Teklu Gemechu Abessa

Objective: This study aimed to investigate the association between moderate thinness (MT) and muscle strength among children aged 5–7 years old in Ethiopia. Design: A school-based comparative cross-sectional study was conducted between June and July 2022. Their nutritional status (MT v. well-nourished (WN) was identified using BMI-for-age-and-sex; hand grip was measured using a digital grip strength dynamometer, and biceps, quadriceps and gastrocnemius strength were measured with Digital (Handheld) Dynamometry. Independent predictors of muscle strength were identified using a multivariable linear regression model. Setting: The study was conducted in Kindergarten and primary schools of Jimma Town, located in Southwest Ethiopia. Participants: Children 5–7 years old (n 388) with moderate thinness (MT = 194) and well-nourished peers (WN = 194). Results: Children with MT (n 198) had significantly lower grip strength, biceps, quadriceps and gastrocnemius muscle groups than WN children (n 198) (P < 0·001). The mean and sd of grip strength were 4·15 (sd 2·56) kg for MT and 5·6 (sd 2·04) kg for WN children. Biceps strength was 34·3 (sd 7·34) Newton (N) for MT and 48 (11·69) N for WN children. Gastrocnemius strength was 30·1 (6·9) N for MT and 45·1 (sd 9·7) N for WN children. After adjusting for background characteristics, WN children had 1·38 times higher grip strength (β = 1·38, P < 0·001), 11·22 times higher biceps strength (β = 11·22, P < 0·001), 16·70 times higher quadriceps strength (β = 16·70, P < 0·001) and 12·75 times higher gastrocnemius strength (β = 12·75, P < 0·001) than MT children. Conclusion: Children with MT had significantly lower muscle strength than their WN counterparts. This highlights the negative functional effect of wasting.

Stroke remains a significant global health challenge, particularly in low- and middle-income Countries (LMICs), where two-thirds of stroke-related deaths occur, and disability-adjusted life years are seven times higher compared to high-income Countries (HICs). The majority of stroke survivors suffer from upper limb impairment, severely limiting their daily activities and significantly diminishing their overall quality of life. Rehabilitation plays a critical role in restoring function and independence, but it faces challenges such as low engagement, limited customization, difficulty tracking progress, and accessibility barriers, particularly in LMICs. Immersive virtual reality (imVR) has shown promise in addressing these challenges, but most commercial imVR systems lack therapeutic design and cultural adaptation. This study aimed to develop culturally adaptable imVR games for upper limb stroke rehabilitation (ULSR) in the context of LMICs, with a particular focus on Ethiopia. The AdaptRehab VR system was developed including six imVR games (Basket Bloom, Strike Zone, TapQuest, FruitFall Frenzy, Precision Pitch, and Bean Picker Pro) through co-creation approaches involving Ethiopian and Belgian physiotherapists, stakeholders, and patients, incorporating game development mechanics in rehabilitation, such as therapeutic aims, cultural factors, feedback, automatic progression recording, task variety, and personalized rehabilitation. It was designed with the Unity 3D engine and Oculus Quest headsets, supporting controllers and hand tracking. This culturally tailored imVR platform has demonstrated significant potential to enhance ULSR accessibility, patient motivation, and outcomes in resource-constrained settings, addressing critical gaps in stroke rehabilitation solutions. In conclusion, the AdaptRehab VR system was successfully developed as a culturally contextualized imVR platform tailored to tackle ULSR challenges in LMICs, with a specific focus on Ethiopia.

