Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach

Analysis of Malnutrition among Children under Five Years across Contrasting Agroecosystems of Northwest Ethiopia: Application of Structural Equation Modeling

Child malnutrition remains a public health challenge in developing countries, but a comprehensive understanding of its burden and its determinants in specific local contexts is generally lacking. This study examined the prevalence of malnutrition and its determinants among children aged <5 years across contrasting agroecosystems in northwest Ethiopia. A community-based cross-sectional study involving 400 respondents was employed. Data were collected through semi-structured questionnaires and anthropometric measurements, complemented with focus group discussions and key informant interviews. The direct and indirect effects of the determinants of malnutrition were examined using structural equation modeling (SEM). The overall prevalence of child malnutrition, measured using the Composite Index of Anthropometric Failure, was 49%, with notable variation across agroecosystems (from 36.1% [midland with red soil] to 59% [lowland and valley fragmented]). Disease experience had significant positive direct effects on malnutrition. Dietary intake had negative and significant total (direct and indirect) effects on malnutrition, partially mediated through disease experience. Serial mediation in SEM analysis revealed significant indirect relationships between malnutrition and food security, feeding and care practices, household environment, health services, maternal diet, maternal empowerment, household wealth, and nutrition-sensitive agricultural practices. In conclusion, child malnutrition was highly prevalent and higher among children in the lowland and valley fragmented agroecosystem, characterized by unfavorable agro-climatic conditions, lower wealth status, poor health services access, and higher disease (particularly malaria) exposure. This study demonstrates the dynamics and multifaceted nature of malnutrition, highlighting the importance of considering geographical differences when planning interventions for childhood malnutrition and its determinants.

Nutritional knowledge, nutritional status and associated factors among pregnant adolescents in the West Arsi Zone, central Ethiopia

When pregnancy occur among teenagers; there is a competition for nutrients between the still-growing adolescent mother and her fetus. Pregnant adolescents' nutrition issues are not addressed well and changes are too slow in Ethiopia. This study aimed to study, nutrition knowledge, nutritional status and associated factors among pregnant adolescents in West Arsi , central Ethiopia. We conducted a cross-sectional study of 426 pregnant adolescents between January 1 and January 25, 2023. Data were collected using kobo collect and analyzed using SPSS version 25. We performed linear regression to identify independent predictors of nutritional status and multivariable logistic regression analyses to identify nutritional knowledge. Odds ratios (ORs) with 95% confidence intervals were estimated to show the strength of the association. Magnitude of good nutrition knowledge was 23.7%, 95% CI (21.4-25.3%), and the odds of having good nutrition knowledge was 7.5 times higher among participants whose education level was above college compared with illiterate participants [(AOR = 7.5, 95% CI = (5.27-9.38)],the odds of having good nutrition knowledge was 8 times higher among adolescent who had ANC visits, [(AOR = 8, 95% CI = (3.63-13.85)], and the odds of having good nutrition knowledge was 5 times higher among adolescents who received nutrition education [(AOR = 5, 95% CI = (3.67- 13.53)]. Receiving nutrition education (β = 0.25, P = 0.002) and good nutrition knowledge (β = 0.08, P < 0.001) were positively associated with nutritional status; however, food insecurity (β = - 0.93, P < 0.001) was negatively associated with nutritional status. The nutrition knowledge of pregnant adolescents was suboptimal; educational status, ANC visits and nutrition education were associated with good nutrition knowledge, whereas food insecurity, low nutrition knowledge, and not receiving nutrition education were predictors of poor nutritional status. Nutritional education interventions, increasing utilization of ANC, and interventions for improving food security are strongly recommended.

