Background: Unhealthy weight control behaviors are a serious concern, impairing the quality of life in adolescents. Although recent epidemiological studies indicate a high level of disordered eating in developing countries, such data in Ethiopia are scarce.Thus, this study aimed to determine the extent of unhealthy weight control behaviors (i.e., purging and nonpurging) and corresponding associated factors among urban Ethiopian adolescents. Method:A cross-sectional study using self-administered questionnaires was applied to 690 randomly selected female high school adolescents in Addis Ababa, Ethiopia in 2017. Measures included unhealthy weight control behaviors, body mass index, subjective perception of body weight, appearance satisfaction, depressive symptoms, and socio-demographic factors. Logistic regression was applied for data analyses, that is, adjusted odds ratio (aOR) with 95% confidence interval (CI). Results:The level of unhealthy weight control behaviors (i.e., a score of at least once a week in the last 1 month) was 30.7% (N = 208). Specifically, the extent of purging and nonpurging weight control behaviors was 1.5% (N = 10) and 29.8% (N = 202), respectively. Factors that were significantly associated with unhealthy weight control behaviors were perception of being overweight [aOR = 3.01; 95%CI: 1.11-8.11], being overweight [aOR = 3.28; 95%CI: 1.54-7.01], severe depression [aOR = 4.09; 95%CI: 1.73-9.96], and high socio-economic status [aOR = 2.07; 95%CI: 1.30-2.80]. Conclusion: This study reveals a considerable level of unhealthy weight control behaviors among female adolescents in an urban setting in Ethiopia. Researchers and policy makers should focus their attention upon this emerging public health challenge and develop associated strategies. K E Y W O R D S disordered eating, Ethiopia, female adolescents, nonpurging, purging, unhealthy weight control
Background Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6–59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1–6 mo. Objective The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1–6 mo. Methods We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1–6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of −3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs. Results The median age, MUAC, and WLZ were 100 d (IQR: 69–145 d), 119 mm (IQR: 103–130 mm), and −1.27 (IQR: −2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%). Conclusions A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1–6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.
Background Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed. Objectives In the present study, we examine the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia. Methods In a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 weeks of gestation. Serum aflatoxin B1-lysine concentration was measured using liquid chromatography-tandem mass spectrometry. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean (SD) gestational age weeks of 19.1 (3.71), 28.5 (3.51), and 34.5 (2.44). Estimated fetal weight was expressed in centiles using the INTERGROWTH-21st reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and unexposed mothers in the study. Results Mothers had a mean (SD) age of 26.0 (4.58) years. The median (P25, P75) serum aflatoxin B1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five % of the females enrolled provided at least two ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational age centile than the unexposed group (ß = -0.92 centiles/week, 95% CI: -1.77, -0.06, p = 0.037). Conclusions Chronic maternal AF exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development.
Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high-impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron-folic acid supplementation and nutrition counselling.We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability.
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