Background: Immersive virtual reality (imVR) has shown promise for upper limb stroke rehabilitation (ULSR). However, optimal implementation and treatment modalities remain unclear. This systematic review and meta-analysis aimed to evaluate imVR’s efficacy in ULSR and determine optimal treatment parameters. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs), comparing imVR to conventional rehabilitation (CR) in adult stroke patients, was conducted. Databases including, the Web of Science, Scopus, and PubMed, were searched. Meta-regression further explored the relationship between intervention duration, frequency, and outcomes. Results: Twenty-three studies were included in the systematic review, representing 395 patients, with thirteen incorporated into the meta-analysis. imVR showed statistically significant improvements in the Fugl–Meyer Assessment Upper Extremity (FMA-UE) Scale (mean difference (MD) = 3.04, 95% CI [1.46; 4.62], p < 0.001) and the Box and Block Test (BBT) (MD = 2.85, 95% CI [0.70; 4.99], p = 0.009) compared to CR, but not in the Action Research Arm Test (ARAT) (MD = 3.47, 95% CI [−0.22; 7.15], p = 0.06). However, these improvements did not reach clinically significant thresholds (7 points for FMA-UE and 6 points for BBT). Clinical subgroup analysis showed significant improvements for both subacute (standardized mean difference (SMD) = 0.92, 95% CI [0.48; 1.36], p = 0.002) and chronic (SMD = 0.69, 95% CI [0.03; 1.35], p = 0.03) stroke stages. Meta-regression indicated that there was a significant positive relationship between the intervention duration and upper limb improvement. Conclusions: imVR demonstrates potential for improving upper limb motor function following stroke, particularly with longer intervention durations and individual session lengths for chronic stroke. However, the improvements observed were not clinically significant, highlighting the need for further research with larger sample sizes and standardized outcome measures to determine optimal treatment protocols.

Background: Malnutrition has extensive consequences, affecting multiple levels of functioning, including motor skill impairments. However, current interventions have mainly focused on dietary treatment, often neglecting motor impairments and relying solely on clinical and anthropometric indicators to assess treatment response. This study aims to bridge this gap by examining the combined effect of ready-to-use supplementary food (RUSF) and high-intensity motor learning (HiML) on motor skill-related physical fitness in children with moderate thinness (MT). Methods: A cluster randomized controlled trial was conducted among children 5–7 years old with MT in Jimma Town. Three schools were randomized to three intervention arms, including a total of 69 children: RUSF (n = 23), RUSF + HiML (n = 25), and no intervention (n = 21). The HiML training was applied for 12 weeks, and RUSF was distributed daily for 12 weeks. HiML was given daily (1 h/day, 5 days/week). The primary outcome was motor skill-related physical fitness assessed at baseline and endline using the performance and fitness test battery (PERF-FIT). The changes from baseline to endline measurements were calculated as differences, and the mean difference in these changes/differences (DID) was then computed as the outcome measure. AN(C)OVA was used to directly investigate differences between groups. Statistical significance was declared at p-value ≤ 0.05. Results: There was a significantly greater and comparable improvement in both the RUSF and RUSF + HiML groups compared to the control group for the ‘stepping’ item (p < 0.001), the ‘side jump’ item (p < 0.001), the ‘standing long jump’ (p < 0.001) and the ‘jumping and hopping’ total (p = 0.005). The RUSF + HiML group showed significantly greater improvements in the ‘bounce and catch’ (p = 0.001) and ‘throw and catch’ (p < 0.001) items compared to the RUSF group, which, in turn, demonstrated greater improvement than the control group in both items (p < 0.01). Conclusions: A 12-week combination of RUSF + HiML was proven to be safe in children with MT and caused clear improvements in motor skill-related physical fitness. When the children received RUSF with HiML training, similar gains in stepping, side jump, standing long jump, and jumping and hopping were observed, except for the ball skills where the HiML training group performed better.

