Background The existing evidence is limited and contradicting on the co-occurrence of anemia and stunting (CAS) at individual level, despite a great overlap in their risk factors. We aimed to determine the prevalence of CAS, and the dietary and non-dietary factors associated with it, among infants and young children in Ethiopia. Method We used a nationally representative sample of 2902 children aged 6–23 months from the Ethiopian demographic and health survey, conducted in 2016. The study was cross-sectional in design. Samples were selected by two-stage clustering sampling method. CAS prevalence was estimated by various sociodemographic factors. To identify the dietary and non-dietary factors associated with CAS, we conducted hierarchical logistic regression analyses. Result The overall prevalence of CAS was 23.9%. The dietary factors found significantly linked to lower odds of CAS were use of vitamin A supplement [adjusted odds ratio (AOR) = 1.19, 95%CI = 1.06–1.33, P = 0.003], consumption of vitamin A rich fruit and vegetables (AOR = 1.15, 95%CI = 1.04–1.27, P = 0.006), meat (AOR = 1.55, 95%CI = 1.17–2.05, P = 0.002), legumes (AOR = 1.38, 95%CI = 1.05–1.81, P = 0.021), and meal frequency > 3 (AOR = 1.22, 95%CI = 1.04–1.37, P = 0.020). The non-dietary household and child factors found significantly linked to higher odds of CAS were rural residence (AOR = 1.29, 95%CI = 1.18–1.41, P < 0.001), low household wealth (AOR = 1.91, 95%CI = 1.53–2.39, P < 0.001), low caregivers’ education level (AOR = 2.14, 95%CI = 1.33–3.44, P < 0.001), male sex (AOR = 1.25, 95%CI = 1.04–1.50, P = 0.015), age 12–23 months (AOR = 1.65, 95%CI = 1.57–1.73, P < 0.001), history of infection (AOR = 1.14, 95%CI = 1.00–1.30, P = 0.048), and small birth size (AOR = 1.99, 95%CI = 1.58–2.51, P < 0.001). Conclusion Among infants and young children in Ethiopia, there was a concerning high level of CAS, which was associated with various dietary and non-dietary factors. Enhanced public health/nutrition interventions, with due emphasis on the multifactorial nature of CAS, might stand an important consideration to reduce the burden of CAS in Ethiopia and beyond.

ObjectiveLow neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual’s own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019.Eligibility criteriaEpidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included.Data extraction and synthesisData extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran’s Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger’s regression test.ResultA total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001).ConclusionNSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity.PROSPERO registration numberCRD42017063889

Based on the WHO standard, the current breast and complementary feeding practice in Ethiopia is good and improving. Integrated intervention is still required for further improvement and minimizing the effect of occupational status.

Objective Ethiopia bears a high stunting burden. However, there is a paucity of evidence on the socioeconomic inequalities of stunting in Ethiopia. Thus, this study was aimed to determine the degree of socioeconomic inequality in stunting and decompose it to the social determinants of stunting. We used a nationally representative sample of 8855 children, aged below 5 years, from the Ethiopian demographic and health survey, conducted in 2016. Subjects were recruited following a two-stage cluster sampling. The socioeconomic status was measured by the household wealth index, categorized into quantiles. The inequality in stunting between the poorest and the richest socioeconomic groups was decomposed into its contributing social factors following the Blinder–Oaxaca decomposition approach. Result The overall prevalence of stunting was 38%, with a significant pro-poor socioeconomic inequality. The prevalence of stunting among the poorest and the richest socioeconomic categories was 45.1% and 26.9%, respectively. Caregivers education status was the main contributor, accounting alone for 33% of the socioeconomic inequality in stunting, followed by region of residence (11%) and birth size (6%). Equity sensitive interventions, which prioritize the vulnerable groups might help to narrow the socioeconomic inequality as well as fasten the progress towards the goal of stunting reduction.

IntroductionInfant and young child feeding (IYCF) is the cornerstone of infant and child survival, healthy growth and development, healthy future generations and national development. In spite of the importance of optimal nutrition in low- and middle-income countries, there has been no review conducted in Ethiopia. Thus, the aim of this systematic review and meta-analysis is to estimate the national coverage and identify the associated factors of IYCF practices in Ethiopia.MethodsPubMed, Scopus, EMBASE, CINHAL, EBSCO, Web of Science and WHO Global Health Library databases will be searched for all available publications from 1 January 2000 to 30 September 2017. All published studies on the timely initiation of breast feeding, exclusive breast feeding and timely initiation of complementary feeding practice in Ethiopia will be screened, selected and reviewed. Bibliographies of identified articles and grey literature will be hand-searched as well. Heterogeneity of studies will be quantified using Higgins’s method where I2 statistic >80% indicates substantial heterogeneity. Funnel plots and Egger’s regression test will be used to assess potential publication bias. The Newcastle–Ottawa Scale (NOS) will be used to assess the quality of evidence and risk of bias. Meta-analysis and meta-regression will be carried out to estimate the pooled national prevalence rate and an OR of each associated factor of IYCF practices. Narrative synthesis will be performed if meta-analysis is not feasible due to the substantial heterogeneity of studies.Ethics and disseminationEthical clearance is not required for this study because primary data will not be collected. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal and presented at an (inter)national research symposium.Systematic review registrationThis systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017056768.

