AbstractHousehold food insecurity (HFI) plays an important role in child malnutrition in many low‐income countries. We determined the association between HFI and stunting and severe stunting among Rwandan children from the Gicumbi district, aged 6–59 months using a cross‐sectional study of 2,222 children. HFI factor was calculated by summing all seven HFI (access) frequency questions and was categorised into food security, mildly food insecurity, moderately food insecurity, and severe food insecurity. The association between stunting, severe stunting, and HFI was determined using the multiple logistic regression analyses that adjust for clustering and sampling weights. The odds of moderate and severe HFI were significantly higher among stunted children aged 6–59 months than those who were not stunted (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI] [1.11, 1.84] and AOR = 1.35; 95% CI [1.08, 1.69], respectively). Children from households with moderate food insecurity were 2.47 times more likely to be severely stunted (AOR = 2.47; 95% CI [1.77, 3.46]), and those from households with severe food insecurity were more likely to be severely stunted (AOR = 1.82; 95% CI [1.34, 2.48]), compared with children aged 6–59 months from households with food security. Other factors included male children and children who did not attend monthly growth monitoring sessions. This study showed that moderate and severe HFI correlated with stunting and severe stunting. Interventions to improve stunting in Gicumbi children should also focus on male children, children who did not attend monthly growth monitoring sessions, and households with moderate and severe food insecurity.
Kingsley E. Agho, Christine Mukabutera, Monica Mukazi et al.
AbstractLow‐ and middle‐income countries shoulder the greatest burden of stunting and anaemia in children. This calls for prompt and effective intervention measures, while the contributing factors are not fully understood. This study evaluates determinants spanning from individual‐, household‐ and community levels including agroecology and antinutrients as unique sets of predictors. Primary data were collected from 660 rural households representing the midland (ML), highland, and upper highland (UHL) agroecological zones from northern Ethiopia. The study relates several predictors to stunting and anaemia in children aged 6–23 months. We found 49.1% and 49.7% of children were stunted and anaemic, respectively. Children living in the ML are approximately twice more likely to be stunted adjusted odds ratio (AOR: 1.869; 95% CI: 1.147–3.043) than in the UHL. The risk of stunting increases by 16.3% and 41.9% for every unit increase in phytate‐to‐zinc and phytate‐to‐iron molar ratios, respectively. A 10% increase in mean aggregated crop yield was observed to reduce the likelihood of stunting occurrence by 13.6%. Households lacking non‐farm income‐generating opportunities, travel longer time to access the marketplace and poor health service utilisation were associated with increased risk of stunting. Low diversity of child's diet, age of the child (18–23 months) and mothers at a younger age are significantly associated with stunting. Risk of anaemia in children is high amongst households with unimproved water, sanitation, and hygiene practices, younger age (6–11 months) and mostly occurs amongst boys. Children in the ML had a 55% reduced risk of being anaemic (AOR: 0.446; 95% CI: 0.273–0.728) as compared to the UHL. Therefore, the influence of these factors should be considered to tailor strategies for reducing undernutrition in children of 6–23 months in rural Ethiopia. Interventions should go beyond the administrative boundaries into targeting agroecological variation.
ABSTRACT Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women's empowerment, defined through both fundamental capabilities and household decision‐making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen's capability approach and Kabeer's empowerment framework, we examined the associations between two distinct dimensions of women's empowerment and child stunting across Ethiopia's diverse regions. We analyzed 18,466 mother–child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women's empowerment and child stunting across Ethiopia's 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women's decision‐making authority increased (mean score: 0.70–0.78), while capabilities remained stable (0.17– 0.16). Higher capabilities were significantly associated with lower odds of stunting ( β = −0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision‐making showed no association ( β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision‐making was observed ( β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision‐making. The study findings suggest that interventions should prioritize capability development through region‐specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi‐sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.
Seyoum Teffera Mengesha, Eva Berde, Amare Zerihun Yohannes et al.
