Seasonality and determinants of child growth velocity and growth deficit in rural southwest Ethiopia

Background: Ethiopia faces cyclic food insecurity that alternates between pre- and post-harvest seasons. Whether seasonal variation in access to food is associated with child growth has not been assessed empirically. Understanding seasonality of child growth velocity and growth deficit helps to improve efforts to track population interventions against malnutrition. The aim of this study was assess child growth velocity, growth deficit, and their determinants in rural southwest Ethiopia. Method: Data were obtained from four rounds of a longitudinal household survey conducted in ten districts in Oromiya Region and Southern Nations, Nationality and Peoples Region of Ethiopia, in which 1200 households were selected using multi-stage cluster sampling. Households with a child under 5 years were included in the present analyses (round 1 n = 579, round 2 n = 674, round 3 n = 674 and round 4 n = 680). The hierarchical nature of the data was taken into account during the statistical analyses by fitting a linear mixed effects model. A restricted maximum likelihood estimation method was employed in the analyses. Result: Compared to the post-harvest season, a higher length and weight velocity were observed in pre-harvest season with an average difference of 6.4 cm/year and 0.6 kg/year compared to the post-harvest season. The mean height of children in post-harvest seasons was 5.7 cm below the WHO median reference height. The mean height of children increased an additional 3.3 cm [95% CI (2.94, 3.73)] per year in pre-harvest season compared to the post-harvest season. Similarly, the mean weight of children increased 1.0 kg [95% CI (0.91, 1.11)] per year more in the pre-harvest season compared to the post-harvest season. Children who had a low dietary diversity and were born during the lean season in both seasons had a higher linear growth deficit. Being member of a highly food insecure household was negatively associated with higher weight gain. Having experienced no illness during the previous 2 weeks was positively associated with linear growth and weight gain. Conclusion: Child growth velocities and child growth deficits were higher in the pre-harvest season and post-harvest season respectively. Low dietary diversity and being part of a highly food insecure household were significantly risk factors for decreased linear growth and weight gain respectively

Parents' Perception, Students' and Teachers' attitude towards School Sex Education

Background: Sex education is described as education about human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, family planning, body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods. This study was conducted to explore perception of parents about school sex education and assess the attitude of teachers and students towards school sex education.Methods: A cross-sectional quantitative and qualitative study was conducted on randomly selected 386 students, total census of 94 teachers and 10 parents in Merawi Town from March 13-27, 2011. Data were collected using self-administered structured questionnaire and in-depth interview guideline. Multiple linear regression analysis was performed using total score to determine the effect of the independent variables on the outcome variable and thematic analysis was used to analyze the qualitative data.Results: All study participants have favourable attitude towards the importance of school sex education. They also agreed that the content of school sex education should include abstinence-only and abstinence-plus based on mental maturity of the students. That means at early age (Primary school) the content of school sex education should be abstinence-only and at later age (secondary school) the content of school sex education should be added abstinence-plus. The students and the teachers said that the minimum and maximum introduction time for school sex education is 5 year and 25 year with mean of 10.97(SD±4.3) and 12.36(SD±3.7) respectively. Teacher teaching experiences and field of studies have supportive idea about the starting of school sex education. Watching romantic movies, reading romantic materials and listening romantic radio programs appear to have a contribution on the predictor of students’ attitude towards the starting time of school sex education.Conclusion: All study participants have a need to start sex education at school. All study participants said that at early age (Primary school) the content of school sex education is abstinence-only and at later age (secondary school) is added abstinence-plus. School Sex education should be under considers the need of students, teachers and parents.Keywords: Sex education, Attitude, perceptionEthiop J Health Sci. Vol. 22, No. 2 July 201

Concordance of poor child feeding and preventive behavior and its predictors in southwest rural Ethiopia

