Tefera Belachew

Previous research has established determinants of young child feeding (IYCF) practices in the general child population, but determinants of these practices in children with severe acute malnutrition (SAM) are unknown. This study assessed the determinants of IYCF practices among children aged 6–23 months with SAM and under SAM treatment in a pastoralist and a predominantly agrarian setting in Ethiopia. As part of the baseline survey for the R‐SWITCH cluster randomized control trial, we screened ~28,000 under‐fives and included 486 children aged 6–23 months with SAM and under SAM treatment. Multivariable regression analysis was used to identify determinants on household, caregiver and child levels. Minimum meal frequency (MMF) was similar between children from the agrarian (53.9%) and pastoralist (51.9%) setting. The prevalence of children with minimum dietary diversity (MDD) was low overall but higher among pastoralist children (31.5%) than children from the agrarian setting (19.0%; p = 0.012). The consumption of egg/flesh foods was lower among pastoralist children (5.6%) than agrarian children (16.9%, p = 0.085). Caregiver literacy was positively associated with a higher likelihood of MMF (IRR = 1.21; 95% CI:1.02–1.43; p = 0.030), while caregiver depression was associated with a lower likelihood of MMF (RR = 0.97; 95% CI:0.95–0.99; p = 0.003). Improved water source (RR = 1.59; 95% CI:1.06–2.38; p = 0.037), caregiver literacy (RR = 2.04; 95% CI:1.25–3.34; p = 0.002), caregiver MDD (RR = 2.21; 95% CI:1.60–3.05; p ≤ 0.001), older children(RR = 1.05; 95% CI: 1.02–1.08; p ≤ 0.001), and pastoralist setting (RR = 1.62; 95% CI:1.07–2.44; p = 0.014) were associated with a significantly higher likelihood of meeting MDD. Conversely, caregiver depression (RR = 0.94; 95% CI:0.90–0.97; p < 0.001), caregiver mobility restriction (IRR = 0.94; 95% CI:0.89–1.00; p = 0.025), and food insecurity (RR = 0.64; 95% CI:0.41–1.01; p = 0.05) were associated with reduced MDD likelihood. Caregiver community involvement (IRR = 1.12; 95% CI:1.00–1.26; p = 0.038), caregiver MDD (RR = 1.67; 95% CI:1.10–2.53; p = 0.043), and older children (RR = 1.08; 95% CI:1.05–1.12; p < 0.001) were associated with increased egg/flesh‐food consumption among children, while living in a pastoralist setting was associated with reduced it (RR = 0.36; 95% CI:0.13–0.97; p = 0.038). Integrated and Targeted interventions recommended: caregiver literacy/depression support to improve IYCF; livelihood‐specific foods (eggs/flesh, fruits/vegetables); WaSH enhancements; community engagement; and IYCF counseling within CMAM programs.

Background: Cancer incidence is an emerging public health problem in low‐ and middle‐income countries. Despite strong recommendations from the European Society for Clinical Nutrition and Metabolism expert to expand nutritional status assessment practices including body composition analysis for newly diagnosed cancer patients, resource‐limited settings like Ethiopia have yet to implement body composition assessments. Aims: This study aimed to demonstrate change in various body composition parameters, their patterns, and predictors among newly diagnosed cancer patients. Methods: A prospective cohort study design was applied on 231 newly diagnosed adult cancer patients at the oncology department of Jimma University Medical Center between 2024 and 2025. Analysis of body composition was done three times starting from prior to chemotherapy initiation (baseline) at about 3 months intervals using bioelectric impedance analyzer. Chi‐squared and independent t ‐test statistical models were used to assess the variation of body composition between well‐nourished and malnourished, while paired t ‐test was used to assess change prior to and post treatment, and linear mixed model was used to identify predictors of patient body composition. Results: There were significant differences in body composition parameters between well‐nourished and malnourished cancer patients. A decreasing pattern in almost all body composition parameters except fat mass was observed in malnourished cancer patients. Aging ( β = −0.033; 95% CI: −0.054, −0.013), advanced cancer stages ( β = −2.49; 95% CI: −3.90, −1.08), and male sex ( β = 1.82, 95% CI: 1.26, 2.37) were found to be predictors of SMMI trajectories among the cancer patients. Conclusions: During chemotherapy, malnourished patients experienced a decline of body composition parameters. Thus, monitoring body weight alone can be misleading, as fat mass gain masks change in the overall nutritional status. Therefore, considering early nutritional assessment, body composition analysis in the diagnosis of cancer, can benefit the patients and mitigate potential complications.

