Tefera Belachew

Background: Food insecurity and limited maternal nutrition knowledge contribute to childhood iron deficiency anaemia (IDA) and stunting. This study evaluated community-based Dietary Intake Behaviour Education (DIBE) for improving iron status and linear growth among children aged 6–59 months in rural central Ethiopia. Methods: A cluster-randomized controlled trial with 1:1 allocation was conducted across 16 community units from April 2021 to January 2023, enrolling 1,012 mother–child pairs. Structured assessments collected data on nutritional status, maternal nutrition knowledge, feeding practices, and related factors. IDA was defined as a haemoglobin concentration below 110 g/L, while stunting was defined as a height-for-age Z -score (HAZ) below −2 SD from the WHO child growth standards. Independent-samples t-tests and generalized estimating equations assessed intervention effects and associated factors. Results: Baseline IDA prevalence was 18.2%, higher in the intervention group (22.13%) than the control group (14.2%). At endline, IDA prevalence decreased to 6.5% in the intervention group but increased to 20.4% in controls. Baseline stunting prevalence was comparable between intervention (41.5%) and control (40.7%) groups. At endline, stunting decreased to 15.0% in the intervention group but increased to 51.8% in controls. DIBE was positively associated with HAZ ( B = 0.744, p = 0.003). Maternal food-preparation practices ( B = 0.242, p = 0.020) and IDA awareness ( B = 0.237) were also positively associated with HAZ. Conclusions: Community-based DIBE improved linear growth and coincided with reductions in IDA and stunting. Integrating practical nutrition education into routine child health services may improve nutritional outcomes in resource-limited settings. Trial registration: ClinicalTrials.gov:NCT04846062. Registered: 15 April 2021, View at: https://clinicaltrials.gov/ct2/show/NCT04846062

Background Traditional Healers (THs) hold significant roles in many developing countries, often sought for ailments like tuberculosis (TB). However, their knowledge, attitude, and practice (KAP) regarding TB, particularly in Ethiopia’s pastoralist areas, remains unexamined. This study evaluates THs’ KAP on TB and their perceptions to collaborate with conventional health systems on TB control. Method A cross-sectional survey was conducted among THs in Kereyu, Ethiopia from September 2014 to January 2015. Using a semi-structured questionnaire, 268 THs were interviewed. Health Extension workers helped identify the THs. Results Of the 268 participants, 80.6% were male. 97.4% were aware of TB (locally “dukubba soombaa”), with 80.2% associating its cause to proximity with a TB patient. Coughing for over two weeks was identified as a primary TB symptom by 87.35%. However, 66.4% displayed limited biomedical knowledge on TB. A notable 38.4% associated TB with sadness and hopelessness, while 47.8% utilized plant-based remedies for treatment. Impressively, 86.2% expressed willingness to collaborate with conventional health services for TB control. Conclusion The THs had limited biomedical knowledge and some misconceptions about TB. Despite providing traditional medicine to treat TB, their readiness to collaborate with established health systems is promising. Thus, Ethiopian TB control initiatives should consider integrating THs via targeted training and health education interventions.

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6–11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6–23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

Dietary diversity is a crucial element of inclusive care for people living with HIV (PLWHIV). Particularly in resource-limited countries where undernutrition and food insecurity prevail, low intention and poor attitude towards diversified diets are the common challenges. The aim of this study was to assess the intention towards dietary diversity behavior among adult PLWHIV in Jimma Zone public hospitals, Southwest Ethiopia. A hospital-based survey study was carried out in five public institutions among 403 sampled adult PLWHIV. Data were entered into Epi-Data (The EpiData Association, Odense, Denmark) and exported to SPSS version 20 (IBM, Armonk, NY, USA) for analysis. Relationships among variables were assessed using correlation coefficients. A multivariable linear regression model was fitted to assess predictors of behavioral intention towards dietary diversity at p-value ≤ 0.05. The quantitative data were supplemented by qualitative data, which were collected through key informant interviews and analyzed thematically. The significant predictors of intention to use dietary diversity were attitude (β = 0.196, p < 0.01) and subjective norm (β = 0.390, p < 0.01) of the adult PLWHIV. The constructs of theory of planned behavior (TPB) independently explained the variance in intention towards dietary diversity by 25.7%. All the intermediate, proximal and distal components of the theory of planned behavior (TPB) explained the final model finding 32.2% of variance in the intention to use dietary diversity. The qualitative findings indicated that delivery of HIV care requires a sense of livelihood development, economical improvement and creating a sense of ownership for sustainable HIV care by creating behavioral change at the individual level. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to understand behavioral intention as a potential determinant of malnutrition and the Poor ART outcomes rather than symptomatic treatment of malnutrition with food by prescription.

Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10–19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47–49% of adolescents had marginal iron store (< 50 µg/l). Hb, SF, and SFol concentrations increased in the intervention group, but not in the control group (P < 0.05). Marginal iron store decreased from 49 to 12% after 3-months of WIFAS; whereas, the proportion of adolescents with elevated SF (> 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P < 0.001). WIFAS intervention for three-months was effective in reducing iron and folate deficiency in adolescent girls. Future studies should evaluate the long-term impact of intermittent WIFAS.

