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Background: Despite significant gains and progress in the last decade, malnutrition remains a major public health problem in Ethiopia. Pregnant and lactating women (PLW), along with children, are among the most vulnerable groups of population during emergencies and droughts. Identifying and targeting of PLW with malnutrition is among the priorities in humanitarian emergencies. However, there is dearth of evidence on PLW nutritional status and its determinants in humanitarian context. Methods: A community-based cross-sectional study was conducted in 10 kebeles of Rayitu district of Ethiopia in June 2013. A total of 900 PLW were assessed for malnutrition using mid-upper-arm circumference (MUAC). Result: Using MUAC < 21 cm as a criteria, 216 (24%) surveyed mothers were found to be malnourished. In multivariable logistic regression analysis, those mothers who did not received antenatal care (ANC) during their pregnancy had 1.83 higher odds of (adjusted odds ratio[AOR] = 1.83, 95% confidence interval [CI]:1.10,3.02) to be malnourished (MUAC < 21 cm) as compared to mothers who received ANC. Housewives had lower odds of (AOR = 0.59, 95 %CI: 0.37, 0.95) to be malnourished compared to those who engaged in as a pastoralist. Mothers belonging to families from which at least one person did not receive targeted supplementary feeding (TSF) in the 6 months before the study had lower odds of (AOR = 0.38, 95 %CI:0.23,0.62) to have acute malnutrition compared to those who lived in families who received TSF. Conclusions: Malnutrition is common among PLW in humanitarian settings, including those with ongoing interventions. Attending antenatal care, maternal occupational status and being a member of families who received TSF were factors associated with maternal nutritional status in this study. This signifies the need for sustainable solutions that address the high prevalence of malnutrition among PLW. Interventions targeting health system responses such as comprehensive nutrition education, support through antenatal care and women empowerment are recommended.
The study was conducted in Rayitu Woreda (District), Bale Zone of Oromia Regional State in Ethiopia. Rayitu is bordered by Sewena and Ginir Districts on the North, Sewena District on the East, Goro to the West and Somali Regional State and Goro District on the South [21]. Currently, Bale zone is divided into 20 woredas. The zone comprises of several mountain ranges, massifs and plateaus, and is dominated by heavy precipitations. It has different climatic zones ranging from semi-arid to afro-alpine moorland, which makes the zone conducive for the existence of various flora and fauna within a relatively small area. Rayitu is one of the 20 woredas in Bale Zone of the Oromia Regional State that are classified as Bale Pastoral Livelihood Zone. Crop production is completely rain-fed. In normal years, the woreda receives annual rainfall in the range of 425–1300 mm. The area is marginal for agricultural production and suffers a food deficit every year. Households depend on both livestock and crop production. The main types of livestock are cattle, sheep, goats and camels. Seasonal livestock migration to the major rivers to seek pasture and water is common during the long dry season (Bona). A community-based cross-sectional study was carried out using quantitative study design in June 2013. The target population in this study consists of pregnant women, lactating mothers and primary caregivers of children 6–23 months of age. A total of 1402 households were surveyed. Ten Kebeles (the smallest administrative units in government structure) were selected randomly from the list of Kebeles and then households were divided among Kebeles based on probability proportional to size (PPS). The allocation of individuals to Kebeles was also made based on PPS sampling methodology. Once the number of households in the Kebeles was determined, the households with the target population to be interviewed were picked from the household list of the Kebele administration. The actual location of the start of the survey in each area was decided based on random walk approach by spinning a pen to select the direction of the first household. Recruitment of the research team was carried out in collaboration with local health institutions. Experienced individuals who had conducted similar interviews were recruited. The principal investigators checked the activities of each team daily. Three principal investigators coordinated the overall data collection process. A total of 21 trained health professionals collected the data for 5 days. Face-to-face interviews were held using a structured and field-tested questionnaire to collect data on socio-demographic and economic characteristics of the women and their households and exploring reproductive health issues. Nutritional status of PLW was determined through measurement of MUAC, which is commonly used approach in diagnosing acute malnutrition among PLW in humanitarian setting. MUAC of each woman was measured at the mid-point between the tips of the shoulder and elbow of the left arm using non-elastic, non-stretchable MUAC tapes. Measurements were recorded to the nearest 0.1 cm. In this study, acute malnutrition or wasting, defined as MUAC < 21 cm, was the dependent variable. This cut-off point was used based on the SPHERE Guidelines [19] and national protocol [20], both of which recognize it as an appropriate level for identifying mothers who are at risk for giving birth to infants with growth retardation in humanitarian settings. Variables considered to build the regression model were age, educational status, marital status, and occupation of the mothers, annual income of the household, attending antenatal care (ANC), type of assistance received by members of the household in the preceding 3 months and receipt of TSF food rations or safety net food rations by any family members in the previous 6 months. The English version of the designed questionnaire was translated into the local language of Oromiffa and checked to ensure equivalence between the English and Oromiffa versions. Pretest of the questionnaires was carried out before conducting the study. Training sessions provided to data collectors and supervisors focused on data collection procedures, quality, interviewing techniques and related issues. Apart from the two-day training and field practice, supervisors reviewed the collected data daily in order to identify errors, omissions and inconsistencies. Data was checked for completeness, accuracy and clarity by the study core team and supervisors. The consistency of data was assessed by double entering 10% of the responses at the end of data entry. Data entry, coding, cleaning and analysis were carried out using SPSS version 19 and STATA 12.0 (Stata Corporation, College Station, TX). Two experienced data entry clerks were involved in the process after receiving orientation on the survey questionnaires. Descriptive statistics were used to assess basic respondent characteristics. Variables explored in assessing determinants of maternal nutritional status were: socio-demographic characteristics (maternal age, educational status, marital status, ethnicity, religion and occupation and annual household income). Access to and utilization of health services (antenatal care and household visit by community health workers) and food assistance related variables (type of assistance mothers or other household members received, receipt of TSF or safety net food rations in the preceding 6 months) were also examined. Variables with a p-value < 0.05 in the bivariate analysis and those variables which frequently showed significant association in previous studies, regardless of the p-value in the current study, were modeled into the multivariable logistic regression analysis to assess the determinant of maternal nutritional status. Both crude odds ratio (COR) and adjusted odds ratio (AOR) with corresponding 95% Confidence Interval were reported to show the nature of associations observed. In multivariable analysis, variables with a p-value of < 0.05 were considered as statistically significant.
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