The growth of children is influenced by various factors, including infections like malaria, diarrhea, and respiratory tract infections (RTIs). This study aimed to assess the associations of these infections with the monthly growth velocity in Tanzanian children. We used data from 2,397 Tanzanian children enrolled in a randomized controlled trial and followed for 18 months (30,079 monthly visits). The exposure variables were infections, whereas the outcome variables were monthly height and weight velocities. Mixed-effects models were used to assess the relationships. The average height velocity was 1.58 cm per month, and average weight velocity was 358 g per month during the follow-up period. Malaria infection was association with a reduction of 0.14 cm/month in height velocity (coefficient [95% CI]: -0.14 [-0.23 to -0.05]) but not significantly associated with weight velocity. RTIs were associated with a reduction of 0.10 cm/month (coefficient [95% CI]: -0.10 [-0.15 to -0.04]) and a decrease of 37 g/month (coefficient [95% CI]: -37 [-72 to -2.6]) in height and weight velocity, respectively. Diarrhea was also inversely associated with both height and weight velocity, with reductions of 0.26 cm/month (coefficient [95% CI]: -0.26 [-0.35 to -0.17])] and 120 g/month (coefficient [95% CI]: -120 [-177 to -62]), respectively. The findings demonstrate that malaria, respiratory infections, and diarrhea are associated with slower growth velocity in children. These results underscore the importance of integrated health care strategies to address these prevalent infections, because preventing them may contribute to healthier child growth and better overall health outcomes.

Effective mentorship is essential for advancing global health research, particularly in low- and middle-income countries (LMICs). This review synthesizes expert perspectives from a highly experienced group of global health research mentors. We identify the characteristics and core competencies of effective global health mentors, emphasizing adaptability, cultural competence, and equitable collaboration. Special attention is paid to addressing barriers faced by underrepresented groups in academia, highlighting the role of mentorship in career advancement and enhancing workforce diversity. We describe a variety of mentoring models, e.g., one-to-one, peer, group, and virtual, and mentoring tools and frameworks, evaluating their relevance to diverse global health contexts. This review emphasizes their potential for customization in LMICs and provides guidance for structuring effective mentor-mentee communication. Recognizing that sustainable impact extends beyond individual relationships, we present strategies for developing institutional mentorship programs, drawing on lessons from Ethiopia and Kenya. Key recommendations include capacity-building for mentors and mentees, institutional ownership of mentoring activities, mentor-mentee matching, accessible training, and regular evaluation linked to recognition and career advancement. The transition from structured mentorship to professional independence merits special consideration, including mechanisms for fostering ongoing collegiality and long-term career support. Our findings underscore the importance of structured, intentional mentorship for building research capacity, driving academic productivity, and advancing global health equity. We advocate for sustained investment by individuals and institutions, recommending adaptable mentorship frameworks and supportive cultures to foster emerging global health leaders. By institutionalizing best practices, global health research mentorship can contribute decisively to stronger health systems worldwide.

Abstract Background Postnatal care is crucial for assessing and improving the health of both mothers and newborns, yet its coverage remains low in Ethiopia. Timely, high-quality postnatal care, especially within the first week after birth, is essential to reduce maternal and neonatal mortality. Family-led postnatal care is an innovative model for reaching postnatal mothers and newborns during the first week after birth. Leveraging self-care principles, mothers, with the support from family and guided by a checklist, perform daily postnatal health checks on themselves and their newborns. This study evaluated the effect of a family-led postnatal care intervention on coverage of postnatal checks within seven days of birth. Methods This study used pre- and post-intervention cross-sectional surveys in four health centers. Eligible postnatal mothers who gave birth in the study health centers were interviewed pre- (November 2022 to January 2023) and post-intervention (February to April 2023) using a structured questionnaire. Bivariate tests and descriptive analyses were used to assess changes in postnatal care coverage over time. Results Surveys were completed with a total of 119 mothers pre-intervention and 110 mothers post-intervention. In the pre-intervention period, 9% (11/119) of mothers and 11% (13/119) of newborns had a postnatal check between 24 and 72 hours after birth, whereas in the post-intervention period this increased to 96% (105/110) mothers and 96% (105/110) newborns (P<0.0001). A similar increase occurred in the proportion of mothers and newborns having postnatal checks between 73 hours and 7 days (3% vs. 96%, P< 0.0001). Compared to pre-intervention, a larger proportion of mothers detected a maternal danger sign during the post-intervention period (6.7% vs 18.2%, P<0.008). Conclusion Family-led postnatal care is a promising self-care model that may increase postnatal checks for mothers and newborns who would not otherwise have received care. Evaluating this model in other settings using a more rigorous design is recommended. Trial registration ClinicalTrials.gov ( NCT05563974 ), first posted on 3 October 2022.

