Modelling trends, determinants and health effects of infant and young child feeding practices in Ethiopia from 2000 to 2016

Optimal infant and young child feeding (IYCF) practices during the first two years of life (1000 days from conception to the second year postpartum) are associated with a reduced risk of adverse health and developmental outcomes in children. Optimally breastfed children have less risk of mortality and morbidity from infectious diseases such as diarrhoea, pneumonia, otitis media and measles. Appropriate complementary feeding of children aged 6–23 months also decreases the risk of childhood malnutrition such as stunting, wasting, underweight and micronutrient deficiency. However, in Ethiopia, the prevalence of optimal IYCF practices (including early initiation of breastfeeding [EIBF], exclusive breastfeeding [EBF], the introduction of complementary foods, minimum dietary diversity [MDD] and minimum acceptable diet [MAD]) are well below the national and global nutritional targets. In connection to this and the ongoing natural and man-made disasters (e.g., internal conflicts and internal displacements), more than five million children are stunted in Ethiopia, and diarrhoea and pneumonia together accounted for more than one-third of under-five deaths. Despite many subnational studies that have been conducted in Ethiopia, there are several gaps in the knowledge base of IYCF practices, including their health outcomes of childhood infections and malnutrition among children under two years of age. The present thesis used a series of five studies to investigate: i) the trends and determinants of EIBF and EBF in Ethiopia from 2000 to 2016; ii) the trends and associated factors of complementary feeding practices in Ethiopia from 2005 to 2016; iii) associations between IYCF practices, and ARI and diarrhoea in Ethiopia; iv) the geospatial variations and determinants of childhood stunting in Ethiopia, and v) a systematic review of child health interventions to improve IYCF practices in Ethiopia. Findings from the current thesis suggest the need for IYCF policy and strategy in Ethiopia. The IYCF policy and strategy describes the Government of Ethiopia's position on IYCF and clarifies the main strategies that need to be used and interventions to be implemented to meet the national IYCF policy objectives. The policy and strategy also provide direction on how to conduct advocacy and resource mobilisation, coordinate activities across stakeholders, and guide the monitoring and evaluation for protecting, supporting and promoting IYCF practices in Ethiopia

Prevalence of mental distress and associated factors among Samara university students, Northeast Ethiopia

Background. Empirical findings have indicated that higher institution students experience a higher prevalence of mental distress compared to the general population. Understanding the magnitude and associated factors of mental distress in university students would be helpful to practitioners and policymakers in Ethiopia. The aim of the present study was to examine the prevalence and associated factors of mental distress among Samara university students, Northeast Ethiopia. Methods. Institution based cross-sectional study design was conducted in Samara university from December to June 2018. A simple random sampling technique was employed to select the study participants. Self-Reporting Questionnaire-20 (SRQ-20) was used to measure the mental distress of students. Multivariable logistic regression modeling was used to examine the association between sociodemographic and psychosocial factors with the mental distress of students. Results. The proportion of students with mental distress were found to be 53.2% (95% confidence interval [CI]: 48.0%, 58.0%). Female students were more likely to be mentally distressed compared to male students (adjusted odds ratio [AOR]: 4.66; 95% CI: 2.81, 7.71). Ever khat use (AOR: 3.09; 95% CI: 1.74, 5.50) and poor sleep quality (AOR: 2.23; 95% CI: 1.12, 3.66) were significantly associated with mental distress of students. Conclusion. Our study indicates that the proportion of mental distress was found to be higher among Samara university students as compared to previously published studies in Ethiopia. Female students, ever khat users and those with poor sleep quality were associated with mental distress. There is a need for evidence-based interventional strategies such as self-help measures, sleep hygiene and peer support, as well as professional mental health services as part of student health services that would be helpful to reduce the burden of mental distress of students

Trends and determinants of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2000 to 2016

