In Ethiopia, full vaccination coverage among children aged 12-23 months has improved in recent decades. This study aimed to investigate drivers of the improvement in the vaccination coverage. The Oaxaca-Blinder decomposition technique was applied to identify the drivers using data from Ethiopian Demographic and Health Survey conducted in 2000 and 2016. The vaccination coverage rose from 14.3% in 2000 to 38.5% in 2016. The decomposition analysis showed that most of the rise in vaccination coverage (73.7%) resulted from the change in the effect of explanatory variables over time and other unmeasured characteristics. Muslim religion had a counteracting effect on the observed increase in vaccination coverage. The remaining 26.3% of the increase was attributed to the change in the composition of the explanatory variables between 2000 and 2016, with maternal educational level and maternal health care utilization as significant contributors. The findings highlight the need for further improvements in maternal health care utilization and educational status to maintain the momentum towards universal coverage of childhood vaccination. Targeted intervention among Muslim-dominated communities is also needed to improve the current situation. Besides which, future studies need to be conducted to identify additional potential modifiable factors.
Introduction: Childhood immunisation is one of the most effective public health interventions, significantly reducing morbidity and mortality from vaccine-preventable diseases. Despite global efforts, many low-income and middle-income countries, including Tanzania, face challenges in achieving high vaccination coverage. This study examined the spatial distribution and determinants of full vaccination coverage among children aged 12-23 months in Tanzania. Methods: A cross-sectional design was applied using 2022 Tanzania Demographic and Health Survey-Malaria Indicator Survey data, including 2143 children aged 12-23 months. Spatial dependence was analysed with Moran's I and Local Indicators of Spatial Association to detect clustering. A Bayesian spatial hierarchical logistic regression, specified with the Besag-York-Mollié model and fitted via Integrated Nested Laplace Approximation, assessed individual and community-level determinants of vaccination coverage. Results: The findings showed that only 54.6% of children were fully vaccinated, which is below the national target and the 90% threshold recommended by the World Health Organization (WHO). Maternal education, antenatal care (ANC) attendance and household wealth were significant predictors of full vaccination. Children of mothers with higher education had higher odds of being fully vaccinated (OR=3.78; 95% CI 1.38 to 12.2), and those whose mothers attended four or more ANC visits were more likely to be fully vaccinated (OR=1.24; 95% CI 0.97 to 1.59). Children from middle-income households also had increased odds (OR=1.39; 95% CI 1.04 to 1.85). Maternal age and place of delivery were not statistically significant. Spatial analysis revealed significant geographic clustering of vaccination coverage (Global Moran's I=0.229, p=0.028), with high-coverage clusters in Kusini Unguja, Kigoma, Mara and Njombe, and low-coverage clusters in Songwe, Rukwa and Shinyanga. Conclusions: The study highlights the importance of enhancing maternal education, strengthening ANC counselling, reducing financial and access barriers and implementing region-specific interventions to improve childhood immunisation coverage and reduce inequalities across Tanzania.
Twahil Hemed Shakiru, Elevatus Nkebukwa Mukyanuzi, Daniel Stephen Kinyota
INTRODUCTION: Achieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective coverage and equity of MCH services in Rwanda in the Millennium Development Goal (MDG) era to help guide policy decisions to improve equitable health gains in the SDG era and beyond. METHODS: Using four rounds of Rwanda demographic and health surveys conducted from 2000 to 2015, we identified coverage and quality indicators for five MCH services: antenatal care (ANC), delivery care, and care for child diarrhoea, suspected pneumonia and fever. We calculated crude coverage and quality in each survey and used these to estimate effective coverage. The effective coverage should be regarded as an upper bound because there were few available quality measures. We also described equity in effective coverage of these five MCH services over time across the wealth index, area of residence and maternal education using equiplots. RESULTS: A total of 48 910 women aged 15-49 years and 33 429 children under 5 years were included across the four survey rounds. In 2015, average effective coverage was 33.2% (range 19.9%-44.2%) across all five MCH services, 30.1% (range 19.9%-40.2%) for maternal health services (average of ANC and delivery) and 35.3% (range 27.3%-44.2%) for sick child care (diarrhoea, pneumonia and fever). This is in contrast to crude coverage which averaged 56.5% (range 43.6%-90.7%) across all five MCH services, 67.3% (range 43.9%-90.7%) for maternal health services and 49.2% (range 43.6%-53.9%) for sick child care. Between 2010 and 2015 effective coverage increased by 154.2% (range 127.3%-170.0%) for maternal health services and by 27.4% (range 4.2%-79.6%) for sick child care. These increases were associated with widening socioeconomic inequalities in effective coverage for maternal health services, and narrowing inequalities in effective coverage for sick child care. CONCLUSION: While effective coverage of common MCH services generally improved in the MDG era, it still lagged substantially behind crude coverage for the same services due to low-quality care. Overall, effective coverage of MCH services remained suboptimal and inequitable. Policies should focus on improving effective coverage of these services and reducing inequities.
