Children In Ethiopia Research Articles

Bayesian multilevel analysis of determinants of acute respiratory infection in children under the age of five years in Ethiopia

BackgroundAcute respiratory tract infection (ARI) is one of the leading causes of illness and mortality in children under the age of five worldwide. Pneumonia, which is caused by a respiratory tract infection, kills about 1.9 million children under the age of 5 years around the world. The majority of these deaths occur in underdeveloped countries. According to the 2016 Ethiopia Demographic and Health Survey (EDHS), the prevalence rate of ARI in Ethiopia was 7%. Prevalence is defined as the number of infectious diseases present at a given period in relation to the total number of children under the age of five who have been exposed to ARI. The goal of this study was to determine the risk factors for acute respiratory infection among children under the age of five in Ethiopia.MethodsTo provide representative samples of the population, a community-based cross-sectional sampling scheme was designed. Bayesian multilevel approach was employed to assess factors associated with the prevalence of ARI among children under age five in Ethiopia. The data was collected from 10,641 children under the age of 5 years out of which 9918 children were considered in this study.ResultsThe ARI prevalence rate in children under the age of 5 years was assessed to be 8.4%, somewhat higher than the country’s anticipated prevalence rate. Children whose mothers did not have a high level of education had the highest prevalence of ARI. The key health, environmental, and nutritional factors influencing the proportion of children with ARI differed by area. Tigray (15.3%) and Oromia (14.4%) had the highest prevalence of ARI, while Benishangul Gumuz had the lowest prevalence (2.6%). The use of vitamin A was investigated, and the results revealed that roughly 43.1% of those who received vitamin A had the lowest prevalence of ARI (7.7%) as compared to those who did not receive vitamin A. Diarrhea affected 11.1% of children under the age of five, with the highest frequency of ARI (24.6%) and the highest prevalence of ARI reported in children whose drinking water source was unprotected/unimproved (9.4%).ConclusionsThe prevalence of ARI among children under the age of 5 years was found to be strongly affected by the child’s age, household wealth index, mother’s educational level, vitamin A supplement, history of diarrhea, maternal work, stunting, and drinking water source. The study also found that the incidence of ARI varies significantly between and within Ethiopian areas. When intending to improve the health status of Ethiopian children, those predictive variables should be taken into consideration.

Increasing Burden of Acute Hepatitis A among Ethiopian Children, Adolescents, and Young adults: A Change in Epidemiological Pattern and Need for Hepatitis A Vaccine.

Hepatitis A is a vaccine-preventable, feco-oral infection due to poor sanitary conditions. It is predominantly acquired during early childhood and results in lasting acquired protective immunity. However, it results in severe disease which can end up in acute fulminant hepatitis and hepatic failure when acquired during adolescence and adulthood. The prevalence of acute hepatitis A is increasing among children, adolescents, and young adults from higher-income households. They acquire this infection at a later age when they are exposed for the first time to contaminated food and drinks after being brought up in a relatively clean environment. This calls for the introduction of the Hepatitis A vaccine in Ethiopia; possibly as part of the Expanded Program on Immunization (EPI). Socio-demographic and clinical data were collected from patients who were diagnosed to have hepatitis A infection at Adera Medical Center in 2020. This study showed that clinical acute hepatitis A is becoming common among children, adolescents, and young adults from relatively high-income families. Among patients with acute hepatitis, 89% were from middle and high-income families. There is a need for the incorporation of hepatitis A vaccine in the Ethiopian EPI program.

Assessment of level of asthma control and related factors in children attending pediatric respiratory clinics in Addis Ababa, Ethiopia

