Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia

Introduction: The period from birth to two years of age is a "critical window" of opportunity for the promotion of optimal growth, health and behavioral development of children. Poor child feeding patterns combined with household food insecurity can lead to malnutrition which is a major public health problem in developing countries like Ethiopia. Methods: A community based cross-sectional study that involved 575 participants from rural Sidama was conducted from February to March 2011. A two-stage stratified sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics. Results: Only 14.4% of mothers fed their children optimally. Prevalence of stunting was higher for infants aged 6 to 8 months (43%) than for those in 0-5 months (26.6%) or 9-23 months (39%) category. Women who did not receive antenatal care(ANC) during pregnancy were 1.5 times more likely to practice pre-lacteal feeding and 2.8 and 1.9 times more likely to feed their children below minimum dietary diversity and minimum meal frequency, respectively (P=0.01). Mothers older than 18 years during the birth of index child were 86% less likely to feed their child below minimum meal frequency than their younger counterparts (P=0.01). Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01). Conclusion: The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ANC attendance should be strengthened through extensive use of the Health Extension Workers to reduce the level of child stunting in the study area.Pan African Medical Journal 2013; 14: 7

Condom utilization and sexual behavior of female sex workers in Northwest Ethiopia: A cross-sectional study

Introduction: Sexually transmitted infections are among the most important public health problems in the world. People who indulge in unsafe sex, such as female sex workers are the most at risk population groups due to multiple sexual partners and inconsistent condom use. The aim of this study was to assess condom utilization and sexual behavior of female sex workers in Gondar town, Northwest Ethiopia. Methods: A quantitative cross-sectional study triangulated with qualitative method was conducted from March 20 - April 10, 2014 in Gondar town. The quantitative data were collected through interviewing 488 female sex workers while in-depth interview was administered to collect qualitative data from 10 female sex workers. The collected data were entered into EPI-INFO version 3.5.3 and exported to SPSS version 20.0 software for analysis. Logistic regression analysis was done to determine the association between condom utilization and independent variables. Results: This study revealed that less than half (47.7%) of the respondents utilized condom with any type of client. Secondary education or above, perceiving themselves at risk of HIV/AIDS infection, having awareness that sexually transmitted infections could increase HIV infection, being tested for HIV/AIDS in the last 12 months, and having lower number of clients in a month were positively associated with condom utilization. Conclusion: This finding depicted that condom utilization was low among female sex workers. Thus, developing and implementing target oriented behavioral change and communication strategies are needed to prevent the risk of acquiring HIV/AIDS and other sexually transmitted infections in female sex workers.Keywords: Female sex worker, Condom utilization, AIDS, STIs, Ethiopi

Food-based dietary guidelines as a gamechanger in Ethiopia’s food system transformation pathway

In this brief, we reflect on the factors that contributed to the Food Based Dietary Guidelines (FBDGs) receiving high level recognition in key Ethiopian policy documents. FBDGs, launched in 2022, have been recognized as a key gamechanger in the effort to improve the Ethiopia food systems

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

Longitudinal profile of antibody response to SARS-CoV-2 in patients with COVID-19 in a setting from Sub-Saharan Africa: A prospective longitudinal study.

BACKGROUND Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. METHODS In this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics. RESULTS Serological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9-15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6-11) vs. 15 (IQR: 13-21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up. CONCLUSIONS Longitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research

Linear growth failure of Ethiopian children : The role of protein, zinc and mycotoxin intake

