Governments globally are stressing both direct nutrition interventions combined with nutrition sensitive policies and programs to combat malnutrition. Governance at all levels has been identified as a critical element in ensuring success of national nutrition plans. For example, the most recent National Nutrition Program (NNP) in Ethiopia discusses the essentiality of governance and coordination at all levels. The research uses a qualitative study based on semi-structured interviews with key informant. The research discussed in this article focuses on governance structures from national to regional to district level in Ethiopia with an emphasis on translation of a strategy and implementation of the NNP. This article concentrates primarily on results from the national and regional levels. Data at both the national and regional levels indicate that there is general agreement on the nature of the nutrition problems in Ethiopia. At all levels of government, under nutrition, food insecurity, and micronutrient deficiencies were listed as the main nutrition problems. The challenges in governance and implementation identified at both the national and regional levels, however, varied. The implementation of the 2013 NNP was in its early stages at the time of this research. While there was palpable energy around the launch of the NNP, respondents indicated issues related to leadership, coordination, collaboration, advocacy, and budget would be challenges in sustaining momentum.

Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership.LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

IntroductionImproving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding and reduce stunting. The Federal Ministries of Health and Agriculture and Natural Resources implement the intervention. The evaluation aims to assess a range of processes, outcomes and impacts.Methods and analysisThe SURE evaluation study is a theory-based, mixed methods study comprising impact and process evaluations. We hypothesise that the package of SURE interventions, including integrated health and agriculture behaviour change communication for nutrition, systems strengthening and multisectoral coordination, will result in detectable differences in minimum acceptable diet in children 6–23 months and stunting in children 24–47 months between intervention and comparison groups. Repeated cross-sectional household surveys will be conducted at baseline and endline to assess impact. The process will be assessed using observations, key informant interviews and focus group discussions to investigate the fidelity and dose of programme implementation, behavioural pathways of impact and contextual factors interacting with the intervention. Pathways of impact will also be explored through statistical analyses.Ethics and disseminationThe study has received ethics approval from the scientific and ethical review committees at the Ethiopian Public Health Institute and the London School of Hygiene and Tropical Medicine. The findings will be disseminated collaboratively with stakeholders at specified time points and through peer-reviewed publications and presentations.

The lactating mothers in developing countries like Ethiopia are the first targeted and nutritionally vulnerable groups to under nutrition due to different socio demographic factors which influence the health and well being of mothers and children. During lactation periods, mothers need more nutritious food than the rests of the household members. The aim of this study was to determine the nutritional status, associated factors and dietary diversity of lactating mothers 15-49 years old in Offa woreda. A crosssectional community based study was carried out to determine the Chronic Energy deficiency of lactating mothers in the studied woreda. The lactating mothers were randomly selected from four rural and two urban kebeles. A total of 422 households were visited and the required data were collected as scheduled in all selected kebeles. The prevalence of under nutrition among the lactating mothers in the studied area was determined using BMI by Anthropometric measurements and the blood sample test for hemoglobin (Hb) concentration was done using Haemocue methods. The collected data were analyzed using Stata version 14.2 software. Among the participated lactating mothers the values 15.8%, 74.2%, 8.3% and 1.7% were obtained for under weight, normal, over weight and obese in their BMI (kg/m2), respectively. The studied participants of 15.8% were in chronic energy deficiency according to WHO guidelines. The lactating mothers' percentage value 36.4%, 59.3%, 4.3% were in age group of 15-24, 25-34 and 35-49 years, respectively. The blood test showed that among the lactating mothers 11.4% were found anemic which had got hemoglobin level less than normal level (12g/dl). The daily dietary diversity intake per day of lactating mothers was classified as high (>5 DDS) 1.2%, medium (4-5 DDS) 50.7% and low (<3 DDS) 47.4% among the nine food groups recommended for women dietary diversity score (WDDS). The independent variables: education, family size, marital status and occupation were significantly associated with nutritional status of the lactating mothers at P<0.05. In conclusion the majority of the lactating women in the study area had normal BMI. The researchers would like to recommend that the government and development agencies should focus on the risk factors identified, to ensure better health and nutrition for lactating mothers in this woreda.