BackgroundAsthma is a common airways disease with significant morbidity and mortality in all ages. Studies of pediatric asthma control and its determinants yielded variable results across settings. However, there is paucity of data on asthma control and its factors in Ethiopian children. We aimed to assess the level of asthma control and the related factors in children attending pediatric respiratory clinics at three tertiary hospitals in Addis Ababa.MethodsWe conducted a cross-sectional study from March 1 to August 30, 2020 using standardized questionnaires and review of patient’s charts. Data was analyzed using SPSS software for window version 26.ResultsA total of 105 children (56.2% male) were included in the study. The mean age (± SD) and age at Asthma diagnosis (± SD) were 6 (± 3.3) and 4 (± 2.8) respectively. Uncontrolled asthma was present in 33 (31%) of children. Comorbidities (Atopic dermatitis and allergic Rhinitis (AOR = 4.56; 95% CI 1.1–18.70; P = 0.035), poor adherence to controller medications (AOR = 3.23; 95% CI 1.20–10.20; P = 0.045), inappropriate inhaler technique (AOR = 3.48; 95% CI 1.18–10.3; P = 0.024), and lack of specialized care (AOR = 4.72; 95% CI 1.13–19.80; P = 0.034) were significantly associated with suboptimal asthma control.ConclusionOne-third of children attending pediatric respiratory clinics in Addis Ababa had uncontrolled Asthma. Treatment of comorbidities, training of appropriate inhaler techniques, optimal adherence to controllers, and proper organization of clinics should be emphasized to improve asthma control among children.

Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study

BackgroundEthiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention.MethodsA multicenter, prospective study was performed on children aged 5–17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated.ResultsA total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence.ConclusionPoor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.

Do Behavioral Interventions Increase the Intake of Biofortified Foods in School Lunch Meals? Evidence from a Field Experiment with Elementary School Children in Ethiopia

BackgroundMany African countries are seeking to improve nutrition by introducing biofortified foods in school feeding programs. These programs are generally designed to create demand for biofortified foods both in and outside of school. Finding ways to encourage child acceptance of novel biofortified foods is key to the success of this strategy. ObjectivesThe aim was to assess effects of 2 behavioral interventions in promoting the consumption of biofortified foods as part of school lunch meals. MethodsThe study is based on a field experiment involving 360 school-going children of in the third, fourth, and sixth grades. We tested if structured provision of information about the nutritional benefits of a biofortified food and its association with an aspirational figure influence its consumption when served alongside a favorite local food as part of school lunch meal. Six schools in Tigray, Ethiopia, were randomly selected to participate, with 4 participating in the Orange-Fleshed Sweetpotato (OFSP) Program. Of the 4 participating in the program, 2 were assigned to provide educational information about sweetpotato, whereas 2 presented the same information plus depictions of an aspirational figure (a famous local athlete) associated with the sweetpotato. ResultsProvision of information on the nutritional benefits of biofortified food combined with an aspirational figure resulted in increased consumption of biofortified food by children. However, provision of the information alone did not detectably increase consumption. An analysis of trends over the course of the study revealed no discernable decay effect. ConclusionsOur results highlight the potential for relatively inexpensive behavioral interventions to increase acceptance of novel biofortified foods among children in a developing-country context. Larger studies with more varied interventions and larger numbers of participating schools could address several of the weaknesses in this study and establish more robust findings.

An observational assessment of the safety of mass drug administration for trachoma in Ethiopian children.

BackgroundThe International Trachoma Initiative (ITI) provides azithromycin for mass drug administration (MDA) to eliminate trachoma as a public health problem. Azithromycin is given as tablets for adults and powder for oral suspension (POS) is recommended for children aged <7 y, children <120 cm in height (regardless of age) or anyone who reports difficulty in swallowing tablets. An observational assessment of MDA for trachoma was conducted to determine the frequency with which children aged 6 mo through 14 y received the recommended dose and form of azithromycin according to current dosing guidelines and to assess risk factors for choking and adverse swallowing events (ASEs).MethodsMDA was observed in three regions of Ethiopia and data were collected on azithromycin administration and ASEs.ResultsA total of 6477 azithromycin administrations were observed; 97.9% of children received the exact recommended dose. Of children aged 6 mo to <7 y or <120 cm in height, 99.6% received POS. One child experienced choking and 132 (2%) experienced ≥1 ASEs. Factors significantly associated with ASEs included age 6–11 mo or 1–6 y, non-calm demeanor and requiring coaxing prior to drug administration.ConclusionsThere is a high level of adherence to the revised azithromycin dosing guidelines and low incidence of choking and ASEs.

