the products reporting higher levels of pathogen contamination. Presence of Listeria monocytogenes, a serious but often overlooked foodborne pathogen, was reported in various foods. Several important value chains were less frequently studied including vegetables, fruits, crops, fish, sheep, goats, and camel. There were few reports of incidence of human FBD or resulting health and economic impacts. High levels of bacterial contamination on the hands of food processors were widely reported. Foodborne parasites were often found at higher prevalences in food than bacterial and viral pathogens, possibly due to differences in ease of identification. Conclusion: There are fundamental gaps in the knowledge of food hazards in Ethiopia, particularly regarding FBD incidence and impact. Furthermore, important value chains and pathogens have been neglected. Greater investment in food safety is needed, with enhanced and coordinated research

Foodborne disease hazards and burden in Ethiopia: A systematic literature review, 1990–2019

Background: Foodborne disease (FBD) affects millions of people each year, posing a health burden similar to malaria, tuberculosis or HIV. A recent World Bank study estimated the productivity losses alone attributed to unsafe food within Africa at $20 billion in 2016, and the cost of treating these illnesses at an additional$3.5 billion. Ethiopia faces multiple food safety challenges due to lack of infrastructure and basic pre-requisites for food safety such as clean water and environment, washing facilities, compounded by limited implementation of food safety regulations, and a lack of incentives for producers to improve food safety. A consolidation of our understanding and evidence of the source, nature and scale of FBD in Ethiopia is needed to inform policy and future research. We performed a Systematic Literature Review (SLR) of publications on FBD occurrence in Ethiopia including hazard presence and impact. Method: The SLR followed Cochrane and PRISMA guidelines. We searched PubMed and CAB-Direct for relevant publications between 1990 and 2019 (inclusive). Observational studies and reviews were included. Two reviewers screened titles and abstracts, and retained publications were reviewed in full for quality and data extraction. Result: In total 128 articles met the inclusion criteria. Most articles focused on the identification of biological hazards in food. High levels of microbial contamination in different food value chains were often found in the small, ad hoc, observational studies that dominated the literature. Raw milk (22/128, 17.0%) and raw beef (21/128, 16.4%) were the most studied food products. Foodborne (FB) parasites were often found at higher rates in food than bacterial and viral pathogens, possibly due to differences in ease of identification. High levels of bacterial contamination on the hands of food handlers were widely reported. There were no reports on the incidence of human FBDs or resulting health and economic impacts. Conclusion: Our findings reflect existing concerns around food safety in Ethiopia. A lack of substantial, coordinated studies with robust methodologies means fundamental gaps remain in our knowledge of FBD in Ethiopia, particularly regarding FBD burden and impact. Greater investment in food safety is needed, with enhanced and coordinated research and interventions

Foodborne hazards in food in Burkina Faso, 1990–2019: A systematic review and meta-analysis

Background: Foodborne diseases impose substantial public health burden and jeopardize socio-economic development worldwide. While accurate information on foodborne hazards is needed for informed decision in food safety interventions, such information is scarce in developing countries such as Burkina Faso. We conducted a systematic review and meta-analysis of studies reporting foodborne hazards in foods in Burkina Faso to describe the present knowledge of the situation. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to conduct this review. Abstracts were searched in PubMed and CAB direct between 1 January 1990 to 30 September 2019. We used random-effects models to estimate pooled prevalence and I2 values to measure heterogeneity between studies. Results: 188 articles were identified, of which 14 are included in this review: 12 were on bacterial hazards (Salmonella, Campylobacter, Staphylococcus, E. coli, Shigella), three on fungal hazards and one on parasitic hazards (Toxoplasma gondii). The overall pooled prevalence of Salmonella spp. was 13% (95% CI: 8–21), the highest in lettuce: 50% (95% CI: 30–70) and the lowest in milk: 1.2% (95% CI: 0–5), demonstrating substantial variation among the studies (I2 = 85, 95% CI: 79–90%, p < 0.01). Campylobacter spp. was reported in chicken carcass, with 50% of the samples being positive. The overall pooled microbial load of Staphylococcus in the studied food samples was 3.2 log (95% CI: 2.8–3.6) CFU per g or ml of food, the highest in poultry samples: 4.5 log (95% CI: 2.8–6.2) CFU per g or ml of food. The overall pooled prevalence of Escherichia coli (E. coli) was 40% (95% CI: 29–51), the highest in beef intestines: 62% (95% CI: 22–91) and the lowest in dairy products: 31% (95% CI: 17–50), showing substantial variation across the studies (I2 = 86, 95% CI: 80–90%, p < 0.01). Conclusion: Our results showed widespread contamination of foods with foodborne hazards across various food value chains indicating poor hygienic handling of foods, raising consumers’ health risk due to foodborne illnesses from the foods. We recommend promotion of awareness creation in food safety and improved monitoring of hazards in food

Consumers do care! Incentivizing food safety through a market-based pull–push approach

Background: Informal markets are vital to food and job security across many low- and middle-income countries (LMIC). There is emerging data on microbiological food safety hazards and risks along food supply chains that allow targeting mitigation options. Efforts include training in better practices and technologies, but these have mostly targeted production, neglecting the market-based processing and retail level, where much cross-contamination occurs, exposing the final consumer to risk. Poor practices are largely due to a lack of knowledge and appropriate technology but also lack of incentives to change poor practices. Previous studies have shown that even poor consumers do care about the safety of their food but have no alternatives in the market or little power to demand for safer food. Objectives: This four-year project (2019 to 2022) investigates if consumer demand can provide the same incentive or "pull approach" for microbiological food safety in LMIC as it has done in high-income countries. It also builds capacity of value chain actors to respond to demand and of regulators to provide an enabling environment (the “push approach”). At the same time, it strengthens food safety capacity at national level through generating evidence on the national burden of foodborne diseases and selected hazards and risks in chicken meat and vegetables. Methods: The project is organized in seven technical work packages: 1) Estimating burden and cost of key foodborne illnesses in Burkina Faso and Ethiopia; 2) Understanding the poultry and vegetable value chains in urban markets in Burkina Faso and Ethiopia; 3) Quantitative microbial risk assessment and cost-effectiveness analysis of candidate market-based interventions; 4) Build capacity and motivation of regulators to manage food safety (intervention 1, push approach); 5) Empower market-level value chain actors to manage food safety (intervention 2, push approach); 6) Design and implementation of a consumer campaign (intervention 3, pull approach); 7) conduct an impact assessment of the push-pull intervention. Expected results: Investments that improve public health are considered highly rewarding. With this project we aim to achieve measurably safer food, credentialed capacity in regulators and value chain actors, improvements in knowledge and practice among value chain actors, and improvements in food safety awareness and practices among consumers