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To date, the changes in maternal metabolic response associated with prenatal aflatoxin exposure remain largely unknown. This study investigated the effects of prenatal aflatoxin exposure on the maternal serum metabolome in rural Ethiopia. A total of 309 pregnant women were enrolled prospectively, and their serum aflatoxin concentrations were measured using targeted liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Serum metabolic fingerprints were obtained using laser-assisted rapid evaporative ionization mass spectrometry (LA-REIMS), followed by combination of univariate and multivariate statistical modelling to evaluate changes in circulating metabolic features between aflatoxin-exposed and unexposed mothers and to select discriminatory metabolic features. The analysis revealed that 81.8% of women were exposed to aflatoxins, with a median concentration of 12.9 pg/mg albumin. The orthogonal partial least square discriminant analysis (OPLS-DA) regression model demonstrated significant disparities in the serum metabolome when comparing Ethiopian pregnant women with low vs high aflatoxin exposure. Thirty-two differentially expressed metabolic features were identified, affecting aminoacyl-tRNA biosynthesis pathway. Several discriminatory metabolites have been identified, including glutamine, tryptophan, tyrosine, carnosine, and 1-methylnicotinamide. In conclusion, our findings indicate that aflatoxin exposure during pregnancy have shown disparities in the maternal serum metabolome, primarily affecting protein synthesis. Further research is needed to identify specific metabolite biomarkers and elucidate the underlying mechanisms., (© 2024. The Author(s).)

Objective: To assess the effect of food insecurity on perinatal depression in rural Ethiopia., Design: We used a prospective cohort in which food insecurity was considered as primary exposure and perinatal depression as an outcome. Food insecurity at baseline (in the period of 8-24 weeks of pregnancy) was measured using the Household Food Insecurity Access Scale (HFIAS), and perinatal depression at follow-up (in 32-36 weeks of pregnancy) was measured using a Patient Health Questionnaire (PHQ-9). We used multivariable regression to assess the effect of food insecurity on the prevalence of perinatal depression. We explored food insecurity's direct and indirect impacts on perinatal depression using structural equation modelling (SEM)., Setting: This paper used data from the Butajira Nutrition, Mental Health and Pregnancy (BUNMAP) cohort established under the Butajira Health and Demographic Surveillance Site (BHDSS)., Participants: Seven hundred and fifty-five pregnant women., Results: Among the study participants, 50 % were food-insecure, and about one-third were depressed at 32-36 follow-up. In SEM, higher values of baseline food insecurity, depressive symptoms and state-trait anxiety (STA) were positively and significantly associated with perinatal depression. The direct impact of food insecurity on perinatal depression accounts for 42 % of the total effect, and the rest accounted for the indirect effect through baseline depression (42 %) and STA (16 %)., Conclusion: The significant effect of food insecurity at baseline on perinatal depression and the indirect effect of baseline food insecurity through baseline anxiety and depression in the current study implies the importance of tailored interventions for pregnant women that consider food insecurity and psychosocial problems.

Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer-Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the "Youden index" to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer-Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications., (© 2024. The Author(s).)

Objective: To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017., Design: Descriptive multi-country secondary data analysis., Setting: Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America., Population: Liveborn infants from 15 population-based cohorts., Methods: Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42 +0 , 39 +0 -41 +6 (reference category), 37 +0 -38 +6 , 34 +0 -36 +6 ,34 +0 -36 +6 ,32 +0 -33 +6 , 30 +0 -31 +6 , 28 +0 -29 +6 and less than 28 weeks., Main Outcome Measures: Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births)., Results: We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 37 0 -38 6  weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality., Conclusions: In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns., (© 2024 John Wiley & Sons Ltd.)

Background: Abnormal fetal growth pattern during pregnancy including excessive fetal size and intrauterine growth restrictions are the major determinants for perinatal outcomes and postnatal growth. Ultrasonography is a useful tool in monitoring fetal growth for appropriate care and interventions. However, there are few longitudinal studies using serial ultrasonography in low and middle-income countries. Moreover, the reference charts used for fetal growth monitoring in low-income countries comes from high income countries with distinct population features. Therefore, the purpose of this study was to evaluate the intrauterine growth pattern of the fetus using serial ultrasonography., Methods: We conducted a prospective community-based cohort study from March 2018 to December 2019. Pregnant women with gestational age of 24 weeks or below living in the Butajira HDSS were enrolled. We followed the pregnant women until delivery. Serial ultrasound measurements were taken, and fetal weight was estimated using the Hadlock algorithm based on biparietal diameter, head circumference, abdominal circumference, and femur length. The z-scores and percentiles of biometric measurements were calculated and compared to the INTERGROWTH-21 st International Standards for Fetal Growth., Results: We reviewed a total of 2055 ultrasound scans and 746 women who fulfill the inclusion criteria were involved". We found similar distribution patterns of biometric measurements and estimated fetal weight compared to the previous study done in Ethiopia, the WHO and INTERGROWTH-21 st references. In our study, the 5 th ,50 th and 95 th percentiles of estimated fetal weight distribution have a similar pattern to the WHO and INTERGROWTH-21 st charts. The 50 th and 95 th percentile had also a similar distribution pattern with the previous study conducted in Ethiopia. We found that 10% of the fetus were small for gestational age (below the 10 th percentile) based on the Z-score of estimated fetal weight., Conclusion: Our study evaluated the fetal growth patterns in rural community of Ethiopia using serial ultrasound biometric measurements. We found similar IUG patterns to the WHO and INTERGROWTH-21 st reference standards as well as the previous study conducted in Ethiopia., (© 2023. BioMed Central Ltd., part of Springer Nature.)

