Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia

Background: More than one-third of deaths during the first five years of life are attributed to undernutrition, which are mostly preventable through economic development and public health measures. To alleviate this problem, it is necessary to determine the nature, magnitude and determinants of undernutrition. However, there is lack of evidence in agro-pastoralist communities like Bule Hora district. Therefore, this study assessed magnitude and factors associated with undernutrition in children who are 6-59 months of age in agro-pastoral community of Bule Hora District, South Ethiopia. Methods: A community based cross-sectional study design was used to assess the magnitude and factors associated with undernutrition in children between 6-59 months. A structured questionnaire was used to collect data from 796 children paired with their mothers. Anthropometric measurements and determinant factors were collected. SPSS version 16.0 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to nutritional status of the children Statistical association was declared significant if p-value was less than 0.05. Results: Among study participants, 47.6%, 29.2% and 13.4% of them were stunted, underweight, and wasted respectively. Presence of diarrhea in the past two weeks, male sex, uneducated fathers and > 4 children ever born to a mother were significantly associated with being underweight. Presence of diarrhea in the past two weeks, male sex and pre-lacteal feeding were significantly associated with stunting. Similarly, presence of diarrhea in the past two weeks, age at complementary feed was started and not using family planning methods were associated to wasting. Conclusion: Undernutrition is very common in under-five children of Bule Hora district. Factors associated to nutritional status of children in agro-pastoralist are similar to the agrarian community. Diarrheal morbidity was associated with all forms of Protein energy malnutrition. Family planning utilization decreases the risk of stunting and underweight. Feeding practices (pre-lacteal feeding and complementary feeding practice) were also related to undernutrition. Thus, nutritional intervention program in Bule Hora district in Ethiopia should focus on these factors

Feeding practices and growth among young children during two seasons in rural Ethiopia

BACKGROUND: The use of indices of infant and young child feeding practices to predict growth has generated inconsistent results, possibly through age and seasonal confounding. The aim of this study was to evaluate the association of a dietary diversity score (DDS) and infant and child feeding index (ICFI) with growth among young children in a repeated cross-sectional and a follow-up study in two distinct seasons in rural southwest Ethiopia. METHODS: We used a repeated cross-sectional design comparing child feeding practices to nutritional status in 6–12 month old children during harvest (HS; n = 320) and pre-harvest season (PHS; n = 312). In addition, 6–12 month old children from the HS were reassessed 6 months later during PHS. In addition to child anthropometry, child feeding practices were collected using 24-h and 7-day dietary recalls. RESULTS: The mean (±SD) length-for-age z-score (LAZ) of the 6–12 month old children was −0.77 (±1.4) and −1.0 (±1.3) in HS and PHS, respectively, while the mean (±SD) of the follow-up children in PHS was −1.0 (±1.3). The median DDS (IQR) was 2.0 (1.0, 3.0.), 2.0 (2.0, 3.0) and 3.0 (2.0, 4.0) for the children in HS, PHS and the follow-up children in PHS, respectively. The DDS in HS was positively associated with LAZ at follow-up (β = 0.16; 95% CI: 0.01, 0.30; P = 0.03) after controlling for confounding factors. ICFI and DDS were not associated with mean LAZ, weight-for-height z-score and weight-for-age z-score within season. However, the odds of being stunted when having a DDS ≤ 2 was 2.3 times (95% CI: 1.10, 4.78; P = 0.03) higher compared to a DDS > 2 child in HS and 1.7 times (95% CI: 1.04, 2.71; P = 0.04) higher for the pooled sample of 6–12 months old children in HS and PHS. CONCLUSIONS: The DDS was found to be an indicator for child stunting during the Ethiopian harvest season. The DDS can be an appropriate tool to evaluate the association of child feeding practices with child growth irrespective of season. Inclusion of other dimensions in the construction of ICFI should be considered in future analysis as we found no association with growth

Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty : a randomized single-blind controlled trial

Background: Children living with foster families in a resource-limited setting such as Ethiopia are at risk of developmental problems. It is not yet clear whether intensive home-based developmental stimulation assisted by play can reduce these problems. The main objective of this study was to examine the effects of play-assisted intervention integrated into basic services on the developmental performance of children living with foster families in extreme poverty. Methods: A randomized single-blind (investigator) controlled trial design was used. The study was conducted in Jimma, South West Ethiopia. Using computer-generated codes, eligible children of 3-59 months in age were randomly allocated to intervention (n = 39) and control (n = 39) groups at a 1:1 ratio. Children in the intervention group received home-based play-assisted stimulation in addition to the basic services provided to children in both groups. The intervention consisted of an hour of play stimulation conducted during a weekly home visit over the course of six months. Personal-social, language, fine and gross motor outcomes were assessed using Denver II-Jimma, and social-emotional outcome was obtained using an adapted Ages and Stages Questionnaire: Social-Emotional (ASQ: SE). Information about sociodemographic characteristics was collected using a structured questionnaire. Anthropometric methods were used to determine nutritional status. The effects of the intervention on the abovementioned outcomes over the study period and group differences in change over time were examined using Generalized Estimating Equations (GEE). Results: Statistically significant intervention effects were found for language (P = 0.0014), personal-social (P = 0.0087) and social-emotional (P < 0.0001) performances. At the midline of the study, language (effect size = 0.34) and social-emotional (effect size = - 0.603) benefits from the play-assisted stimulation had already been observed for the children in the intervention group. For language, the intervention effect depended on the child's sex (P = 0.0100) and for personal-social performance, on family income (P = 0.0300). Conclusions: Intensive home-based play-assisted stimulation reduced the developmental problems of children in foster families in the context of extreme poverty. Longer follow-up may reveal further improvements in the developmental performance of the children

