Prevalence and Factors Associated with Undernutrition among Exclusively Breastfeeding Women in Arba Minch Zuria District, Southern Ethiopia: A Cross-sectional Community-Based Study

Undernutrition and associated factors among internally displaced lactating mothers in Sekota camps, northern Ethiopia: A cross-sectional study

Background

Undernutrition is the term used to describe when a person consumes insufficient amounts of nutrients and energy to meet their needs for maintaining health. Despite substantial progress, undernutrition remains a serious public health concern in many low and middle-income nations, including Ethiopia. Women and children are, in reality, the most nutritionally vulnerable individuals, particularly in times of crisis. In Ethiopia, 27 percent of lactating women are thin or malnourished, and 38% of children are stunted. Although the issue of undernutrition may worsen in times of emergency, like war, there are limited studies available in Ethiopia that show the nutritional status of lactating mothers in humanitarian settings.

Objectives

The main aim of this study was to determine the prevalence and investigate the factors associated with undernutrition among internally displaced lactating mothers in Sekota camps, in northern Ethiopia.

Methods

A cross-sectional study through a simple random sampling technique was conducted among 420 randomly selected lactating mothers in Sekota Internally Displaced Persons (IDP) camps. Data were collected using a structured questionnaire and anthropometric measurements. Logistic regression analysis was employed to identify independent factors associated with maternal undernutrition.

Results

Using a cut-off mid-upper arm circumference <23 cm, the prevalence of undernutrition among internally displaced lactating mothers was 54.8%. Large family size [adjusted odds ratio (AOR) = 4.35; 95% CI: 1.32, 10.22], short birth interval (AOR = 4.85; 95% CI: 1.24, 10.00), low maternal daily meal frequency (AOR = 2.54; 95% CI: 1.12, 5.75), and low dietary diversity score (AOR = 1.79; 95% CI: 1.03, 3.10) were all significantly associated with undernutrition.

Conclusion

The prevalence of undernutrition among internally displaced lactating mothers is relatively high. Governments and other concerned organizations involved in providing care and support to Sekota IDP camps should increase their efforts to improve the nutritional status of lactating mothers.

Anaemia, anthropometric undernutrition and associated factors among mothers with children younger than 2 years of age in the rural Dale district, southern Ethiopia: A community‐based study

Mothers in resource‐poor settings are affected by different forms of undernutrition. However, the nutritional status of mothers in rural areas, particularly after delivery, is not well documented. This study assessed haemoglobin levels and body mass index (BMI) of mothers with children below 2 years of age in a rural district of southern Ethiopia. Factors associated with low haemoglobin levels and low BMI were analysed. A community‐based cross‐sectional study was conducted among 931 mother‐child pairs. Structured and standard questionnaires were used to collect data on background information, 24 h dietary recalls, and household food insecurity. Anthropometric and haemoglobin level assessments were performed. Anaemia was defined as haemoglobin levels below 12.0 g/dl, and anthropometric undernutrition was defined as a BMI <18.5 kg/m². Multilevel linear regression was used to determine associations. Out of 931 mothers, 12.8% were anaemic and 12.6% had a BMI <18.5 kg/m². The prevalence of minimum dietary diversity was 37.8%. The majority (78.5%) of the households were food insecure. Weight (β 0.02; 95% CI: 0.003−0.03), dietary diversity (β 0.08; 95% CI: 0.03−0.12) and secondary school attendance (β 0.34; 95% CI: 0.08−0.59) were associated with the mothers' haemoglobin level. Dietary diversity (β 0.08; 95% CI: 0.01−0.16) and household's wealth (β 0.6; 95% CI: 0.27−0.94) were associated with the mothers' BMI. Findings suggest that education and community‐based nutrition interventions must be strengthened to ensure household food security. Implementation of the national food‐based strategies should be considered, to improve the dietary diversity and nutritional status of mothers.

Anaemia and underweight were less prevalent among mothers with young children in the rural Dale district, southern Ethiopia, than the national report of the Ethiopian Demographic and Health Survey in 2016.

