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Malnutrition among women of reproductive age is a critical public health issue in LMICs, where undernutrition coexists with rising overweight and obesity rates. In Ethiopia, particularly among urban women, maternal and child undernutrition remains high despite efforts to combat poverty and food insecurity. This study examined the relationship between food affordability and the nutritional status of 4797 women in Addis Ababa. Using repeated cross-sectional surveys, body mass index was calculated, and women's nutritional status was categorized. Data on the affordability of 11 healthy family food groups were collected and categorized into terciles. Multinomial logistic regression models analyzed the association between food affordability and nutritional status, adjusting for confounding factors. The prevalence of underweight among women was 7.3%, while 39.1% were overweight or obese. On average, families could afford 6.1 out of the 11 food groups. Women with higher food affordability had increased odds of being overweight (AOR: 1.32; 95% CI 1.09, 1.60) or obese (AOR: 1.50; 95% CI 1.14, 1.97). The findings highlight that two out of five women are either overweight or obese, with obesity more likely in those with greater perceived food affordability. Addressing food choices as food affordability improves is crucial, as better food affordability is associated with an increased risk of becoming overweight and obese.

Introduction: Homelessness among women of reproductive age is a globalproblem. Several unique gender-based issues affect homeless women’s wellbeing, including reproductive health issues, their homelessness experiences,and a high rate of sexual violence. In this study, we aimed to describe women’sexperiences of street homelessness in their own terms and their suggestions toaddress their unmet needs.Methods: This photovoice study draws on photos, focus group discussions, andsemi-structured interviews. We conducted the study in collaboration with womenin their reproductive years experiencing homelessness (n = 9). A total of 80 photoswere taken, and 40 were chosen to be discussed in interviews and further focusgroup discussions. The participating women selected photographs, explained theirsignificance, and codified them based on how they related to their lives. Data fromthese discussions were then analysed using a reflexive thematic approach.Results: Four themes were developed from the data: (a) deprivation of basicneeds; (b) experiencing dependency, shame, and seclusion while dealingwith the burden of street life; (c) the vulnerability and neglect of children; and(d) being resilient to harsh conditions. In this study, women’s street life wascharacterised by numerous unfavourable aspects, including unmet needs,human rights violations, social exclusions, substance use, and child protectionissues. Participants provided suggestions for change and confirmed their beliefthat adequate housing represents one of the most urgent unmet basic needsof people experiencing homelessness. They also emphasised the critical needfor employment opportunities, non-discriminatory provision of social support,treatment programs for substance misuse, and legal and social protection.Conclusion: This study contributes to understanding how women experiencinghomelessness describe and articulate their living circumstances and whatthey perceive needs to be addressed. Based on participants’ proposal forchange, comprehensive services are needed to address women’s multifacetedissues. However, the mitigation strategies and long-term effects of women’shomelessness require further research.

Background

Food choice decisions are complex processes influenced by various factors that affect the family’s diet and, thus, their health and nutrition. In low- and middle-income countries like Ethiopia, these factors are shaped by the ongoing nutrition transition, urbanization, and socio-economic challenges. Despite growing concerns about the double burden of malnutrition, the factors influencing food choices among parents of children under five in Addis Ababa, Ethiopia, remain poorly understood. This study explores these factors.

Methods

Five focus groups with fathers and mothers (30 participants total, 5–7 per group) were conducted, along with 11 in-depth interviews with mothers of children under the age of five, for a total of 41 participants. Participants were permanent residents of Addis Ababa, having lived in the city for at least six months. Using health extension workers and community guides, participants were purposively sampled from two districts in Addis Ababa. Data were collected from November 2023 to April 2024, with interviews conducted in Amharic, audio-recorded, transcribed, and translated into English. Thematic analysis, both inductive and deductive, was performed using Bronfenbrenner’s socio-ecological model as a lens.

Results

Factors influencing parental food choice were identified at three levels: individual, community, and environmental. Health concerns, affordability, child food preferences, and convenience were most frequently mentioned at an individual level. At the community level, family norms and social pressure played key roles. Food safety concerns and marketing influences were identified as important influences at the environmental level. Parents reported that while food availability was not typically a concern, changes in the food environment and economic constraints significantly impacted their food choices. They also emphasized that food safety and the reliability of food markets were essential issues.

Conclusion

This study underscores the complex, multi-level factors shaping food choices among parents of children under five in Addis Ababa. Health concerns, affordability, food safety, and market reliability were identified as key influences on food choices. These multi-level factors can guide interventions to improve children’s diets by addressing individual motivations and the broader environmental contexts influencing food choices.

Background: Despite improvements in food access and nutrition security over the last few decades, malnutrition remains a major public health problem. One of the significant contributors to these problems is affordability of nutritious food. This study aimed to examine the association between perceived food affordability and pre-school children's diet diversity in Addis Ababa, Ethiopia.

Methods: Cross-sectional data from 2017 to 18 were used for the analysis. A 24-hour dietary recall assessment was done to assess children's dietary diversity (DD). We used a modified operational definition of affordability indicator called perceived affordability of dietary diversity (afford-DD) to evaluate the impact of the food environment in terms of affordability at the household level. A sample (n 4,898) of children aged 6-59 months representative of households in Addis Ababa was randomly selected using a multistage sampling procedure including all districts in the city. Mixed-effects linear regression models were used to assess the association between children's DD and afford-DD.