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia

Background: Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors ( such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. Methods: A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personalsocial, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. Results: Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and motherchild relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. Conclusion: Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation

Dietary diversity predicts dietary quality regardless of season in 6–12-month-old infants in south-west Ethiopia

Objective: Simple, cost-effective and convenient instruments like food group-based scores are proposed to assess micronutrient adequacy of children in developing countries. We assessed the predictive ability and seasonal stability of a dietary diversity score (DDS) to indicate dietary quality of infants. Design: A 24 h dietary recall assessment was carried out on a sample of 320 and 312 breast-fed infants aged 6–12 months during harvest (HS) and pre-harvest (PHS) seasons, respectively, in Ethiopia. DDS was calculated based on seven food groups, while mean micronutrient density adequacy (MMDA) was calculated for eight micronutrients. Multiple linear regression models were used to assess the relationship between DDS and MMDA, and differences in nutrient intake between the two seasons. A receiver-operating characteristic curve analysis was performed to derive DDS cut-offs that maximized sensitivity and specificity of assessing dietary quality. Setting: The study was conducted in the catchment of the Gilgel Gibe Field Research Centre of Jimma University, south-west Ethiopia. Results: The mean (sd) DDS for HS and PHS was 2·1 (0·94) and 2·3 (1·1), respectively. The DDS was associated with MMDA (β=0·045, P<0·0001 in HS; β=0·044, P<0001 in PHS). A DDS of ≤2 food groups best predicted ‘low’ MMDA (<50 %) with 84 % and 92 % sensitivity, 36 % and 43 % specificity, and 47 % and 51 % correct classification for the HS and PHS, respectively. Conclusions: DDS is predictive of dietary quality of breast-fed infants. The study supports the use of DDS to indicate inadequate intakes of micronutrients by breast-fed infants in different seasons

Neither n-3 long-chain PUFA supplementation of mothers through lactation nor of offspring in a complementary food affects child overall or social-emotional development : a 2 × 2 factorial randomized controlled trial in rural Ethiopia

Background: The n-3 (omega-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. Objective: We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. Methods: We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention x time interaction). Results: The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention x time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (beta: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). Conclusions: n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention

Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration : a randomized controlled trial in rural Ethiopia

Background: For infants and young children in low-income settings, human milk (HM) is the main source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). However, the n-3 LCPs concentrations of HM show wide variability, largely depending on the maternal intake of marine foods. This may put children living far from coastal areas at risk of inadequate intake. We evaluated the efficacy of fish-oil (FO) supplementation of lactating mothers on HM n-3 LCPs concentrations in a rural setting from Ethiopia. Methods: Mothers (n = 360) with children 6–12 months old were randomized to receive either intervention FO capsules (215 mg DHA + 285 mg EPA) or control corn-oil capsules (without n-3 LCPs). In a random subsample of 154 participants, we analyzed LCPs in HM and child capillary blood using gas chromatography. Results: Compared to the control, FO supplementation increased HM concentrations of DHA by 39.0% (95% CI: 20.6, 57.5%; P < 0.001) and EPA by 36.2% (95% CI: 16.0, 56.4%; P < 0.001), whereas the arachidonic acid (AA)/(DHA + EPA) ratio decreased by 53.5% (95% CI: −70.2, −36.7%; P < 0.001). We also found statistically significant association between the changes in (DHA + EPA)/AA ratio in HM and child capillary blood (P < 0.001). However, HM DHA concentrations remained lower than international norms after FO supplementation. Conclusions: FO supplementation improves n-3 LCPs content of HM. Future studies should evaluate different doses of n-3 LCPs and consider potential effect modifiers such as genetic polymorphism and diet. This trial was registered at clinicaltrials.gov as NCT01817634

Adaptation and standardization of a Western tool for assessing child development in non-Western low-income context

Abstract Background Due to lack of culturally relevant assessment tools, little is known about children’s developmental profiles in low income settings such as Ethiopia. The objective of this study was to adapt and standardize the Denver II for assessing child development in Jimma Zone, South West Ethiopia. Methods Culture-specific test items in Denver II were modified. After translation into two local languages, all test items were piloted and fine-tuned. Using 1597 healthy children 4 days to 70.6 months of age, the 25, 50, 75 and 90 % passing ages were determined for each test item as milestones. Milestones attainment on the adapted version and the Denver II were compared on the 90 % passing age. Reliability of the adapted tool was examined. Results A total of 36 (28.8 %) test items, mostly from personal social domain, were adapted. Milestones attainment ages on the two versions differed significantly on 42 (34 %) test items. The adapted tool has an excellent inter-rater on 123 (98 %) items and substantial to excellent test-retest reliability on 119 (91 %) items. Conclusions A Western developmental assessment tool can be adapted reliably for use in low-income settings. Age differences in attaining milestones indicate a correct estimation of child development requires a population-specific standard