Background: At the national level in Ethiopia, there is limited knowledge of trends and factors associated with early initiation of breastfeeding and exclusive breastfeeding (EBF), particularly during the Millenium Development Goal (MDG) era (2000–2015). The study aimed to examine the trends and determinants of early initiation of breastfeeding and EBF in Ethiopia between 2000 and 2016. Methods: Using the Ethiopia Demographic and Health Survey (EDHS) data for the years: 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037) and 2016 (n = 3861), trends in early initiation of breastfeeding and EBF were estimated. Multivariate logistic regression models that adjusted for confounders, sampling weight, clustering and stratification were used to examine the association between socioeconomic, demographic, health service and community level factors with early initiation of breastfeeding and EBF from 2000 to 2016. Results: The prevalence of early initiation of breastfeeding increased from 48.8% in 2000 to 75.7% in 2016 in Ethiopia. Improvement in EBF prevalence was not statistically significant (from 54.5% in 2000 to 59.9% in 2016). Over the study period, informal maternal employment (Adjusted Odds Ratio [aOR] 0.75; 95% Confidence Interval [CI] 0.68, 0.83), frequent antenatal care visits (aOR 0.74; 95% CI 0.65, 0.85), and cesarean birthing (aOR 0.22; 95% CI 0.17, 0.30) were associated with delayed initiation of breastfeeding. Birthing in the health facility (aOR 1.35; 95% CI 1.05, 1.75) and residing in the metropolis region (aOR 1.95; 95% CI 1.65, 2.32) were associated with timely initiation of breastfeeding. In a similar period, informally employed mothers (aOR 1.37; 95% CI 1.15, 1.63) and those with six or more family size (aOR 1.46; 95% CI 1.10, 1.93) were more likely to exclusively breastfeed their babies. Conclusion: Early initiation of breastfeeding improved in Ethiopia during the MDG era but it is still below the national target; progress in EBF remained slow. To improve breastfeeding outcomes and meet the global breastfeeding targets in Ethiopia, infant feeding efforts should focus on improving key modifiable factors, including place and mode of birthing and socioeconomic status of mothers

Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016

Introducing appropriate complementary feeding at 6 months of age is crucial for the optimal growth and development of an infant. In Ethiopia, however, no previous national‐level studies have examined the trends and associated factors of complementary feeding practices. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2,520), 2011 (N = 2,850), and 2016 (N = 2,864). Percentage point changes in complementary feeding indicators were estimated to examine the trends over the EDHS years. Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service, and community‐level factors and (a) the introduction of complementary foods, (b) minimum dietary diversity (MDD), (c) minimum meal frequency (MMF), and (d) minimum acceptable diet (MAD). The proportion of mothers who met MDD increased from 6.3% to 13.5% (p < .001), and MAD increased from 4.1% to 7.1% (p = .003) from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%, p = .051) and MMF (from 41.3% to 43.6%, p = .288) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF, and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Our analysis of the EDHS suggests that the proportion of MDD and MAD were unacceptably low. Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage, and media exposure

Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia : a propensity score matching approach

Background Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children. Methods This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding. Results Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89). Conclusion The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps

Male Partner&apos;s Involvement in HIV Counselling and Testing and Associated Factors among Partners of Pregnant Women in Gondar Town, Northwest Ethiopia

Background. Despite the existence of several programmes promoting male involvement in HIV counselling and testing during their wife&apos;s pregnancy as a part of PMTCT, few men have heeded the call. The aim of this study was to assess male partner&apos;s involvement in HCT and its associated factors. Methods. This study was based on institution based cross-sectional study design that used systematic random sampling technique. A total of 416 partners were interviewed in the data collection. Multivariable logistic regression model was fitted to identify the independent predictors. Result. In this study, the prevalence of male involvement in HCT was found to be 40.1% (95% CI: 35.3%-44.7%). The independent predictors of male involvement were partners who were younger, were cohabitant, were with multigravida wives, were knowledgeable on route of mother-to-child transmission, and discussed HCT. Conclusion. The prevalence of male involvement in HCT was found to be suboptimal compared to similar studies in Ethiopia. There is a need of interventions on partners who are older, separated, and with lower gravidity wife. Awareness creation campaign should also be created on the route of mother-to-child transmission of HIV and on the importance of discussion with wife