Diet is one of the prime determinants of health and nutritional status. An inadequate diet, poor in both quality and quantity, is one of the major reasons for high levels of malnutrition in women. A cross-sectional survey was conducted to assess dietary practices and to identify factors associated with sub-optimal dietary practices of pregnant women in Wondo Genet District, Southern Ethiopiain. A two-stage cluster sampling technique was used to select a representative sample of 153 pregnant women aged 19-49 years from three rural villages ("Kebeles"). About 43.8% of study participants commonly skipped lunch and 24.2% skipped breakfast. About 21% of the pregnant mothers restricted their food intake. Majority (75.2 %) of study participants did not take any additional meal during pregnancy. Factors like not growing enset, eating no legumes and no additional meal have a significant association with food restriction habit of the respondents. Taking no additional meal was significantly associated with family size, growing khat, not growing vegetables and fruits, and no consumption of white vegetables and roots. Skipping meal was significantly associated with family size and number of pregnancy. The dietary practice of the pregnant women in study area was suboptimal. Pregnant women in the study area suffered from suboptimal dietary practices such as taking no additional meal during pregnancy, skipping meals, food restriction and taking less diversified diet.

Inadequate quality and quantity diet is one of the major reasons for high levels of malnutrition in pregnant women. A cross-sectional survey was conducted in Wondo Genet District, Southern Ethiopia. A two-stage cluster sampling technique was used to select a representative sample of 153 pregnant women aged 19-49 years from three rural villages ("Kebeles"). Energy and nutrient intakes from foods were calculated from one-day weighed food records on a sub-sample (n = 77). The result of the study showed that the intakes of most nutrients were lower than the recommended intake. The energy intake of the study participants both in 2nd and 3rd trimesters of pregnancy were 2,308 kcal and 1,420.5 kcal compared to the recommended 2,340 kcal and 2,452 kcal, respectively. Except iron, almost all micronutrient intakes were lower than the recommended intake. Vitamin A intake was 3 µg compared with the recommended 800 µg, while protein intake of the study respondents in 2nd and 3rd trimester of pregnancy was 45.9 g and 31.5 g, respectively, compared with the recommended 71 g. Risk factors for undernutrition were multiple pregnancy and no consumption of cereal-based foods. This study revealed that the energy and nutrient intake of the pregnant women in study area was below the recommended intakes. Furthermore, the situation might be aggravated by high phytate content food consumption reported. Nutritional status of pregnant women in study area was not adequate to support the increased energy and nutrient requirement of the participants.

BackgroundIn Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers.MethodsA qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes.ResultsSURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition.ConclusionDespite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach.

Background Well-trained anthropometrists are essential for the delivery of high-quality anthropometric data used to evaluate public health nutrition interventions. Scant data are currently available on the precision of data collected by large teams of anthropometrists employed for nutrition surveys in low-income country settings. Objective The purpose of this study was to assess the precision of child mid-upper arm circumference (MUAC) and length/height measurements taken by fieldworkers training for nutrition survey deployment. Methods Following three days of training, an anthropometry standardization exercise was conducted in small teams of trainees at seven sites in Amhara region, Ethiopia. In groups of two to four, trainee anthropometrists (n = 79) each measured sixteen children aged 6–47 months (n = 336) twice for MUAC and length/height. Intra-observer and inter-observer precision were analyzed using technical error of measurement (TEM), relative TEM, coefficient of reliability (R), and repeatability metrics. Bland-Altman limits of agreement were calculated for intra-observer measurements. Results Intra-observer technical error of measurement (TEM) was between 0.00 and 0.57 cm for MUAC (Bland-Altman 95% limits of agreement: −0.50 to 0.54 cm) and between 0.04 and 2.58 cm for length/height measurements (Bland-Altman 95% limits of agreement: -1.43 to 1.41 cm). Inter-observer TEM was between 0.09 and 0.43 cm for MUAC and between 0.06 and 2.98 cm for length/height measurements. A high proportion of trainees achieved intra-observer R &gt; 0.95 (MUAC 95%; length/height 97%). Most teams also achieved inter-observer R &gt; 0.95 (MUAC 90%; length/height 95%). Conclusions Large numbers of anthropometrists (over 75) in low-income settings can attain satisfactory precision in anthropometry following training and standardization. These protocols permit researchers to assess trainees, identify individuals who have not achieved the desired level of precision, and retrain or adjust roles prior to survey deployment.