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.

Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs)., Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000., Setting: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America., Population: Live birth neonates., Methods: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies., Main Outcome Measures: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification., Results: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies., Conclusions: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021., Design: Descriptive multi-country secondary data analysis., Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021., Population: Liveborn infants., Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study., Results: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%)., Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found ( p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future.

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., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Milk is a complete food useful to promote growth and development of the infant mammals as it contains vital nutrients (proteins, essential fats, vitamins, and minerals) in a balanced proportion. It is also a nutritious food for adults too. Milk can also contain hazardous chemicals and contaminants including heavy metals which can be a risk for health. This study was aimed at determining the level of heavy metals in cow's milk collected from Butajira and Meskan districts, south Ethiopia. Cows' milk was collected from 193 healthy lactating cows. Samples were digested by optimized microwave digestion method using HNO 3 and H 2 O 2 . Analysis was done using ICP-OES for Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn levels. MP-AES was used for Ca, Mg, K, and Na. Ni was not detected in all samples. Concentrations of heavy metals in the studied samples were Cd (0.0-0.03), Cr (0.0-0.4), Cu (0.03-1.1), Fe (0.0-1.9), Mn (0.0-0.7), Pb (0.0-12.3), Zn (0.0-8.2), Ca (380.1-532.4), Mg (159.6-397.9), K (1114.2-1685.8), and Na (495.9-1298.3) ppm. These values were compared with permissible values prescribed by different international organizations and available literatures. Cd, Cr, Cu, Mn, Pb, Zn, and Mg levels were found above the permissible limits. Thus, special attention needs to be given to the level of heavy metals in cows' milk, as they are difficult to remove from the body. Their accumulation to a level greater than their permissible limit could be deleterious to the health of the user., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed., Objectives: In the present study, we examined the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia., Methods: In a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 wk of gestation. Serum aflatoxin B1-lysine concentration was measured using LC-tandem MS. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean ± SD gestational age weeks of 19.1 ± 3.71, 28.5 ± 3.51, and 34.5 ± 2.44. Estimated fetal weight was expressed in centiles using the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and unexposed mothers in the study., Results: Mothers had a mean ± SD age of 26.0 ± 4.58 y. The median (25th, 75th percentile) serum aflatoxin B1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the females enrolled provided at least 2 ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational-age centile than the unexposed group (ß = -0.92; 95% CI: -1.77, -0.06 centiles/week; P = 0.037)., Conclusions: Chronic maternal aflatoxin exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019., Methods: In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data., Results: The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg)., Conclusions: The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population's median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers., Competing Interests: NO authors have competing interests., (Copyright: © 2022 Tadesse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., Competing Interests: None of the authors have any competing interests., (© the authors; licensee ecancermedicalscience.)

Mid-upper arm circumference (MUAC) is an age-sensitive anthropometric measurement in infants. However, exact age is difficult to know, particularly in low-income countries. We evaluated the diagnostic accuracy of an age-independent mid-upper arm circumference-to-length (MUAC/L) ratio measurement in detecting wasting among infants aged 1-6 months in Ethiopia. A facility-based diagnostic accuracy study was conducted on 467 in-patient infants aged 1-6 months from March to May 2019. The receiver operating characteristic (ROC) curve was used to evaluate the ability of MUAC/L to detect wasting. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive and negative predictive values were calculated. The magnitude of severe wasting was 21⋅6 % and moderate wasting was 13⋅0 %. The area under the ROC curve (AUC) of MUAC/L was 0⋅77 (95 % CI 0⋅73, 0⋅81) for detecting moderate wasting and 0⋅92 (95 % CI 0⋅89, 0⋅94) for detecting severe wasting. MUAC/L had a sensitivity of 91⋅1 % (95 % CI 81⋅3, 94⋅4), a specificity of 84⋅7 % (95 % CI 80⋅6, 88⋅2), a positive likelihood ratio of 5⋅82 (95 % CI 4⋅53, 7⋅48) and a negative likelihood ratio of 0⋅13 (95 % CI 0⋅07, 0⋅22) in total infants. The optimal MUAC/L cut-off was <0⋅190 for boys and <0⋅185 for girls. MUAC/L had an AUC of 0⋅77 and 0⋅92 in predicting moderate and severe wasting in infants aged 1-6 months, respectively. Using MUAC/L to treat Ethiopian infants with severe wasting and infants with similar characteristics in other countries could improve treatment coverage., (© The Author(s) 2022.)

Objective: This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity., Design: Systematic review and meta-analysis., Setting: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included., Participants: A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses., Results: In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores., Conclusion: In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.

