Malnutrition remains prevalent and existing health problem globally. Particularly Undernutrition is a major public health issue in developing countries. Globally the causes of severe acute undernutrition varies across context. The aim of this study was to identify the determinants of severe acute malnutrition to uncover contextual factors based on UNICEF conceptual framework, as there was no study done in a similar context in Ethiopia. Health facility based (health post) un-matched case control study with Key informant interview was conducted to identify determinant factors of severe acute malnutrition (SAM) among children between 6 and 36 months. 246 children (82 cases and 164) with their mothers or care takers participated the study which was conducted between December 20, 2019 to January 20, 2020 in Kalafo district in Shebele River. Odds ratio with 95% confidence interval was calculated to identify the determinants of SAM among children aged 6–36 months using multivariate logistic regression. The odds of severe acute malnutrition was 2.28 (1.22, 4.26); 4.68 (2.29, 9.58); 2.85 (1.26, 6.45); 2.39 (1.16, 4.96) and 3.262 (1.46, 7.31) and 3.237 (1.45, 7.23); respectively for mothers with three or more under five children, Children with inadequate dietary diversity, experienced diarrhea in past 2 weeks, their mothers had not nutrition counselling during pregnancy and younger (6–11 and 12–17 months) children as compared to controls. The finding of this study reveals the main determinants of severe acute malnutrition in riverine context are multi-level. In addition to this, poor childcare and polygamy identified in qualitative finding. Decisive and multi-sectoral approach is required to addressing SAM in the riverine area.

Background: Malnutrition remains prevalent and existing health problem globally. Particularly Undernutrition is a major public health issue in developing countries.Globally the causes of severe acute undernutrition varies across context. The aim of this study was to identify the determinants of severe acute malnutrition to uncover contextual factors based on UNICEF conceptual framework, as there was no study done in a similar context in Ethiopia.Methods: Health facility based (health post) un-matched case control study with Key informant interview was conducted to identify determinant factors of severe acute malnutrition(SAM) among children between 6 to 36 months. 246 children (82 cases and 164) with their mothers or care takers participated the study which was conducted between December 20, 2019 to January 20, 2020 in Kalafo district in Shebele River. Odds ratio with 95% confidence interval was calculated to identify the determinants of SAM among children aged 6-36 months using multivariate logistic regression.Results: The Odds of Severe Acute Malnutrition was 2.28(1.22,4.26); 4.68(2.29,9.58); 2.85(1.26,6.45); 2.39(1.16,4.96) and 3.262(1.46,7.31) and 3.237(1.45,7.23); respectively for mothers with three or more under five children, Children with inadequate dietary diversity, experienced diarrhea in past two weeks, their mothers had not nutrition counselling during pregnancy, Children’s age between 6-11 and 12-17 months as compared to controls.Conclusion: The finding of this study reveals that the main determinants of severe acute malnutrition in riverine context are multi-level. On top of poor childcare and polygamy in qualitative finding, Diarrhea and inadequate dietary intake under the category of immediate cause of malnutrition. Having more than (≥3) under-five children, young age (6-11 and 12-17months) and not having nutrition counseling during pregnancy were also among basic determinants of severe acute malnutrition in riverine context. Decisive and multi-sectoral approach is required to addressing SAM in the riverine area.

BACKGROUND Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. OBJECTIVE The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. METHODS The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. RESULTS Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97(95%CI: 41.68, 69.77) in earlier (2016-2017) studies than recent 37.33(95%CI: 24.82, 50.77) studies (2018-2020). CONCLUSIONS The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. CLINICALTRIAL Registration: the protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762