Results: The survey revealed that the mean (standard deviation [SD]) of children's DD was 3.9 [±1.4] while the mean [SD] of afford-DD was 4.6 [±2.1]. Overall, 59.8% of children met the minimum dietary diversity (≥ 4 food groups). White roots and tubers were the most commonly consumed food groups regardless of their affordability. Considerable variations were observed between households that reported the food item affordable and not affordable in consumption of Vitamin A rich vegetables and fruits, meat and fish, egg, and dairy. The children's DD was positively associated with afford-DD after adjusting for maternal education, household wealth status and other relevant confounding. Higher maternal education modified the association between affordability and children's diet diversity.

Conclusions: This study suggests higher perceived food affordability was associated with better diet diversity in children. A higher level of maternal education had the potential to mitigate affordability challenges in meeting the children's dietary diversity needs. Our study emphasizes the need for inclusive food programs and nutrition interventions addressing social differences, intensifying efforts to make nutrient-rich diets affordable for the less privileged, and highlights the potential benefits of targeting maternal education in addressing child dietary diversity.

Background: Mental health conditions are among the health issues associated with homelessness, and providing mental healthcare to people experiencing homelessness is challenging. Despite the pressing issue of homelessness in Addis Ababa, Ethiopia, there is scant research on how service providers address women's mental health and psychosocial needs. Therefore, we explored service providers' and programme coordinators' perceptions and experiences regarding mental healthcare and psychosocial services delivery to women experiencing street homelessness in the city.

Methods: We conducted a descriptive qualitative study with selected healthcare and social support providers and programme coordinators. The study involved 34 participants from governmental and non-governmental organisations in Addis Ababa, Ethiopia. Data were analysed using an inductive thematic approach.

Results: Four themes were derived from the analysis. The first of these was "divergent intentions and actions". While service providers and programme coordinators showed empathy and compassion, they also objectified and blamed people for their own homelessness. They also expressed opposing views on mental health stigma and compassion for these people. The second theme addressed "problem-solution incompatibility", which focused on the daily challenges of women experiencing homelessness and the types of services participants prioritised. Service providers and programme coordinators proposed non-comprehensive support despite the situation's complexity. The participants did not emphasise the significance of gender-sensitive and trauma-informed care for women experiencing street homelessness in the third theme, "the lack of gendered and trauma-informed care despite an acknowledgement that women face unique challenges". The fourth theme, "mismatched resources," indicated structural and systemic barriers to providing services to homeless women.

Conclusions:Conflicting attitudes and practices exist at the individual, organisational, and systemic levels, making it challenging to provide mental healthcare and psychosocial services to women experiencing homelessness. An integrated, gender-sensitive, and trauma-informed approach is necessary to assist women experiencing homelessness.

Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children's diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children's diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers' consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.

Objectives The present study evaluates body circumferences as a nutrition screening tool for women of reproductive age with children less than 5 years of age to improve the detection of overweight and obesity in a community setting.

Design This study draws data from a community-based cross-sectional study conducted between July–August 2017 and January–February 2018 to account for seasonality in Addis Ababa, Ethiopia.

Setting One hundred and sixteen districts were included in Addis Ababa, Ethiopia.

Participants A total of 4914 women of reproductive age with children less than 5 years of age were participated in this study.

Primary and secondary outcome measures Primary outcome measures included anthropometric indices. There were no secondary outcomes.

Results The optimal cut-off points to identify overweight women of reproductive age were >87.5 cm for waist circumference (WC), >31.7 cm for neck circumference (NC) and >28.0 cm for mid-upper arm circumference (MUAC) based on the highest corresponding Youden index. The area under the receiver operating characteristics curve was 0.92 (95% CI: 0.91 to 0.93) for WC, 0.83 (95% CI: 0.82 to 0.84) for NC and 0.91 (95% CI: 0.89 to 0.92) for MUAC.

Conclusions Our result shows that WC and MUAC are alternative tools to body mass index. Both WC and MUAC are effective in identifying overweight women. We recommend using MUAC in large-scale population-based assessments to identify overweight and obesity in low-income settings as it is logistically simpler and operationally feasible.

In Sub-Saharan Africa, being overweight in childhood is rapidly rising while stunting is still remaining at unacceptable levels. A key contributor to this double burden of malnutrition is dietary changes associated with nutrition transition. Although the importance of socio-economic drivers is known, there is limited knowledge about their stratification and relative importance to diet and to different forms of malnutrition. The aim of this study was to assess diet diversity and malnutrition in preschoolers and evaluate the relative importance of socioeconomic resources. Households with children under five (5467) were enrolled using a multi-stage sampling procedure. Standardized tools and procedures were used to collect data on diet, anthropometry and socio-economic factors. Multivariable analysis with cluster adjustment was performed. The prevalence of stunting was 19.6% (18.5-20.6), wasting 3.2% (2.8-3.7), and overweight/obesity 11.4% (10.6-12.2). Stunting, overweight, wasting and limited diet diversity was present in all social strata. Low maternal education was associated with an increased risk of stunting (Adjusted odds ratio (AOR): 1.8; 1.4-2.2), limited diet diversity (AOR: 0.33; 0.26-0.42) and reduced odds of being overweight (AOR: 0.61; 0.44-0.84). Preschoolers in Addis Ababa have limited quality diets and suffer from both under- and over-nutrition. Maternal education was an important explanatory factor for stunting and being overweight. Interventions that promote diet quality for the undernourished whilst also addressing the burgeoning problem of being overweight are needed.

The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data were collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrients and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.

Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.