Background: In Ethiopia, moderate thinness (MT) is a persistent issue among children. Yet, evidence on the effects of dietary supplementation and motor skills training in these children is limited. Objective: This study aimed to assess the effect of Ready-to-Use Supplementary Food (RUSF), whether or not combined with high-intensity motor learning (HiML), on weight, height, body composition, and muscle strength in children 5–7 years old with MT living in Jimma Town, Ethiopia. Methods: A cluster-randomized controlled trial was carried out among 69 children (aged 5–7) with MT assigned to receive RUSF (n = 23), RUSF + HiML (n = 25), or no intervention (control group, n = 21). A multivariable Generalized Estimating Equations model was used and the level of significance was set at alpha < 0.05. Results:At baseline, there were no significant differences in the outcome measurements between the RUSF, RUSF + HiML, and control groups. However, after 12 weeks of intervention, there were significant mean differences in differences (DIDs) between the RUSF group and the control arm, with DIDs of 1.50 kg for weight (p < 0.001), 20.63 newton (N) for elbow flexor (p < 0.001), 11.00 N for quadriceps (p = 0.023), 18.95 N for gastrocnemius sup flexor of the leg (p < 0.001), and 1.03 kg for fat-free mass (p = 0.022). Similarly, the mean difference in differences was higher in the RUSF + HiML group by 1.62 kg for weight (p < 0.001), 2.80 kg for grip strength (p < 0.001), 15.93 for elbow flexor (p < 0.001), 16.73 for quadriceps (p < 0.001), 9.75 for gastrocnemius sup flexor of the leg (p = 0.005), and 2.20 kg for fat-free mass (p < 0.001) compared the control arm. Conclusion: RUSF alone was effective, but combining it with HiML had a synergistic effect. Compared to the control group, the RUSF and RUSF + HiML interventions improved the body composition, height, weight, and muscle strength of the studied moderately thin children. The findings of this study suggest the potential that treating moderately thin children with RUSF and combining it with HiML has for reducing the negative effects of malnutrition in Ethiopia. Future research should explore these interventions in a larger community-based study. This trial has been registered at the Pan African Clinical Trials Registry (PACTR) under trial number PACTR202305718679999.

Stroke is the second most common cause of death worldwide, and it greatly impacts the quality of life for survivors by causing impairments in their upper limbs. Due to the difficulties in accessing rehabilitation services, immersive virtual reality (IVR) is an interesting approach to improve the availability of rehabilitation services. This systematic review evaluates the technological characteristics of IVR systems used in the rehabilitation of upper limb stroke patients. Twenty-five publications were included. Various technical aspects such as game engines, programming languages, headsets, platforms, game genres, and technical evaluation were extracted from these papers. Unity 3D and C# are the primary tools for creating IVR apps, while the Oculus Quest (Meta Platforms Technologies, Menlo Park, CA, USA) is the most often used headset. The majority of systems are created specifically for rehabilitation purposes rather than being readily available for purchase (i.e., commercial games). The analysis also highlights key areas for future research, such as game assessment, the combination of hardware and software, and the potential integration incorporation of biofeedback sensors. The study highlights the significance of technological progress in improving the effectiveness and user-friendliness of IVR. It calls for additional research to fully exploit IVR’s potential in enhancing stroke rehabilitation results.

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between −3 and −2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn–soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I² = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I² = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Background: Severe Acute Malnutrition (SAM) remains a major cause of child mortality. To improve the management and survival of children the World Health Organization (WHO) endorsed the protocol for the management of SAM. The protocol suggested the integration of psychosocial stimulation as part of the medico-nutritional care process to prevent the long-term adverse developmental impact of the SAM. However, there is little scientific evidence behind the recommended stimulation intervention.Method: A parallel-group cluster-randomized controlled trial will be conducted among 144 children with SAM age 6–59 months in Southern Ethiopia. The study will have two groups where: children with SAM admitted in the intervention health facilities will receive psychosocial stimulation in addition to the routine inpatient care and for 6 months after discharge. Children with SAM admitted in the SC of the control health facilities will receive the routine inpatient care without psychosocial stimulation and home-based follow up for 6 months after discharge. All mothers/ caregivers will also receive uniform health education on child health-related issues. The primary outcome of the study will be child development while the secondary outcomes will include child growth and treatment outcome. All outcomes will be assessed four times: at enrollment, upon discharge from the SC, at 3 and 6 months of follow up. The data will be analyzed using STATA Version 15 Statistical Software. The anthropometric Z-scores and percentile of the median will be calculated child using WHO Anthro Version 3.2.2 Statistical Software. To assess the overall effect of the intervention by controlling other potential contributing factors, a generalized linear mixed model will be used.Discussion: The present study will have an important contribution in generating supplementary evidence regarding the effect of psychosocial stimulation interventions on the development and growth outcomes of children with SAM. The study will further address the impact of the intervention on treatment outcome indicators that are still under-researched areas requiring new scientific evidence.Trial registration: Pan African Clinical Trials Registry -PACTR201901730324304. Registered 25 November 2018,https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5739

Background: The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM.Method: Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital.The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations.Results: The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes.Conclusion: Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available.Trial registration: The trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) #NCT03036176.

The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (β: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.