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IntroductionThe WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy... more
IntroductionThe WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia.Methods and analysisENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at <24 weeks gestation are enrolled (n=2400). ANC quality is strengthened across all centres. Health centres are randomised to receive an enhanced nutrition package (ENP) or standard nutrition care, and within each health centre, individual women are randomised to receive an enhanced infection management package (EIMP) or standard infection care. At ENP centres, women receive a regular supply of adequately iodised s...
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Additional file 1. Health centers selected for Phase 1&2 studies (pre- and post-QI).
Background Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent... more
Background Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent data reporting systems, and missing data from non-facility births. This paper describes birthweight data quality and the prevalence of LBW before and after implementation of a birthweight quality improvement (QI) initiative in Amhara region, Ethiopia. Methods A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine fi...
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Background Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data... more
Background Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. Methods We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendatio...
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There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate... more
There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate COVID-19 vaccine hesitancy and other predictors of readiness to get vaccinated. We conducted surveys among adults residing in nine urban and rural areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania in late 2021. Log binomial regression models were used to identify prevalence and factors associated with vaccine hesitancy and beliefs around COVID-19 misinformation. We completed a total of 2,833 interviews. Among all respondents, 9% had never heard of a COVID-19 vaccine, 12% had been vaccinated, and 20% knew someone else who had been vaccinated. The prevalence of vaccine hesitancy varied by country (Ethiopia 29%, Burkina Faso 33%, Nigeria 34%, Ghana 42%, Tanzania 65%), but not by rural or urban context. People who did not think the vaccine was safe...
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Background Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. Objective This study investigated the economic impacts of... more
Background Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. Objective This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. Methods We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants’ dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19. Results Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maxi...
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Background The COVID-19 pandemic has increased mental health problems among healthcare workers globally. However, studies from low- and middle-income countries on this matter were minimal. This study assessed the change in depression... more
Background The COVID-19 pandemic has increased mental health problems among healthcare workers globally. However, studies from low- and middle-income countries on this matter were minimal. This study assessed the change in depression prevalence during the first year of the COVID-19 pandemic and associated factors among healthcare providers in Addis Ababa, Ethiopia. Methods We conducted surveys among healthcare workers in Addis Ababa at two-time points, September 2020 and October 2021. A total of 577 study participants were randomly selected based on registers obtained from professional associations. Computer-assisted telephone interviewing technique was used for data collection. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. Multivariable logistic regression analysis was performed to identify potential factors associated with depression. Result The prevalence of depression among healthcare workers was 2.3% (95% CI [1.1–4.8]) in Time 1 and 6.5% (95% CI [4...
ABSTRACT. The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study... more
ABSTRACT. The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study surveyed 2,829 adults in urban and rural sites among five sub-Saharan African countries: Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana. Participants completed a mobile phone survey that assessed self-reported sociodemographics, COVID-19 preventive practices, psychological distress, and barriers to healthcare access. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPRs) and 95% CIs to investigate potential factors related to psychological distress and barriers to reduced healthcare access. At least 15.6% of adults reported experiencing any psychological distress in the previous 2 weeks, and 10.5% reported that at least one essential healthcare service was difficult to access 2 years into the pandemic. The m...
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BackgroundSub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods, nutrition, and food security, with recovery slowed down by lagging vaccination progress.ObjectiveThis study investigated the economic... more
BackgroundSub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods, nutrition, and food security, with recovery slowed down by lagging vaccination progress.ObjectiveThis study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania.MethodsWe conducted a repeated cross-sectional study and used a mobile platform to collect data. Data collected from round 1 (July-November, 2020) and round 2 (July-December, 2021) were considered. We assessed participants’ dietary intake of 20 food groups over the previous seven days. The study’s primary outcome was the Prime Diet Quality Score (PDQS), with higher scores indicating better dietary quality. We used linear regression and generalized estimating equations to assess factors associated with diet quality during COVID-19.ResultsMost of the respondents were male and the mean age (±SD) was 42.4 (±12.5) years. Mean PDQS ...
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COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in... more
COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence inte...
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Objectives Nutritionally adequate diet during pregnancy is essential to promote the nutrition and health of pregnant women and their fetuses, but there are few measures to assess diet quality. We examined the associations of a new metric,... more
Objectives Nutritionally adequate diet during pregnancy is essential to promote the nutrition and health of pregnant women and their fetuses, but there are few measures to assess diet quality. We examined the associations of a new metric, the Global Diet Quality score (GDQS), with nutritional status among pregnant women in rural Amhara, Ethiopia. Methods We used baseline dietary data among 2363 pregnant women at ≤ 24 weeks’ gestation enrolled in the Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health (ENAT) study from July 2020 to December 2021. The GDQS was generated using the weekly consumption of 25 food groups. We assigned 0–1 serving/wk (0 point), 2–3 servings/wk (1 point), and ≥ 4 servings/wk (2 points) for 16 healthy foods, and the scoring was reversed for 7 unhealthy foods. One point was given only for 2–3 servings/wk of red meat and whole milk. Points for each group were summed (0–44 points) and categorized into quintiles. Multivariate linear...