Multilevel Analysis of Factors Associated with Underweight Among Under-Five Children in Ethiopia

Multilevel Analysis of Factors Associated with Underweight Among Under-Five Children in Ethiopia

Trends and Determinants of Anemia among Under-Five Children in Ethiopia, Evidence from 2005 – 2016 Ethiopian Demographic and Health Survey; Mixed-Effect Binary Logistic Regression and Multivariate Decomposition Analysis

Background: Anemia is a major public health problem and it is defined as the condition of having a low number of red blood cells or a low amount of haemoglobin from the normal level. This situation touches most under-five-year old children. Objective: This study aimed to examine the trends of anemia prevalence among children aged between 6 to 59 months and its determinants in Ethiopia based on three consecutive Ethiopian Demographic and Health Surveys (EDHSs). Methods: A total of 3,716 in 2005, 8,365 in 2011 and 7,563 in 2016 children aged between 6 to 59 month were involved in this study. To identify significantly contributing factors for the increase in anemia prevalence in Ethiopia over the last 11 years’ logit-based multivariate decomposition analysis was used and mixed-effect logistic regression model was fitted to identify determinant factors. Result: 47.13% of the change in anemia prevalence over time was attributable to difference in behavior. Being single (AOR = 0.665; 95%CI: 0.482 – 0.737), big stunted (AOR = 1.533; 95%CI: 1.359 – 1.729), being underweight (AOR = 1.200; 95%CI: 1.040 – 1.384), being wasted (AOR = 1.261; 95%CI: 1.038 – 1.530), having more than three under-five children (AOR = 1.463; 95%CI: 1.041 – 2.058), source of drinking water was not improved (AOR =1.165; 95%CI: 1.052 – 1.291) mother was anemic (AOR = 1.664; 95%CI: 1.487 – 1.862), fever history (AOR = 1.427; 95%CI: 1.211 – 1.683) were more likely to experience the prevalence of anemia. Conclusion: This study found that the prevalence of anemia has increases over time in Ethiopia since 2005. Stunning, underweight, wasting, mothers age, source of drinking water, number of under-five children, wealth status, maternal anemia, birth order, being twin or single, age of children, birth size, fever and cough history were significant predictors of anemia prevalence. Designing interventions that address maternal anemia and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia. Keywords: Childhood anemia, Mixed effect logistic regression, Multivariate decomposition analysis, Ethiopia DOI: 10.7176/JCSD/67-03 Publication date: January 31 st 2022

Rotavirus Prevalence and Vaccine Coverage Among Children in Ethiopia: Study Review

Rotavirus infection is one of viral infectious disease associated severe dehydration and gastroenteritis among children in both developed and developing countries will be infected with rotavirus in the first five years of life. Therefore, the aim of this review is to derive information of rotavirus prevalence, dominant strains and vaccine coverage in Ethiopia, 2022. Different studies conducted between 2003 to 2020 years. All gathered articles were stored into the mendeley software library and duplicate were identified. The studies were selected using nine evaluation criteria, and then studies which acquired scores above 50% were considered as having a low risk of bias included in review. The data analyzed and finding were presented by tables, bar graph and pie chart. Results of 13 studies selected for review, six studies on prevalence of rotavirus, while seven studies on vaccine coverage. From reviewed studies, 606 22.7% (95% CI = 21.1%-24.3%) tested rotavirus positive out of 2671 enrolled children. Predominant strains of rotavirus detected was G1P [8] 22.2%, G3P [6] 19.7% and G12P [8] 11% and vaccine coverage was 69.8% (95% CI: 66.8, 72.5). Out of vaccinated children, 1344 (92.2%) and 1270 (86.2%) were taken Rota 1 and Rota 2 respectively. The studies revealed that rotavirus common among Ethiopian children and safe effective interventions against rotavirus infection needed to prevent severe disease.

Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey.

