Geospatial inequality of anaemia among children in Ethiopia

Anaemia remains a severe public health problem among children in Ethiopia and targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. An analysis was performed using Ethiopia Demographic and Health Survey 2016 data. Blood specimens for anaemia testing were collected from 9268 children aged 6-59 months. A child was considered as anaemic if the bloodhaemoglobin count was less than 11.0 g/dL. We applied Kulldorf’s spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran the local indicator of spatial association and the Getis-Ord Gi* statistics to detect and locate hotspots and multilevel multivariable analysis to identify risk factors for anaemia clustering. More than half of children aged 6-59 months (57%) were found to be anaemic in Ethiopia. We found significant geospatial inequality of anaemia among children and identified clusters (hotspots) in the eastern part of Ethiopia. The odds of anaemia among children found within the identified cluster was 1.5 times higher than children found outside the cluster. Women anaemia, stunting and high fertility were associated with anaemia clustering

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high‐impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron‐folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability

Burden of mortality from cancer among adults in Addis Ababa, Ethiopia, using verbal autopsy, 2007–2017

Background: Cancer is one of the leading causes of death; worldwide, there were 10.0 million cancer deaths in 2020. In Ethiopia, 51,865 people died from the disease in the same year. We aimed to describe the burden of cancer mortality, the socio-demographic and other characteristics of deceased adults in Addis Ababa from 2007 to 2017. Methods: This study was part of the Addis Ababa Mortality Surveillance Programme. Based on the burial-based surveillance, there were 133,170 adult deaths from 2007 to 2017. The standard verbal autopsy questionnaire was applied to collect information on the causes of death of 10% of the randomly selected deaths. Results: Cancer accounted for 11% of all deaths studied. The median age of death in years was 60 (range = 47–70). Stomach cancer was the leading cause of cancer death (131, 13.6%), followed by breast cancer (116, 12.0%) and liver cancer (101, 10.5%). Conclusion: Cancer-related deaths accounted for a significant portion of all deaths. Premature deaths accounted for majority of the deaths. Cancer deaths were most commonly caused by stomach, breast and liver cancers. Advocating for a healthy lifestyle, effective cancer screening and effective alcohol-control regulations should be tailored to the country

Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case–control study

Abstract Background Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children. Methods A case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria. Results Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children. Conclusion Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria

The relationship between screen time and overweight/obesity among adolescents in Addis Ababa, Ethiopia: 2018

Adolescents are one of the most vulnerable populations as the frequency of obesity and overweight is rising globally at the moment. The increased prevalence of overweight and obesity has drawn attention to reduced physical activity and sedentary behavior, especially screen usage. Despite this, there is little research available regarding the link between screen usage and rising overweight/obesity in Ethiopia. The study aimed to ascertain how screen time and adolescent overweight/obesity relate to one another. A school-based cross-sectional study was conducted among adolescents in Addis Ababa, Ethiopia. The sample size was calculated using the single population proportion formula, and the final sample size was 550. Data were collected using interviewer-administered questionnaires. Finally, SPSS software version 20 was used to perform descriptive statistics, bivariate analysis, and multivariable logistic regression analyses, and a p-value less than 0.05 was used to declare a statistically significant association. The study found that the mean screen time in the study population was 4.1±2.2 hrs. per day. 290 (53.7%) of adolescents spent more than 2 hours per day on screens. And the prevalence of overweight and obesity were 12.3% and 1.85%, respectively. Female sex AOR 1.90 (1.05–3.43), high socio-economic status AOR 2.86 (1.06-7.73), high screen time AOR 3.01 (1.53-5.90), eating habits while watching TV AOR 4.05 (1.83–9.03), and physical activity AOR 0.27 (0.13-0.59) were found to have a significant association with overweight/obesity. This study demonstrated a 53.7% prevalence of screen time above the recommended amount and a positive association between longer periods of screen time and overweight/obesity among adolescents in Addis Ababa. Therefore, parents and adolescents should be aware of this association and encouraged to involve their children in other forms of recreational activity

Caffeine, alcohol, khat, and tobacco use during pregnancy in Butajira, South Central Ethiopia.

BACKGROUND:The use of excessive caffeine and consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the prevalence's of the use of substances among pregnant women were not well studied in developing countries such as Ethiopia. Therefore, the study aimed to estimate the prevalence of caffeine and alcohol consumption, khat chewing, and tobacco use during pregnancy and identify key factors associated with excess caffeine consumption. METHODS:We conducted a community based cross-sectional study and used a random sampling technique to recruit 352 pregnant women. We adapted a questionnaire from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), Global Adult Tobacco Survey (GATS), and Ethiopian Demographic Health Survey 2016 for caffeine, alcohol consumption, tobacco use, and khat chewing assessment, respectively. We conducted non-consecutive two days 24-hour recall to determine the habitual intake of caffeine from caffeinated beverages and foods. Prevalence with 95% confidence interval was estimated for excess caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. We ran a multivariable binary logistic regression model to identify factors associated with excess caffeine intake. RESULTS:Almost all pregnant women (98.2%) consumed caffeine as estimated using the 2 days 24-hour average. The median daily caffeine intake was 170.5 mg and ranged from 0.00 mg to 549.8 mg per day. In addition, 17.6% (95% CI: 13.9%, 22.0%) of them had a daily caffeine consumption of 300 mg and above exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%) respectively. None of the pregnant women were active tobacco smokers. However, 23.2% (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that pregnant women in the richest wealth quintile (AOR = 3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR = 4.04; 95% CI: 1.26, 13.05) had higher odds of consuming excessive caffeine. CONCLUSIONS:The study showed a considerable magnitude of substance use among pregnant women in the study area. Given this findings, we recommend, programs and services focusing on pregnant women to consider addressing substance use