Dietary diversity is positively associated with haemoglobin level and body mass index among mothers with children younger than 2 years of age.

The existing nutrition interventions such as the Productive Safety Net Programme need strengthening, to improve the sustained food access to rural households.

Planing and implementing community‐based small‐scale activities, such as school gardening, and fish and poultry farming, to ensure the availability and affordability of nutritious foods.

Under-Nutrition and Associated Factors Among Lactating Mothers in Ethiopia: A Systematic Review and Meta-analysis

INTRODUCTION

Under-nutrition (body mass index < 18.5 kg/m²) is a global problem with an increasing trend in recent years. The burden is high in low and middle-income countries, especially in Africa. Lactating mothers are among the most vulnerable groups for under nutrition; particularly in sub-Saharan Africa. In Ethiopia, the prevalence of under-nutrition among this group is inconsistent and inconclusive. Therefore, we aimed to assess the pooled prevalence of under-nutrition and its associated factors among lactating mothers in Ethiopia.

METHODS

To write this review and meta-analysis, we followed the preferred reporting items for systematic review and meta-analysis guidelines. Primary articles were searched from PubMed, Hinari, Cochrane Library, science direct databases, Google, and Google scholar. STATA version 16 software and a standardized Microsoft excel format were used for analysis and data extraction, respectively. Heterogeneity between studies was checked. To determine the pooled prevalence of under-nutrition, we used a random-effect model. Begg's and Egger's tests were done to detect publication bias. Subgroup analysis was also steered and association was uttered by a pooled odds ratio with 95% CI.

RESULTS

The pooled prevalence of under-nutrition among lactating mothers was 23.84% [95% CI (19.40, 28.27)]. Educational status (no formal education) {Pooled OR 2.30 [95% CI (1.34, 3.96)]} was significantly associated with under-nutrition.

CONCLUSION

The pooled prevalence of under-nutrition was high. Maternal educational status was significantly associated with under-nutrition. Therefore, the federal ministry of health and the concerned stakeholders should give attention to these most vulnerable groups and strengthen the implementation of the previously designed strategies.

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m²), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.

Underweight and associated factors among lactating women in Uganda: Evidence from the Uganda demographic health survey 2016

BACKGROUND

Lactating mothers are at increased risk of being underweight because of the physiological changes that lead to disproportionately higher energy and nutrient requirements compared to their non-pregnant and non-lactating counterparts.

OBJECTIVE

We aimed to determine the prevalence and factors associated with being underweight among lactating women in Uganda.

METHODS

We used the Uganda Demographic and Health Survey (UDHS) 2016 data of 1356 women aged 20 to 49 years. Multistage stratified sampling was used to select study participants. The data were collected using validated questionnaires. We used multivariable logistic regression to determine factors associated with underweight among 20 to 49-year-old lactating women in Uganda.

RESULTS

The prevalence of underweight was 8.2% (111/1356) (95% confidence interval, [CI]: 7.0-10.0). Women who had no education were 10.21 (adjusted odds ratio, [AOR] = 10.21; 95% CI: 1.61-64.74) times as likely to be underweight as those who had higher (post-secondary) education levels. Women who were not working were 50% (AOR = 0.50; 95% CI: 0.26-0.94) less likely to be underweight compared to those who were working. Women in the Western (AOR = 0.15; 95% CI: 0.07-0.32), Eastern (AOR = 0.34; 95% CI: 0.18-0.66), and Central (AOR = 0.30; 95% CI: 0.12-0.74) regions were 85%, 66% and 70% respectively less likely to be underweight compared to those in the Northern region.

CONCLUSION

Based on the findings of this and other studies, it is important for the different stakeholders to design targeted nutrition programs for lactating women particularly those with low levels of education and those from the Northern region.

Prevalence of undernutrition and its associated factors among pregnant women in Konso district, southern Ethiopia: a community-based cross-sectional study

Background

Undernutrition during pregnancy is an important public health problem. It is highly prevalent in Ethiopia but not sufficiently addressed yet. Hence, this study aimed to assess the prevalence of undernutrition and its associated factors among pregnant mothers in Konso district, Ethiopia.