Suboptimal complementary feeding remains a major public health concern in Ethiopia, particularly among pastoralist and agro‐pastoral communities where mobile livelihoods hinder access to conventional health services. In these settings, numerous studies have highlighted the potential of leveraging culturally embedded leadership structures to enhance health promotion efforts. This study examined whether engaging traditional Dala leaders as agents of Nutrition Behavior Change Communication (DALA‐BCC) could improve complementary feeding indicators among infants and young children in the agro‐pastoral areas of northern Ethiopia. A cluster‐randomized controlled trial was conducted in Dubti District, Afar Region, involving 16 non‐adjacent clusters randomly assigned to intervention and control arms (eight each). A total of 474 mother–infant pairs (237 per arm) were enrolled at 6–17 months of age and followed over 6 months. Over a 6‐month period, the intervention group received DALA‐BCC delivered by Dala leaders, consisting of monthly group sessions and cooking demonstrations during the first 3 months, followed by home‐based individualized counseling from Month 3 to Month 6, while the control group continued usual care. Core infant and young child feeding (IYCF) indicators were measured at baseline and endline. At end line, the intervention group achieved higher rates of minimum dietary diversity (MDD) (39.7% vs. 24.7%; p = 0.001), minimum meal frequency (MMF) (67.9% vs. 47.6%; p < 0.001), and minimum acceptable diet (MAD) (28.6% vs. 12.1%; p < 0.001). Generalized estimating equation (GEE) analysis showed significant time × group interactions, indicating greater improvements in the intervention group for MDD (RR = 2.43; 95% CI: 1.35–4.39), MMF (RR = 2.08; 95% CI: 1.25–3.48), and MAD (RR = 2.35; 95% CI: 1.10–5.04). The findings demonstrate that the DALA‐BCC intervention significantly improved complementary feeding practices, highlighting the effectiveness of culturally grounded, community‐led nutrition strategies in Agro‐pastoral settings. Trial Registration: PACTR202311816542918. Registered 10 November 2023.

Severe acute malnutrition remains a major public health concern, yet a large proportion of affected children do not receive appropriate treatment. Understanding the barriers and associated factors is essential for informing targeted, context‐specific interventions. A door‐to‐door screening campaign among children aged 6–59 months was conducted from May to September 2024 in Kersa (agrarian) and Jeldessa (pastoralist) woredas of Ethiopia. The treatment coverage of severe acute malnutrition was 12.8% (95% CI: 9.0%–17.9%). The most frequently reported barriers to treatment included lack of awareness of the child's nutritional status, time and financial constraints, and absence of family permission. Multivariable analysis revealed that household wealth index (aPR: 2.9; 95% CI: 1.5–5.5), use of water treatment methods (aPR: 4.6; 95% CI: 1.7–11.9), recent community MUAC screening (aPR: 12.0; 95% CI: 5.4–26.8), availability of treatment services at a nearby health post (aPR: 3.2; 95% CI: 1.1–9.9), and possession of a vaccination card (aPR: 3.2; 95% CI: 1.1–9.1) were significantly associated with severe acute malnutrition treatment coverage. The findings highlight that severe acute malnutrition treatment coverage in both pastoralist and agrarian settings of Ethiopia remains critically low. Stronger implementation of active screening and treatment services recommended by Ethiopian national guidelines, together with social protection measures for the poorest households, may improve treatment coverage. Trial Registration: ClinicalTrials.gov (NCT06380504).