Celestin Hategeka, Catherine Arsenault, Margaret E. Kruk
BACKGROUND: Children in developing countries are highly vulnerable to impaired physical growth because of poor dietary intake, lack of appropriate care, and repeated infections. This study aimed at assessing the prevalence of stunting and associated factors among children 6-59 months of age in Libo-kemekem district, northwest Ethiopia. METHODS: A community based cross sectional study was conducted in Libo-Kemekem from October 15 to December 15, 2015. The multistage sampling technique was employed to select 1,320 children aged 6-59months. Data were collected by trained community health extension workers under regular supervision. Data were entered into EPI-Info version 3.5.1, and height for age was converted to Z-score with ENA-SMART software. Data were then exported to SPSS version 20 for descriptive and binary logistic regression analysees. The significance of associations was determined at p<0.05. RESULTS: Out of 1287 children included in the analysis, 49.4% (95% CI: 46.7%-52.3%) were found to be stunted. In the multivariate analysis, increased child age [AOR = 6.31, 95%CI: (3.65, 10.91)], family size of six and above [AOR = 1.77, 95%CI: (1.35, 2.32)] were positively associated with stunting, while, fathers with secondary school education [AOR = 0.50, 95%CI: (0.30, 0.81)], farmers as household heads [AOR = 0.56, 95%CI: (0.38, 0.84)] and self-employed parents as household head [AOR = 0.45, 95% CI: (0.28, 0.72)] were found to be preventive factors. CONCLUSION: The prevalence of stunting was high in the study area. We found that stunting was significantly correlated with child age, occupational status of household head, family size, and fathers' education. Therefore, intervention focusing on supporting housewives, family planning, and education on child feeding and nutrition should be implemented.
Child dietary diversity is poor in much of rural Africa and developing Asia, prompting significant efforts to leverage agriculture to improve diets. However, growing recognition that even very poor rural households rely on markets to satisfy their demand for nutrient-rich non-staple foods warrants a much better understanding of how rural markets vary in their diversity, competitiveness, frequency and food affordability, and how such characteristics are associated with diets. This article addresses these questions using data from rural Ethiopia. Deploying a novel market survey in conjunction with an information-rich household survey, we find that children in proximity to markets that sell more non-staple food groups have more diverse diets. However, the association is small in absolute terms; moving from three non-staple food groups in the market to six is associated with an increase in the number of non-staple food groups consumed by ˜0.27 and the likelihood of consumption of any non-staple food group by 10 percentage points. These associations are similar in magnitude to those de-scribing the relationship between dietary diversity and household production diversity; moreover, for some food groups, notably dairy, we find that household and community production of that food is especially important. These modest associations may reflect several specific features of our sample which is situated in very poor, food-insecure localities where even the relatively better off are poor in absolute terms and where, by international standards, relative prices for non-staple foods are very high.
Derek Headey, Kalle Hirvonen, John Frederick Hoddinott et al.
Stunting affects over one-third of children under five in Ethiopia, particularly in rural, food-insecure areas. Maize is the country’s most widely grown staple but often lacks critical nutrients essential for child growth. Specialty maize varieties, such as Quality Protein Maize (QPM), provitamin A maize, and zinc-enriched maize, offer a sustainable and food-based approach to improving child nutrition. This review evaluates the potential of specialty maize to reduce childhood stunting in Ethiopia’s maize-growing regions by synthesizing current literature, field studies, and policy perspectives. While promising, the success of such interventions requires integration with broader nutrition, agriculture, and health systems.