Methods

Community-based cross-sectional study was conducted with a qualitative inquiry from December 2018 to January 2019. A multistage stratified sampling technique was used to select 527 subjects and quantitative data were collected from these subjects using a structured interviewer-administered questionnaire and additionally qualitative data were generated through two focus group discussions among purposely selected discussants. Mid upper arm circumference (MUAC) was measured by standard non-stretchable MUAC tape. Data were entered into Epi-data version3.1 and analyzed by SPSS version 21. In multivariable binary logistic regression, a statistically significant association was declared at p-value < 0.05 while thematic framework analysis was employed for the qualitative data.

Results

Among 501 participants, the overall prevalence of undernutrition (MUAC < 23 cm) was 43.1% (95% CI 38.7–47.5%). Household food security (AOR = 3.1; 95% CI: 2.1–4.6), low dietary diversity score (AOR = 4.9; 95% CI: 2.6–9.2), medium dietary diversity score (AOR = 2.3; 95% CI: 1.2–4.7), absence of latrine (AOR = 1.8; 95% CI: 1.2–2.6) and having family resource decision making by husband only (AOR = 1.7; 95% CI: 1.1–2.6) were significantly associated factors. Traditional believes to restrict food such as egg, milk, and milk products, avocado for women, weak nutrition education and malnutrition screening program, daily consumption of locally prepared alcoholic drink called “Cheka”, drought-prone nature of this setting, traditional way of farming practices and low socio-economic status were found to be barriers for women’s undernutrition.

Conclusions

The prevalence of undernutrition was found to be higher than previously reported findings. Household food security, dietary diversity, latrine availability, family resource decision making, food restrictions, weak maternal nutrition education, and malnutrition screening program, the practice of depending on a local alcoholic drink called “Cheka”, drought, traditional way of farming and low socio-economic status were identified factors. Hence, interventions targeting maternal nutrition education, hygiene, and sanitation promotion, household food insecurity improvement strategies should be implemented to improve the nutritional status of pregnant women.

Nearly one-third of lactating mothers are suffering from undernutrition in pastoral community, Afar region, Ethiopia: Community-based cross-sectional study

Background

Undernutrition is responsible for a significant proportion of maternal and child morbidity and mortality. Lactating women are nutritionally vulnerable groups because this period places a high nutritional demand on the mother and leads to nutritional stress. Poor nutrition during lactation has a significant negative consequence to mothers and children’s survival, growth, and development. Therefore this study aimed to assess the nutritional status of lactating mothers and associated factors in pastoral community, Afar region, Ethiopia.

Methods

A community-based cross-sectional study was conducted from January 5/2020 to February 10/2020, in the Abala district. The data were collected from a sample of 366 lactating mothers whose children aged less than 24 months. Data was collected through face-to-face interviews and anthropometric measurements. Study participants were recruited using a systematic sampling technique. Anthropometric measurements (both body mass index and mid-upper arm circumference) were taken from each mother using calibrated equipment and standardized techniques. Data were entered into Epi-data version 4.2 and exported to SPSS version 22 for analysis. Predictor variables with a P-value < 0.25 at bivariable analysis were candidates for the final model. Statistical significance was declared at P-value of < 0.05 in the multivariable logistic regression.

Result

This study showed that 120(32.8%) and 122(33.3%) surveyed mothers were undernourished using a cut-off body mass index <18.5 kg/m² and mid-upper arm circumference <23 Centimeter, respectively. Lactating mothers who didn’t meet the minimum dietary diversity score were more than five (Adjusted odds ratio (AOR) = 5.103; 95% confidence interval (CI): 2.128, 12.238) times more likely to be undernourished than those who met the minimum dietary diversity score. Mothers with short birth intervals were also more than four (AOR = 4.800; 95% CI: 2.408, 9.567) time more likely to be undernourished.

Conclusion

Nearly one-third of lactating mothers were undernourished. Undernutrition among lactating mothers was significantly associated with maternal dietary diversity score and birth interval. Health education on proper and adequate maternal dietary feeding practices, and proper family planning utilization during lactation should be emphasized.

