Prioritizing the Scale-Up of Evidence-Based Nutrition and Health Interventions to Accelerate Stunting Reduction in Ethiopia

Evaluating the coverage and quality of nutrition programs via a bottom-up approach: A secondary analysis of real-time data from an end-user monitoring system in Ethiopia

Over the last two decades, great efforts and investments have been made in Ethiopia to ensure that all children have equal access to nutrition services in health facilities. While quality health systems are a prerequisite for quality nutrition services, little attention has been given to the evaluation of the supply and delivery services. The purpose of the study was to evaluate the coverage and quality of the nutrition-specific interventions delivered through the health system. Using an end-user monitoring (EUM) system, we monitored the delivery of nutrition-specific interventions in 500 districts, having 2514 health facilities distributed throughout Ethiopia. Data were collected through third-party monitors between August 2020 and 2021. Roughly 90% of health facilities were performing severe acute malnutrition management in line with the national guideline/protocol, and 2/3 of the assessed facilities were delivering iron and folic acid, vitamin A supplementation and deworming. A third of the messages on AMIYCN were retained by beneficiaries. Warehouse conditions were good in 64.3% of the facilities, but only 22% had good recording practices and about half had problems related to the quality and availability of nutrition supplies. Most beneficiaries were satisfied with the nutrition supplies and service delivered at the health facility level. This study also suggests the relevance of an EUM system to assess the quality of nutrition service delivery and its related supply management, as well as to improve the implementation of nutrition interventions as a decision-making tool.

Understanding delays in the introduction of complementary foods in rural Ethiopia

Age-appropriate breastfeeding and introduction to complementary foods can shape child feeding practices, ensure adequate energy and nutrient intake and prevent linear growth faltering. This study aimed to assess mothers' and health workers' knowledge of timely introduction to complementary foods and evaluate the relationship between delays in complementary feeding and subsequent linear growth. We conducted two rounds of surveys (March/August 2017) among 249 health workers (n = 249) and caregivers (n = 2635) of children 6-23 months of age. We collected information about socio-demographic characteristics, knowledge and practice related to timely introduction to complementary foods. The study was conducted in households from the Productive Safety Net Programme (PSNP) districts, in four highland regions of Ethiopia. Delays in the introduction to complementary feeding were widespread with 53% of children 6-8 months of age not consuming solid, semisolid or soft foods in the past 24 h. After controlling for child, caregiver and household characteristics, children not introduced to complementary foods by 6-8 months had a 0.48 SD lower length-for-age z-score at 12-15 months. Caregivers' knowledge was strongly and inversely correlated with untimely introduction of complementary foods in logistic regressions (OR = 0.55, p < 0.01). In turn, local health extension worker's knowledge was strongly correlated with caregiver's knowledge. Consequently, frequent and timely visits by health extension workers emphasising not only on what to feed but also when and how to feed a child are needed. Innovative ways of increasing reach, intensity and frequency of nutrition messaging by using the PSNP interactions as an additional point of contact would need to be explored further.

Analysis of Determinants of Stunting and Identifications of Stunting Risk Profiles Among Under 2-Year-Old Children in Ethiopia. A Latent Class Analysis

Background

Childhood stunting has a long-term impact on cognitive development and overall well-being. Understanding varying stunting profiles is crucial for targeted interventions and effective policy-making. Therefore, our study aimed to identify the determinants and stunting risk profiles among 2-year-old children in Ethiopia.

Methods and materials

A cross-sectional study was conducted on 395 mother-child pairs attending selected public health centers for growth monitoring and promotion under 5 outpatient departments and immunization services. The data were collected by face-to-face interviews, with the anthropometric data collected using the procedure stipulated by the World Health Organization. The data were entered using Epi Data version 4.6 and exported to STATA 16 and Jamovi version 2.3.28 for analysis. Bayesian logistic regression analysis was conducted to identify potential factors of stunting. Likewise, lifecycle assessment analysis (LCA) was used to examine the heterogeneity of the magnitude of stunting.

