Prevalence of stunting and associated factors among public primary school pupils of Bahir Dar city, Ethiopia: School-based cross-sectional study

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Study Justification:
– Stunting is a well-established child-health indicator of chronic malnutrition.
– Understanding the prevalence of stunting and its associated factors among public primary school children is crucial for addressing child malnutrition.
– This study provides valuable information on the nutritional status of children in Bahir Dar city, Ethiopia.
Study Highlights:
– The study was conducted among 370 primary school pupils in Bahir Dar city.
– The prevalence of stunting among the participants was 15.13%.
– Older age (11 years and above) and male sex were significantly associated with stunting.
Study Recommendations for Lay Reader:
– Parents and caregivers should be aware of the importance of a balanced diet for their children’s growth and development.
– Efforts should be made to improve access to nutritious food for all families in Bahir Dar city.
– Health institutions should provide support and guidance to families with stunted children to prevent further complications.
Study Recommendations for Policy Maker:
– Develop and implement policies that promote nutrition education and awareness among parents and caregivers.
– Allocate resources to improve access to nutritious food for families in Bahir Dar city.
– Strengthen the healthcare system to provide necessary support and interventions for stunted children.
Key Role Players:
– Researchers and data collectors
– School directors and teachers
– Parents and caregivers
– Health institutions and healthcare professionals
– Policy makers and government officials
Cost Items for Planning Recommendations:
– Nutrition education materials and campaigns
– Food supply and distribution programs
– Training and capacity building for healthcare professionals
– Monitoring and evaluation systems
– Research and data collection expenses
– Policy development and implementation costs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is clearly described as a cross-sectional study, and the sample size calculation is provided. The data collection methods are also explained in detail. However, there are a few areas that could be improved. First, the abstract does not mention the response rate, which is important for assessing the representativeness of the sample. Second, the statistical analysis methods are briefly mentioned, but more details on the specific tests used and the results of the analysis would be helpful. Finally, the abstract could provide more information on the limitations of the study and potential sources of bias. To improve the evidence, the authors could include the response rate, provide more details on the statistical analysis, and discuss the limitations of the study.

Background Stunting is a well-established child-health indicator of chronic malnutrition, which reliably gives a picture of the past nutritional history and the prevailing environmental and socioeconomic circumstances. Objective To investigate the prevalence of stunting and associated factors among public primary school children of the Bahir Dar city. Method A cross-sectional study was carried out from March to June 2019. Data were coded and entered into the Epi-Data and exported to SPSS version 23 software. The pupil was stunted if the height- for-age was ≤ -2 SDs from the median growth standards according to the WHO. A descriptive summary was computed using frequency, percent, mean, median and standard deviation. A simple logistic regression model was fitted to identify associated factors between the independent variables and the dependent variable at a 95% confidence interval (CI) and p-value <0.05. Results 370 primary school pupils were included in the study with the mean age of 10.15 (± 2.23 SD) years. 51.6% of the pupils were females. The total prevalence of stunting was 15.13% (95% CI; 11%, 19%). The burden of stunting was higher in the age group of 11 years and older. Pupil’s age older than 11 years (AOR = 15. 6; 95%CI; 3.31, 73.45; p-value < 0. 001) and male sex (AOR = 7. 07; 95%CI: 2.51, 19.89; p-value < 0. 0002) were significantly associated with stunting. Conclusion The prevalence of stunting was relatively lower than the regional estimated stunting level. Older age and male sex were significantly associated with stunting.

A school-based cross-sectional study was conducted among Bahir Dar city public primary school pupils from March 10 to June 10, 2019. Bahir Dar city is located 565 km away from Addis Ababa, the capital city of Ethiopia Bahir Dar city is the second biggest city in Ethiopia, next to Addis Ababa [16]. Bahir Dar city is the capital city of the Amhara regional state, where the higher prevalence of stunting was observed [17]. The city includes six administrative units or sub-cities. The total population of the city is estimated to be 249,851 (estimated population and household survey of 2017/18) (124,426 females and 125,425 males) [18]. In the city, there are 19 public primary schools (1 up to 8 graded) [19]. The source population for this study consisted of all pupils attending primary schools of the Bahir Dar city. The study population for this study was pupils attending the primary schools selected for the city. Those who were drop outs or absent during the data collection period were excluded. The sample size was determined using a single population proportion formula by considering: 95% confidence level, 5% margin of error, with the proportion of stunting of 18.3% in Bahir Dar city [20]. Taking the design effect 1.5 and 10% non-response rate, and considering the correction formula (N 0.05). A simple logistic regression model was used to identify the association between the explanatory variables and stunting. Adjusted Odds ratio (AOR) with 95% CI (confidence interval) was used to measure the strength of association between explanatory variables and the stunting. The chi-square (X2) test was checked and a p-value < 0.05 at x2 test was considered as having relationship between predictor variables and stunting and these variables were run in to bivariate regression analysis. Then, predictor variables having a p-value < 0.20 at bivariate regression analysis were taken into a multivariable logistic regression analysis to see associations between dependent and independent variables. The backward logistic regression method was used, and variables with a p-value of < 0.05 at multivariable analysis were considered as statistically significant predictors of stunting. Ethical approval was obtained from GAMBY Medical and Business College, Research and Publication Office with the reference number of GC-221/2011. Before the beginning of data collection, permission letter was obtained from the Amhara National, Regional Institute of Public Health prior to the data collection period. The support letter was obtained from Bahir Dar city health and education department. The school directors were informed about the purpose of the study that it will contribute to the health needs of the students. For pupils of 7–12 years old, the written consent was taken from his/her parents/guardians. For pupils of 13–17 years old, consent was secured from them only with parental/guardian permission. However, for pupil’s older than 17 years, written consent was secured solely from them. The objective of the study was clarified to the respondents and they were notified that they have the right to refuse or terminate the study at any point of the interview. The written consent and the data collection tools were documented and kept confidential in a secure place. Stunted pupils’ families were extensively advised on the importance of a balanced diet and they were referred to consult the nearby health institution for technical support for the at least to halt the further complication of stunting.