Introduction: Mycotoxin exposure during pregnancy has been associated with adverse birth outcomes in low- and middle-income countries. The evidence, however, is inconsistent and mainly limited to the assessment of a single mycotoxin. We assessed biomarkers of exposure to multiple mycotoxins during pregnancy and their associations with adverse birth outcomes in rural Ethiopia., Methods: We analyzed data from 579 pregnant women between 8 and 24 weeks of completed gestation enrolled in a prospective cohort study. Serum mycotoxin concentrations were determined using liquid chromatography coupled with tandem mass spectrometry. Multivariable linear probability models, adjusted for potential confounding factors and multiple comparisons, were fitted to assess the associations between mycotoxin exposure and small for gestational age and preterm birth. We applied principal component analysis to reduce the dimensionality of biomarker data from several taxonomic mycotoxin groups., Results: All pregnant women were co-exposed to at least five mycotoxins, and one pregnant woman was co-exposed to 27 mycotoxins. Fumonisins (FB), i.e., FB 2 , FB 3 , FB 1 , and tenuazonic acid were the most frequently identified mycotoxins in 98.8, 95.3, 93.3, and 81.4% of the samples respectively. Deoxynivalenol was detected in 38.7%, nivalenol in 50.1%, ochratoxin α in 67.9%, and zearalenone in 50.9% of the serum samples. After adjustment, we found no statistically significant (all P ≥ 0.05) associations between mycotoxin exposures and birth outcomes., Conclusions: Despite our study providing no evidence for relationships between mycotoxin biomarkers and adverse birth outcomes, our findings do indicate an extensive presence of multiple mycotoxin exposure among pregnant women. Public health policies and nutrition-sensitive interventions must ensure exposure to mycotoxins is reduced in rural Ethiopia., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The etiology and risk factors of anemia are multifactorial and varies across context. Due to the geospatial clustering of anemia, identifying risk factors for anemia should account for the geographic variability. Failure to adjust for spatial dependence whilst identifying risk factors of anemia could give spurious association. We aimed to identify risk factors of anemia using a Bayesian geo-statistical model., Methods: We analyzed the Ethiopian Demographic and Health Survey (EDHS) 2016 data. The sample was selected using a stratified, two- stage cluster sampling design. In this survey, 9268 children had undergone anemia testing. Hemoglobin level was measured using a HemoCue photometer and the results were recorded onsite. Based on the World Health Organization's cut-off points, a child was considered anaemic if their altitude adjusted haemoglobin (Hb) level was less than 11 g/dL. Risk factors for anemia were identified using a Bayesian geo-statistical model, which accounted for spatial dependency structure in the data. Posterior means and 95% credible interval (BCI) were used to report our findings. We used a statistically significant level at 0.05., Result: The 9267 children in our study were between 6 and 59 months old. Fifty two percent (52%) of children were males. Thirteen percent (13%) of children were from the highest wealth quintile whereas 23% from the lowest wealth quintile. Most of them lived in rural areas (90%). The overall prevalence of anemia among preschool children was 57% (95% CI: 54.4-59.4). We found that child stunting (OR = 1.26, 95% BCI (1.14-1.39), wasting (OR = 1.35, 95% BCI (1.15-1.57), maternal anemia (OR = 1.61, 95% BCI (1.44-1.79), mothers having two under five children (OR = 1.2, 95% BCI (1.08-1.33) were risk factors associated with anemia among preschool children. Children from wealthy households had lower risk of anemia (AOR = 0.73, 95% BCI (0.62-0.85)., Conclusion: Using the Bayesian geospatial statistical modeling, we were able to account for spatial dependent structure in the data, which minimize spurious association. Childhood Malnutrition, maternal anemia, increased fertility, and poor wealth status were risk factors of anemia among preschool children in Ethiopia. The existing anaemia control programs such as IFA supplementation during pregnancy should be strengthened to halt intergenerational effect of anaemia. Furthermore, routine childhood anaemia screening and intervention program should be part of the Primary health care in Ethiopia., (© 2022. The Author(s).)

Objectives: We aim to analyse the trends and causes of mortality among adults in Addis Ababa., Setting: This analysis was conducted using verbal autopsy data from the Addis Ababa Mortality Surveillance in Addis Ababa, Ethiopia., Participants: All deceased adults aged 15 years and above between 2007-2012 and 2015-2017 were included in the analysis., Outcome Measures: We collected verbal autopsy and conducted physician review to ascertain cause of death., Result: A total of 7911 data were included in this analysis. Non-communicable disease (NCD) accounted for 62.8% of adult mortality. Mortality from communicable diseases, maternal conditions and nutritional deficiencies followed this by accounting for 30.3% of total mortality. Injury accounted for 6.8% of total mortality. We have observed a significant decline in mortality attributed to group one cause of death (43.25% in 2007 to 12.34% in 2017, p<0.001). However, we observed a significant increase in mortality attributed to group II cause of death (from 49.95% in 2007 to 81.17% in 2017, p<0.001). The top five leading cause of death in 2017 were cerebrovascular disease (12.8%), diabetes mellitus (8.1%), chronic liver disease (6.3%), hypertension (5.7%), ischaemic heart disease (5.7%) and other specified neoplasm (5.2%)., Conclusion: We documented an epidemiological shift in cause of mortality from communicable diseases to NCD over 10 years. There is a great progress in reducing mortality due to communicable diseases over the past years. However, the burden of NCDs call for actions for improving access to quality health service, improved case detection and community education to increase awareness. Integrating NCD intervention in to a well-established and successful programme targeting communicable diseases in the country might be beneficial for improving provision of comprehensive healthcare., Competing Interests: Competing interests: The authors declare no competing interest., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

Adolescent undernutrition is a major public health problem in Ethiopia. Inadequate dietary intake of nutrients is the major determinants of undernutrition. However, the adequacy of dietary intake among adolescents was not sufficiently explored. The present study aims to estimate the inadequacy of nutrient intake among adolescent girls in south central Ethiopia. A community-based cross-sectional study was conducted. We assess food and nutrient intake using repeated multiple-pass 24-h dietary recall. The study was conducted in Damot Gale district, Woliyta zone, Southern Ethiopia. Data were collected from 288 female adolescents. The majority of adolescent girls consumed cereals (96⋅9 %) and roots/tubers (75⋅3 %). However, only less than 1 % of them consumed flesh food. The mean energy, carbohydrate, protein and dietary fibre intake of the adolescent girls per day was 1452⋅7 ± 356⋅3 kcal, 305⋅6 ± 72⋅4 g, 35⋅7 ± 13⋅3 g and 18⋅6 ± 8⋅4 g, respectively. The median fat intake was 13⋅3 g (IQR 8⋅8, 19⋅8). The contribution of carbohydrate, protein and fat for the total energy was 80, 10 and 8 %, respectively. The prevalence of inadequate intake of protein was 60⋅9 %. The prevalence of inadequate intake of iron for early adolescents and late adolescents was 82 and 53 %, respectively. The prevalence of inadequate intake of folate was 83⋅9 % and zinc was 58 %. The prevalence of inadequate intake was greater than 90 % for vitamin B12, vitamin C and calcium. The present study found an alarmingly high prevalence of inadequate intake of some nutrients among adolescent girls of Damot Gale district., (© The Author(s) 2021.)

