Effectiveness of the women’s development team leaders in delivering nutrition education on pulse sprouting in Southern Ethiopia

Effectively implemented nutrition education can provide participants with the knowledge and skills to make healthy food choices in the context of their lifestyles and economic resources. In Ethiopia, the government equips health extension workers (HEWs) to provide nutrition education to communities by enabling HEWs to transfer knowledge to women’s development team leaders (WDTLs) who in turn share the knowledge with the one-to-five network leaders (1-5NWL) and members. The objective of this study was to examine the effectiveness of WDTLs in delivering nutrition education to women as the intervention group (IG). This was compared to having trained HEWs educate women directly (the positive control group, PCG), and having women receive no specific education (negative control group, NCG). A cluster randomized trial design was used. Three kebeles (villages of 5000 people) were purposively selected from which the WDTLs were randomly selected and their respective 1-5NWL and members were participants. Nutrition education to teach pulse sprouting was provided every other week for 6 months to intervention and positive control groups. Focus group discussions and demonstrations were held to reinforce knowledge and skills. Knowledge, attitude and practice (KAP) of the women were evaluated pre and post-intervention. At baseline all three groups had similar low scores in KAP. After the education intervention, knowledge improved in IG compared to PCG (p=0.009), and both were greater than NCG (p=0.001). Attitude in IG improved more in PCG (p=0.008) and both increased compared to NCG (p=0.001). Practices improved, similarly, in IG and PCG (p=0.084) after intervention, and both were better than NCG (p=0.001). From this study, we conclude that nutrition education delivered through WDTLs, as is intended in communities in Ethiopia having HEWs, was more effective than delivery by HEWs alone. Nutrition education on pulse sprouting has the potential to bring positive changes on KAP of rural women who depend on this processing skill to provide nutritious foods for their families

Formulation of complementary food using amaranth, chickpea and maize improves iron, calcium and zinc content

Malnutrition is the cause of the majority of deaths in children under five years old in Ethiopia. Micronutrient deficiencies such as iron, zinc and calcium, often seen in malnourished children, are major public health problems throughout Ethiopia. These deficiencies have negative consequences on the cognitive and physical development of children, and on work productivity of adults. There is, therefore, a need for sustainable methods to address iron inadequacy in complementary feeding. Animal products are a good source of iron, zinc and calcium, but due to their high costs, their consumption by most children in Ethiopia has declined. The grain amaranth grows wild in areas of Ethiopia but is considered a weed. This study, conducted in rural Ethiopia, was initiated to prepare nutrient-rich complementary food using recipes that substituted the usual maize gruel with porridge made from amaranth and chickpea flours. Using a laboratory based experimental study design, four porridges suitable for complementary feeding, with different proportions of amaranth grains, maize and chickpeas were formulated in triplicate and analyzed in triplicate for minerals including iron, and phytate levels. Mother-child pairs were recruited for acceptability testing, at the community level. Results showed adding amaranth improved the content of iron and other nutrients as compared to control porridge (100% maize) and decreased phytate levels. The lowest phytate to iron ratio (0.24) was observed in the 70% amaranth and 30% chickpea blend, and the lowest viscosity measure was also observed in this same formulation. Soaking amaranth seeds in warm (50oC) water then germinating in lemon juice-containing water at 32oC for 72 hours resulted in the lowest phytate levels. In sensory testing, all of the formulated porridges with different proportions of amaranth flour were acceptable to mothers and their children, although the red color was disliked by mothers and their children. Flavor preference was not altered; however, overall acceptability was reduced with increasing amounts of amaranth. The study indicated that a processed 70% amaranth and 30% chickpea product can be used to produce low-cost, nutrient-rich complementary food with moderate acceptability. Increased nutritional awareness, production and consumption of grain amaranth products may be the way to address mineral deficiencies including iron, in the study area.Keywords: Micronutrients, Phytates, Complementary feeding, Amaranth grain, Chickpea, Ethiopia, Iron, Zinc

Respectful maternity care in Ethiopian public health facilities

Background: Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. Methods: This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers' RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicators, mean score of providers' RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics. Results: Women on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals). Higher likelihood of performing high level of RMC was found among male vs. female providers ((beta) over cap = 0: 65, p = 0.012), midwives vs. other cadres ((beta) over cap = 0: 88, p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R (c)) ((beta) over cap = 1: 31, p = 0.003), and among laboring women accompanied by a companion (beta) over cap = 0: 99, p = 0.003). No factor was associated with observed mistreatment of women. Conclusion: Quality improvement using SBM-R (c) and having a companion during labor and delivery were associated with RMC. Policy makers need to consider the role of quality improvement approaches and accommodating companions in promoting RMC. More research is needed to identify the reason for superior RMC performance of male providers over female providers and midwives compared to other professional cadre, as are longitudinal studies of quality improvement on RMC and mistreatment of women during labor and childbirth services in public health facilities

Formulation of a complementary food fortified with broad beans (Vicia faba) in Southern Ethiopia

The formulation of a broad bean-containing porridge produced a higher protein food with acceptable sensory characteristics when compared to the customary cereal-based porridge of the Titecha kebele region of Ethiopia. Participant children and mothers preferred the taste of the 10% broad bean porridge. This study demonstrated successful use of locally-available and affordable foods to enhance nutritional quality of complementary foods. Most mothers were preparing food in the form of a low protein cereal-based gruel, and although grown in the area, broad beans with higher protein content than cereal grains were not widely consumed

Formulation Of A Complementary Food Fortified With Broad Beans (Vicia Faba ) In Southern Ethiopia

Adequate nutrient intake, especially of protein and micronutrients, enhances growth of children and decreases susceptibility to disease. Major contributing factors to malnutrition among infants and children are low purchasing power of the family resulting in poor quality foods. A cross-sectional and laboratory-based study was conducted at Titecha Kebele in Ethiopia to assess the consumption pattern of broad bean. The work also assessed use of broad bean for complementary feeding of young children, following FAO/WHO/UNU’s recommendation of adding up to a maximum of 40% legumes to cereal-based complementary food for young children. Study participants were mother-child pairs (n=169), and children were between 6-35 months of age. Most families were in poverty with stunting, wasting, and underweight present in 22.5, 4.7, and 8.3% of study children, respectively. Questionnaires gathered information on dietary intakes, and focus group discussions were used to obtain in-depth information on the mother’s attitude and knowledge of child feeding, as well as overall consumption of broad beans. The mean dietary diversity score of children was approximately two out of a possible eight, and no child had consumed meat, fish, or vitamin A-containing fruits or vegetables the day before the study. Sixty percent of mothers did not provide bean-based food for their children, with the most frequently reported reason being lack of knowledge of its nutrient value for young children. To a typical complementary food of barley-maize porridge, 10, 20 and 30% of cereal was replaced by processed broad beans (Vicia faba ), which increased in protein content, with no meaningful change in phytate content. Sensory evaluation showed that participant children and mothers preferred the taste of the 10% broad bean porridge; however, all added broad bean porridges had similar acceptability to the barley-maize control. Thus, inclusion of processed broad bean can effectively be done to improve nutrient content and nutrient availability of traditional cereal-based complementary foods in the Titecha kebele region of Ethiopia