Background: A food considered as a taboo is strictly forbidden, for health, cultural or spiritual reasons. Food taboos are known from virtually all human societies and may be found in various forms all over the world. Pregnancy is viewed as a critical period in the life of women and is usually subjected to a number of food taboos as a way of safeguarding their lives and that of the unborn baby. Poor maternal nutrition, especially in rural settings, adversely affects pregnancy and birth outcomes. In many local communities, pregnant women have food taboos with consequent depletion of vital nutrients. Malnutrition is one of the most serious health problems affecting children and their mothers in Ethiopia. As a result, there is lack of comprehensive information regarding practices and the factors associated with them in the study area. Therefore this study was aimed at measuring women who are likely to have certain taboos/misconceptions during pregnancy among pregnant women attending ANC services in public health institutions of shashemene district. Method: An institution based descriptive cross-sectional study design followed by Simple random sampling technique was used for 295 pregnant women, who are attending ANC service from public health institutions of Shashemene district. The Data was coded, entered in to EPI info 3.5.1 and exported to SPSS version 20.0 for further analysis. Frequencies, percentages, crude odds Ratio, 95% Confidence Intervals and multiple logistic-regressions were analyzed. Finally, the result of the study was presented using texts, figures and tables. Result: one half (49.8%) of total pregnant mothers encountered food taboos at least for one food item. food items avoided were, linseed 92 times, honey 84 times, milk 67 times, fatty meat 63 times, eggs 50 times, fruits 41 times and vegetables 17 times. Reasons mentioned for avoidance of this food item; Plastered on the fetal head, makes fatty baby and difficult delivery, fear of abortion, evil eye, fetal abnormality. Educational status showed a significant association with belief of balanced diet. Conclusion: The study revealed that food taboos and traditional beliefs relating to pregnancy exist and larger proportion of women still believes in old unscientific tales. This can be improved by strengthening the nutrition counseling component of ANC which was inadequate in the ANC package received. Empowering community based health workers in providing effective nutrition counseling should be explored. There is a need for nutrition education and awareness generation among women; Increasing literacy status to reduce taboos/misconceptions.

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54•0% (95% uncertainty interval [UI] 38•1-65•8), 17•4% (7•7-28•4), and 59•5% (34•2-86•9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.Funding Bill & Melinda Gates Foundation.

Maternal health service utilizations are poorly equipped, inaccessible, negligible, and not well documented in the pastoral society. This research describes a quantitative and qualitative study on the determinants of institutional delivery among pastoralists of Liben Zone with special emphasis on Filtu and Deka Suftu woredas of Somali Region, Ethiopia. The study was funded by the project “Fostering health care for refugees and pastoral communities in Somali Region, Ethiopia”. This community-based cross-sectional study was conducted during November 2015. Interviews through a questionnaire and focus group discussions were used to collect the data. Proportional to size allocation followed by systematic sampling technique was used to identify the study units. The major determinants of institutional delivery in the study area were as follows: being apparently healthy, lack of knowledge, long waiting time, poor quality services, cultural beliefs, religious misconception, partner decision, and long travel. Around one-third (133, 34.5%) of the women had visited at least once for their pregnancy. More than half (78, 58.6%) of the women had visited health facilities due to health problems and only 27 (19.9%) women had attended the recommended four antenatal care visits. Majority (268, 69.6%) of the pregnant women preferred to give birth at home. Women who attended antenatal care were two times more likely to deliver at health facilities (AOR, 95% confidence interval [CI] =2.38, 1.065–4.96). Women whose family members preferred health facilities had 14 times more probability to give birth in health institutions (AOR, 95% CI =13.79, 5.28–35.8). Women living in proximity to a health facility were 13 times more likely to give birth at health facilities than women living far away (AOR, 95% CI =13.37, 5.9–29.85). Nomadic way of life, service inaccessibility, and sociodemographic and cultural obstacles have an effect on the utilization of delivery services. Increasing access, information, education, and communication need to reach pastoral women in need.

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2•5th and 97•5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62•6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, withincountry geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs asses...

Health service utilization among pastoralists in Ethiopia is not well documented. Available data are very few and institution-based. Health services are particularly inadequate and poorly equipped, being scarce, inaccessible, and inappropriate to the pastoralist way of life. Effective antenatal care (ANC) use has been shown to influence women's use of maternal health services, probably the most effective intervention in reducing maternal mortality in the developing world. Despite many studies done on ANC service utilization among agrarian women, the studies done on pastoralist women are almost negligible. Therefore, this study assesses utilization of ANC services among pastoralists of Afar Region, Ethiopia. A community cross-sectional study was carried out from 5 January to 5 February, 2015. The data was collected by interviews through a questionnaire. Statistical analyses were done to describe pertinent findings. Of 788 women, 42.4 % (334) made at least one ANC visit, while 19.5 % (65) had adequately utilized ANC (i.e. made four or more ANC visits). Only 9.7 % of women visited an ANC centre during the first trimester (12 weeks). Institutional delivery service utilization of the district was extremely low at 7.4 % (58). Educational status of the mother had a significant association with institutional delivery. Mothers who attended college/university were five times more likely to utilize delivery service than those mothers who are illiterate. ANC utilization in peri-urban areas was two times more than ANC utilization in rural areas with CI of 1.376, 3.595. Multivariate analyses, being in periurban residence (adjusted odds ratio (AOR) = 2.224; 95 % CI 1.38, 3.60), possessing radio/TV (AOR = 3.134; 95 % CI 2. 204, 4.457), were positively associated with ANC service utilization. Every pregnant woman should receive at least four ANC visits, but only 20 % of the respondents were able to fulfil the recommendation. Pastoralist lifestyles, access, demographic, and socio-cultural barriers affect proper utilization of maternal health services. Increasing service coverage and promotion of available services in the community, accessible health services, transportation and improving information, education, and communication on maternal health services must be intensified to reach women in pastoralist communities of the country. Rigorous efforts are needed to reach disadvantaged groups so as to overcome health inequities between agrarian and disadvantaged pastoralist women.