Background: The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population., Method: The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods., Result: The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days' period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice., Conclusions: Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy., (© 2021. The Author(s).)

Objective: The present study aimed to estimate the consumption of Na and K and to assess salt-related knowledge, attitude and behaviour among adults in Addis Ababa, Ethiopia., Design: A community-based cross-sectional study was conducted. Estimates of Na and K intake were made using repeated multiple-pass 24-h dietary recall as well as using random urine. The usual intake of Na and K from the 24-h dietary recall was determined using the National Cancer Institute methodology. Estimated 24-h Na and K excretion was calculated using International Cooperative Study on Salt, Other Factors, and Blood Pressure and Tanaka formula., Settings: Addis Ababa, the capital city of Ethiopia., Participants: Individuals aged 20 years and above residing in the city., Result: The mean Na and K intake estimated using the diet recall data was 3·0 (0·9) g/d and 1·9 (0·6) g/d, respectively. Based on the urine analysis, the estimated mean Na and K intakes were 3·3 (0·7) g/d and 1·9 (0·4) g/d, respectively. Moreover, the analysis showed that the mean Na:K ratio was 2·5 (1·4). The daily intake of K was below the recommended amount for all study participants. More than 98 % and 90 % of participants had an excess intake of Na and Na:K ratio, respectively., Conclusion: We found a high prevalence of inadequate K intake as well as excess intake of Na resulting in an increased prevalence of excess Na:K ratio. Thus, interventions targeting to decrease Na intake and to increase K intake are needed.

Eating behaviours have been associated both with being underweight or overweight and poor growth. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used measure of child eating behaviours. The instrument is, however, mostly validated in high-income countries, with a scarcity of evidence among developing countries such as Ethiopia. The present study aims to assess the cultural adaptability and validity of the CEBQ to be used in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged 3-6 years in selected preschools. Tests of factorial validity, convergent validity and reliability were performed. The Confirmatory Factor Analysis model indicated that eight subscales provided the best fit (root-mean-square error of approximation = 0⋅05 (90 % CI 0⋅045, 0⋅055); Comparative Fit Index = 0⋅92 and Tucker-Lewis Index = 0⋅90) after seven items from the original CEBQ were removed. Convergent validity with child's weight status was found for emotional overeating, food fussiness, satiety responsiveness and slowness in eating subscales. Reliability, measured using Cronbach's α , provided values between 0⋅50 and 0⋅79. The eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity among preschool children. Further replication of the study among low-income countries is essential to improve the literature on children's eating behaviours., (© The Author(s) 2021.)

Background: Immunization is essential to prevent between 2 and 3 million deaths globally each year and it is widely accepted that it is one of the most cost-effective health interventions. Despite all its advantages, immunization in Ethiopia is still far from the target set by the United Nations Sustainable Development Goals to achieve universal immunization by all countries in 2030. The 2016 Ethiopian Demographic and Health Survey (EDHS) reported an overall full immunization rate of only 38.3%. The objective of this study was to evaluate the spatial distribution of under immunization in 12 to 23 months old children and further identify the determinants of under immunization clustering in the Butajira Health and Demographic Surveillance Site (HDSS)., Methods: We conducted a community based sectional survey from March to April, 2016 in Butajira HDSS. We collected data on immunization status from a total of 482 children between the age of 12 to 23 months. We randomly selected household and interviewed mothers and /or observed vaccination cards when available to collect data on child's immunization status. We also collected the geographic location of all villages within the ten Kebeles using a Handheld Global Positioning System (GPS) (Garmin GPSMAP®). We analyzed the spatial distribution of under immunization and clustering using the SatScan® software which employs a purely spatial Bernoulli's model. We also ran a logistic regression model to help evaluate the causes of clustering., Results: We found that only 22.4% [95% CI: 18.9, 26.4%] of children were fully immunized. This study identified one significant cluster of under immunization among children 12-23 months of age within the Butajira HDSS (relative risk (RR) = 1.24,P < 0·01). We found that children residing in this cluster had more than 1.24 times risk of under immunization compared with children residing outside of the identified cluster. We found significant differences with regard to Maternal Tetanus Toxoid immunization status and place of delivery between cases found within a spatial cluster and cases found outside the cluster. For example, the odds of home delivery is more than two times [AOR 2.21: 95%CI; 1.06, 4.63] among children within an identified spatial cluster than the odds among children found outside the identified cluster., Conclusions: Under immunization of 12-23 months old children and under immunization with specific vaccines such as Polio, BCG, DPT (1-3) and Measles clustered geographically. Spatial studies could be effective in identifying geographic areas of under immunization for targeted intervention like in this study to gear health education to the specific locality.