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia

Ethiopia introduced its flagship poverty-targeted social protection program, the Productive safety net program (PSNP), in 2005 and Community-Based Health Insurance (CBHI) in 2011. Although both programs operate in several districts with some overlaps, evidence is scarce on how these large-scale programs jointly affect the food security of vulnerable groups. This study examines the impacts of a combination of these programs on food security outcomes among female-headed households in a chronically food-insecure and drought-prone district. Cross-sectional data were collected from 365 female-headed households selected through multi-stage sampling technique and analyzed using Inverse-probability-weighted regression adjustment (IPWRA) strategy to assess the effect of the programs on food security. The results show that while 63.6% of sample households are enrolled in CBHI and 48.8% are beneficiaries of PSNP's conditional cash transfer (CCT) component, membership in both social protection programs was 38.9%. The IPWRA analysis finds that inclusion in the CCT combined with CBHI, on average, increased dietary diversity score by 0.918 (95% CI 0.779-1.057) and food consumption score by 0.576 (95% CI 0.464-0.688). It also reduced household food insecurity access scale by 8.658 (95% CI -9.775 - -7.541). In all assessments, a combination of CBHI and CCT always produced results of a larger magnitude than each of CBHI and CCT alone. The findings provide evidence of the potentials of integrating social protection programs to increase food security outcomes among the most vulnerable and marginalized groups in a developing country. In addition, the results have also useful implications to achieve sustainable development goals related to ending hunger and achieving food security among vulnerable groups.

Exploring spatial patterns, and identifying factors associated with insufficient cash or food received from a productive safety net program among eligible households in Ethiopia: a spatial and multilevel analysis as an input for international food aid programmers

BACKGROUND

In low-income countries, households' food insecurity and the undernutrition of children are the main health problems. Ethiopia is vulnerable to food insecurity and undernutrition among children because its agricultural production system is traditional. Hence, the productive safety net program (PSNP) is implemented as a social protection system to combat food insecurity and enhance agricultural productivity by providing cash or food assistance to eligible households. So, this study aimed to explore spatial patterns of households' insufficient cash or food receiving from PSNP, and identify its associated factors in Ethiopia.

METHODS

The 2019 Ethiopian Mini Demographic and Health Survey dataset was used. A total of 8595 households were included in this study. Data management and descriptive analysis were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for spatial exploration and visualization. SaTScan version 9.5 software was used for spatial scan statistics reports. In the multilevel mixed effect logistic regression analysis, explanatory variables with a p-value of less than 0.05 were considered significant factors.

RESULTS

Overall, 13.5% (95% CI: 12.81-14.27%) of the households' level beneficiaries received cash or food from PSNP. The spatial distribution of households' benficiaries received cash or food from PSNP was not random, and good access to cash or food from PSNP was detected in Addis Ababa, SNNPR, Amhara, and Oromia regions. Households' heads aged 25-34 (AOR:1.43, 95% CI: 1.02, 2.00), 35-44 (AOR: 2.41, 95% CI: 1.72, 3.37), and > 34 (AOR: 2.54, 95% CI: 1.83, 3.51) years, being female (AOR: 1.51, 95% CI: 1.27,1.79), poor households (AOR: 1.91, 95% CI:1.52, 2.39), Amhara (AOR:.14, 95% CI: .06, .39) and Oromia (AOR:.36, 95% CI:.12, 0.91) regions, being rural residents (AOR:2.18, 95% CI: 1.21,3.94), and enrollment in CBHS (AOR: 3.34, 95% CI:2.69,4.16) are statistically significant factors.

CONCLUSIONS

Households have limited access to cash or food from the PSNP. Households in Addis Ababa, SNNPR, Amhara, and Oromia regions are more likely to receive benefits from PSNP. Encouraging poor and rural households to receive benefits from the PSNP and raise awareness among beneficiaries to use the benefits they received for productivity purposes. Stakeholders would ensure the eligibility criteria and pay close attention to the hotspot areas.

Examining linkages among multiple sustainable development outcomes: does the productive safety net program increase on-farm agrobiodiversity?

In Ethiopia, on-farm agrobiodiversity and the Productive Safety Net Program (PSNP) play a key role in building smallholders' resilience. However, the impact of PSNP on on-farm agrobiodiversity is not yet well investigated. In this paper, we develop an analytical framework that links PSNP participation to on-farm agrobiodiversity. Both diverse farming systems and PSNP require labour inputs while providing income stabilization, which might result in a negative relationship between the two. Conversely, higher income from PSNP might allow farmers to increase their long-term on-farm investments, as opposed to the strategies oriented toward the highest immediate profit or calorie intake outcome. We base our empirical analysis on the World Bank's Ethiopian Socioeconomic Survey, a panel dataset encompassing nearly 3000 respondents and a Tobit model, based on Difference-in-Difference and the Propensity-Score Matching methods. We find that Ethiopia's PSNP has a negative impact on farm labour input, both in terms of labour intensity and duration. Furthermore, our results show that participation in the program is associated, on average, with lower on-farm crop diversity. We conclude that the PSNP participation may be crowding-out production stabilizing farming activities, such as intercropping or cover cropping, that are more labour intensive. Our findings call for embedding tools in the new phase of the PSNP (2021-2025) that could incentivise on-farm resilience-oriented investments, in particular leading to higher crop diversification.