Linear growth failure manifested as stunting is a major public health problem in developing countries. Stunting is often considered as an important marker of an adverse quality of population’s life and child development. Over 90% of stunted children live in 10 developing countries, in Asia and Africa. Ethiopia is the country with the high burden of linear growth failure. In 2016, it was estimated that about 5 million children suffered from poor linear growth or stunting in Ethiopia. The prevalence of stunting in Ethiopia has been reduced from 52% in 2000 to 37% in 2019, however, the number of stunted children has increased by about 1 million in the same period. There is a high level of commitment to reducing stunting globally and nationally. Although the government of Ethiopia formulated ambitious goals to reduce stunting, the progress to reduce stunting in Ethiopia remains too slow partly due to the fact that the aetiology of linear growth failure is still poorly understood. Stunting or poor linear growth is caused by a diverse and complex interaction of household, environmental, socioeconomic and cultural influences, related to, amongst others, poor nutrition, infectious diseases, unfavorable prenatal conditions and genetic disorders. The aim of this thesis was to contribute to the understanding of the aetiology of poor linear growth and stunting in rural Ethiopia by studying the effect of household-level quality protein maize (QPM) promotion and consumption, and the role of protein, zinc, and mycotoxins intake on linear growth of Ethiopian children. The first chapter provides background information on the role of QPM, protein, and zinc (in soil and serum) in linear growth of children. Furthermore, the research questions were described in detail. Chapter 2 describes a randomized controlled trial conducted in real practice in which households make their own decisions whether to adopt QPM, how much to adopt and cultivate, and whether and how to incorporate QPM into children’s diets. The intervention had two components: a) nutrition-focused adoption encouragement and provision of free QPM seed (AE), and b) a consumption encouragement (CE) primarily targeting female caregivers and encouraging earmarking and integration of QPM into diets for infants and young children. Eligible children (n=873) aged 6-35 months at baseline were randomly assigned to 3 groups: a first intervention group receiving AE only; a second intervention group receiving both AE and CE; and a control group. We hypothesized that promotion and consumption of QPM could improve the protein and amino acids status, which could, in turn, improve linear growth of children. Children consumed QPM based foods on average 4 days per week, while non-QPM based foods were consumed mostly. In addition, the quantitative intake of QPM was low (27 gram per day) contributing to only 5% of their total protein, 12% of lysine and 15% of tryptophan intakes, compared with conventional maize (80 gram per day) contributing to 16%, 9%, 13% of protein, lysine and tryptophan intakes respectively. Encouragement to adopt and feed QPM to infants and young children in a real-life setting had no effect on children’s protein biomarkers (p=0.19) or linear growth (p=0.17). Further evaluation of multi-year interventions is needed to understand how biofortified crops promoted at scale could change behavior and increase intakes at the household level which in turn improve biomarkers and outcomes in target populations. In chapter 3, we performed a cross-sectional analysis using baseline data of the QPM intervention study conducted in chapter 2. We investigated the association between protein intake, and protein and amino acids status with linear growth of children. The results indicated that protein intake (b=0.01, p=0.01) and protein status (b=2.58, p=0.04) as well as tryptophan intake/status (p<0.05) were positively associated with linear growth of children. Furthermore, most children had low energy intake (76%) coupled with high intestinal parasites (48%) and inflammation (35%). Also, protein and amino acids status were negatively correlated with inflammation, which suggests that the current requirement of protein and amino acids may not be adequate for children with low food intake or low energy intake and infection in Ethiopia. Linear growth failure in Ethiopian children is likely associated with low-quality protein intake and inadequate energy intake. Nutrition programs that emphasize improved protein quantity and quality and energy