Feeding is a source of interaction and communication. It affects children's physical and psychological/emotional development. The present study aims to examine the association between caregiver and child characteristics and caregivers' feeding practices among preschools in Addis Ababa. We conducted a cross-sectional study among 542 caregivers of children aged between 3 and 6 years old in selected preschools. We used the Child Feeding Questionnaire (CFQ) to measure caregivers' feeding practices. Multiple linear regression was used for analysis. Caregivers who had higher levels of perceived feeding responsibility ( β 0⋅20, P < 0⋅001), who were more concerned about their child being overweight ( β 0⋅11, P < 0⋅001) and who had more depressive symptoms ( β 0⋅23, P 0⋅05) were associated with food restriction practice. Caregivers who were less concerned about their child being overweight ( β -0⋅10, P < 0⋅001) and who had higher levels of perceived feeding responsibility ( β 0⋅25, P < 0⋅001) were associated with pressure to eat practice. Caregivers who had higher education ( β 0⋅29, P < 0⋅05), who had higher levels of perceived feeding responsibility ( β 0⋅47, P < 0⋅001), who were more concerned about their child being overweight ( β 0⋅15, P < 0⋅001) and who were less concerned about their child underweight ( β -0⋅06, P < 0⋅05) were associated with monitoring feeding practice. In addition, as the children have gotten older ( β 0⋅08, P < 0⋅05), there is increased use of monitoring feeding practice. This study is one of few studies that show the association between caregiver and child characteristics and feeding practices in developing countries such as Ethiopia. It is essential to include responsive feeding components in national nutritional programmes to improve preschool children's nutritional status in Ethiopia., (© The Author(s) 2021.)

Introduction: Mid-upper arm circumference (MUAC) has been suggested as an alternative screening tool to identify overweight and obesity in children and adolescents. Several studies have examined the diagnostic performance of MUAC to identify overweight and obesity in children and adolescents. However, the existing literature shows a considerable variability in measures of diagnostic performance and hence makes it difficult to direct clinical and public health practice. Therefore, this systematic review and meta-analysis aimed to synthesise evidence on the performance of MUAC to identify overweight and obesity in children and adolescents., Methods and Analysis: A systematic search of databases including PubMed, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO will be conducted. The search will cover all studies until 1 April 2021. Grey literature will also be retrieved from Google Scholar. Titles and abstracts will be screened by two independent reviewers. The Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used to assess the risk of bias and clinical applicability of each study. To assess possible publication bias, we will use Deeks' funnel plot. We will investigate the sources of heterogeneity by visual inspection of the paired forest plots and summary receiver operating characteristic plots. The pooled summary statistics for the area under the curve, sensitivities, specificities, likelihood ratios and diagnostic ORs with 95% CI will be reported., Ethics and Dissemination: The underlying study is based on published articles thus does not require ethical approval. The findings of the systematic review and meta-analysis will be published in a peer-reviewed journal and disseminated in different scientific conferences and seminars., Prospero Registration Number: CRD42020183148., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate the performance of mid-upper arm circumference (MUAC) to identify thinness in the late adolescence period (aged 15-19 years) in Ethiopia., Design: We conducted a school-based cross-sectional study. The receiver operating characteristics curve was used to examine the validity of MUAC compared with BMI Z-score to identify adolescents with thinness (BMI Z-score <-2 sd)., Settings: Fifteen high schools (grade 9-12) located in Addis Ababa, Ethiopia., Participants: A total of 851 adolescent (456 males and 395 females) were included in the study., Results: The prevalence of thinness and severe thinness among high-school adolescents in Addis Ababa was 9·5 % (95 % CI 7·7, 11·7 %). The overall AUC for MUAC against BMI Z-score <-2 SD was 0·91 (95 % CI 0·88, 0·93). The optimal MUAC cut-offs to identify thinness were 23·3 cm for males and 22·6 cm for females. These cut-off points give high sensitivity and specificity for both males (a sensitivity of 87·9 % and a specificity of 75·9 %) and females (a sensitivity of 100 % and a specificity 88·2 %)., Conclusions: MUAC has a comparable level of accuracy with BMI Z-score to identify thinness in adolescents aged 15-19 years. Hence, MUAC could be used as an alternative tool for surveillance and screening of thinness among adolescents aged 15-19 years. The optimum cut-off proposed by this study may incorrectly include a large number of adolescents when used in a relatively well-nourished population. In this situation, it would be necessary to choose a cut-off with greater positive predictive value.

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (β = .23, p < .001), tend to emotionally overeat (β = .09, p < .01), enjoy food more (β = 0.23, p < .001) and have more desire to drink (β = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (β = .09, p < .001), were more satiety responsive (β = .13, p < .001) and tended to eat slower (β = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests regarding the publication of this paper., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Malnutrition in hospitalized adults is a highly prevalent problem. During hospital admission, nutritional care and nutritional screenings are often overlooked components of the health care facilities in developing countries. Identifying patients who are at risk of malnutrition at admission are vital to ameliorate clinical outcomes. Therefore, the present study was aimed at assessing the magnitude of hospital malnutrition at the time of admission and evaluates its effect on the length of hospital stay among adult patients., Method: We conducted a prospective cohort study in patients ≥18 years admitted in Tikur Anbessa Specialized hospital in Ethiopia. At admission, patient's nutritional status was assessed within 48 h using the Subjective Global Assessment (SGA). The main clinical outcome, length of stay in hospital (LOS) was captured for patients in days. We ran a multivariate Cox's regression analysis to determine the relationship between malnutrition at admission and its effect on LOS., Result: Four hundred seventeen patients were enrolled. Based on Subjective Global Assessment (SGA), 62.1% were malnourished. The mean (SD) length of hospital stay for all patients admitted was 13.84 days ± 7.53, with a significant difference (p < 0.01) in length of stay between malnourished patients and well-nourished patients. Malnourished patients had significantly longer hospital stays (17.2 ± 6.8 days) than well-nourished patients (8.3 ± 4.9 days) during 30 days observations. The multivariate Cox's regression model controlled for age, sex, living conditions, number of medications, and number of diagnostic categories, disease severity score, number of comorbidities and presence of cancer found that malnutrition at admission was independently associated with prolonged LOS (adjusted hazard ratio (AHR), 0.29; 95% CI, 0.22,0.38)., Conclusion: Malnutrition at admission was highly prevalent and was highly associated with prolonged length of hospital stay. Therefore, it is essential to assess the nutritional status of patients early in admission and to institute appropriate nutritional therapy., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Nutrition 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., Methods: We 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., Results: The 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)., Conclusion: Our 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., Competing Interests: The authors have declared that no competing interests exist.