Mapping geographical differences and examining the determinants of childhood stunting in Ethiopia : a Bayesian geostatistical analysis

Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors

MyVoice Pulse Survey of WSU Staff: Working Through the COVID-19 Pandemic

The COVID-19 pandemic profoundly affected both staff and students in higher education institutions globally, with teaching and learning moving online, and research being suspended or adapted via videotelephony. Western Sydney University (WSU) surveyed its staff to develop a comprehensive understanding of the reported impacts of COVID-19 on both their work and life, and the strengths and challenges of utilising videotelephony for teaching and research. All WSU staff were surveyed via the MyVoice Pulse survey, with data collected by The Voice Project. A total of 2335 staff completed the survey, with a response rate of 86%. Permission was secured from 1695 (62.4%) staff for their responses to be included in this research. Out of these respondents, 59.6% identified as female, and 33.1% identified themselves as academic staff. Diversity related questions had Cronbach’s alpha of 0.63. All other questions when tested returned a Cronbach’s alpha of greater than 0.75 implying those questions were consistent. The current study provides valuable insight into the reported impacts of COVID-19 on the work and life of staff at WSU, as well as staff perspectives on some of the innovative practices that were adopted in response. The timeliness and the potential impact for informing University policy and practice are among the strengths of the study. The crosssectional nature of the data means that clear temporal associations between demographic factors and outcomes cannot be established. Additionally, it is important to note that results may be impacted by the uneven sample size in some groups. As COVID-19 transformed the work of the University and its staff dramatically, it appears that staff beliefs about the impacts of these changes varies substantially. If innovative practices such as remote teaching and HDR supervision, and videotelephony for research continue it will be important to conduct further research to identify exemplary practice given the current divide in staff opinion. Similarly, findings may serve as a catalyst for policies and practices that seek to address some of the inequities highlighted in staff voices

Interventions to improve infant and young child feeding practices in Ethiopia : a systematic review

Objective In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia. Source of information A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021. Study eligibility criteria Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included. Study appraisal and synthesis All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study. Results Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention. Conclusion Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia

Trends and drivers of unmet need for family planning in currently married Tanzanian women between 1999 and 2016

The current study investigated the trends and factors associated with the unmet need for family planning (FP) for limiting and spacing births among married Tanzanian women between 1999 and 2016. The study used Tanzania Demographic and Health Survey (TDHS) data for the years 1999 (N = 2653), 2004–2005 (N = 2950), 2010 (N = 6412), and 2015–2016 (N = 8210). Trends in the unmet need for FP were estimated over the study period. Multivariable multinomial logistic regression models were used to investigate the association between community-level, predisposing, enabling, and need factors with the unmet need for FP in Tanzania. The results showed no significant change in percentage of married women with an unmet need for birth spacing between 1999 and 2016. The proportion of married women with an unmet need for limiting births decreased from 9.5% (95% confidence interval (CI): 7.9%, 10.6%) in 1999 to 6.6% (95% CI: 5.9%, 7.3%) in 2016. Residing in a rural area, parity between 1–4 and 5+, visiting a health facility for any health services within twelve months, and planning to have more children (after two years and/or undecided) were factors positively associated with the unmet need for FP-spacing. Women with parity of 5+ were more likely to experience an unmet need for FP-limiting. Women’s age between 25–34 and 35–49 years, women’s employment status, watching television, women’s autonomy of not being involved in household decisions, and planning to have more children were factors associated with lower odds of having an unmet need for FP-spacing. Women’s age between 25–34 years, watching television, autonomy, and planning to have more children were factors with lower odds of having an unmet need for FP-limiting. Improving FP uptake among married Tanzanian women can reduce the unmet need for FP. Therefore, reducing unmet needs for FP is attainable if government policies and interventions can target women residing in rural areas and other modifiable risk factors, such as parity, health facility visits, planning to having more children, employment, watching television, and women’s autonomy