Background: Infant and young child feeding (IYCF) practices are critical for child growth and survival, yet they are strongly shaped by sociocultural and livelihood contexts. In pastoralist settings, feeding practices are influenced by traditional beliefs, mobility, environmental constraints and access to health services. However, limited evidence exists on how community norms and social structures influence IYCF in remote pastoralist communities of Ethiopia. Objective: This study aimed to explore maternal and community perspectives on IYCF practices in the pastoralist communities of Afar Region, Ethiopia. Design: Qualitative observational study using a phenomenological approach. Setting: Pastoralist communities in the Afar Region, Ethiopia. Participants: 16 mothers of children aged 6–23 months participated in in-depth interviews, and 20 community members (religious leaders, elders and clan leaders) participated in three focus group discussions. Methods: Participants were purposively selected. Data were collected using semi-structured interviews and focus group guides, audio-recorded, transcribed verbatim and translated into English. Data were analysed using an inductive thematic analysis approach. Results: Four interrelated themes shaped IYCF practices. Cultural rituals and elder authority influenced breastfeeding initiation, particularly following home births, where pre-lacteal feeding linked to the Onor/Onqor ritual was described as delaying initiation. Although awareness of exclusive breastfeeding was commonly reported among participants, seasonal water supplementation and maternal workload limited consistent adherence. Complementary feeding was generally introduced at 6 months; however, dietary diversity was constrained by pastoral livelihood instability, drought, market inaccessibility and rising food prices. Gendered household dynamics shaped resource control and caregiving responsibilities, with women bearing primary responsibility for childcare, feeding and hygiene. Clan-based social networks provided support during hardship but also reinforced some traditional feeding practices. Conclusions: IYCF practices in pastoralist Afar are shaped by cultural norms, gender relations and structural constraints, including livelihood insecurity and limited service access. Interventions should integrate culturally responsive community engagement with gender-sensitive and livelihood-informed nutrition strategies.

Objective: This review aimed to synthesize women’s experiences of maternity waiting homes (MWHs) in sub-Saharan Africa. Introduction: Globally, most maternal deaths occur in low-resource settings, with three-fourths of them occurring in sub-Saharan Africa. MWHs have been promoted as an approach to improving maternal health outcomes in these settings; however, utilization rates are low, and evidence is lacking on women’s experiences of MWHs in sub-Saharan Africa. Eligibility criteria: This review considered studies of women residing in sub-Saharan Africa who had experiences with MWHs during the final weeks of pregnancy or the first 2 weeks after childbirth. Qualitative studies conducted in English between January 2000 and July 2025 were considered for inclusion if they exclusively used qualitative research methods, including phenomenology, grounded theory, ethnography, action research, or feminist research. Methods: PubMed, Web of Science, Scopus, HINARI, Google Scholar, and MedNar databases were searched in July 2025. The standardized JBI tool was used to critically appraise the eligible studies. The meta-aggregative approach was used to synthesize the findings, and the ConQual approach was used to assess confidence in the findings. Results: Ten studies were included for data extraction and synthesis. The review yielded a total of 78 findings with illustrations. These findings were grouped into 13 categories based on similarity in meaning and were subjected to in-depth analysis. The review generated 5 synthesized findings: i) Positive perceptions and attitudes motivate women to use MWHs; ii) Fear of complications, high-risk pregnancies, and lack of awareness affect women’s decision to use MWHs; iii) Family support motivates the use of MWHs, whereas women’s lack of autonomy and household chores affect their decisions to use MWHs; iv) Health facility–level factors, such as lack of basic amenities and respectful care, affect access to MWHs; and v) Geographic barriers, such as long distance and poor road conditions, impede women’s access to MWHs. Conclusions: Positive perceptions and attitudes motivated women to use MWHs; however, lack of autonomy, household chores, lack of awareness, lack of basic facilities, and geographic barriers affected women’s decisions to use MWHs. The findings from this review can be used to inform policies, practices, and research to improve women’s access to maternal health services, including MWHs, in sub-Saharan Africa. Review registration: PROSPERO CRD42022306003

Child undernutrition remains a major public health concern. Although Ethiopia is committed to achieving the sustainable development goals of ending child h

This study aims to compare motor skill-related physical fitness in children with moderate thinness (MT) to those with normal weight (NW) (aged 5-7) living in a rural Ethiopian area. In this comparative, school-based cross-sectional study, BMI-for-age was used to define the nutritional groups in 167 children aged 5-7, including 74 MT children (BMI-for-age =[-3;-2]) and 93 NW children (BMI-for-age=[-1z;+1z[). The Performance and Fitness test battery (PERF-FIT) measured motor skill-related physical fitness. Differences in PERF-FIT subscales and total score were explored with ANOVA (independent variables: nutritional status and age group). Variables explaining the variance in total PERF-FIT scores were identified through multivariable linear regression. A significant interaction effect between BMI category and age groups was found for the PERF-FIT total score (F_2,161=5.69, p = 0.004) and the Motor Skill subscale (F_2,161=7.01, p = 0.001). On the Agility and Power subscale, performance increased with age (F_2,163=9.76, p < 0.001). Also, children with MT perform significantly poorer than their NW peers (F_1,163=5.58, p = 0.019). Food security, age, grip strength and education of the mother explained 32.4% of the variance in total PERF-FIT scores. Overall, children with MT exhibit poorer motor skill-related fitness than their NW peers.

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.