Background: Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6-59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1-6 mo., Objective: The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1-6 mo., Methods: We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1-6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of -3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs., Results: The median age, MUAC, and WLZ were 100 d (IQR: 69-145 d), 119 mm (IQR: 103-130 mm), and -1.27 (IQR: -2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%)., Conclusions: A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Understanding the national burden and trend of micronutrient deficiencies helps to guide effective intervention strategies under various circumstances. There is, however, a lack of evidence on trends, age- and sex-specific variations in Ethiopia., Objective: This study aimed to provide evidence on the trends of common micronutrient deficiencies including, dietary iron, iodine, vitamin A and other nutritional deficiencies in Ethiopia, from 1990 to 2017, using findings from the Global Burden of Disease study., Method: We used estimates from the GBD 2017 study to report the incidence, prevalence and disability-adjusted life years of micronutrient deficiencies in Ethiopia from 1990 to 2017. All estimates, both crude counts, as well as all-age and age-standardized rates per 100,000 population, are accompanied by 95% uncertainty intervals (UIs). We summarized the age- and sex-specific patterns and we compared the burden with the sub-Saharan Africa and global estimate., Results: From 1990 to 2017, the age-standardized prevalence rate of dietary iron, vitamin A and iodine deficiency decreased by 20.1%, 16.7%, and 91.6%, respectively. However, MNDs still account for a large number of DALYs in the country. In 2017, the all-age total DALYs due to dietary iron deficiency were estimated to be 448.4 thousand [95% UI: 298.9-640.7], accounting for 1.18% of the total DALYs. Similarly, the all-age total DALYs due to vitamin A deficiency were 397.8 thousand [256.1-589.2]. The total DALYs due to iodine deficiency were estimated to be 89.6 thousand [48.3-155.4]., Conclusions: Micronutrient deficiencies and associated morbidity and mortality are still high in Ethiopia compared with the sub-Saharan and global estimate. Adolescent and early adult females and children aged under-five are disproportionately affected segments of the population. Therefore, in collaboration with other sectors, the National Nutrition Program needs to place greater emphasis upon improving accessibility and utilization of nutrient-rich foods and supplementation, particularly for vulnerable groups of the population.

Background: Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts., Methods: This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers., Result: We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers., Conclusion: We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service., Competing Interests: The authors have declared that no competing interests exist.

After 6 months, children require increased food and nutrient intake from complementary food for their growth and development. However, quantitative data on macro and micronutrient intakes from complementary food is limited. Thus, this study is designed to identify the adequacy of energy and micronutrient intake from complementary foods among children aged 6-23 months and to characterize current feeding practice in Southern Ethiopia. A community-based cross-sectional study was conducted from February to March 2016. Simple random sampling was used to recruit 190 mothers/primary caregivers of children aged 6-23 months. A repeated interactive multiple-pass 24-hr recall survey was used to assess' food and nutrient intake of children. Complementary food was low in animal sources, fruits, and vegetables. Most of the children (94.7%) consume grain, roots, and tubers. Vitamin A-rich fruits and vegetables are consumed by 71 (37.8%) children. Very few (1.6%) children consume iron-fortified food. Median protein intake exceeds the estimated requirement from complementary food. Except for vitamin B2 and B6, intake of energy and micronutrient were below world health organization (WHO) recommendations among children aged 9-23 months. In conclusion, infant and young child feeding practices in Butajira district did not conform to recommendations. Intake of energy and micronutrient from complementary food among children aged 6-23 months in Butajira district was inadequate. Consumption of a diverse diet by including animal source food (ASF) such as poultry, organ meat, chicken liver, beef, fruits, and vegetables is needed to fill the nutrient intake gap among the study participant., Competing Interests: The authors declare that we have no conflict of interest., (© 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y., Objectives: The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level., Methods: This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000-2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken., Results: National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls' education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls' education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction., Conclusions: Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Background: Adolescent overweight and obesity is a global public health problem, associated with an increased risk of metabolic syndrome. Recently, mid-upper arm circumference (MUAC) has been suggested as a screening tool to identify overweight and obesity among school-age children and early adolescents (5-14 years). However, little is known about the potential use of MUAC in the late adolescence period (15-19 years). Therefore, the present study aimed to evaluate the performance of MUAC to identify overweight (including obesity) in the late adolescence period in Ethiopia., Methods: We conducted a cross-sectional study among 851 adolescents aged 15 to 19 years. We collected anthropometric data including MUAC, weight and height with the help of trained field workers. The receiver operating characteristic (ROC) curve analysis was used to examine the validity of MUAC compared to BMI Z score in identifying adolescents with overweight or obesity. Furthermore, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), proportion of correctly classified, positive, and negative likelihood ratio for the proposed optimal cut-offs., Results: MUAC was strongly correlated with BMI Z score with a correlation coefficient (r) of 0.81 (95% CI; 0.79-0.84). The optimal MUAC cut-off for identifying adolescents with overweight or obesity was 27.7 cm for males and 27.9 cm for females. The area under the ROC curve (AUC) was 0.96 (95% CI; 0.93-0.98) for males and 0.96 (95% CI; 0.94-0.98) for females. The accuracy level of MUAC to identify adolescents with overweight (including obesity) was high for both sexes (overall a sensitivity of 91.1% and a specificity of 90.3%)., Conclusions: MUAC has relatively equivalent accuracy with BMI Z score to identify overweight and obesity in adolescents. Hence, MUAC could be used as an alternative tool for surveillance and screening of overweight in adolescents aged 15-19 years., Competing Interests: The authors have declared that no competing interests exist.