Ethiopian diagnostic facilities currently use Western hematological reference ranges, lacking national standardization. This study establishes hematological reference values for healthy adults in Northwest Ethiopia through a population-based cross-sectional study conducted from June to August 2023. Whole blood samples from 759 participants were analyzed using the Siemens ADVIA-560 hematology analyzer. Data were processed with Stata 17.0, and reference intervals (RIs) were calculated for the central 95% of the distribution, with gender & altitude differences assessed via the Mann-Whitney U test (p < 0.05). Sex and altitude based partitioning was done using Harris & Boyd’s Z-test and Lahti et al.’s proportion criteria. Results showed significant variations by sex and altitude, with males exhibiting higher median values for several hematological parameters. The combined 95% reference intervals (RIs) were: WBC (3.11–9.89 × 10⁹/L), NEU (0.96–6.54 × 10⁹/L), LYM (0.69–2.89 × 10⁹/L), MON (0.31–1.46 × 10⁹/L), and BAS (0.05–0.42 × 10⁹/L), with corresponding differential percentages also established. Sex-specific RIs were defined for key parameters. In men: RBC (4.54–6.39 × 10¹²/L), HGB (13.68–19.21 g/dL), HCT (41.39–57.01%), MCHC (32.01–34.91 g/dL), and PLT (127.10–367.10 × 10⁹/L); and in women: RBC (4.17–5.55 × 10¹²/L), HGB (12.51–16.39 g/dL), HCT (37.91–48.89%), MCHC (31.51–34.70 g/dL), and PLT (146.22–411.00 × 10⁹/L). Altitude-based stratification further revealed higher values at high altitude. In men, monocytes, eosinophils, RBC, HGB, HCT, and PLT were elevated, while in women, higher values were observed for neutrophils, monocytes, basophils, HGB, HCT, MCV, and MCH. These findings demonstrate that hematological reference intervals vary by sex and altitude among healthy adults in Northwest Ethiopia. The study highlights the potential value of using locally derived and context-specific reference intervals to improve interpretation of laboratory results. Further multicenter validation studies across diverse Ethiopian populations are recommended to support their application in clinical practice and research.

Cancer is uncontrolled abnormal cell growth. In 2022, an estimated 19.3 million new cancer diagnoses and 10 million cancer deaths were recorded globally. Breast cancer is among the leading cancers that result in death in Ethiopia. This study analyzed trends in breast cancer incidence in Ethiopia. Data were extracted from the Addis Ababa population based cancer registry. Of the 28,108 registered cancer patients, 7,160 were breast cancer cases. Crude, age-standardized incidence rate (ASR), annual percentage change (APC), and the Mann-Kendall trend test were utilized using R and Joinpoint regression software. Breast cancer accounted for more than 25

Abstract Background High-quality antenatal care (ANC) can improve the detection, management, and monitoring of pregnancy-related complications. International guidelines recommend at least 8 antenatal care contacts during pregnancy. Interventions to improve the quality of antenatal care may promote positive pregnancy outcomes. Objectives To assess the impact of enhanced nutrition and infection intervention packages on antenatal quality of care indicators among pregnant women in rural Amhara, Ethiopia Methods Pregnant women presenting at 12 rural health centers at <24 weeks of gestation were enrolled in this pragmatic clinical effectiveness study. Using 2×2 factorial design, health facilities were allocated to provide an Enhanced Nutrition Package (ENP) or routine nutrition care (non-ENP), followed by individual-level randomization into Enhanced Infection Management Package (EIMP) or routine care (non-EIMP). The composite antenatal quality of care (QoC) score was calculated and compared between arms using cluster-level analyses, at the health center level (for ENP marginal effects), multivariate regression analyses (for EIMP marginal effects), and generalized estimating equations (for combined effects versus routine care). All models were adjusted for imbalanced individual and household factors. Results From August 2020 to December 2021, a total of 2392 women were randomized (604 ENP+EIMP, 600 ENP alone, 593 EIMP alone, 595 neither package) and followed until June 2022. There was a significant difference in the number of ANC contacts in the ENP group (vs non-ENP: adjusted mean difference [aMD]=1.67, 95% CI: 1.18 to 2.16), EIMP (vs non-EIMP: aMD=0.38, 95% CI: 0.14 to 0.62), and ENP+EIMP (vs routine: aMD=1.92, 95% CI: 1.48 to 2.36). There was also a significant difference in ANC quality of care (ANC QoC) score in ENP (vs non-ENP: aMD=2.13, 95% CI: 0.54 to 3.72); EIMP (vs non-EIMP: aMD=0.89, 95% CI, 0.44 to 1.34), and ENP+EIMP (vs routine: aMD=2.77, 95% CI: 1.28 to 4.27). Conclusions Combination of enhanced nutrition and infection management interventions had the largest effect on the number of ANC contacts and ANC QoC score. Bolstering nutrition and infection management services during pregnancy could encourage additional ANC contacts, providing an opportunity to provide targeted care.