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Prevalence and risks of soil transmitted helminths among Ethiopian school children: A cross-sectional study

Objective: To assess the prevalence and associated factors of soil transmitted helminths (STHs) among Endemata primary school in North West Ethiopia, 2021.Methods: A cross-sectional study with 195 school children was conducted from May to July 2021 at Endemata primary school. The study participants were selected by using systematic random sampling technique. Stool samples were processed via direct wet mount and formol-ether concentration techniques. Data was entered by Epi-Dara version 3.1 and data analysis was done using SPSS version 20.0. Variables were considered to be statistically significant if P<0.05 at 95% confidence level.Results: The overall prevalence of STHs was 10.8% (95% CI 7.1-16.0). The prevalence of Ascaris lumbricoides, hookworm and Trichuris trichiura were 5.6% (95% CI 3.1-9.9), 3.1% (95% CI 1.3-6.7) and 2.1% (95% CI 0.6-5.3), respectively. Grade 1-4 students were more likely to get infected with STHs as compared to grade 5-8 students (adjusted OR 4.7, 95% CI 1.3-16.6). Students who did not have latrines at their home were at higher risk to develop STHs infection comparing with those who had latrine at their home (adjusted OR 5.0, 95% CI 1.7-15.2). Similarly, the school children who did not wear shoes were more likely to be infected by STH parasite than those who did it (adjusted OR 6.3, 95% CI 1.9-20.7). The odds of being infected by STH parasites in children who did not trim their fingernails were 4.9 as compared to those who did it (adjusted OR 4.9, 95% CI 1.5-15.7).Conclusions: The prevalence of STHs among Endemata primary school children was low. Student grade level, latrine availability, shoes wear and nail status were significantly associated with STHs infection. Therefore, we recommend policy makers and stakeholders to follow the integration of deworming with water, hygiene and sanitation as well as the consistent health education of school children to control and prevent STH infections.

COVID-19 in hospitalized Ethiopian children: characteristics and outcome profile.

Introductionconsidering the number of people affected and the burden to the health care system due to the coronavirus pandemic, there is still a gap in understanding the disease better leaving a space for new evidence to be filled by researchers. This scarcity of evidence is observed especially among children with the virus. Therefore, this study aimed to assess the characteristics and outcome profile of children with COVID-19 admitted to Millennium COVID-19 Care Center in Ethiopia.Methodsa prospective cohort study was conducted among 90 children with COVID-19 who were admitted from June 23rd to September 17th, 2020. Data were summarized using frequency tables, mean ± standard deviation or median with inter quartile range values. A chi-square test/Fischer´s exact test was used to compare disease severity between groups.Resultsthe median age of the participants was 15 years and 57 were females. The most common reported route of disease transmission was through close contact with a diagnosed person (41/90). Only three had a history of pre-existing comorbid illness. One-third (31/90) had one or more symptoms at diagnosis, the most common being cough (20/90). Among the 90 patients, 59 were asymptomatic, 14 had mild disease and the rest 17 had moderate disease. Based on the chi-square/Fischer´s exact test result, no statistically significant difference was observed between the age groups and sex.Conclusionpediatric patients seemed to have a milder disease presentation and a favorable outcome compared to other countries report and also the adult pattern observed in our country.

Predictors of Efavirenz Plasma Exposure, Auto-Induction Profile, and Effect of Pharmacogenetic Variations among HIV-Infected Children in Ethiopia: A Prospective Cohort Study

(1) Background: Efavirenz plasma concentration displays wide between-patient variability partly due to pharmacogenetic variation and autoinduction. Pediatric data on efavirenz pharmacokinetics and the relevance of pharmacogenetic variation are scarce, particularly from sub-Saharan Africa, where >90% of HIV-infected children live and population genetic diversity is extensive. We prospectively investigated the short- and long-term effects of efavirenz auto-induction on plasma drug exposure and the influence of pharmacogenetics among HIV-infected Ethiopian children. (2) Method: Treatment-naïve HIV-infected children aged 3–16 years old (n = 111) were enrolled prospectively to initiate efavirenz-based combination antiretroviral therapy (cART). Plasma efavirenz concentrations were quantified at 4, 8, 12, 24, and 48 weeks of cART. Genotyping for CYP2B6, CYP3A5, UGT2B7, ABCB1, and SLCO1B1 common functional variant alleles was performed. (3) Results: The efavirenz plasma concentration reached a peak at two months, declined by the 3rd month, and stabilized thereafter, with no significant difference in geometric mean over time. On average, one-fourth of the children had plasma efavirenz concentrations ≥4 µg/mL. On multivariate analysis, CYP2B6*6 and ABCB1c.3435 C > T genotypes and low pre-treatment low-density lipoprotein (LDL) were significantly associated with higher plasma efavirenz concentration regardless of treatment duration. Duration of cART, sex, age, nutritional status, weight, and SLCO1B, CYP3A5, UGT2B7, and ABCB1 rs3842 genotypes were not significant predictors of efavirenz plasma exposure. (4) Conclusion: Pre-treatment LDL cholesterol and CYP2B6*6 and ABCB1c.3435 C > T genotypes predict efavirenz plasma exposure among HIV-infected children, but treatment-duration-dependent changes in plasma efavirenz exposure due to auto-induction are not statistically significant.