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We developed the model using a prospective cohort of 379 pregnant women in South Ethiopia. A stepwise multivariable analysis was done to develop the prediction model. To improve the clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. All accuracy measures were internally validated using the bootstrapping technique. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The AUC of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify pregnant women at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications, thus improving the overall maternal and child healthcare in low- and middle-income countries.

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., Competing Interests: The authors have declared that no competing interests exist.

Background: Unhealthy weight control behaviors are a serious concern, impairing the quality of life in adolescents. Although recent epidemiological studies indicate a high level of disordered eating in developing countries, such data in Ethiopia are scarce. Thus, this study aimed to determine the extent of unhealthy weight control behaviors (i.e., purging and nonpurging) and corresponding associated factors among urban Ethiopian adolescents., Method: A cross-sectional study using self-administered questionnaires was applied to 690 randomly selected female high school adolescents in Addis Ababa, Ethiopia in 2017. Measures included unhealthy weight control behaviors, body mass index, subjective perception of body weight, appearance satisfaction, depressive symptoms, and socio-demographic factors. Logistic regression was applied for data analyses, that is, adjusted odds ratio (aOR) with 95% confidence interval (CI)., Results: The level of unhealthy weight control behaviors (i.e., a score of at least once a week in the last 1 month) was 30.7% (N = 208). Specifically, the extent of purging and nonpurging weight control behaviors was 1.5% (N = 10) and 29.8% (N = 202), respectively. Factors that were significantly associated with unhealthy weight control behaviors were perception of being overweight [aOR = 3.01; 95%CI: 1.11-8.11], being overweight [aOR = 3.28; 95%CI: 1.54-7.01], severe depression [aOR = 4.09; 95%CI: 1.73-9.96], and high socio-economic status [aOR = 2.07; 95%CI: 1.30-2.80]., Conclusion: This study reveals a considerable level of unhealthy weight control behaviors among female adolescents in an urban setting in Ethiopia. Researchers and policy makers should focus their attention upon this emerging public health challenge and develop associated strategies., (© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc.)

Background: Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia., Methods: We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach's alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status., Results: This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity., Conclusions: The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale's applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in-depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try "Desta," a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child ("continuing users," n = 14) or had stopped feeding Desta ("noncontinuing users," n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited "appropriate use" and "continued use." For "appropriate use," defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to "continued use," the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings., (© 2019 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

The evidence base for micronutrient powder (MNP) interventions predominantly consists of quantitative studies focused on measuring coverage, utilization, and/or biological outcomes. We need other types of studies to broaden the scope of our knowledge about determinants of MNP programme effectiveness. Addressing this knowledge gap, this paper focuses on the process of designing an ethnographic research protocol to obtain caregivers' perspectives on the factors that influenced their use of intervention delivery services and their adherence to MNP recommendations. The research was undertaken within the context of formative evaluations conducted in Mozambique and Ethiopia. Ethnography provides a means for acquiring and interpreting this knowledge and is an approach particularly well suited for formative evaluation to understand the response of a population to new interventions and programme delivery processes. We describe decisions made and challenges encountered in developing the protocol, and their implications for advancing methodology in implementation research science. In addition to a core team of three investigators, we added an "advisory group" of 10 experts to advise us as we developed the protocol. The advisory group reviewed multiple drafts of the interview protocol and participated in mock interviews. In the protocol development process, we faced the issues and made decisions about concerned gaps in content, cultural adaptations and comprehension, and interview guide structure and format. Differences between the core team and the advisory group in methodological approaches to the structure and content of questions call attention to the importance of establishing greater communication among implementation scientists working in nutrition interventions., (© 2019 The Authors. Maternal & Child Nutrition Published by John Wiley & Sons Ltd.)

Background: The intergenerational continuity of undernutrition is influenced by shared genetic, household socio-economic and cultural resources which will be associated with the mother and the child nutritional status, possibly to the same degree. Provided that this assumption is valid, maternal height and BMI could be a simple way of measuring nutritional status of their children., Methods: Data were obtained from the 2011 Ethiopia Demographic and Health Survey (EDHS 2011). An analytical sample of 8, 505 children whose mothers are not pregnant and live with their biological mothers was included. The bivariate associations between nutritional indices of the mother and the children were analyzed with Pearson correlation coefficients. The sensitivity, specificity, predictive values and area under Roc curves were calculated. Logistics regression for binary outcomes was also used to evaluate the predictors of child undernutrition., Results: Children who experienced stunting, underweight or wasting had mothers with lower mean BMI than those who did not ( p  < 0.001). Maternal and child nutritional status were positively correlated. The sensitivity of maternal underweight (defined by BMI < 18.5 kg/m 2 ) as a predictor of child's nutritional status (<- 2 z-scores) is low, failing to reach 50% for any of the child nutrition indices. In logistics regression, maternal BMI was associated with stunting, underweight and wasting ( p  < 0.001) while maternal height was only associated with stunting and underweight ( p  < 0.001)., Conclusion: The sensitivity and specificity of maternal anthropometric indicators to identify growth deficits among children were too low to justify using maternal indicators as a replacement for child growth measurements., Competing Interests: Competing interestsThe authors declare that they have no competing of interest., (© The Author(s). 2019.)

