BackgroundThe cause of under-nutrition in schoolchildren is complex and varying from region to region. However, identifying the cause is the basic step for nutritional intervention programs.MethodsSchool based cross-sectional survey was conducted among 450 schoolchildren aged 7-14 years, using multi-stage sampling techniques in Dale Woreda, southern Ethiopia.A structured questionnaire and 24-hour recall methods were administered to determine the sociodemographic and dietary intake of participants. Stool microscopic examination was done. Weight and height were measured using a standard calibrated scale. Odds ratio generated from logistic regression was used to determine the strength of variables association.ResultsOlder age group (10-14 vs. 7-9) (AOR = 3.4; 95% CI, 1.7-6.6) and having Trichuris Trichura infection (AOR = 3.9; 95% CI, 1.4 -11.6) increased the risk of being stunted. Children whose mothers have completed primary education are less likely to be stunted than children whose mothers do not have formal education (AOR = 0.3; 95% CI, 0.2-0.8).Having large family size (AOR = 3.3; 95% CI, 1.4-7.9) and inadequate intake of carbohydrate (AOR = 3.1; 95% CI, 1.4-6.8) were independent predictors of wasting. Children whose mothers completed primary education are less likely to be underweight (AOR = 0.3; 95% CI, 0.1-0.9). Children live in food insecure households are more likely to be stunted, under-weight and wasted than children live in food secure households (AOR = 2.5; 95%, 1-5.6; AOR = 3.9; 95% CI, 1.2-12.0; AOR = 4.8; 95% CI, 1.7-13.6;).ConclusionHousehold food insecurity, low maternal education and infection with Trichuris trichura were some of the major factors contributing to under-nutrition in the study area.

BackgroundAlthough the common direct obstetric causes of maternal mortality are known from the literature, the contribution of each cause and the change in trend over decades is unknown in Ethiopia. The objective of this review was to assess the trend of proportion of maternal mortality due to the common direct causes.MethodsThis systematic review was done on eighteen health facility based maternal mortality studies conducted between 1980 and 2012 in Ethiopia. Emphasis was given to the proportion of maternal mortality due to direct causes and their case fatality rates.ResultsThe summary of the findings has shown that the top four causes of maternal mortality in the year 1980–1999 were abortion related complications (31%), obstructed labor/uterine rupture (29%), sepsis/infection (21%) and hemorrhage (12%). In the last decade, however, the top four causes of maternal mortality were obstructed labor/uterine rupture (36%), hemorrhage (22%), hypertensive disorders of pregnancy (19%) and sepsis/infection (13%).ConclusionAbortion and infection related maternal deaths have declined significantly in the last decade. Obstructed labor continues to be the major cause of maternal deaths; maternal deaths due to hypertensive disorders and hemorrhage showed an increasing trend. The findings in this review were somehow comparable with the WHO analysis for Africa in the same period with the exception of obstructed labor.

BackgroundThe World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life. However, the proportion of EBF in Ethiopia is 58%. The EBF practice and factors affecting it have not been studied in Hawassa, Southern Ethiopia. The aim of this study was to assess the prevalence and determinants of EBF practice among infants less than six months age in Hawassa city, Ethiopia.MethodsA total of 529 mothers with infants aged 0–6 months were involved in this study between November 2015 and January 2016. Trained interviewers collected data from the mothers of the infants. Exclusive breastfeeding was assessed based on infant feeding practice in the prior 24 h. Multivariable logistic regression analysis was conducted.ResultsInfants aged 0–5.9 months were studied with comparable gender composition (51.4% females). The exclusive breastfeeding prevalence was 60.9% (95% CI 56.6, 65.1). Mothers with infants aged 0–1.9 months and 2–3.9 months practiced EBF more likely than mothers with infants aged 4–6 months (Adjusted odds ratio [AOR] 3.59; 95% CI 2.07, 6.2) and (AOR 2.08; 95% CI 1.23, 3.5), respectively. Married mothers practiced EBF more likely than singles (AOR 2.04; 95% CI 1.03, 4.06). Housewives practiced EBF more likely than employed mothers (AOR 2.57; 95% CI 1.34, 4.9). Mothers who had a vaginal birth were more likely to practice EBF than mothers who gave birth via Cesarean section (AOR 2.8; 95% CI 1.7, 4.6). Mothers who gave birth at a healthcare facility were more likely to practice EBF than mothers who gave birth at home (AOR 8.8; 95% CI 5.04, 15.4). Mothers without a breast complication practiced exclusive breastfeeding more than mothers with breast complications (AOR 2.05; 95% CI 1.5, 4.1).ConclusionsThis study showed a low prevalence of exclusive breastfeeding. Younger infants, babies born to married women, who are housewives, having a vaginal birth in a health facility, and whose mother’s breasts were healthy, were predictors for EBF. The promotion of an institutional delivery, optimal breastfeeding practices, and designing strategies to better support employed mothers are recommended.

BACKGROUND: Although there is a general agreement on the importance of antenatal care to improve the maternal and perinatal health, little is known about its importance to improve health facility delivery in developing countries. The objective of this study was to assess the association of antenatal care with birth in health facility. METHODS: A systematic review with meta-analysis of Mantel-Haenszel odds ratios was conducted by including seventeen small scale studies that compared antenatal care and health facility delivery between 2003 and 2013. Additionally, national survey data of African countries which included antenatal care, health facility delivery and maternal mortality in their report were included. Data were accessed via a computer based search from MEDLINE, African Journals Online, HINARI and Google Scholar databases. RESULTS: The regression analysis of antenatal care with health facility delivery revealed a positive correlation. The pooled analysis also demonstrated that woman attending antenatal care had more than 7 times increased chance of delivering in a health facility. The comparative descriptive analysis, however, demonstrated a big gap between the proportion of antenatal care and health facility delivery by the same individuals (27%-95% vs 4%-45%). Antenatal care and health facility delivery had negative correlation with maternal mortality. CONCLUSION: The present regression and meta-analysis has identified the relative advantage of having antenatal care to give birth in health facilities. However, the majority of women who had antenatal care did not show up to a health facility for delivery. Therefore, future research needs to give emphasis to identifying barriers to health facility delivery despite having antenatal care follow up.

Background The mode of delivery in term singleton breech presentation has been debated for more than half a century and has been examined in both randomised and observational studies.Objective To determine the absolute and relative risks of perinatal mortality and morbidity in planned vaginal breech delivery.Search strategy A computer-based literature search was conducted mainly in the databases of HINARI, PubMed and Google scholar for studies comparing planned vaginal delivery and planned caesarean section.Selection criteria Studies that assessed the perinatal mortality and morbidity in relation to the term singleton breech mode of delivery between 1993 and 2014 were included.Data collection and analysis In this meta-analysis, 27 articles with a total sample size of 258 953 women were included. Relative and absolute risks of perinatal mortality and morbidity in relation to mode of delivery were determined.Main results The relative risk of perinatal mortality and morbidity was about two-to five-fold higher in the planned vaginal than in the planned caesarean delivery group. The absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7 and neonatal asphyxia in the planned vaginal delivery group were 0.3, 0.7, 0.7, 2.4 and 3.3%, respectively.Conclusion Perinatal mortality and morbidity in the planned vaginal breech delivery were significantly higher than with planned caesarean delivery. Even taking into account the relatively low absolute risks of vaginal breech delivery, the current study substantiates the practice of individualised decision-making on the route of delivery in a term breech presentation.Keywords Absolute risk, birth trauma, meta-analysis, neonatal asphyxia, perinatal mortality, relative risk, term breech caesarean delivery, term breech vaginal delivery.