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Objectives To assess community access to adequately iodized salt in rural Amhara, Ethiopia. Methods We collected market and household salt samples from December 2020-January 2021 in West Gojam and South Gondar, Amhara, Ethiopia. A total... more
Objectives To assess community access to adequately iodized salt in rural Amhara, Ethiopia. Methods We collected market and household salt samples from December 2020-January 2021 in West Gojam and South Gondar, Amhara, Ethiopia. A total of 24 salt samples were collected from markets randomly chosen in proximity to six rural health centers prior to the Enhancing Nutrition and Antenatal infection Treatment (ENAT study). 12 salt samples were unpackaged salt sold in open markets and 12 samples were packed samples procured from local shops. Household salt samples were also collected among mothers consecutively enrolled in the ENAT study over a one-month period at baseline. Quantitative assessment of iodine content was performed by iodometric titration at a central referral laboratory. In addition, a rapid qualitative salt assessment (MBI rapid test, Chennai, India) was done for 238 randomly selected households in walking proximity to the study health centers. The MBI test used rapid qual...
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The African continent has some of the world’s lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among health care providers (HCP) is another factor that... more
The African continent has some of the world’s lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among health care providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-19 vaccine hesitancy among HCP, and its contributing factors in Africa. We evaluated COVID-19 vaccine hesitancy among 1,499 HCP enrolled in a repeated cross-sectional telephone survey in Burkina Faso, Ethiopia, Nigeria, Tanzania and Ghana. We defined COVID-19 vaccine hesitancy among HCP as self-reported responses of definitely not, maybe, unsure, or undecided on whether to get the COVID-19 vaccine, compared to definitely getting the vaccine. We used Poisson regression models to evaluate factors influencing vaccine hesitancy among HCP. Approximately 65.6% were nurses and the mean age (±SD) of participants was 35.8 (±9.7) years. At least 67% ...
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COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the levels and determinants of COVID-19 vaccine hesitancy among adolescents in... more
COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the levels and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2803 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence interval...
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ABSTRACT. The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation... more
ABSTRACT. The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation strategies on adolescents in sub-Saharan Africa are unclear. This study aimed to examine adolescents’ knowledge, perceptions, and practices related to COVID-19 and the impacts of the pandemic on the daily lives of adolescents in sub-Saharan Africa. The survey was conducted in Burkina Faso, Ethiopia, and Nigeria using computer-assisted telephone interviews to enable rapid and remote data collection. Two sites were included in each country, with approximately 300 adolescents per site and 1,795 adolescents in total. Variations across the six sites were noted for the proportions of the adolescents who could correctly identify all key COVID-19 symptoms (4–25%), transmission methods (16–59%), and prevention approaches (33–79%). Most (> 72%) of the adolescent...
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ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic may have short-term and long-term impacts on health services across sub-Saharan African countries. A telephone survey in Burkina Faso, Ethiopia, and Nigeria was conducted to... more
ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic may have short-term and long-term impacts on health services across sub-Saharan African countries. A telephone survey in Burkina Faso, Ethiopia, and Nigeria was conducted to assess the effects of the pandemic on healthcare services from the perspectives of healthcare providers (HCPs) and community members. A total of 900 HCPs (300 from each country) and 1,797 adult community members (approximately 600 from each country) participated in the study. Adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were computed using modified Poisson regression. According to the HCPs, more than half (56%) of essential health services were affected. Child health services and HIV/surgical/other services had a slightly higher percentage of interruption (33%) compared with maternal health services (31%). A total of 21.8%, 19.3%, and 7.7% of the community members reported that their family members and themselves had difficulty accessin...
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ABSTRACT. Coronavirus disease 2019 (COVID-19) is a public health emergency affecting the lives of millions of people globally. Different measures and extraordinary steps are being taken to contain the transmission of the virus. The levels... more
ABSTRACT. Coronavirus disease 2019 (COVID-19) is a public health emergency affecting the lives of millions of people globally. Different measures and extraordinary steps are being taken to contain the transmission of the virus. The levels of knowledge and implementation of preventive practices related to COVID-19 in sub-Saharan African countries are unclear. Additionally, there is a lack of evidence regarding the impacts of the pandemic on mental health. This study aimed to describe knowledge and practices related to COVID-19 and to assess mental health status among adults in three sub-Saharan African countries: Burkina Faso, Ethiopia, and Nigeria. A total of 1,797 adults were included in the survey, and data were collected using computer-assisted telephone interviews. The proportions of adults who identified more than 80% of COVID-19 symptoms, transmission methods, and prevention mechanisms were 69.9%, 79.2%, and 90.7%, respectively. The practice of preventive measures was relative...
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Background Priority setting process for the health care sector in low- and middle-income countries involves multiple agencies, each with their unique power, decision-making and funding mechanisms. Methods This paper developed and applied... more
Background Priority setting process for the health care sector in low- and middle-income countries involves multiple agencies, each with their unique power, decision-making and funding mechanisms. Methods This paper developed and applied a new framework to analyze priority setting processes in Ethiopia, Nigeria, and Tanzania, from a scoping review of literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. Results a framework was developed based on 40 articles selected from 6860 distinct search records. 21 interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and...