Background: Inappropriate child feeding and caring practices are a major cause of malnutrition. To date, no studies have examined concordance and discordance of child feeding and preventive behavior and their predictors in developing countries. Methods: We used baseline data generated from A 2-year-longitudinal agriculture-nutrition panel survey conducted from February 9 to April 9, 2014, in nine districts encompassing 20 randomly selected counties in Oromiya Region and Southern Nation, Nationality and Peoples Region in Ethiopia. Households were recruited using the Expanded Program on Immunization sampling method. A total of 623 children under the age of 5 years and their respective caregivers were included in the analyses. Generalized estimating equations were used to account for clustered observations. Results: Concordance of poor child feeding and preventive behavior was observed in 45.1% of the children, while 45.5% of the children were suffering from discordance of poor child feeding and preventive behavior. Concordance and discordance of poor child feeding and preventive behavior had almost different predictors. Concordance of poor child feeding and preventive behavior was significantly associated with the age of the caretaker of >= 40 years (odds ratio (OR) = 2.14; 95% confidence interval (CI): 1.04, 4.41), low household dietary diversity (OR = 3.69; 95% CI: 1.93, 7.04), medium household dietary diversity (OR = 2.17; 95% CI: 1.17, 4.00), severe household food insecurity (OR = 1.72; 95% CI: 1.01, 2.93), and increase with increasing child age. Conclusion: A substantial number of children in the southwest of rural Ethiopia are exposed to both poor child feeding and preventive behavior. Low household dietary diversity and extreme food insecurity household were predictors of concordance of poor child feeding and poor preventive behavior and provide useful entry points for comprehensive interventions to address child feeding and caring in the area

Predictors of regular physical activity among Type 2 diabetes mellitus patients in Wolaita Sodo University teaching hospital using the Trans-Theoretical Model

Background: Globally, 382 million people are estimated to have diabetes. To date there is paucity of evidence regarding predictor of regular physical activity among Type 2 diabetes mellitus patients with application of Trans-theoretical model. Therefore the objective of this study was to determine predictors of regular physical activity among type 2 diabetes mellitus patients in Wolaita Sodo University hospital using the Trans- theoretical model. Method: Institutional based cross-sectional study was conducted on 400 systematic random selected Type 2 diabetes mellitus patients. One-way ANOVA was used to show mean scores differences of processes of change, decisional balance and self-efficacy across stages of change. Multivariable logistic regressions were also conducted.Result: Of the participants, 34.3% were physically active. The processes of change, the pros and the self-efficacy significantly increased from precontemplation to maintenance stage while the cons decreased across the stages (p<0.05). The result of multivariable logistic regression showed that pros, cons, self-efficacy, self-liberation and counter conditioning were predictors of physical activity.Conclusion: Type 2 diabetes mellitus patients’ physical activity was very low. Stage matched intervention should be designed to increase processes of change, pros and self-efficacy from precontemplation to maintenance stages. [Ethiop. J. Health Dev. 2018;32(2):97-103]Key words: Physical activity, Type 2 diabetes mellitus, Transtheoretical mode

Barriers and facilitators of ART adherence in Hawassa town, Southern Ethiopia: A grounded theory approach

Background: Antiretroviral therapy (ART) has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis and improve quality of life. Patient’s adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients’ adherence to ART and improve the service. This study aims to explore patients’ and health care professionals’ views about factors that facilitate and hinder adherence to ART among adult HIV patients.Methods: A qualitative grounded theory study using non-participant observation; and in-depth interview with 23 ART users and 5 health professionals were carried out at two health facilities that serve a large number of HIVpositive individuals in Hawassa town, Southern Ethiopia. The study was conducted from February to April 2014. Simultaneous data collection and analysis was conducted and taped Notes were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. To manage the overall coding process, Atlas.ti (v.7) software was used.Results: The commonest barriers to adherence-included poverty, substance misuse, forgetfulness and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers.Conclusion: The study revealed a range of barriers to adherence including individual, medical, environmental and economic related factors. The findings from our study can be used to inform the development of effective interventions that address the barriers and facilitators of ART adherence in Ethiopia. Priority should be given to improving adherence by alleviating financial constraints to ART adherence, better access to treatment services, education and counseling to tackle culture related obstacles, stigma and discrimination. [Ethiop. J. Health Dev. 2016;30(2):66-77]Keywords: Grounded theory, ART, HIV/AIDS, qualitative researc

Research priorities for nutrition of school-aged children and adolescents in low- and middle-income countries.

PURPOSE: A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities. METHODS: Using the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years. RESULTS: Between 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across 38 countries, with the largest proportion focusing on work in East and Southern Africa. Of the research questions ranked in the top ten, half focused on delivery strategies for reaching adolescents and half on improving existing interventions. There were few differences in the ranked order of questions between age groups but those related to in-school children and adolescents had higher expert agreement than those for out-of-school adolescents. The top ranked research question focused on tailoring antenatal and postnatal care for pregnant adolescent girls. CONCLUSION: Nutrition programmes should incorporate implementation research to inform delivery of effective interventions to this age group, starting in schools. Academic research on the development and tailoring of existing nutrition interventions is also needed; specifically, on how to package multisectoral programmes and how to better reach vulnerable and underserved sub- groups, including those out of school

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.info:eu-repo/semantics/publishedVersio