Background: Adolescence is characterized by rapid growth and development with a significantly increased need for macro and micronutrients. However, there is little empirical evidence on the burden of anaemia among adolescent girls in developing countries such as Ethiopia. This study aims to address this gap by evaluating the magnitude of anaemia with an aim to guide design of intervention modalities to address anaemia among adolescent girls., Methods: The study employed a community based cross sectional design. The study was conducted on weekends to capture both in school and out of school adolescent girls. Data was collected from a total 1323 adolescent girls. From each district, we randomly selected villages and ensured that the sampled households had a range geographical spread (lowlands, highlands) within the larger category of rural and urban. We performed anaemia testing using HemoCue B-Haemoglobin analyser. We applied a complex survey data analysis method to estimate the level of anaemia. The hemoglobin level was adjusted for altitude and smoking status. We ran a logistic regression model to evaluate predictors of anaemia., Results: The overall anaemia prevalence ranged from 24 to 38%, with an average rate of 29%. Less than half of the girls heard the term anaemia, and about one third knew the relationship between anaemia and the intake of iron rich foods. The risk of anaemia is higher among adolescent girls in their early adolescence period (10-14 years) (Adjusted Odds Ratio (AOR); 1.98; 95% CI; 1.03, 3.82] and among adolescent girls who lived in moderately food insecure households (AOR 1.48; 95% CI; 1.05-2.09). However, knowing the term "anaemia" was found to be protective against the risk of anaemia., Conclusions: The risk of anaemia was particularly high among adolescent girls in their early age and among those living in food insecure households. The prevalence of anaemia among adolescent girls is a moderate public health problem. According to the WHO set criteria, the districts could be candidates for intermittent iron and Folic acid supplementation program.

Background: Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia., Methods: This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations' World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition., Result: Government effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition., Conclusion: This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.

Background: In low-income countries it is difficult to obtain complete data that show spatial heterogeneity in the risk of tuberculosis within-and-between smaller administrative units. This may contribute to the partial effectiveness of tuberculosis control programs. The aim of this study was to estimate the spatial risk of tuberculosis distribution in Gurage Zone, Southern Ethiopia using limited spatial datasets., Methods: A total of 1601 patient data that were retrieved from unit tuberculosis registers were included in the final analyses. The population and geo-location data were obtained from the Central Statistical Agency of Ethiopia. Altitude data were extracted from ASTER Global Digital Elevation Model Version 2. Aggregated datasets from sample of 169(40%), 254(60%) and 338(80%) kebeles were used to estimate the spatial risk of TB distribution in the Gurage Zone by using a geostatistical kriging approach. The best set of input parameters were decided based on the lowest prediction error criteria of the cross-validation technique. ArcGIS 10.2 was used for the spatial data analyses., Results: The best semivariogram models were the Pentaspherical, Rational Quadratic, and K-Bessel for the 40, 60 and 80% spatial datasets, respectively. The predictive accuracies of the models have improved with the true anisotropy, altitude and latitude covariates, the change in detrending pattern from local to global, and the increase in size of spatial dataset. The risk of tuberculosis was estimated to be higher at western, northwest, southwest and southeast parts of the study area, and crossed between high and low at west-central parts., Conclusion: This study has underlined that the geostatistical kriging approach can be applied to estimate the spatial risk of tuberculosis distribution in data limited settings. The estimation results may help local public health authorities measure burden of the disease at all locations, identify geographical areas that require more attention, and evaluate the impacts of intervention programs.

Objective: We aimed to evaluate the association between household food insecurity and maternal depression in Ethiopia. Design/Setting/Subjects In 2014, we conducted a cross-sectional study in southern Ethiopia, including 591 food-secure and 2500 food-insecure households. We measured depression status of women using the Patient Health Questionnaire-9 validated for Ethiopia, with a cut-off of ≥5. We evaluated household-level food insecurity using a validated Household Food Insecurity Access Scale. We applied Bayesian modelling to evaluate the relationship between food insecurity and maternal depression accounting for other observed characteristics., Results: Among the analytic sample, 80·8 (95 % CI 79·4, 82·2) % of women were living in food-insecure households. The overall prevalence of probable depression (mild and moderate forms) was 4·7 (95 % CI 4·1, 5·6) %. All individual depressive symptoms had a significantly higher prevalence in the food-insecure group, except for suicidal ideation (but small numbers; P<0·001). In the Bayesian model adjusting for paternal characteristics, there was a significant dose-response linear relationship (trend) between household food insecurity and maternal depression (P<0·01). The adjusted OR (95 % Bayesian credible interval) for depression for differing levels of food insecurity were: mild food insecurity, 3·29 (1·63, 6·18); moderate, 3·82 (1·91, 7·45); severe, 12·50 (3·38, 32·70)., Conclusions: The study documented a high burden of depression among women who lived in food-insecure households. Given this finding, we recommend integrating mental health in the livelihood programmes in areas suffering from food insecurity.

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.