The aim of this study was to review the factors associated with stunting in the northern province of Rwanda by assessing anthropometric status, dietary intake, and overall complementary feeding practices. This was a cross-sectional study with 138 children 5 to 30 mo of age. A structured questionnaire was used to collect information on sociodemographic characteristics of each mother and child and breastfeeding and complementary feeding practices. Anthropometric status was assessed using height-for-age z-scores for children and body mass index for caregivers. Dietary intakes were estimated using a 24-h recall. Multiple linear and logistic regression models were performed to study the predictors of height-for-age z scores and stunting. There was a 42% stunting prevalence. Prevalence of continued breastfeeding and exclusive breastfeeding were 92% and 50%, respectively. Most children (62%) fell into the low dietary diversity score group. The nutrient intake from complementary foods was below recommendations. The odds of stunting were higher in children >12 mo of age (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08–1.29). Exclusive breastfeeding (OR, 0.22; 95% CI, 0.10–0.48) and deworming tablet use in the previous 6 mo (OR, 0.25; 95% CI, 0.07–0.80) decreased significantly the odds of stunting in children. Also, the body mass index of the caretaker (β = 0.08 kg/m2; 95% CI, 0.00–0.17) and dietary zinc intake (β = 1.89 mg/d; 95% CI, 0.29–3.49) were positively associated with the height-for-age z scores. Interventions focusing on optimal nutrition during the complementary feeding stage, exclusive breastfeeding, and the use of deworming tablets have the potential to substantially reduce stunting in children in the northern province of Rwanda.
Vestine Uwiringiyimana, Marga C. Ocké, Sherif Amer et al.
Empirical studies that examine the implication of supermarket purchase on child nutritional outcomes are scarce. This article investigates the link between supermarket shopping and height-for-age Z-scores (HAZ) and weight-for-age Z-scores (WAZ) of children and adolescents under the age of 18 years. We use two rounds of survey data (2012 and 2015) from urban Kenya in a series of instrumental variable panel data models. Findings reveal that buying from supermarkets and spending higher shares of income in supermarkets significantly increases child HAZ and decreases the probability of being stunted. Supermarket purchase also positively affects WAZ of children but to a lower extent compared to HAZ outcomes. By examining the dietary differences between supermarket shoppers and non-shoppers, we find that supermarket shoppers have a higher dietary diversity compared to those buying from traditional markets only. Findings have relevance for policies that need to take advantage of the rapid transformation of the retail sector in developing countries for better health outcomes. Acknowledgement : We thank enumerators and field supervisors for their effort in data collection. We also acknoledge respondents for devoting their time to answer our questions. Funding was provided by the German Research Foundation (DFG).
Bethelhem Legesse Debela, Kathrin Demmler, Stephan Klasen et al.
Child nutrition is a pressing issue in Ethiopia. Reports show that 28% of child deaths are associated with under-nutrition, where 38.0% of children under five years are stunted, 23.6% underweight, 9.9% are wasting, and anaemia prevalence among under-five children is extremely high at 57.0%. This paper examines the impact of women's empowerment in agriculture on intra-gender nutritional outcomes of children below five years old. We use a two-round survey panel data (baseline in 2013 and midline in 2015) of the Women Empowerment in Agriculture Index (WEAI) collected by IFPRI, Central Statistics Agency of Ethiopia, and Addis Ababa University in the Feed-the-Future and non-Feed-the-Future zones in Ethiopia. The primary objective is to examine whether an empowered woman can influence the household decision for better nutritional outcomes for the household members. The allocation decision is obviously influenced by unobserved individual-specific effects such as child gender preference and community variables. We applied the correlated random effects panel model with instrumental variables method to estimate the impact of women's empowerment in agriculture on children's nutrition outcomes. To identify which empowerment domain has a larger effect on intra-gender child nutritional outcomes, we separately estimate the five disempowerment scores on child nutrition outcomes. Nutrition outcomes, in this case, Weight-for-age z-score (waz06), Length/height-for-age z-score (whz06), Weight-for-length/height z-score (haz06), and Child Dietary Diversity Score on the interaction variable of women empowerment in agriculture and gender dummy indicated dissimilar evidence, implying that women empowerment in agriculture, and gender dummy interacted with women empowerment does not show a gender-biased effect on child nutrition outcomes. Similarly, child nutrition outcomes are improved by programme interventions but with no bias to gender. The five domains of disempowerment score negatively correlate with child nutrition outcomes, yet with no gender-biased effect. Therefore, these results suggest that exerting additional efforts on women's empowerment in agriculture can improve child nutrition outcomes without gender bias.
Globally, high maternal and infant morbidity and mortality rates have more often than not been associated with the low consumption of services offered within the maternal and child well-being programmes.
Kagendo J. Francis, Leonard Musyoka Kisovi, Samuel C. J. Otor