Seasonality and predictors of childhood stunting and wasting in drought-prone areas in Ethiopia: a cohort study

BACKGROUND AND OBJECTIVES

Over centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate seasonal variations in child stunting and wasting, and identify factors associated with both forms of child malnutrition in drought-prone areas.

METHODS

This cohort study was conducted among a random sample of 909 children in rural southern Ethiopia. The same children were followed for 1 year (2017-2018) with quarterly repeated measurements of their outcomes: height-for-age and weight-for-height indices (Z-scores). Linear regression models were used to analyse the association between both outcomes and baseline factors (eg, household participation in a social safety net programme and water access) and some time-varying factors (eg, household food insecurity).

RESULTS

Child wasting rates varied with seasonal household food insecurity (ᵪ² _trend = 15.9, p=0.001), but stunting rates did not. Household participation in a social safety net programme was associated with decreased stunting (p=0.001) and wasting (p=0.002). In addition to its association with decreased wasting (p=0.001), protected drinking water access enhanced the association between household participation in a social safety net programme and decreased stunting (p=0.009). Absence of a household latrine (p=0.011), lower maternal education level (p=0.001), larger family size (p=0.004) and lack of non-farming income (p=0.002) were associated with increased child stunting.

CONCLUSIONS

Seasonal household food insecurity was associated with child undernutrition in rural Ethiopia. Strengthening community-based food security programmes, such as the Ethiopian social safety net programme, could help to reduce child undernutrition in drought-prone areas. Improving clean water access and sanitation could also decrease child undernutrition.Key terms: Z-scores; Social safety net program; Water access.

COVID-19 and the gendered impacts on adolescent wellbeing: Evidence from a cross-sectional study of locally adapted measures in Ethiopia, Jordan, and Palestine

BACKGROUND

The COVID-19 pandemic and associated policy responses have interrupted services, increased financial stress, and driven social isolation, with acute impacts for adolescents. This study explores relationships between gender, COVID-19 vulnerability, social protection, and adolescent wellbeing in three diverse contexts: Ethiopia, Jordan, and Palestine.

METHODS

This study presents findings from a quantitative phone survey with adolescents in Ethiopia, Jordan, and Palestine (n = 5752) on household-level vulnerability to COVID-19-related shocks, household-level social protection (cash transfers or food aid), and locally adapted outcome measures designed to capture the gendered impacts of COVID-19 (collected between November 22, 2020 and February 25, 2021). We examine the relationship between each outcome and household-level COVID-19 vulnerability and social protection (and their interaction) using multivariate regressions, adjusting for adolescent and household characteristics.

FINDINGS

For all adolescents, increased vulnerability to COVID-19-related shocks is associated with worse outcomes for resilient coping and time spent on domestic tasks and care work. Across samples, girls spent over two additional hours on domestic and care work compared to boys. Girls in more vulnerable households experienced greater gendered constraints on behaviour. We find no association between receipt of social protection and adolescent wellbeing, and find that it only moderates the effect of COVID-19 vulnerability for less vulnerable households. Disability status, being out of school, and experiencing child marriage are also associated with adverse outcomes.

INTERPRETATION

Our study highlights that the pandemic has exacerbated underlying gender inequalities across adolescents in three very different settings, and that existing social safety nets are not adequate to fully address these impacts, particularly for the most vulnerable.

FUNDING

This work was supported by UK aid through a grant from the Foreign, Commonwealth & Development Office to the Gender and Adolescence: Global Evidence (GAGE) longitudinal research study; the EMERGE project (Bill & Melinda Gates Foundation grants: OPP1163682 and INV018007; PI Anita Raj) and the World Health Organization (WHO) Regional Office for the Eastern Mediterranean.