Maternal psychological well-being is a critical determinant of health outcomes for mothers and their children, encompassing emotional, mental, and social dimensions of health during pregnancy, childbirth, and the postpartum period. This chapter explores the multifaceted concept of maternal psychological well-being, examining its biological, psychological, social, and cultural determinants. Hormonal fluctuations, physical health, pre-existing mental health conditions, self-efficacy, and social support systems all play pivotal roles in shaping maternal mental health. The consequences of poor psychological well-being are far-reaching, impacting mothers’ physical recovery, children’s behavioral and cognitive development, and family dynamics. Interventions, including cognitive-behavioral therapy, mindfulness-based approaches, peer support programs, and policy measures such as maternity leave and integrated mental health care, are effective in promoting maternal mental health. Drawing on global trends and evidence from Ethiopia, this chapter emphasizes the need for a multidisciplinary approach to address maternal psychological well-being, recognizing its centrality to maternal and child health outcomes.
Background Sub-Saharan Africa, particularly pastoralist communities, experiences high levels of household food insecurity. Household food insecurity adversely affects both short- and long-term health and nutritional outcomes of mothers and their children. However, despite a growing body of research, evidence on food insecurity in Ethiopia remains limited among pastoralist populations. Therefore, this study assessed the prevalence and associated factors of household food insecurity among lactating mothers in pastoralist communities of Jigjiga town, Somali Region, Eastern Ethiopia, from 20 July to 03 September 2024. Methods A community based cross sectional study was conducted among 458 randomly selected households with lactating mothers. Data were collected using a structured questionnaire through face to face interviews. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS). Data were analyzed using SPSS version 26. Binary logistic regression analysis was performed to identify factors associated with household food insecurity. All relevant statistical assumptions were tested. A p value of < 0.05 was considered statistically significant. The strength of associations was reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results Of the 439 lactating mothers, 305 (69.4%; 95% CI 65.8–74.9) households were food insecure. The mean HFIAS score was 20.82 (SD = 4.0). Poor (AOR = 2.63; 95% CI 1.68–4.12) and medium (AOR = 2.07; 95% CI 1.27–3.39) household wealth index, consumption of fewer than three meals per day (AOR = 1.63; 95% CI 1.21–3.75), and poor dietary diversity (AOR = 1.81; 95% CI 1.22–2.68) were associated with higher odds of household food insecurity. In contrast, maternal age of 25–34 years (AOR = 0.25; 95% CI 0.13–0.50) and attainment of secondary education (AOR = 0.41; 95% CI 0.19–0.89) or college level and above education (AOR = 0.29; 95% CI 0.14–0.60) were associated with lower odds of household food insecurity. Conclusion Nearly two-third of households with lactating mothers experienced food insecurity. Maternal age, educational attainment, household wealth status, meal frequency, and dietary diversity were key predictors. Targeted multisectoral interventions aimed at improving maternal education, household economic status, and dietary diversity may help reduce household food insecurity in Ethiopia’s pastoralist settings Furthermore, integration of food security screening into the existing maternal and child health service may be important to early diagnostic and take action.
Kadra Ahmed Omar, Hayimanot Mezmur, Berhe Gebremichael et al.
AbstractConcurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed‐effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5–4.9)), with respectively 2.5% (95% CI: 2.1–3.1) and 4.9% (95% CI: 4.7–5.2) among children in urban and rural settings. Children: (i) in the age group 12–23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20–5.42)) and 24–59 months (AOR: 3.08, 95% CI: (2.28–4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57–2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11–1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10–1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48–0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55–0.89)), having a mother with a normal body mass index (18.5–24.9 kg/m2) (AOR: 0.57, 95% CI: (0.48–0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50–0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32–0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.
Biniyam Sahiledengle, Kingsley E. Agho, Pammla Petrucka et al.