Background: Application of advanced body composition measurement methods is not practical in developing countries context due to cost and unavailability of facilities. This study generated ethnic specific body fat percent prediction equation for Ethiopian adults using appropriate data. Methods: A cross-sectional study was carried ifrom February to April 2015 among 704 randomly selected adult employees of Jimma University. Ethnic specific Ethiopian body fat percent (BF%) prediction equation was developed using a multivariable linear regression model with measured BF% as dependent variable and age, sex, and body mass index as predictor variables. Agreement between fat percent measured using air displacement plethysmography and body fat percent estimated using Caucasian prediction equations was determined using Bland Altman plot. Results: Comparison of ADP measured and predicted BF% showed that Caucasian prediction equation underestimated body fat percent among Ethiopian adults by 6.78% (P < 0.0001). This finding is consistent across all age groups and ethnicities in both sexes. Bland Altman plot did not show agreement between ADP and Caucasian prediction equation (mean difference = 6.7825) and some of the points are outside 95% confidence interval. The caucasian prediction equation significantly underestimates body fat percent in Ethiopian adults, which is consistent across all ethnic groups in the sample. The study developed Ethnic specific BF% prediction equations for Ethiopian adults. Conclusion: The Caucasian prediction equation significantly underestimates body fat percent among Ethiopian adults regardless of ethnicity. Ethiopian ethnic-specific prediction equation can be used as a very simple, cheap, and cost-effective alternative for estimating body fat percent among Ethiopian adults for health care provision in the prevention of obesity and related morbidities and for research purposes.

Background: Metabolic Syndrome (MetS) is becoming a big public health problem in developing countries like Ethiopia. Developing countries have an almost two-fold higher risk of death due to non-communicable diseases (NCDs) compared to high-income countries. This study aimed to assess the magnitude and factors associated with MetS among adult residents of Mekelle city. Methods: A population-based cross-sectional study was carried out among 266 randomly selected adults from July to September 2019. Data were collected on socio-demographic, clinical, anthropometric, and lifestyle characteristics using a structured questionnaire adapted from the WHO STEPs survey tool. Fasting Blood Glucose (FBG) and lipid profiles were tested using a blood sample. Bivariate and multivariable logistic regression analyses were used to identify factors associated with MetS and variables were considered statistically significant at p ≤ 0.05. Results: The findings of this study showed the magnitude of MetS was 21.8%. The proportion of MetS was relatively higher among women (24.6%) than men (18.5%). Raised blood pressure was the most prominent (42.5%) component of MetS followed by central obesity (41.7%). The magnitude of the other components of MetS was 38.0%, 21.4%, and 14.3% for elevated triglyceride, raised FBG, and low HDL-C, respectively. Advanced age, medium and high monthly income, walking less than 10 minutes per day, raised Body Mass Index (BMI), higher waist to hip ratio, and elevated total cholesterol were significantly associated with a higher risk of metabolic syndrome. Conclusion: In this study, we found a high prevalence of metabolic syndrome and its components, which highlights an urgent need for a public health strategy for its prevention, early diagnosis, and management.

Objective: We hypothesise that exposure to aflatoxins and fumonisins, measured in serum, alters protein synthesis, reducing serum protein and insulin-like growth factor 1 (IGF-1), increasing inflammation and infection, leading to child’s linear growth failure.Design: Children 6–35 months, stratified by baseline stunting, were subsampled from an intervention trial on quality protein maize consumption and evaluated at two time-points.Setting: Blood samples and anthropometric data were collected in the pre-harvest (August–September 2015) and post-harvest (February 2016) seasons in rural Ethiopia.Participants: 102 children (50 stunted and 52 non-stunted).Results: Proportions of children exposed to aflatoxin G1, aflatoxin G2 and aflatoxin M1 were higher in the pre-harvest (8, 33 and 7, respectively) compared to post-harvest season (4, 28 and 4, respectively). The proportion of children exposed to any aflatoxin was higher in the pre-harvest than post-harvest season (51 % v. 41 %). Fumonisin exposure ranged from 0 % to 11 %. In joint statistical tests, aflatoxin exposure was associated with serum biomarkers of inflammation (C-reactive protein, α-1-glycoprotein) and protein status (transthyretin, lysine, tryptophan), IGF-1 and linear growth (all P < 0·01). However, exposure to specific aflatoxins was not significantly associated with any biomarkers or outcomes (all P > 0·05).Conclusions: Aflatoxin exposure among rural Ethiopian children was high, with large variation between seasons and individual aflatoxins. Fumonisin exposure was low. There was no clear association between aflatoxin exposure and protein status, inflammation or linear growth. A larger study may be needed to examine the potential biological interactions, and the assessment of aflatoxins in food is needed to determine sources of high exposure.