Spatial Variations and Determinants of Acute Malnutrition Among Under-Five Children in Ethiopia: Evidence from 2019 Ethiopian Demographic Health Survey.

Background and aims:Childhood acute malnutrition, in the form of wasting defined by a severe weight loss as a result of acute food shortage and/or illness. It is a critical public health problem that needs urgent attention in developing countries, like Ethiopia. Despite its variation between localities, the risk factors and its geospatial variation were not addressed enough across the various corner of the country. Therefore, the current study was undertaken to assess spatial variation and factors associated with acute malnutrition among under-five children in Ethiopia.Methods:A total weighted sample of 4 955 under-five children were included from the 2019 Demographic and Health Survey. Getis-Ord spatial statistical tool used to identify the hot and cold spot areas of severe and acute malnutrition. A multilevel multivariable logistic regression model using was used to examine predictors of acute malnutrition. In the multivariable multilevel analysis, Adjusted Odds Ratio with 95% CI was used to declare significant determinants of acute malnutrition among children.Result:Among 4 955 under-five children, 7% of them were wasted and 1% of them were severely wasted in Ethiopia during the 2019 national demographic survey. The distribution was followed some spatial geo-locations where most parts of Somali were severely affected (RR = 1.46, P37 value <0.001), and the distribution affected few areas of Afar, Gambella, and Benishangul Gumz regions. Factors that significantly associated with childhood wasting were: gender(male)1.9 (1.3–2.7), age (above 36 months) 0.5 (0.2–0.9), wealth index(richest) 0.5 (0.2–0.8), and water source (unimproved source) 1.5 (1.0–2.3).Conclusions:Our finding implies, the distribution of childhood wasting was not random. Regions like Afar, Somali, and pocket areas in Gambella and SNNP should be considered as priority areas nutritional interventions for reducing acute malnutrition. The established socio-demographic and economic characteristics can be also used to develop strategies.

Abstract 13547: Secondary Prevention of Rheumatic Heart Disease in Ethiopia

Introduction: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant causes of morbidity and mortality. Ethiopia has a high RHD prevalence but has no national strategic guidelines for preventing RHD and no data on the status of secondary prevention in children with RHD. Generating local information is essential to designing effective prevention and control strategies. This study describes the status of secondary RHD prevention in Ethiopian children. Methods: A multicenter, cross-sectional study was performed in children aged 5-17 years with an echocardiogram-based RHD diagnosis. Participants with congenital heart disease and a recent RHD diagnosis (&lt;1 year) were excluded. Good adherence was defined as at least 80% completion of intramuscular benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Covariates included socio-demographics, type and severity of RHD, and ARF recurrence. Chi-square test and Student’s t-test were used to assess differences. Multivariate logistic regression was performed. Results: We included 337 participants with a mean age (±standard deviation) of 12.9±2.6 years. The majority were females (54%) and 73% had severe aortic/mitral disease. BPG (80%) and Amoxicillin (20%) were the prophylaxis of choice. Predictors of good adherence were female sex (P=0.04), use of BPG (0.03), and shorter mean duration of prophylaxis in months (48.5±31.5 vs. 60.7±33, P&lt;0.008). Running out of medicines (35%), interrupted follow-up (27%), and the COVID pandemic (26%) were the three most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin (40% vs. 16%, P&lt;0.001) and in those with poor adherence (36.8% vs. 17.9%, P=0.005). Type and duration of prophylaxis (OR 0.5, P =0.02; OR=1.1, P =0.04, respectively), and sex (OR=1.9, P =0.03) were independent predictors of poor adherence. Conclusion: Poor adherence is prevalent in Ethiopian children with RHD. Amoxicillin is a suboptimal option for prophylaxis associated with lower adherence and a higher rate of ARF recurrence.