Background Anemia remains a major public health problem among children under five years old in Ethiopia, rising unexpectedly from 44% national prevalence in 2011 to 57% in 2016. In this study, we investigated the household, maternal and child-related dietary and non-dietary factors associated with hemoglobin (Hb) level of infants and young children. Method We analyzed data from a nationally representative sample of 2902 children aged 6–23 months, included in the 2016 Ethiopian demographic and health survey (EDHS). Hierarchical linear regression analysis was done to identify the factors associated with Hb level. We reported adjusted β (aβ) with 95% confidence interval (CI). Result Overall, 72% of children under 2 years of age were anemic in Ethiopia in 2016. Household factors: rich household wealth category (aβ = 0.48, 95%CI = 0.33–0.63, P < 0.001), and agrarian regions (aβ = 0.64, 95%CI = 0.40–0.88, P < 0.001) were significantly associated with a higher mean Hb level. Maternal factors: secondary and above education level (aβ = 0.69, 95%CI = 0.23–1.16, P = 0.004), and being not anemic (aβ = 0.40, 95%CI = 0.26–0.53, P < 0.001) were significantly associated with a higher mean Hb level. Child factors: age below 12 months (aβ = 0.72, 95%CI = 0.57–0.88, P < 0.001), female sex (aβ = 0.16, 95%CI = 0.03–0.30, P = 0.019), being not underweight (aβ = 0.22, 95%CI = 0.02–0.42, P = 0.031), average birth size (aβ = 0.25, 95%CI = 0.08–0.42, P = 0.003), no history of recent infection (aβ = 0.18, 95%CI = 0.02–0.33, P = 0.025), currently breastfeeding (aβ = 0.28, 95%CI = 0.12–0.44, P = 0.002), vitamin A supplementation (aβ = 0.17, 95%CI = 0.06–0.28, P = 0.021), and frequent meal feeding (aβ = 0.11, 95%CI = 0.05–0.16, P = 0.034) were significantly associated with a higher mean Hb level. Conclusion Hb level was associated with various dietary and non-dietary influences originating from household, maternal, and child levels. A comprehensive approach, addressing the multi-factorial nature of Hb status, might stand an important consideration to reverse the recent rise in anemia prevalence in Ethiopia.

BackgroundThere are pervasive pregnancy-related food taboos and myths (PRFT) in Ethiopia. The evidence, however, is limited on whether PRFT contributes to the burden of maternal anemia. Thus, this study was aimed to determine the magnitude of PRFT, the reasons for adherence to PRFT, and the association of adherence to PRFT with anemia, among pregnant Ethiopian women.MethodsThe study was case-control in design and recruited a sample of 592 pregnant women attending antenatal care in four health facilities in Addis Ababa, Ethiopia. Participants were classified into anemic cases (n = 187) and non-anemic controls (n = 405) based on their hemoglobin level. PRFT was assessed by the participants’ subjective reporting of avoidance of certain food items during the current pregnancy due to taboo reasons. The specific types of food items avoided and the underlying reasons for the avoidance were also assessed. The relation of PRFT with anemia was evaluated by multiple logistic regression analysis, controlling for covariate factors.ResultAlmost a fifth of the study participants (18.2%) avoided one or more food items due to PRFT. Adherence to PRFT was 26.2 and 14.6% among the anemic and the non-anemic individuals, respectively. The food items most avoided due to adherence to PRFT were green chili pepper, organ meat, and dark green leafy vegetables like spinach, lettuce, kale, and broccoli. The underlying reasons for the adherence to PRFT were largely traditionally held beliefs and misconceptions. After controlling for covariates, PRFT was significantly and independently associated with a higher odds of anemia [adjusted odds ratio (AOR) = 2.12, 95% confidence interval (CI) = 1.32–3.42, P = 0.002].ConclusionPRFT might be contributing to the burden of maternal anemia in Ethiopia. It is time for public health authorities in Ethiopia to recognize PRFT as a public health risk, strengthen maternal nutrition counseling, and create public awareness of the consequences of PRFT.Trial registrationClinicalTrials.gov (NCT03251664), 16 August 2017.

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