Dietary diversity and practice of pregnant and lactating women in Ethiopia: A systematic review and meta-analysis

The dietary diversity of pregnant and lactating women remains unacceptably poor in resource-limited countries such as Ethiopia. Despite the presence of inconsistent and inconclusive small-scale studies, it is difficult to portray an actual picture of dietary diversity and dietary practices of women in Ethiopia. This study aimed to identify the prevalence of dietary diversity, dietary practice, and dietary patterns of pregnant and lactating women in Ethiopia. Electronic and gray literature sources were explored. A total of 3,256 articles were found, of which 38 were included in the final analysis. The data were analyzed by using STATA version 15. The pooled estimates were presented using random-effects models due to considerable heterogeneities among studies. In this study, 16,412 pregnant and lactating women were included. The pooled prevalence of low, medium, and high dietary diversity scores of pregnant women was 37.1%, 41.55%, and 39.3%, respectively. Likewise, low, medium, and high dietary diversity scores of lactating women were 50.31%, 41.22%, and 9.1%, respectively. The mean dietary diversity of pregnant and lactating women was 3.99 ± 0.20. Regarding the minimum dietary diversity, 56.6% of pregnant women and 50.21% of lactating women were found to have inadequate dietary diversities. Two-third (65.7%) of pregnant women were found to have poor dietary practice. Starchy foods were the main staple foods of study subjects, whereas organ meats were least consumed food types. The dietary diversity score, minimum dietary diversity, and dietary practices of women are suboptimal and below WHO and FAO recommendations. This could lead to both macro- and micronutrient deficiencies. Policymakers, program managers, healthcare workers, and stakeholders need to redesign nutrition promotion and intervention programs to alleviate this issue.

Food Choice Behaviors of Lactating Women: Association with Body Mass Index and Fruits and Vegetables Intake in Central Amhara Region, Ethiopia-An Observational Study

BACKGROUND

What food people choose to eat is embraced by circumstances that are essentially influenced by the underlying motives of food choices which are important to a healthful dietary change. Therefore, this study aimed to explore food choice behaviors associated with nutritional status and FVs intake in women during lactation from central Amhara.

METHODS

A multistage sampling technique was applied to select study participants. A study was conducted among 423 randomly selected lactating women using a face-to-face interview of the questionnaire. A community-based cross-sectional, quantitative study with descriptive and analytical components was done. Anthropometrics measurements such as weight, height, waist, and hip circumference were taken from all participants. Body mass index was calculated to determine the nutritional status of women. Data were analyzed using SPSS version 20 computer software program. Association between dependent and independent variables was identified by logistic regression analysis, and a P-value< 0.05 was taken as statistically significant.

RESULTS

About 21.7% of women were underweight. Approximately 37.4% of women had good consumption trends to fruits and vegetables. Healthy meal eating motivation, price-consciousness, and mood concern were identified as the most significant behaviors of food choice, influencing the nutritional status of women with AOR (95% CI) of 2.1 (1.21-3.62), 3.01 (1.32-6.9), and 0.5 (0.30-0.95), respectively. Natural content (AOR (95%): 2.37 (1.39-4.06)), mood concern (AOR (95%): 2.29 (1.15-4.56)), religion concern (AOR (95%): 2.45 (1.37-4.4)), husband encouragement (AOR (95%): 2.26 (1.04-4.89)), and availability of milk and milk products (AOR (95%): 1.6 (1.39-2.74)) and fruits and vegetables (AOR (95%): 1.66 (1.16-3.48)) in home were associated significantly with a good intake of fruit and vegetables.

CONCLUSIONS

This finding provides a useful insight into the food choice motivations of a group of women with preference for natural foods, mood concern, religion concern, and husband support with good fruit and vegetable intake. This can help practitioners make recommendations for health promotion strategies. Emphasis on assisting women with healthy meal eating and avoiding psychological stress is important. Nutrition education about healthy food choice is recommended for communities.