Abstract Background Optimal nutrition in the first 24 months of life is vital for child development. While socioeconomic factors associated with feeding practices are well-documented, evidence regarding the psychosocial correlates of minimum meal frequency (MMF) in Eastern Ethiopia remains scarce. Objective To assess the magnitude of minimum meal frequency and identify Health Belief Model (HBM) constructs and sociodemographic factors associated with minimum meal frequency among children aged 6–23 months in Harar City, Eastern Ethiopia. Methods A facility-based analytical cross-sectional study was conducted from December 2023 to January 2024 among 514 mothers/caregivers of children aged 6–23 months attending three randomly selected public health centers in Harar City. Participants were selected using systematic random sampling. Minimum meal frequency was defined according to WHO guidelines: ≥2 meals (breastfed, 6–8 months); ≥3 meals (breastfed, 9–23 months); ≥4 feeds (non-breastfed, 6–23 months). The Health Belief Model (HBM) was applied to assess psychosocial factors, including perceived susceptibility, severity, benefits, barriers, and self-efficacy. Data were collected using a structured questionnaire administered via KoboToolbox. Bivariable and multivariable logistic regression analyses were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify factors associated with MMF. Results The prevalence of MMF was 61.5% (95% CI: 57.3–65.7). Achieving MMF was significantly associated with being breastfed (AOR = 3.20; 95% CI: 1.80–5.68), child age 6–8 months (AOR = 1.85; 95% CI: 1.10–3.12), and maternal primary education (AOR = 2.40; 95% CI: 1.05–5.45). Other significant correlates included high maternal knowledge (AOR = 3.40; 95% CI: 1.40–8.10), household food security (AOR = 3.10; 95% CI: 1.40–6.70), and postnatal care (PNC) attendance (AOR = 3.10; 95% CI: 1.70–5.50), and higher household wealth. HBM constructs were also independently associated with MMF: high maternal self-efficacy (AOR = 2.05; 95% CI: 1.30–3.25) and high perceived susceptibility (AOR = 1.45; 95% CI: 1.05–2.20) were associated with higher odds of meeting MMF requirements. Conclusions A substantial proportion of children did not meet recommended feeding frequency. Maternal psychosocial factors, particularly self-efficacy and perceived susceptibility, were significantly associated with feeding practices, alongside key sociodemographic and health service-related factors. Interventions should move beyond food security toward building caregiver confidence and utilizing PNC as a key touchpoint for behavioural change.
BACKGROUND: Mother-to-child transmission (MTCT) is an important route of new hepatitis B virus (HBV) infections. In Africa, limited and conflicting data on the effectiveness of hepatitis B birth dose vaccination (HepB-BD) have contributed to fragmented adoption and sub-optimal implementation. We aimed to assess the effectiveness of timely HepB-BD in preventing HBV MTCT in Ethiopia. METHODS: We conducted a multi-centre cross-sectional observational study in Ethiopia from May 2022 to June 2024. We identified mothers who had tested positive for hepatitis B surface antigen (HBsAg) during pregnancy and assessed mother-infant pairs at 6-12 months post-partum for HBV MTCT. We stratified effectiveness of HepB-BD by maternal risk profile (HBV DNA level, hepatitis B e-antigen (HBeAg) status). RESULTS: The analysis included 387 children born to HBV-positive, HIV-negative mothers who had completed routine HBV vaccination (HepB3). The median age of infant testing was 10 months (IQR 7.0-11). Overall MTCT risk was 5.2% (95% CI 3.4,7.8). MTCT was significantly lower among infants receiving HepB-BD alone (0/39, 0% [95% CI 0-9.0]) compared to those without immunoprophylaxis at birth (20/131, 15.3% [95% CI 10.1-22.4]) (p = 0.009). No transmission occurred with HepB-BD plus HBIg (0/217, 0% [95% CI 0-1.7]). Maternal viral load >200,000 IU/ml (AOR 16.6, 95% CI 4.82,57.19) and HBeAg positivity (AOR 4.21, 95% CI 1.08,16.44) were associated with increased MTCT risk amongst infants without immunoprophylaxis at birth. CONCLUSIONS: In Ethiopia, the current vaccination series starting at 6 weeks is insufficient to prevent HBV MTCT. Timely HepB-BD is highly effective in reducing HBV MTCT and should be prioritised for scale-up in Africa.
