IntroductionImproving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding and reduce stunting. The Federal Ministries of Health and Agriculture and Natural Resources implement the intervention. The evaluation aims to assess a range of processes, outcomes and impacts.Methods and analysisThe SURE evaluation study is a theory-based, mixed methods study comprising impact and process evaluations. We hypothesise that the package of SURE interventions, including integrated health and agriculture behaviour change communication for nutrition, systems strengthening and multisectoral coordination, will result in detectable differences in minimum acceptable diet in children 6–23 months and stunting in children 24–47 months between intervention and comparison groups. Repeated cross-sectional household surveys will be conducted at baseline and endline to assess impact. The process will be assessed using observations, key informant interviews and focus group discussions to investigate the fidelity and dose of programme implementation, behavioural pathways of impact and contextual factors interacting with the intervention. Pathways of impact will also be explored through statistical analyses.Ethics and disseminationThe study has received ethics approval from the scientific and ethical review committees at the Ethiopian Public Health Institute and the London School of Hygiene and Tropical Medicine. The findings will be disseminated collaboratively with stakeholders at specified time points and through peer-reviewed publications and presentations.

Edible parts of some wild and traditional vegetables used by the Gumuz community, namely, Portulaca quadrifida, Dioscorea abyssinica, Abelmoschus esculentus, and Oxytenanthera abyssinica, were evaluated for their minerals composition and bioavailability. Mineral elements, namely, Ca, Fe, Zn, and Cu, were analyzed using Shimadzu atomic absorption spectrophotometer. Effects of household processing practices on the levels of mineral elements were evaluated and the bioavailability was predicted using antinutrient-mineral molar ratios. Fe, Zn, Ca, Cu, P, Na, and K level in raw edible portions ranged in (0.64 ± 0.02–27.0 ± 6.24), (0.46 ± 0.02–0.85 ± 0.02), (24.49 ± 1.2–131.7 ± 8.3), (0.11 ± 0.01–0.46 ± 0.04), (39.13 ± 0.34–57.27 ± 0.94), (7.34 ± 0.42–20.42 ± 1.31), and (184.4 ± 1.31–816.3 ± 11.731) mg/100 g FW, respectively. Although statistically significant losses in minerals as a result of household preparation practices were observed, the amount of nutrients retained could be valuable especially in communities that have limited alternative sources of these micronutrients. The predicted minerals' bioavailability shows adequacy in terms of calcium and zinc but not iron.

Background Well-trained anthropometrists are essential for the delivery of high-quality anthropometric data used to evaluate public health nutrition interventions. Scant data are currently available on the precision of data collected by large teams of anthropometrists employed for nutrition surveys in low-income country settings. Objective The purpose of this study was to assess the precision of child mid-upper arm circumference (MUAC) and length/height measurements taken by fieldworkers training for nutrition survey deployment. Methods Following three days of training, an anthropometry standardization exercise was conducted in small teams of trainees at seven sites in Amhara region, Ethiopia. In groups of two to four, trainee anthropometrists (n = 79) each measured sixteen children aged 6–47 months (n = 336) twice for MUAC and length/height. Intra-observer and inter-observer precision were analyzed using technical error of measurement (TEM), relative TEM, coefficient of reliability (R), and repeatability metrics. Bland-Altman limits of agreement were calculated for intra-observer measurements. Results Intra-observer technical error of measurement (TEM) was between 0.00 and 0.57 cm for MUAC (Bland-Altman 95% limits of agreement: −0.50 to 0.54 cm) and between 0.04 and 2.58 cm for length/height measurements (Bland-Altman 95% limits of agreement: -1.43 to 1.41 cm). Inter-observer TEM was between 0.09 and 0.43 cm for MUAC and between 0.06 and 2.98 cm for length/height measurements. A high proportion of trainees achieved intra-observer R > 0.95 (MUAC 95%; length/height 97%). Most teams also achieved inter-observer R > 0.95 (MUAC 90%; length/height 95%). Conclusions Large numbers of anthropometrists (over 75) in low-income settings can attain satisfactory precision in anthropometry following training and standardization. These protocols permit researchers to assess trainees, identify individuals who have not achieved the desired level of precision, and retrain or adjust roles prior to survey deployment.

Background: In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Government has adopted the National Nutrition Programme that emphasizes the need for multisectoral collaboration to effectively deliver nutrition-sensitive and nutrition-specific interventions. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities. Methods: Data were collected from eight districts in Ethiopia using 16 key informant interviews and eight focus group discussions conducted with district and community-level focal persons for nutrition including health and agriculture extension workers. A framework analysis approach was used to analyze data. Results: Few respondents were aware of the National Nutrition Programme or of their own roles within the multi-sectoral coordination mechanism outlined by the government to deliver nutritional programmes and services. Lack of knowledge or commitment to nutrition, lack of resources and presence of competing priorities within individual sectors were identified as barriers to effective coordination between health and agriculture sectors. Strong central commitment to nutrition, increased involvement of other partners in nutrition and the presence of community development workers such as health and agriculture extension workers were identified as facilitators of effective coordination. Conclusions: Federal guidelines to implement the Ethiopian National Nutrition Programme have yet to be translated to district or community level administrative structures. Sustained political commitment and provision of resources will be necessary to achieve effective inter-sectoral collaboration to deliver nutritional services. The health and agriculture extension platforms may be used to link interventions for sustained nutrition impact.

Objectives Despite much nutrition research conducted in Ethiopia, none has described existing opportunities for synergy or possible missed opportunities to use research to inform policy and program decisions to foster accelerated progress. The study aimed to describe prevailing processes on evidence use in formulating nutrition policy and program decisions and identify potential barriers and opportunities for evidence-based decision-making for nutrition for Ethiopia's context. Methods In 2017, 29 purposively selected key informants (KIs) were interviewed. They were identified using a consultative stakeholder mapping workshop and represented National Nutrition Program coordinators, key actors in government sectors, program coordinators from selected local and international NGOs, local and international universities and research institutes involved in nutrition research and key actors in policy decision-making. A framework analysis including identifying themes, coding, indexing, charting, mapping and interpretation was used. A validation workshop discussed findings and added perspectives to interpretation. Results The KIs perceived that demand for evidence from the Ethiopian government had been increasing over time. Majority referred to poor research quality as a barrier for using research in decision-making processes. Other challenges identified included limited cross-linkage, coordination gaps between researchers and decision makers, and inadequate translation of research evidence into meaningful information for policy makers. Availability of different forums, research dissemination conferences and suitable institutional structures that enable research and evidence dissemination were considered to be opportunities that should be leveraged to inform policy making. Conclusions The quality of research, and of collaborative engagement between those who produce evidence and decision makers who formulate policies need to be strengthened. Regular evidence dissemination events and publication of action oriented easy to read briefs could increase use of evidence among nutrition policy makers. Funding Sources Ethiopian Public Health Institute and Evidence-informed Decision-making in Health and Nutrition Network.