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.

Maternal and child nutrition is critical for child health and survival. Appropriate feeding practices are of fundamental importance for health, nutrition, survival and development of infants and children. In pastoral areas of Ethiopia, barriers related to culture, knowledge, social norms, beliefs, behaviors, decision making in the household and burden of other responsibilities contribute to nutritional status of women and children to deteriorate. Policies and strategies are recommending assessment of barriers for designing programs and interventions to improve maternal and child nutrition practices. This study is aimed to assess barriers of optimal maternal and child feeding practices in Pastoralist areas of Somali region, Eastern Ethiopia. A qualitative community based research method was used involving 17 focus group discussions and 20 in-depth interviews with mothers, grandmothers, health professionals and religious leaders from three districts. Data from FGDs and interviews were transcribed and coded. The agreed upon codes were synthesized and grouped into exhaustive categories. The categories were then merged into themes representing the most common barriers on maternal and child feeding practice that emerged from the FGDs and interviews. We found that traditional beliefs, myths, culture custodian influence, low accessibility and availability of nutritional foods, pattern and burden of other responsibilities, poor knowledge and health seeking behavior, perceived milk insufficiency as main barriers for optimal maternal and child feeding practices. Barriers on optimal maternal and child feeding are very common in the study areas. More work needs to be done to strengthen community-based nutrition with strong social behavioral change communication with emphasis on age-specific counselling on maternal and child nutrition at health facilities, during antenatal and early postnatal visits in the study areas through different media channels, particularly, Somali Region TV

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.

BackgroundThere is high burden of malnutrition worldwide, including wasting that is compromising growth and development of children and nations. In Ethiopia, severe acute malnutrition (SAM) remains a public health problem. Prevalence of acute malnutrition i.e. wasting is highest (22.7%), (17.5 %) in Somali region of Ethiopia. This study assessed the bottlenecks and met needs for SAM treatment coverage in Doolo zone Somali regional state of Ethiopia. MethodsThis study used Tanahashi model of service coverage to identify bottlenecks for SAM treatment coverage at health facility platform using multi-stage sampling in Doolo zone, Somali regional state of Ethiopia. T racer interventions were selected to make the analysis more manageable and systematic.The collected data were entered in to excel then thoroughly cleaned and analysed. Indicators for supply-side, demand and quality were calculated. The shortest bar of the graph was considered as a bottleneck for supply-side while sharp decline or drop-in between one bar of the graph to the next was considered as a bottleneck in demand and quality sides. Performance thresholds were set for the indicators as (Good, fair and poor) and met need for SAM was then calculated. ResultThe analysis identified bottlenecks across the six determinants of coverage for the treatment of SAM.Major supply-side bottlenecks identified were commodity stock-outs, mainly ready to use therapeutic foods (RUTF) and shortage of trained health extension workers in three of the four districts studied.On the demand side, despite reasonable initial utilizations in most of the districts studied, there were poor continuity of services (high defaulter rate) and low quality of SAM treatment (effective coverage). The met need was lowest in Bokh district (12%) and highest in Danod district (70%).Despite average treatment coverages of 85% and above for Geladi, Warder and Danod districts, yet the met need was found to be 54%, 60% and 70% respectively which was not commensurate with average treatment coverages Conclusion 3The identified bottlenecks for SAM treatment coverage cut across the supply side, demand and quality aspects. The low quality for SAM treatment could have resulted from a combination of supply and demand bottlenecks i.e. frequent stock out of basic commodities (RUTF), shortage of trained health extension workers and poor health-seeking behaviour and/or poor continuity of service or high defaulter rate). The overall met need for SAM program was found to be 37% which could imply high unmet need and poor impact of the program. It is recommended that further causality analysis be undertaken for the major bottlenecks discovered in this study to establish root causes of bottlenecks and devise appropriate solutions adapted to the local setting.

Background. Breast milk substitute (BMS) is any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose. Determinant use of breastmilk substitutes for infant feeding despite the WHO recommendation have been the subject of various research studies. However, there are limited data in the developing countries, particularly in the study area. The purpose of this study was to assess determinant the use of BMS for mothers with infants less than six months in Jigjiga city. Methods. Quantitative Community based matched case-control was conducted from 24th of June, 2019 to 6th of August, 2019, using interviewer administered questionnaire. This study included 160 mothers with infants less than six months. Data were cleaned and exported to SPSS version 20 and both descriptive and analytical analyses were executed. The level of significance was set at P<0.05. Binary logistic regression was used to produce summary of statistics including crude and adjusted odds ratio and 95% confidence intervals. Result. the study identified six main variables as influencers for use of BMS among mothers with infants less than six months, after multivariate logistic regression analysis, lack of breastfeeding counselling during antenatal and postnatal care visits, infants older than three months, unhealthy infants at birth and exposure of BMS before delivery were independent associated with use BMS. Conclusion. Commercial promotion of breastmilk substitute through local Medias is very common in study area, as result of this, confidence of mother to exclusively breast feed infants is significantly affected. These alarms more work on strengthening counselling, particularly, age specific counselling on exclusive breastfeeding at health facilities and through local Medias, to counteract promotion of breastmilk substitutes from others TVs in Somalia and female merchants.