International Journal of Child Health and Nutrition

11-24

Authors: Monica Zikusooka, Hebatullah Tawfik, Joseph Robare

Objectives: Undernutrition is a global public health challenge, especially in countries that experience extreme climate conditions and armed conflict. In Somalia, undernutrition is chronic, often graded for emergency response. The purpose of this study was to provide evidence on immediate, proximate, and distal risk factors for undernutrition in the most affected region of Somalia. Setting: Data for the study was from cross-sectional nutritional surveys implemented by the Somalia Food Security and Nutrition Analysis Unit. Sampling for the surveys followed a multistage cluster sampling methodology where in the first stage, 30 clusters were randomly assigned to villages, and then 30 households were randomly selected from each cluster. Generalized Estimation Equations were used to determine risk factors for undernutrition. Data analysis followed survey analysis procedures. Participants: 60,856 children aged 6-59 months from cross-sectional nutritional surveys implemented in South-CentralSomalia from 2007 to 2012.Results: When factors at the individual, household, and society level were considered simultaneously, diarrhea diseases and geographical region were the main risk factors for underweight, child gender, meal frequency, and livelihood zone were risk factors for stunting, while diarrhea and livelihood zone were the risk factors for wasting. Geographical region and livelihood system were significant factors for undernutrition.Conclusions: Interventions to address undernutrition in Somalia should be tailored to the region and livelihood zone while prioritizing innovative climate-smart food production and addressing childhood illnesses. The study findings provide evidence to inform nutrition policy and programs that could eliminate nutrition disparities and the burden of childhood undernutrition in Somalia and other countries with similar contexts

30-41

Authors: Maliheh Barzegari, Pourya Fathollahi, Fatemeh Afsharpour, Elaheh Foroumandi

Objectives: The community-based Child Health Integrated Program (CHIP) was established to improve children’s health status in Iran. The current study was performed to understand how this program was implemented and experienced by the care providers and target group. Methods: A total number of 249 mothers who had children under 5 years (clients) and 70 caregivers (providers) were selected from 42 health care centers of Tabriz city to participate in the study. Quantitative and qualitative data were collected using two separated semi-structured interviews as well as self-developed questionnaires. The mixed-method process evaluation study was examined and reported the exposure and satisfaction status of the clients, and reach, delivery, fidelity rates, and contextual factors toward the CHIP. Results: Overall, low reach (11.2%), moderate-exposure (62.6%), and high satisfaction (80.1%) rates of the clients were reported to the program. The fidelity rate of the program tools was 42.9%, considered as an inadequate rate. Anthropometric measurement and vaccination of the children, as well as face-to-face training sessions for the mothers, were well delivered. However, some parts of the program including follow-up and group training sessions were delivered poorly. Conclusions: This process evaluation study demonstrated that the CHIP is a promising intervention for improving children's health care. However, the barriers identified in this study warrant consideration in subsequent health care needs among children. Further research is required to identify ways to improve the implementation and delivery of this intervention. Practice Implications: There is a dire need to enter some audit and feedback strategies in the form of monthly tracking of process indicators to extent of implementation of intervention component

49-59

Authors: Fassikaw Kebede, Birhanu Kebede, Tsehay Kebede

Despite efforts to decrease the burden, vaccine hesitancy is increasing worldwide and deterring efforts to control the spread of COVID-19 after the approval of SARS-CoV-2 vaccines. This study aims to assess levels of COVID19 vaccine acceptance and predictors of hesitancy for pregnant women attending antenatal care in Ethiopia. Methods: Facility-based cross-sectional study was employed among 336 pregnant women from April 7 to June 10, 2021. The systematic random sampling technique was used to select pregnant from three health centers. Epi-Data version 3.2 and STATA/14 software were used for both data entry and analysis, respectively. A Logistic regression model was used to identify predictors of COVID-19 vaccine hesitance. Adjusted odds ratio (AOR) with a 95% confidence interval was used to estimate the strength of association at P<0.05. Result: This study included 336 pregnant mothers who were booked ANC in three health centers. The overall levels of COVID-19 vaccine acceptance among pregnant mothers were 79.17 %(95%CI: 74.5 --83.2). Whereas, having poor attitude towards COVID-19 vaccines (AOR=9.4; 95%CI: 3.7--21.1, P<0.001), monthly income ≤118.5 US dollar (AOR =6.3; 95%CI: 2.9--12.2, P<0.002), Mother who are illiterate and started ANC (AOR=9.5; 95%CI: 4.6--22.6, P<0.001), Being unplanned pregnant (AOR =7.5; 95%CI: 3.6-11.2, P<0.002), first time ANC initiated (AOR =4.2; 95%CI: 2.9--15.1, P<0.001), and pregnant didn’t used social media (AOR= 6.0: 95%CI: 2.5--14.6, P< 0.02) were significantly associated with COVID-19 Vaccine hesitance. Conclusion: The acceptability of the COVID-19 vaccine among pregnant mothers was insufficient compared with previous research. Health care workers should provide health education during ANC visits to change their negative attitude and reassurance for the safety and effectiveness of the COVID-19 vaccine.