Nega Berhe, Hailemichael Desalegn, Hiwot Mengistu et al.
Background: Several studies have highlighted the high impact of HAIs and their effects on pediatric recovery in Ethiopia. Objectives: This study examined the effect of hospital-acquired infections (HAIs) on the recovery of children with severe acute malnutrition (SAM). Design: A retrospective cohort study was conducted at Asella Referral and Teaching Hospital in Oromia, Ethiopia. Materials and methods: Hospital acquired infections (HAIs) defined as infections occurred within 48 hours or more after admission to the Hospital and documented by treating clinicians in medical records. Diagnosis was made using routine clinical assessment, and available laboratory findings according to the standard hospital practice. Of 635 children admitted during the study period, 142 records were excluded (not meeting SAM criteria, unacceptable age range, or incomplete data). Consequently, 493 eligible children with comprehensive documentation were included in the final study. Kaplan–Meier survival analysis was used to compare recovery times between children with and without HAIs. Time to nutritional recovery (in days), defined as the length of hospital stay until recovery, and compared between children with and without hospital-acquired infections. Results: Children without hospital-acquired infections had a higher probability of recovery over time compared to those with HAIs (log-rank test, p < 0.001). Factors significantly associated with HAIs included rural residence, incomplete immunization, and nasogastric tube feeding. Conclusions: Hospital-acquired infections are a common complication among children admitted with severe acute malnutrition and are associated with slower recovery and prolonged hospital stay. Improving child survival requires an integrated approach that strengthens infection prevention and control (IPC), ensures reliable WASH infrastructure, and promotes safe feeding and hygiene practices in therapeutic feeding units. Addressing these structural and procedural gaps is essential to achieving sustainable improvements in nutrition recovery and infection control in Ethiopian hospitals.
Teshome Bekele Elema, Solomon Gebretsadik, Ashenafi Habtamu et al.
Background: Stunting in the first two years of life remains a major public health concern in Kenya, affecting about one in five children and leading to long-term consequences on cognitive development and economic productivity. Traditional, largely reactive approaches that rely on linear statistical models have a limited ability to capture the complex, non‑linear determinants of stunting. Given that stunting arises from an interplay of immediate, underlying, and structural determinants, machine learning (ML) methods offer a promising alternative. ML techniques can leverage large, heterogeneous datasets to uncover hidden patterns and non‑linear interactions among associated factors, potentially enabling earlier and more accurate identification of children with higher probabilities of stunting. Objective of the study: This study applied supervised machine learning techniques to predict early childhood stunting among children aged 0-23 months and identify associated factors using nationally representative data from the 2022 Kenya Demographic and Health Survey. Methods: Three models—logistic regression (LR), balanced random forest (BRF), and categorical boosting (CatBoost)—were developed and evaluated using metrics aligned with programmatic priorities, including recall, area under the receiver operating characteristic curve (AUC), F1-score, and Brier Score. To address class imbalance, balanced class weights were applied, and models were trained at a threshold of 0.4 to optimize sensitivity. Results: CatBoost achieved the highest overall performance (AUC = 70.8%, recall = 85.8%), while LR remained highly competitive (AUC = 71.5%, Recall = 77.2%), outperforming BRF. Across all three models, consistent predictors included the child’s age, sex, birth size, twin status, maternal stature, household wealth, and geographic location, reflecting the multifactorial nature of stunting and aligning with existing literature. Conclusions: Simpler models, when combined with domain-informed feature engineering, could perform comparably to advanced algorithms while supporting transparency, which is essential for policy-relevant decision-making. The findings also provide methodological support for integrating predictive modelling into nutrition research and highlight opportunities to improve stunting prevention strategies.