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Background Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This... more
Background Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This process at country level has not been well studied. Methods This paper developed and applied a new framework to analyze decision-making process for priority setting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refine the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. Results A framework was developed...
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ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented public health crisis globally. Understanding healthcare providers’ (HCPs’) knowledge and perceptions of COVID-19 is crucial to identifying effective strategies... more
ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented public health crisis globally. Understanding healthcare providers’ (HCPs’) knowledge and perceptions of COVID-19 is crucial to identifying effective strategies to improve their ability to respond to the pandemic in sub-Saharan Africa. A phone-based survey of 900 HCPs in Burkina Faso, Ethiopia, and Nigeria (300 per country) was conducted to assess knowledge, perceptions, COVID-19 prevention measures, stigma, and mental health of HCPs. Modified Poisson regression models were used to evaluate predictors of knowledge, perceptions, and prevention measures; adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were calculated. Three-fourths of the HCPs had adequate knowledge, and over half had correct perceptions of risk and high levels of self-reported prevention measures. The majority of the HCPs (73.7%) reported self-perceived social stigma. There was relatively low prevalence of depression (6.6%), ...
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ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development... more
ABSTRACT. The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development of evidence-based strategies to mitigate its direct and indirect health consequences. To address this need, the Africa Research, Implementation Science, and Education (ARISE) Network established a mobile survey platform in SSA to generate longitudinal data regarding knowledge, attitudes, and practices (KAP) related to COVID-19 prevention and management and to evaluate the impact of COVID-19 on health and socioeconomic domains. We conducted a baseline survey of 900 healthcare workers, 1,795 adolescents 10 to 19 years of age, and 1,797 adults 20 years or older at six urban and rural sites in Burkina Faso, Ethiopia, and Nigeria. Households were selected using sampling frames of existing Health and Demographic Surveillance Systems or national surveys wh...
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Objectives Malnutrition affects 25% of women in Ethiopia. We are conducting a study to determine the impact of a prenatal nutrition intervention on maternal and infant health in Ethiopia. The objective of this formative study was to... more
Objectives Malnutrition affects 25% of women in Ethiopia. We are conducting a study to determine the impact of a prenatal nutrition intervention on maternal and infant health in Ethiopia. The objective of this formative study was to better describe dietary practices among pregnant women and community members in rural Ethiopia prior to initiation the parent study. Methods This formative study was conducted from October-November 2018 among pregnant women and community members in the rural Amhara region of Ethiopia, prior to the “Enhancing Nutrition and Antenatal Infection Treatment (ENAT)” study [ISRCTN15116516]. 28 in-depth interviews (IDIs) were conducted among 16 pregnant women and 12 community members. IDIs were recorded, transcribed, and translated. We used a grounded theory approach and inductive reasoning for content analysis of interview transcripts. Results Fasting norms in the Ethiopian Orthodox religion had a significant impact on dietary behaviors which occurs for more tha...
Objectives Providing balanced protein energy (BEP) supplementation to pregnant women in low-and-middle income countries has been shown to improve pregnancy outcomes. The objective of this study was to assess the feasibility,... more
Objectives Providing balanced protein energy (BEP) supplementation to pregnant women in low-and-middle income countries has been shown to improve pregnancy outcomes. The objective of this study was to assess the feasibility, acceptability, and adherence of a proposed BEP product among pregnant women in rural Ethiopia prior to initiation of a clinical effectiveness study. Methods This formative study was conducted from October-November 2018 among pregnant women in the rural Amhara region of Ethiopia, prior to the “Enhancing Nutrition and Antenatal Infection Treatment (ENAT)” study [ISRCTN15116516]. Questionnaires to assess acceptability of a micronutrient fortified corn soy blend (CSB) BEP supplement were administered using a 7-point Likert scale (0 = strongly disagree, to 7 = strongly agree) after 2 and 4 weeks of utilization. Acceptability domains included: color, taste, texture, odor, portion size, ease of use, and adult favorability. Women were also given weekly provisions of dai...
Objectives COVID-19 has far-reaching consequences for developing countries through the combined effects of infection and mortality and unintended consequences from mitigation measures. COVID-19 can adversely impact food systems and... more
Objectives COVID-19 has far-reaching consequences for developing countries through the combined effects of infection and mortality and unintended consequences from mitigation measures. COVID-19 can adversely impact food systems and dietary diversity for populations. This cross-sectional study evaluated, using a mobile platform, the effect of COVID-19 on food prices and dietary diversity and quality, among 1797 households in Nouna and Ouagadougou (Burkina Faso), Addis Ababa and Kersa (Ethiopia), and Lagos and Ibadan (Nigeria). Methods Dietary intake was assessed as the frequency of consumption of 20 food groups over the previous 7 days. Dietary diversity scores (DDS; range: 0–10) and Prime Diet Quality Score (PDQS; range: 0–40) assessed dietary diversity and quality. Linear regression models were used to evaluate associations between changes in the prices of staples, pulses, vegetables, fruits, and animal source foods (ASF) with DDS and PDQS during COVID-19. Results Most households r...