Explore the vast range of titles available.

Dietary diversity in early life can prevent all forms of malnutrition and can establish a healthier dietary pattern for later life. However, multicountry national estimates are lacking. The aim of this study was to estimate the proportion of infants and young children (IYC) meeting the minimum dietary diversity (MMD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). We calculated the proportion of IYC (6–23 mo of age) meeting the updated MDD, MMF, and MAD for 49 low- and middle-income countries. We calculated the proportion of IYC meeting the MDD by region, rural/urban residence, and wealth quintile. The proportion of stunting cases that would have been averted if 90% of the IYC met their MDD was estimated. The proportion of IYC meeting MDD, MMF, and MAD was very low. Only 4 of 49 countries had >50% of IYC meeting MDD. The lowest MDD was for the sub-Saharan African region (18%) and the highest was for the Latin America and Caribbean (54%) region. Stark inequalities exist between countries, rural/urban residence, and wealth quintiles. A significant proportion (>11 million) of stunting cases could have been averted if ≥90% of IYC had met the MDD. MDD proportions increased with higher gross national income purchasing power parity, maternal literacy, and food supply diversity (P < 0.05). Closing the gap in dietary inequalities between and within countries is urgently needed to prevent wider, long-term socioeconomic and health inequalities. Diet-quality targets should be set and monitored routinely to promote dietary diversity and prevent all forms of malnutrition. •Dietary diversity is low in most low- and middle-income countries.•Stark disparities in diet diversity exist by rural/urban residence and wealth.•Diet quality is associated with income, maternal literacy, and food supply diversity.•More than 11 million stunting cases can be averted with major improvements in diet diversity.

The Ethiopian Orthodox Christian (EOC) fasts, although adopted for religious purposes, combines aspects of energy restriction, time-restricted feeding, and a vegan dietary pattern, all of which have been independently associated with weight loss and healthier body composition. However, combined effect of these practices as part of EOC fast remains unknown. This longitudinal study design evaluated the effect of EOC fasting on body weight and body composition. Information on socio-demographic characteristics, physical activity level, and fasting regimen followed was captured through an interviewer-administered questionnaire. Weight and body composition measurements were taken before and at the end of major fasting seasons. Body composition parameters were measured by bioelectrical impedance (BIA), Tanita® BC-418®, Japan). Significant changes in body weight and body composition were observed for both fasts. Significant decreases in body weight (14/44 day fast: − 0.45; P  = 0.004/− 0.65; P  = 0.004), FFM (− 0.82; P  = 0.002/− 0.41; P  < 0.0001), and trunk fat mass (− 0.68; P  < 0.0001/− 0.82; P  < 0.0001) were observed after adjusting for covariates including age, sex, and physical activity. The EOC fasting regimen leads to significant reductions of body weight and compositions. Longer fasting duration led to much higher effects in body weight and body composition and may be non-pharmacological strategy in prevention or treatment of chronic diseases.

Women empowerment is an underlying factor of child feeding and nutrition. However, the lack of standardized measurements has made it difficult to design interventions that embed women empowerment and measure their impacts. This study aimed to assess temporal trends in women empowerment in Ethiopia and evaluate their contribution towards improving dietary diversity in infants and young children. We used women and child data from the Ethiopian Demographic and Health Survey 2005, 2011, and 2016, yielding a total sample of 6113 mother–child pairs. The survey‐based women's empowerment index (SWPER) developed and validated for use in Africa was used to assess three dimensions of women empowerment: (i) social autonomy, (ii) decision making; and (iii) attitude to violence. We used multiple‐linear and multivariable logistic regression to assess the associations between SWPER and the number of food groups consumed/and the minimum dietary diversity (MDD). To determine drivers of changes over time, a regression decomposition analysis was run. Women empowerment indices have improved over the 2005–2016 period, but a significant proportion of women had low standardized SWPER scores for autonomy/social independence (47%) and attitude to violence (49%) domains in 2016. SWPER autonomy and SWPER decision‐making scores were strongly associated with the odds of meeting MDD. Changes in women empowerment accounted for 17% of the improvements in MDD between 2005 and 2016. SWPER was a stronger predictor of the change in MDD, than known predictors like wealth, child age, and urban residence. As a critical underlying driver of child nutrition, women empowerment should be boldly addressed and integrated in nutrition interventions.