Results

The overall prevalence of stunting in children under 24 months was 47.34% (95% confidence interval (CI): 42.44-52.29%). The LCA identified 3 distinct risk profiles. The first profile is Class 1, which is labeled as low-risk, comprised 23.8% of the children, and had the lowest prevalence of stunting (23.4%). This group characterized as having a lower risk to stunting. The second profile is Class 2, which is identified as high-risk, comprised 47.1%, and had a high prevalence of stunting (66.7%), indicating a higher susceptibility to stunting compared to Class 1. The third profile is Class 3, which is categorized as mixed-risk and had a moderate stunting prevalence of 35.7%, indicating a complex interplay of factors contributing to stunting.

Conclusion

Our study identified 3 distinct risk profiles for stunting in young children. A substantial amount (almost half) is in the high-risk category, where stunting is far more common. The identification of stunting profiles necessitates considering heterogeneity in risk factors in interventions. Healthcare practitioners should screen, provide nutrition counseling, and promote breastfeeding. Policymakers should strengthen social safety nets and support primary education.

Does birth season correlate with childhood stunting? An input for astrological nutrition

INTRODUCTION

Chronic malnutrition is highly prevalent in Sub-Saharan Africa and a severe public health problem in Ethiopia.At country level in the past three decades,the prevalence of stunting is above 40%.Different researchs and intervention were implemented in the past;but the progresss is non-remarkable.Despite; the effect of birth season on childhood chronic malnutrition was not studied yet in Ethiopia.

METHODS

This research was extracted from the 2016 demographic health survey of Ethiopia. The data was collected based on national and international scientific protocols. A total of 645 enumeration areas were selected for the national survey.The surevey uses two stage stratified sampling technique to gather data from the sampling unit. After excluding non eligible children a total of 8855 participants were included for final analysis.Height and weight were measured based on the standards nutritional assessment procedure.SPSS version 20 was used to analyze the data.Descriptive statistics were used to present the data. Binary and multivariable logistic regression models were regressed to identify the potential predictors.A p-value of less than 0.05 with 95% CI were used to declare an association.

RESULT

The prevalence of stunting in Ethiopia was 38.7% (95% CI: 36.8, 40.6). Season of birth had a significant association with stunting. The odds of being stunted among children born in the spring season were decreased by 16% as compared to children born in the winter season.

CONCLUSION

Children born in the spring season were less likely to be stunted (the so called October effect). The clear scientific relation between the season of birth and child anthropometric indicator is not well understood. Nutritional interventions and policies are better to consider the birth season of the child.

The Potential Contribution of the Health System to Reducing Stunting in SUN Countries

BACKGROUND

The global nutrition community has called for a multisectoral approach to improve nutritional outcomes. While most essential nutrition interventions are delivered through the health system, nutrition-sensitive interventions from other sectors are critical.

OBJECTIVE

We modeled the potential impact that Scaling Up Nutrition (SUN) interventions delivered by the health system would have on reaching World Health Assembly (WHA) stunting targets. We also included results for targets 2, 3, and 5.

METHODS

Using all available countries enrolled in the SUN movement, we identified nutrition interventions that are delivered by the health system available in the Lives Saved Tool. We then scaled these interventions linearly from 2012 up to nearly universal coverage (90%) in 2025 and estimated the potential impact that this increase would have with regard to the WHA targets.

RESULTS

Our results show that only 16 countries out of 56 would reach the 40% reduction in the number of stunted children by 2025, with a combined total reduction of 32% across all countries. Similarly, only 2 countries would achieve the 50% reduction in anemia for women of reproductive age, 41 countries would reach at least 50% exclusive breastfeeding in children under 6 months of age, and 0 countries would reach the 30% reduction in low birth weight.

CONCLUSIONS

While the health system has an important role to play in the delivery of health interventions, focusing investments and efforts on the health system alone will not allow countries to reach the WHA targets by 2025. Concerted efforts across multiple sectors are necessary.

Vitamin A supplementation and estimated number of averted child deaths in Ethiopia: 15 years in practice (2005-2019)

Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.