intake may enhance linear growth of young children. In chapter 4, we assessed exposure to aflatoxins and fumonisins measured in serum in two seasons, post-harvest and pre-harvest, and we also assessed mechanisms through which linear growth of children was affected. Children (n=873) 6-35 months old were enrolled in an intervention trial on quality protein maize consumption in rural Ethiopia as described in chapter 2. These children were stratified by baseline stunting status, and 102 children (50 stunted and 52 non-stunted) were randomly selected for this sub-study. Blood samples were collected during pre-harvest (August-September 2015) and post-harvest (February 2016) season. In the pre-harvest season, the proportions of children exposed to AFG1 (8%), AFG2 (33%) and AFM1 (7%) were higher than in the post-harvest season (4%, 28% and 4%, respectively). Likewise, the proportion of children exposed to any aflatoxin was higher in the pre-harvest than in the post-harvest season (51% vs. 41%). Exposure to fumonisins ranged from 0-11%, depending on the type of fumonisins. Exposure to any aflatoxin was not associated with inflammation (p>0.05), serum transthyretin (p >0.05) or serum IGF-1 (p >0.05), nor with linear growth (p >0.05) after adjusting for potential confounders. Our study revealed that exposure to most aflatoxins was high in pre-harvest season. Good practices in both post-harvest (to reduce accumulation of aflatoxins) and pre-harvest (to reduce aflatoxin levels) are needed for preventing contamination of aflatoxin. The mechanism in which aflatoxin affects linear growth of children is not clear. Aflatoxins are carcinogenic properties and the current exposure is a major public health problem that warrants intervention. Future studies on mechanisms between aflatoxin exposure and linear growth and sources of exposure with large sample size needed. In addition, future research is also needed on the complex and interacting pathophysiology of multiple mycotoxins and exposure management. In chapter 5, we use data from the cross-sectional, nationally representative Ethiopian National Micronutrient Survey (n=1776), which provided anthropometric and serum zinc (n=1171) data on children aged 6–59 months. Data on soil zinc levels were extracted for each child from the Africa Soil Information Service. With these data, we assessed the geographic distribution of poor soil zinc, poor zinc status and growth faltering at the national level. Zinc deficiency in soil was prevalent (20%) at the national level, with a higher prevalence in low land of Ethiopia (87%). Nationally, one in four children was zinc deficient, as measured by serum zinc level. High zinc in agricultural soils was positively associated with zinc status (b=0.9, p=0.02), however, linear growth of children was not associated with soil zinc or serum zinc. The findings from our study suggest that agricultural biofortification of zinc could be an alternative strategy for reducing zinc deficiency in developing countries. In Ethiopia most households consume food that comes from own production, however, crop production on zinc-deficient soils and its effect on human health has not yet been studied. Therefore, a future longitudinal experimental study on the effects of soil zinc application on crop zinc content and human serum zinc levels will help to elucidate this relationship. The phytate content of foods may affect zinc bioavailability. Future research is also needed on the effect of phytate on zinc bioavailability of crops grown on zinc-deficient soils. Finally, chapter 6 discusses the main findings, and the internal and external validity of the studies addressed in this thesis. Furthermore, the public health perspective including recommendations for possible future research is presented. Overall, we can conclude that low protein (of low quality) intake, high prevalence of zinc deficiency and high exposure to multiple aflatoxins are public health problems in Ethiopia. Linear growth of children is positively associated with protein intake, energy intake, as well as protein status, but not with zinc soil levels, zinc status or multiple aflatoxin exposure. Our study has demonstrated that the implementation of QPM in real life had no effect on the protein and amino acids status nor on linear growth of children. Therefore, in our study and also in other nutrition intervention programs, measuring intermediate indicators as outcomes of improved linear growth may be a more feasible approach than measuring linear growth or stunting

Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. Pan Afr Med J. 2013;14:75. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review

Abstract Introduction: The period from birth to two years of age is a "critical window" of opportunity for the promotion of optimal growth, health and behavioral development of children. Poor child feeding patterns combined with household food insecurity can lead to malnutrition which is a major public health problem in developing countries like Ethiopia. Methods: A community based cross-sectional study that involved 575 participants from rural Sidama was conducted from February to March 2011. A two-stage stratified sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics. Results: Only 14.4% of mothers fed their children optimally. Prevalence of stunting was higher for infants aged 6 to 8 months (43%) than for those in 0-5 months (26.6%) or 9-23 months (39%) category. Women who did not receive antenatal care(ANC) during pregnancy were 1.5 times more likely to practice pre-lacteal feeding and 2.8 and 1.9 times more likely to feed their children below minimum dietary diversity and minimum meal frequency, respectively (P=0.01). Mothers older than 18 years during the birth of index child were 86% less likely to feed their child below minimum meal frequency than their younger counterparts (P=0.01). Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01). Conclusion: The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ANC attendance should be strengthened through extensive use of the Health Extension Workers to reduce the level of child stunting in the study area

Quality of Community Based Nutrition of Integrated Refresher Training Provided for Health Extension Workers

Improving nutrition contributes to productivity, economic development, and poverty reduction by getting better cognitive development, school performance, physical work capacity, and maintaining health status by reducing morbidity and mortality. Poor nutrition perpetuate the cycle of poverty. Community-Based Nutrition (CBN) is an important component of the National Nutrition Program, designed to build upon the Health Extension Program packages to improve nutritional status of under-five children and pregnant and lactating women. As part of this program shift, CBN training modules have been shortened and incorporated into the Integrated Refresher Training (IRT). The nutrition components of Integrated Refresher Training have not been assessed so far. This study aims to assess the quality of CBN component of integrated refresher training, stakeholder perceptions on the quality of training and change in the knowledge of HEWs. Institutional based cross-sectional study with both qualitative and quantitative data collection methods was used. Four Woredas were chosen purposively from a listing of all woredas receiving IRT module II in Amhara region from June-July 2012. Many MTs and trainees mentioned difficulty of delivering the training as designed due to shortage of time allocated. This was also observed in IRT session

Development and characterization of bread from wheat, banana (Musa spp), and orange-fleshed sweet potato (Ipomoea batatas L.) composite flour

AbstractMalnutrition is a major challenge in Ethiopia. On the other hand, there is high production of banana and orange-fleshed sweet potatoes in the northern part of Ethiopia. However, it is exposed to postharvest loss without value addition to them. This study aimed to characterize bread developed from wheat, banana, and orange-fleshed sweet potato composite flour. The bread was developed with different proportions of wheat, banana, and orange-fleshed sweet potato flour in the ratio of 100:0:0, 90:5:5, 80:10:10, 70:15:15, and 60:20:20, respectively. The value of moisture%, ash%, crude fiber%, crude fat%, and β-carotene µg/100 g was in the range of 7.92–11.23, 1.76–3.66, 1.99–6.43, 1.13–3.20, and 0.13–73.51, respectively, whereas the content of crude protein and carbohydrate and caloric values were in the range of 8.08–11.02%, 67.36–76.27%, and 330.56–359.33 kcal/100 g, respectively. According to the sensory scores, bread composite flour containing (60:20:20) wheat, banana, and orange-fleshed sweet potato was preferred. Based on the result of this finding, it is better to produce bread from wheat, banana, and orange-fleshed sweet potato composite flour than usual wheat flour bread. The results showed that the incorporation of banana and orange-fleshed sweet potato powder can improve the ash and β-carotene content of bread

Efficacy of Calcium-Containing Eggshell Powder Supplementation on Urinary Fluoride and Fluorosis Symptoms in Women in the Ethiopian Rift Valley

Dietary calcium binds Fluoride (F), thus preventing excess F absorption. We aimed to assess the efficacy of supplementing calcium-containing Eggshell Powder (ESP) on F absorption using urine F excretion and on fluorosis symptoms. In total, 82 women (41 Intervention Group, IG; 41 Control Group, CG) were recruited; overall, 39 in each group completed the trial. Morning spot urine was collected before (baseline, BL) and after (endline, EL) the intervention that was 6-months daily supplementation with 2.4 g ESP (providing ~1000 mg of calcium). Dental, skeletal, and non-skeletal fluorosis assessments was carried out at BL and, except for dental, at EL. Relative risk (RR) and linear generalized estimating equation were used to compare outcomes between groups. At BL, urinary F excretion in the IG and CG groups was similar, ~10 mg/L. At EL, urinary F excretion in IG women was six-fold lower (β = −6.1 (95% CI: −7.1, −5.1)) compared to CG. The risk of developing skeletal and non-skeletal fluorosis were significantly (p < 0.001) reduced in the intervention group. A significant reduction in urinary F excretion and reduction in many fluorosis symptoms were observed among women supplemented with calcium-containing ESP, thus providing evidence for using this dietary calcium source for mitigation of fluorosis. Clinical trials registration: NCT03355222