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women in remote areas to access healthcare professionals and receive prenatal care through virtual consultations. This can help overcome geographical barriers and ensure that women receive the necessary medical advice and support during their pregnancy.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information and resources related to maternal health can empower women with knowledge about pregnancy, childbirth, and postnatal care. These apps can also send reminders for prenatal appointments and provide access to emergency services.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in underserved areas can help improve access to maternal health services. These workers can also serve as a link between the community and healthcare facilities, ensuring that women receive appropriate care when needed.

4. Maternal health clinics: Establishing dedicated maternal health clinics in areas with limited access to healthcare facilities can provide comprehensive prenatal care, including regular check-ups, screenings, and vaccinations. These clinics can also offer counseling services and educational programs for expectant mothers.

5. Mobile clinics: Setting up mobile clinics that travel to remote areas can bring essential maternal health services directly to communities that lack access to healthcare facilities. These clinics can provide prenatal care, screenings, vaccinations, and health education to pregnant women who may otherwise have difficulty accessing these services.

6. Health education programs: Implementing targeted health education programs that focus on maternal health can help raise awareness about the importance of prenatal care, nutrition, and hygiene practices during pregnancy. These programs can be conducted in schools, community centers, and through mass media channels to reach a wider audience.

7. Financial incentives: Providing financial incentives, such as cash transfers or subsidies, to pregnant women in low-income communities can help alleviate the financial burden associated with accessing maternal health services. This can encourage more women to seek prenatal care and ensure that they receive the necessary medical attention during pregnancy.

It’s important to note that the specific context and needs of the community should be considered when implementing these innovations to ensure their effectiveness and sustainability.
AI Innovations Description
Based on the provided information, the recommendation to improve access to maternal health would be to implement a comprehensive maternal health program that focuses on addressing the factors associated with stunting among primary school children in Bahir Dar city, Ethiopia. This program could include the following components:

1. Nutrition Education: Provide parents and caregivers with education on the importance of a balanced diet and the impact of nutrition on child growth and development. This can be done through workshops, community outreach programs, and the distribution of educational materials.

2. Dietary Diversification: Promote the consumption of a diverse range of foods, including cereals, vegetables, and animal products, to ensure that children receive adequate nutrition. Encourage parents to provide a variety of foods in their children’s meals.

3. Food Security: Address household food security issues by providing support and resources to families to ensure they have access to safe, sufficient, and nutritious food at all times. This can include initiatives such as income-generating activities, agricultural training, and access to food assistance programs.

4. Health Care Access: Improve access to healthcare services by ensuring that primary school children have regular check-ups and screenings for stunting and other health conditions. This can be achieved through partnerships with local health institutions and the provision of mobile health clinics in schools.

5. Parental Awareness: Increase awareness among parents and caregivers about the signs and symptoms of stunting, as well as the importance of early intervention and seeking medical help. This can be done through community awareness campaigns, parent-teacher meetings, and the distribution of informational materials.

6. Collaboration and Coordination: Foster collaboration between schools, healthcare providers, and community organizations to ensure a coordinated approach to addressing stunting and improving maternal health. This can involve establishing partnerships, sharing resources and expertise, and coordinating efforts to reach the target population effectively.

By implementing these recommendations, it is expected that access to maternal health will be improved, leading to a reduction in the prevalence of stunting among primary school children in Bahir Dar city, Ethiopia.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile Clinics: Implementing mobile clinics that can travel to remote areas and provide essential maternal health services such as prenatal care, vaccinations, and postnatal care.

2. Telemedicine: Utilizing telemedicine technology to connect pregnant women in rural areas with healthcare professionals who can provide virtual consultations, advice, and monitoring.

3. Community Health Workers: Training and deploying community health workers who can provide basic maternal health services, education, and support to women in underserved areas.

4. Transportation Support: Establishing transportation systems or subsidies to help pregnant women in remote areas access healthcare facilities for prenatal visits, delivery, and emergency care.

5. Health Education Programs: Developing and implementing health education programs that focus on maternal health, including topics such as nutrition, hygiene, family planning, and pregnancy complications.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of prenatal visits, percentage of deliveries attended by skilled birth attendants, and maternal mortality rates.

2. Data collection: Gather baseline data on the selected indicators from the target population before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement the recommendations: Introduce the recommended innovations, such as mobile clinics, telemedicine services, or community health worker programs, in the target areas.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can be done through regular reporting, surveys, or monitoring systems.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on the selected indicators. Compare the post-implementation data with the baseline data to determine any improvements in access to maternal health.

6. Evaluate and adjust: Evaluate the findings and identify any gaps or areas for improvement. Use the results to make adjustments to the recommendations or implementation strategies if necessary.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on how to further enhance maternal healthcare services.

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