Nonlinear Physical Growth of Children from Infancy to Middle Adolescence in Low- and Middle-Income Countries

Background: The growth curve has a significant role in understanding the growth trajectories over time and examining the mathematical relationship between the outcome variable and time. Study design: A longitudinal prospective cohort study. Methods: This study aimed to identify a nonlinear growth curve that best represents the growth trajectories in children’s physical growth from ages 1 to 15 years. The data were obtained from the Young Lives study conducted in Ethiopia, India, Peru, and Vietnam. Nonlinear growth curves were studied through the families of three-parameter nonlinear mixed-effects models. Results: The study examined the performances of different three-parameter nonlinear growth curves for the growth trajectory analysis, and the Logistic curve was chosen for the trajectory analysis. Gender and country differences had significant effects on the child’s growth. Females reached asymptotic height earlier and shorter than males. The mean height values at the end of the growth stage for children in Ethiopia, India, Peru, and Vietnam were 171.78, 170.37, 171.30, 174.31cm, respectively. Children in Ethiopia approached adult height earlier than those in India but later than children in Peru. However, no significant growth change was observed between children in Ethiopia and Vietnam. This indicates that children in Ethiopia and Vietnam have no significant differences regarding approaching adult height. Conclusion: The study concludes that the Logistic curve was found to be the best growth curve to describe the growth trajectories. Children in all four countries exhibited different growth parameters.

Nonlinear Physical Growth of Children from Infancy to Middle Adolescence in Low- and Middle-Income Countries.

Background: The growth curve has a significant role in understanding the growth trajectories over time and examining the mathematical relationship between the outcome variable and time.Study design: A longitudinal prospective cohort study.Methods: This study aimed to identify a nonlinear growth curve that best represents the growth trajectories in children’s physical growth from ages 1 to 15 years. The data were obtained from the Young Lives study conducted in Ethiopia, India, Peru, and Vietnam. Nonlinear growth curves were studied through the families of three-parameter nonlinear mixed-effects models.Results: The study examined the performances of different three-parameter nonlinear growth curves for the growth trajectory analysis, and the Logistic curve was chosen for the trajectory analysis. Gender and country differences had significant effects on the child’s growth. Females reached asymptotic height earlier and shorter than males. The mean height values at the end of the growth stage for children in Ethiopia, India, Peru, and Vietnam were 171.78, 170.37, 171.30, 174.31cm, respectively. Children in Ethiopia approached adult height earlier than those in India but later than children in Peru. However, no significant growth change was observed between children in Ethiopia and Vietnam. This indicates that children in Ethiopia and Vietnam have no significant differences regarding approaching adult height.Conclusion: The study concludes that the Logistic curve was found to be the best growth curve to describe the growth trajectories. Children in all four countries exhibited different growth parameters.

Complementary Feeding Habits in Children Under the Age of 2 Years Living in the City of Adama in the Oromia Region in Central Ethiopia: Traditional Ethiopian Food Study.

Updated information on child feeding practices, nutritional status, and trends related to parental sociodemographic variables is required in developing countries. The objective of this study was to describe infant feeding practices and associated sociodemographic factors among Ethiopian children with an emphasis on complementary feeding (CF). Information on infant feeding and anthropometric measures was obtained from 1,054 mother-child pairs participating in a birth cohort study of children born between 2017 and 2020 prospectively followed in the city of Adama located in the Oromia region of central Ethiopia. Logistic regression models were used to identify sociodemographic and food groups associated with the initiation of CF. The introduction of complementary foods at 6 months of age was 84.7% (95% CI, 82.5, 86.8). Vegetables, cereals (teff, wheat, barley), and fruits were most often the earliest types of foods introduced. Wasting, stunting, underweight, and low body mass index (BMI) by age were found in 6.0, 16.9, 2.5, and 6.3%, respectively. Maternal age and occupation were the factors associated with timely initiation of CF [OR = 2.25, (95% CI, 1.14, 4.41)] and [OR = 0.68, (95% CI, 0.48, 0.97)], respectively. This study demonstrates that the majority of Ethiopian children in the Oromia region follow the recommendations of WHO on CF.

