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      Undernutrition and associated factors among children aged 6–59 months in nutrition-sensitive agriculture intervention implemented Basona district, North Shewa Zone, Amhara region, Ethiopia

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          Abstract

          Background

          In Ethiopia, child malnutrition is a significant public health problem. To address the problem, Nutrition-Sensitive Agriculture (NSA) program was introduced. However, there is a paucity of evidence about the prevalence of child undernutrition in NSA-implemented districts. Therefore, this study aimed to assess the prevalence of undernutrition among children aged 6–59 months in NSA-implemented districts.

          Method

          A community-based cross-sectional study was conducted by enrolling 422 children aged 6–59 months paired with their mothers. A systematic sampling technique was used to select respondents. Data were collected by Open Data Kit (ODK) data collection platform, and Stata version 16 was used for analysis. The multivariable logistic analysis model was fitted to assess the association between variables, and 95% CI was estimated to measure the strength of the association. The level of statistical significance was declared at a p-value of less than 0.05 in the multivariable model.

          Result

          Overall, 406 respondents participated in the study, and a response rate of 96.2% was obtained. The prevalence of stunting, wasting, and underweight was 24.1% (95% CI: 19.9–28.4), 8.87% (95% CI: 6.3–12.1) and 19.95% (95% CI: 16.2–24.2), respectively. Household food insecurity was significantly associated with being underweight (AOR: 3.31, 95% CI (1.7–6.3). Child dietary diversity (AOR: 0.06, 95% CI: 0.01–0.48) and being a beneficiary of the NSA (AOR: 0.12, 95% CI: 0.02–0.96) program were associated with wasting. Lack of ANC visits and diarrhea in the past two weeks was associated with stunting and wasting, respectively.

          Conclusion

          The prevalence of malnutrition was a moderate public health problem. Wasting was more prevalent than the recent national and Amhara region averages. However, the prevalence of stunting and underweight was lower than the national average and other studies conducted in Ethiopia. Healthcare providers should work to increase dietary diversity, ANC visits, and reduce diarrheal disease.

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          Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia

          Background More than one-third of deaths during the first five years of life are attributed to undernutrition, which are mostly preventable through economic development and public health measures. To alleviate this problem, it is necessary to determine the nature, magnitude and determinants of undernutrition. However, there is lack of evidence in agro-pastoralist communities like Bule Hora district. Therefore, this study assessed magnitude and factors associated with undernutrition in children who are 6–59 months of age in agro-pastoral community of Bule Hora District, South Ethiopia. Methods A community based cross-sectional study design was used to assess the magnitude and factors associated with undernutrition in children between 6–59 months. A structured questionnaire was used to collect data from 796 children paired with their mothers. Anthropometric measurements and determinant factors were collected. SPSS version 16.0 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to nutritional status of the children Statistical association was declared significant if p-value was less than 0.05. Results Among study participants, 47.6%, 29.2% and 13.4% of them were stunted, underweight, and wasted respectively. Presence of diarrhea in the past two weeks, male sex, uneducated fathers and > 4 children ever born to a mother were significantly associated with being underweight. Presence of diarrhea in the past two weeks, male sex and pre–lacteal feeding were significantly associated with stunting. Similarly, presence of diarrhea in the past two weeks, age at complementary feed was started and not using family planning methods were associated to wasting. Conclusion Undernutrition is very common in under-five children of Bule Hora district. Factors associated to nutritional status of children in agro-pastoralist are similar to the agrarian community. Diarrheal morbidity was associated with all forms of Protein energy malnutrition. Family planning utilization decreases the risk of stunting and underweight. Feeding practices (pre-lacteal feeding and complementary feeding practice) were also related to undernutrition. Thus, nutritional intervention program in Bule Hora district in Ethiopia should focus on these factors.
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            Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme

            Background Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Methods Using a cross-sectional survey across four of South Africa’s nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. Results A quarter of respondents remained uninsured, even higher among 20–29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. Conclusions By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country’s financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.
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              Factors associated with adherence to antiretroviral therapy among HIV infected children in Kabale district, Uganda: a cross sectional study

              Objectives This study was set out to assess the level of adherence to antiretroviral therapy (ART) and its determinants among children receiving HIV treatment in Kabale district, south western Uganda, in order to inform interventions for improving pediatric ART adherence. Results Overall, 79% (121/153) of the children did not miss ART doses over the 7 days. Caregiver forgetfulness was the major reason for missing ART doses, 37% (13/35). Other reasons included transportation costs to the health facilities, 17%, (6/35) and children sitting for examinations in schools. Older children (11–14 years) were more likely to adhere to ART than the younger ones (0–10 years) (AOR = 6.41, 95% CI 1.31–31.42). Caregivers, who knew their HIV status, had their children more adherent to ART than the caregivers of unknown HIV status (AOR = 21.64: 95% CI 1.09–428.28). A significant proportion of children in two facilities 21.5% (32/153) missed ART doses within the previous week. Support for providers to identify clues or reminders to take drugs, extending HIV testing to caregivers and innovative models of ART delivery that alleviate transport costs to caregivers and allow sufficient drugs for children in school could enhance drug adherence among children.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 April 2023
                2023
                : 18
                : 4
                : e0284682
                Affiliations
                [1 ] School of Public Health, College of Medicine and Health Sciences, Jijiga University, Jijiga, Ethiopia
                [2 ] College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [3 ] Addis Ababa Food and Drug Control Authority, Addis Ababa, Ethiopia
                [4 ] Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
                [5 ] Department of Public Health Nutrition, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
                COMSATS University Islamabad - Lahore Campus, PAKISTAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-4965-6070
                Article
                PONE-D-21-41083
                10.1371/journal.pone.0284682
                10132697
                37099523
                94c1c8b7-af69-4af9-9d40-344e27613944
                © 2023 Yehuala et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 December 2021
                : 5 April 2023
                Page count
                Figures: 4, Tables: 4, Pages: 20
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Nutrition
                Diet
                Food
                Biology and Life Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Nutrition
                Malnutrition
                Biology and Life Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Nutrition
                Diet
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                Nutrition
                Medicine and Health Sciences
                Nutrition
                People and Places
                Geographical Locations
                Africa
                Ethiopia
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Diarrhea
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Diarrhea
                Medicine and Health Sciences
                Women's Health
                Maternal Health
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