The Effect of Productive Safety Net Programme on Household Food Consumption and Dietary Diversity in Ethiopia

This study empirically investigates the effect of productive safety net programme (PSNP) on household food consumption and dietary diversity in Ethiopia. The study applied random effects with instrumental variable to estimate the effect of PSNP membership. The study indicates that though PSNP membership improves household food consumption, it reduces household dietary diversity score. Household food consumption and dietary diversity are also significantly influenced by sex, age, education status of household head, household size, livestock ownership, distance to the nearest market and participation in non-farm activities. The findings of this study suggest that PSNP membership should be reinforced by building household awareness of the benefits of consuming a variety of foods. In addition, PSNP membership should be designed to endow the households to accumulate essential assets, especially livestock.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

OBJECTIVE

In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia.

SOURCE OF INFORMATION

A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021.

STUDY ELIGIBILITY CRITERIA

Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included.

STUDY APPRAISAL AND SYNTHESIS

All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study.

RESULTS

Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention.

CONCLUSION

Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia.

PROTOCOL REGISTRATION NUMBER

PROSPERO, CRD42020155519.

The application of a structural nutritional care management model in severe acute pancreatitis patients undergoing early enteral nutrition via nasal jejunal nutrition tubes

OBJECTIVE

To investigate the advantages of a structural nutritional care management model (hereafter referred to as structural management) in severe acute pancreatitis (SAP) patients undergoing early enteral nutrition via nasal jejunal nutrition tubes.

METHODS

A total of 88 patients with SAP diagnosed and treated in our hospital were recruited as the study cohort and underwent enteral nutrition treatment. A random number table was used for the random grouping. The control group was routinely managed, and the study group was also administered structural management. In the study, we observed and compared the differences and changes in the relevant nutritional indexes (albumin (ALB), prealbumin (PA), and transferrin (TRF)) and the gastrointestinal hormone indexes (gastrin (MTL), vasoactive peptide (VIP), and 5-hydroxytryptamine (5-HT)) before and after the treatment. Between the two groups, we also compared the times required for the recovery of the relevant gastrointestinal physiological function indexes, the mechanical ventilation times, the hospitalization durations in the ICU, the complications, the satisfaction indexes and the satisfaction rates.

RESULTS

After the treatment, the relevant nutritional indicators, including ALB (35.26±3.35 g/L), PA (25.19±5.64 g/L), and TRF (2.82±0.54 g/L) in the study group were higher than the ALB (28.19±2.74 g/L), PA (21.29±4.32 g/L), and TRF (2.26±0.32 g/L) in the control group (all P<0.05). After the treatment, the relevant gastrointestinal hormone indicators, including MTL (269.72±37.18 pg/mL) and 5-HT (2214.61±432.95 ng/mL) in the study group were higher than the MTL (231.25±32.63 pg/mL) and 5-HT (1914.26±391.53 ng/mL) in the control group (all P<0.05). Moreover, the VIP in the study group was 53.13±6.17 pg/mL, which was significantly lower than the VIP in the control group (65.29±9.35 pg/mL, P<0.05). The time required for the recovery of the gastrointestinal function indexes in the study group was less than it was in the control group (P<0.05). The duration of the mechanical ventilation (8.16±1.93 days) and the hospitalization durations in the ICU (9.24±0.77 days) in the study group were significantly shorter than the duration of the mechanical ventilation (12.24±1.65 days) and the hospitalization durations in the ICU (13.23±0.88 days) in the control group (all P<0.05). The overall complication rate in the study group was significantly lower than it was in the control group (P<0.05), and the satisfaction rate in the study group was significantly higher than it was in the control group (P<0.05).

CONCLUSION

The combined use of structural management in SAP patients undergoing enteral nutrition treatment significantly improved the relevant nutritional indicator and gastrointestinal hormone indicator levels. It also contributed to the recovery of the gastrointestinal function indicators in the SAP patients, reduced the durations of their mechanical ventilation, their hospitalization durations in the ICU, and their complications and contributed to a significant increase in their satisfaction with the nursing.