A single 24 h recall overestimates exclusive breastfeeding practices among infants aged less than six months in rural Ethiopia

Abstract Background Exclusive breastfeeding (EBF) to six months is one of the World Health Organization’s (WHOs) infant and young child feeding (IYCF) core indicators. Single 24 h recall method is currently in use to measure exclusive breastfeeding practice among children of age less than six months. This approach overestimates the prevalence of EBF, especially among small population groups. This justifies the need to look for alternative measurement techniques to have a valid estimate regardless of population characteristics. Method The study involved 422 infants of age less than six months, living in Gurage zone, Southern Ethiopia. The study was conducted from January to February 2016. Child feeding practices were measured for seven consecutive days using 24 h recall method. Recall since birth, was used to measure breastfeeding practices from birth to the day of data collection. Data on EBF obtained by using single 24 h recall were compared with seven days repeated 24 h recall method. McNemar’s test was done to assess if a significant difference existed in rates of EBF between measurement methods. Result The mean age of infants in months was 3 (SD −1.43). Exclusive breastfeeding prevalence was highest (76.7%; 95% CI 72.6, 80.8) when EBF was estimated using single 24 h recall. The prevalence of EBF based on seven repeated 24 h recall was 53.2% (95% CI: 48.3, 58.0). The estimated prevalence of EBF since birth based on retrospective data (recall since birth) was 50.2% (95% CI 45.4, 55.1). Compared to the EBF estimates obtained from seven repeated 24 h recall, single 24 h recall overestimated EBF magnitude by 23 percentage points (95% CI 19.2, 27.8). As the number of days of 24 h recall increased, a significant decrease in overestimation of EBF was observed. Conclusion A significant overestimation was observed when single 24 h recall was used to estimate prevalence of EBF compared to seven days of 24 h recall. By increasing the observation days we can significantly decrease the degree of overestimation. Recall since birth presented estimates of EBF that is close to seven repeated 24 h recall. This suggests that a week recall could be an alternative indicator to single 24 h recall

Validity of Mini Nutritional Assessment tool among an elderly population in Yeka sub-city, Addis Ababa, Ethiopia

Background: The widely used nutritional assessment tool used for the elderly includes the Mini Nutritional Assessment (MNA) and Mini Nutritional Assessment–Short Form (MNA-SF) tool. These tools have not been evaluated for their validity and reliability among the elderly population of developing countries such as Ethiopia. This study aimed to evaluate the reliability and validity of the full and short form of the Mini Nutritional Assessment tool among the elderly in Ethiopia. Method: We evaluated the reliability and validity of the tools using a community-based cross-sectional study among 506 elderly individuals. Accuracy, sensitivity, specificity and cut-off point were evaluated to determine the validity of both the full MNA and MNA-SF tool. Reliability was assessed using Cronbach’s α coefficient. The criterion-related validity of the MNA tool was evaluated by computing the correlation between the total MNA score and anthropometric measurements. The Youden index was used to determine best cut-off points of the full MNA and MNA-SF. Result: The mean MNA score was 19.9 ± 4.5. Cronbach’s α value of the full MNA tool was 0.7. The overall accuracy of the full MNA was 91% (95% CI, 87.5%–94.9%). The sensitivity and specificity of the full MNA tool using an established cut-off point was 87.9% and 89.6% respectively. Youden index analysis showed that the best cut-off point to detect the malnourished and those at risk of malnutrition using the full MNA was 16 (sensitivity 90.4% and specificity 86.8%). The reliability of the MNA-SF as measured by Cronbach’s α was 0.5. The overall accuracy of the MNA-SF was found to be 93% (95% CI, 0.90–0.96). By using the Youden index the best cut-off point for MNA-SF to detect malnutrition was 7.5 (sensitivity 85.7% and specificity 89%). Conclusion: The full MNA tool was a valid and reliable tool to identify elderly individuals who are malnourished, at risk of malnutrition and well-nourished with modulation of cut-off points. However, the short MNA tool was valid and but not reliable in this study

Concurrence of stunting and overweight/obesity among children: Evidence from Ethiopia.

BackgroundNutrition transition in many low- and middle-income countries (LMICs) has led to shift in childhood nutritional outcomes from a predominance of undernutrition to a double burden of under- and overnutrition. Yet, policies that address undernutrition often times do not include overnutrition nor do policies on overweight, obesity reflect the challenges of undernutrition. It is therefore crucial to assess the prevalence and determinants of concurrence stunting and overweight/obesity to better inform nutrition programs in Ethiopia and beyond.MethodsWe analyzed anthropometric, sociodemographic and dietary data of children under five years of age from 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 8,714 children were included in the current study. Concurrence of stunting and overweight/obesity (CSO) prevalence was estimated by basic, underlying and immediate factors. To identify factors associated with CSO, we conducted hierarchical logistic regression analyses.ResultsThe overall prevalence of CSO was 1.99% (95% CI, 1.57-2.53). The odds of CSO was significantly higher in children in agrarian region compared to their counter parts in the pastoralist region (AOR = 1.51). Other significant factors included; not having improved toilet facility (AOR = 1.94), being younger than 12 months (AOR = 4.22), not having history of infection (AOR = 1.83) and not having taken deworming tablet within the previous six months (AOR = 1.49).ConclusionOur study provided evidence on the co-existence of stunting and overweight/obesity among infants and young children in Ethiopia. Therefore, identifying children at risk of growth flattering and excess weight gain provides nutrition policies and programs in Ethiopia and beyond with an opportunity of earlier interventions through improving sanitation, dietary quality by targeting children under five years of age and those living in Agrarian regions of Ethiopia