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Introduction: Investigation of effective modes of community engagement remains an important topic in research yet is often overlooked. Studies focusing on how to move beyond a tokenistic involvement of community members into one with true collaboration remain spread across a broad range of disciplines. Objective: This umbrella review aims to bring together existing systematic reviews to highlight best practice related to community engagement in research. Method: The Health Research Literature Explorer (PCORI), PubMed, and Google Scholar were searched. Studies published in English since 1990 on any aspect of end-user engagement in research were considered. A total of 23 articles met the inclusion criteria and withstood quality appraisal using the Joanna Briggs Institute appraisal checklist. Results: Our findings indicate no conclusive evidence on which type of community engagement is most effective. Rather, we found engagement activities varied depending on the type and stages of the study. Conclusion: Hence, the need for innovative approaches to measure the impact of community engagement was stressed in the review. However, it was possible to narrow the gap between research and implementation by adhering to cultural context, community concern, and attitudes. Recommendation: Thus, research in general should underpin robust community engagement activities to gain better outcomes.

Background: Community engagement in research has gained momentum as people have realised the importance and value it brings to research. However, a lack of standardization in the engagement approach has been reported in the literature. This systematic review aims to identify and synthesize the different engagement approaches to contextualize future implementation efforts. Methods: The databases Patient Centred Outcomes Research Institute (PCORI), PubMed and Google Scholar were searched for English language studies published between 2008 and 2021 that focused on stakeholder involvement and phases of research engagement. Independent reviewers conducted literature search, screening, quality assessment, data extraction and analysis following previous study formats. Results: Of the 2227 original articles retrieved, 125 were reviewed fully, of which 48 studies were included in this review. Of these 48 studies, 34 (70.8%) were health studies involving any form of engagement, while 14 (29.2%) were non-health. Most studies originated from high income countries, mainly the USA and engaged ethnic minorities, patients, disadvantaged groups and war veterans. All studies reported engagement at various levels. However, there was no standard criteria to select the type of engagement. Engagement with communities was used to develop research tools, identify research questions and harness local experiences. There were different terminologies and engagement approaches, which makes it difficult to synthesise and conceptualize the evidence. Conclusions: Harnessing local experiences and perspectives by involving stakeholders at the earliest stage is beneficial in terms of clarifying approaches which best fits the local context. It is important to delineate between the traditional and community engagement approach.

Objective: To perform a systematic review to evaluate iron, vitamin A, zinc, and iodine status and intakes in children and adolescents (0-19 years) in Ethiopia, Kenya, Nigeria, and South Africa.Method: Both national and subnational data published from the year 2005 to 2015 were searched via MEDLINE, Scopus, and national public health websites. For each micronutrient and country, status data from relevant studies and surveys were combined into an average prevalence and weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes.Results: This review included 55 surveys and studies, 17 from Ethiopia, 11 from Kenya, 12 from Nigeria, and 16 from South Africa. The WAVG prevalence of anemia ranged from 25% to 53%, iron deficiency from 12% to 29%, vitamin A deficiency (VAD) from 14% to 42%, zinc deficiency from 32% to 63%, and iodine deficiency from 15% to 86% in children aged 0 to 19 years from 4 countries. Generally, children <5 years had higher prevalence of anemia (32%-63%), VAD (15%-35%), and zinc deficiency (35%-63%) compared to children aged 5 to 19 years. Studies with intake data indicated that inadequate intakes ranged from 51% to 99% for zinc, 13% to 100% for iron, and 1% to 100% for vitamin A. Households failing to consume adequately iodized (>15 ppm) salt ranged from 2% in Kenya to 96% in Ethiopia.Conclusion: With large variation within the 4 African countries, our data indicate that anemia and vitamin A, zinc, and iodine deficiencies are problems of public health significance. Effective public health strategies such as dietary diversification and food fortification are needed to improve micronutrient intake in both younger and older children.

Background: The role of fathers in proper nutrition of young children has not been a frequent topic of studies. Mothers are usually the primary caregivers for young children. However, the father is often responsible for the financial choices of the household, especially in developing countries; we wondered to what extent fathers were involved in child feeding.Objective: This study aimed to investigate the extent of perceptions, practices, and challenges of fathers from low-income settings in routine child care, particularly in relation to child-feeding practices.Methods: A qualitative study was conducted in northern Ethiopia. Ten fathers, who had children between 6 and 23 months, were participated in the study. To validate fathers’ comments, 10 mothers (from different households) also participated. In-depth interviews and focus group discussions were carried out. A thematic analysis was completed to identify emergent themes within the data.Results: In general, traditional fathers, fathers in transition, and modern fathers are the 3 types of fathers identified based on their perception, practice, and challenges of routine child care and feeding.Conclusion: Our findings provide new insight to the literature in describing fathers’ roles and challenges in routine child-care and feeding practices. We have developed a model that could help researchers, programmers, policy makers, and health workers to approach fathers in different child intervention research and plans. Our findings suggest that targeting fathers may be a worthwhile approach and that it seems justifiable to plan interventions involving fathers.

Background Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited.Objective This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in EthiopiaMethods Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region.Results Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels.Conclusions Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.

ABSTRACTBackgroundWomen’s development group leaders are volunteer community health workers in Ethiopia who, among other duties, promote health and prevention of diseases. They link and extend essential health services from health posts to households.ObjectiveTo assess the characteristics, knowledge, and practice of women’s development group leaders in the field of maternal, neonatal, and child health care.MethodThis study used a cluster-sampled cross-sectional survey conducted from December 2016 to February 2017 in four regions of Ethiopia: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples. One of the volunteers, who was available at the time of the survey, was included from each cluster. A total of 187 women’s development group leaders participated in this quantitative study.ResultClose to half of the women’s development group leaders were illiterate. The leaders had a wide variation in the number of women in their groups. Two-thirds had received some training during the last year, covering a broad range of health topics. Their knowledge of maternal, newborn, and child health was relatively low. Two-thirds had monthly contact with health extension workers. Around half had interacted with other local stakeholders on maternal and child health matters during the last three months. Two-thirds had visited pregnant women, and half had made home visits after delivery in the previous quarter. Activities regarding sick newborns and under-five children were less frequent.ConclusionThe women leaders were given a wide range of tasks, despite having a low educational level and receiving training through brief orientations. They also showed limited knowledge but had a relatively high level of activities related to maternal health, while less so on neonatal and child health.

BackgroundMalaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies.ObjectiveTo present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions.DesignFrom a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992–2012, but two-thirds of the observations related to 2006–2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality.ResultsRates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparumparasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level.ConclusionsThe wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.