Agricultural sector plays a key role towards achieving healthier diets that are deemed critical for improving health and nutritional outcomes. To what extent the current food supply systems support healthy diets remains unknown. Using annual and nationally representative data on crop and livestock production in Ethiopia, we assess the national agricultural sector from a nutrition lens and its role in supporting healthy diets in the country. We do so by converting the agricultural production into energy and nutrients for the period of 2011-2015. These data show that the national food production has increased dramatically over the 5-year period to supply more than 3,000 calories per capita in 2015. Moreover, nutrient production gaps have substantially decreased (2011-15), but deficits in energy (5%), vitamin C (16%), and calcium (9%) production remained in 2015. However, this production growth-coming primarily from the cereal sector and at the expense of other food groups-led to a decrease in production diversity as reflected by a drop in the Shannon index between 2011 and 2015. Together these findings imply that the production increases in Ethiopia would need to be sustained to feed the rapidly growing population but more emphasis should be given to diversification to support healthy and nutritionally diversified diets.

There is limited evidence on the burden and drivers of the co-occurrence of overweight/obesity and undernutrition at the individual level in low- and middle-income countries. This gap hinders the design of double-duty actions (DDAs) that can effectively address all forms of malnutrition. This multi-country study aimed to determine the magnitude of double burden of malnutrition (DBM) among under five children and identify household and individual level determinants in Eastern and Southern Africa (ESA) countries. We pooled data of 79,394 children aged 6–59 months, collected from Demographic and Health Surveys (DHS) conducted in 12 ESA countries between 2013 and 2016. We identified confounders a priori . A random effect logistic regression was performed to identify factors associated with the co-occurrence of Stunting and Overweight (StOw), Overweight and Anemia (OwA), and Stunting Overweight and Anemia (StOwA). The study revealed that the burden of co-occurrence of StOwA, StOw, and OwA among under-five children were 5.38%; 95% confidence interval (CI) (5.00-5.79), 4.04 (95% CI: 3.86–4.23), and 5.72% (95% CI: 5.40–6.04), respectively. South Africa had the highest burden of co-occurrence of StOwA (15.58%) and OwA (22.30%), while Namibia and Burundi had the lowest StOwA (2.19%) and OwA (2.78%), respectively. Male children were more likely than female children to experience co-occurrence of StOwA [adjusted odds ratio (AOR) (95% CI): 1.96 (1.49–2.57)], OwA [AOR = 1.51: (95% CI) (1.22, 1.86)], and StOw [AOR = 1.59: (95% CI) (1.36, 1.87)]. Children from the poorest and poorer households had higher odds of co-occurrence of StOwA, OwA, and StOw compared to those from the richest households. Compared to children born to mothers with normal body mass index, those born to mothers with overweight/obese had 60% and 39% higher risk, whereas those born to mothers who were underweight had 49% and 36% lower risk of StOw and OwA, respectively. The DBM among children poses a significant public health and economic problem in ESA countries. The DDAs approach should be strengthened in the ESA region to address all forms of malnutrition.

Low‐ 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. Half of the studied children aged 6–23 months are found to be stunted and anaemic, posing serious public health concerns in rural Ethiopia. Several factors are associated with stunting and anaemia at community, household, and individual levels. Interventions should therefore take these contributing factors into account. Key messages Prevalence of stunting and anaemia are significantly varied across the different agroecological zones. A lower aggregated crop productivity and higher molar ratios of phytate to iron or zinc are associated with occurrence of stunting. At the household level, use of health facilities, access to the market, and involvement in non‐farm income lower the risk of stunting, while improved water, sanitation, and hygiene reduces the occurrence of anaemia. Stunting is more common in children aged 18–23 months and with a lower dietary diversity, whereas anaemia is more common in children aged 6–11 months and amongst boys. Interventions should consider these contributing factors and go beyond the administrative boundaries into targeting community‐level contextual variations.

Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.

Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10–19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47–49% of adolescents had marginal iron store (< 50 µg/l). Hb, SF, and SFol concentrations increased in the intervention group, but not in the control group (P < 0.05). Marginal iron store decreased from 49 to 12% after 3-months of WIFAS; whereas, the proportion of adolescents with elevated SF (> 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P < 0.001). WIFAS intervention for three-months was effective in reducing iron and folate deficiency in adolescent girls. Future studies should evaluate the long-term impact of intermittent WIFAS.

The quality of complementary feeding can have both short‐ and long‐term health impacts by delaying or promoting child growth and establishing taste preferences and feeding behaviours. We aimed to assess the healthy and unhealthy feeding practices of infants and young children in rural Ethiopia. We conducted two rounds of surveys in December 2017/18 in Habru district, North Wello, rural Ethiopia among caregivers of infants and young children (N = 574). We characterised the consumption of infants and young children using non‐quantitative 24 h recall and the World Health Organization infant and young child feeding indicators. Sociodemographic characteristics, anthropometry and haemoglobin concentrations were assessed. Breastfeeding was a norm as 82% and 67% were breastfed in the first and second rounds. Between the two rounds, dietary diversity increased from 5% to 17% (p < 0.05), but more pronounced increases were observed in the consumption of ultra‐processed food (UPFs). Up to one‐in‐five (22%) of the children consumed UFPs. With an average of only three food groups consumed, the consumption of nutrient‐dense foods like animal source foods, fruits and vegetables was very low particularly among younger children. UPFs are an additional risk factor that contributes to poor quality diets. Behavioural Change Communication interventions, including those in rural areas, should explicitly discourage the consumption of UPFs. Future studies should aim to quantify the amount of UPFs consumed and evaluate how this is associated with diet adequacy and nutritional outcomes. Ultra‐processed foods (UPFs) are an additional risk factor that contributes to poor quality diets in rural Ethiopia. Behavioural Change Communication interventions, including those in rural areas, should explicitly discourage the consumption of UPFs. Key messages Complementary diets in rural Ethiopia are extremely low in diversity. Consumption of unhealthy foods is more prevalent than the proportion that meets the minimum dietary diversity. Consumption of ultra‐processed foods was not associated with household wealth score. Indicators of unhealthy feeding practices should be integrated into nutrition programme monitoring.

Background. Dietary diversity is very critical for fetal growth and development, as well as for the health and wellbeing of the mother. In Ethiopia, 41% of pregnant mothers consume diversified diets. There has been no study assessing whether pregnant women in southwest Ethiopia consume a varied diet. Objective. To estimate the proportion of adequate diversified dietary intake and to determine whether there is an association between diversified dietary intake and mothers’ social capital. Design. A community-based cross-sectional study was conducted on 367 pregnant women in South West Ethiopia. A 24-hour multiple-pass dietary recall method was used to measure dietary intake and the 10 food groups of FANTA/FAO 2016 were used to analyze dietary diversity. Social capital was assessed based on the number of social networks in which a mother participated. Result. The proportion of diversified dietary intake was 14.7% (95% CI: 11.1, 18.3). Pregnant mothers who had social capital, had their own income, had emotional support from their husbands, were from a rich family, and had a frequent dietary intake were statistically associated with a diversified dietary intake, with an AOR of 7.8 (95% CI 1.02, 2.3 (95% CI 1.12, 4.44), 4.0, (95% CI 1.16, 13.7), 59.19), 2.3 (95% CI 1.04, 5.26), and 1.5 (95% CI 1.04, 2.07), respectively. Conclusion. Diversified dietary intake was found to be lower than previously reported, and it was associated with social capital. Methodologically rigorous studies are required to verify the association between social capital and adequate diversified dietary intake.