A mixed-methods study exploring adherence to the referral of severely sick children in primary health care in Southern Ethiopia

BackgroundWe have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primary healthcare register reviews and explore health care providers’ and parents’ perceptions regarding factors that hinder or enhance referral.MethodsA mixed-methods study was conducted in 11 districts and a town administration of the Hadiya zone in Ethiopia’s Southern region from May to June 2019. Data collection included interviews and focus group discussions with healthcare providers, key informant interviews with parents of sick children who had been referred, and reviewing registers of sick children treated during the last 12 months at health posts and health centres. We analysed the association between healthcare providers’ and sick children’s characteristics and providers’ compliance with referral guidelines for sick children 0–59 months old. Content analysis was undertaken to explore the perceived factors that influenced referral and adherence to referral from providers’ and parents’ perspectives.ResultsHealthcare providers did not refer nearly half of the severely ill children that should have been referred, according to guidelines. Providers who had received in-service training on child healthcare were more likely to adhere to referral guidelines. The severity of the child’s illness and mobile phone communication and transport availability were perceived to be positively associated with adherence to referral guidelines. Lack of knowledge of treatment guidelines and skills, and high health worker workload, were among the factors perceived to be linked to lower adherence to guidelines. The healthcare providers considered parents of referred sick children as having low compliance with the referral advice. In contrast, parents had the opinion that compliance with a referral for sick children was high. Perceived awareness of severity of the child’s illness, ability to afford referral costs, and availability of transport or ambulance services were perceived to motivate parents to take their children to the referral facility. Traditional illness perceptions, lack of confidence in the referral site’s medical care, and a long distance were perceived to hurdle caregivers’ referral compliance.ConclusionsWe found that the healthcare providers’ adherence to referral guidelines was not optimal. Care providers and parents had divergent opinions on parents’ compliance with referral advice. Factors related to the health system, family economy, and available ambulance services influence whether care providers and parents pursued severely ill children’s referral. Adequate referral of sick children is an aspect of primary healthcare quality that is essential to avoid unnecessary under-five deaths.

Exploring Spatial Variations and Determinants of Dietary Diversity Among Children in Ethiopia: Spatial and Multilevel Analysis Using EDHS (2011-2016).

IntroductionDietary diversity has a significant impact on children’s nutritional health. For developing and implementing interventions, it is critical to understand the regional distribution of dietary diversity and underlying factors. However, the application of spatial techniques in dietary studies has not been well documented. The study’s goal was to look into the regional variances and factors that influence children’s dietary diversity. Further, we have discussed the spatial correlation of dietary diversity with nutritional status.MethodsData from the National Demographic and Health Survey were used during analyses. This work evaluated the overall dietary diversity of children aged 6–23 months based on the 2017 WHO and UNICEF classification of minimum dietary diversity (MDD). The Local Anselin Moran’s I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariate multilevel logistic regression was used for factor analyses.ResultsOverall, only 13.3% (95% CI: 10.2–14.7%) of children in 2011 and 24% (95% CI: 15.5–26.5%) in 2016 achieved MDD. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) in the districts of northern Ethiopia, notably in the Amhara, Tigray, and Afar regions, and clusters of low inadequate dietary diversity (cold spots) in the country’s central and western regions. In both studies, the frequency of dietary diversity was significantly higher among older children, those who had media exposure, and mothers and fathers who had received formal education.ConclusionAccording to our findings, the MDD of children in Ethiopia, as measured by WHO dietary assessment, slightly increased from 2011 to 2016. The dietary diversity of children was distributed non-randomly in different districts across regions of Ethiopia. Localized intervention and preventative methods to improve dietary patterns and culture can be developed using existing socio-demographic factors and districts with a larger distribution of inadequate dietary diversity.