Background/Objectives: Scoliosis in children leads to complex physical, psychosocial, and functional impairments, yet evidence from low-resource settings is limited. To evaluate health-related quality of life (HRQoL) in Ethiopian children with scoliosis using WHODAS 2.0 and EQ-5D-Y, and to identify clinical and demographic correlates of disability. Methods: A hospital-based cross-sectional study was conducted at CURE Children's Hospital of Ethiopia (1 April 2024-31 March 2025). Ninety-seven children aged 6-15 years with confirmed scoliosis were assessed. WHODAS 2.0 (36-item) captured disability across six domains, while EQ-5D-Y measured physical, psychosocial, and pain-related HRQoL. Clinical severity indicators (Cobb angle, trunk rotation, thoracic morphometrics, anthropometrics) were recorded. Analyses in Python 3.12 included descriptive statistics, correlation, and multiple regression to examine associations between scoliosis severity and HRQoL outcomes. Results: Ninety-seven Ethiopian children diagnosed with scoliosis (mean age 11.4 years, mean Cobb angle 73.5°) were assessed; congenital scoliosis was most common (45.4%), followed by idiopathic (38.1%) and neuromuscular (16.5%). WHODAS 2.0 revealed substantial disability, particularly in mobility (46.4%) and social participation (62.8%), with life activities and participation as the strongest contributors. Greater deformity, younger age, and smaller body size were linked to worse outcomes, with neuromuscular and very severe thoracolumbar cases most affected. EQ-5D-Y showed marked HRQoL impairments across domains, with psychological distress (mean 2.24/3), pain, and self-care limitations emerging as key burdens. The mean EQ score was 8.89/15 (59.2%), indicating reduced quality of life. Regression analyses highlighted pain, psychological distress, and self-care limitations as the domains most strongly associated with poorer HRQoL, while greater Cobb angle and higher ATR degree were also correlated with reduced quality of life. Conclusions: Ethiopian children with scoliosis experience significant multidimensional impairments in HRQoL, with mobility, social participation, pain, and psychological distress as dominant burdens. WHODAS 2.0 and EQ-5D-Y proved complementary in capturing these impacts, supporting their use for early detection, clinical care, and public health planning in resource-limited settings.

BACKGROUND:Scoliosis is a progressive spinal deformity that often develops during childhood and adolescence. In Ethiopia, population-level prevalence data are scarce, and school-based screening, though practical, may overestimate cases without radiographic confirmation. Understanding its distribution and severity is critical for guiding clinical and public health strategies. OBJECTIVES:To estimate the prevalence of scoliosis among Ethiopian schoolchildren, characterize its types and severity, and examine associations with clinical and anthropometric variables. METHODS:A cross-sectional school-based screening was conducted from March 2024 to June 2025 across 42 public primary schools in six regions. Children aged 6-15 years were screened using the Adam's Forward Bend Test and scoliometer; suspected cases (ATR ≥ 7°) were referred for radiographic confirmation. Prevalence estimates and associations were analyzed using chi-square tests and t-tests. Data were analyzed in Python, with quality control ensured through standardized training, pilot testing, and double-entry verification. RESULTS:Of 32,000 children screened, 48 were suspected of scoliosis (0.15%; 95% CI: 0.11-0.20%), and 21 were radiographically confirmed (0.066%; 95% CI: 0.04-0.10%). Congenital scoliosis was most common (61.9%), with male predominance (69%), while idiopathic scoliosis (23.8%) was more frequent in females (60%). Neuromuscular and syndromic scoliosis were rare. Severity analysis showed male predominance in mild and very severe cases, with equal sex distribution in severe scoliosis. The mean Cobb angle was 47.4° (SD ± 28.9), most cases involved the thoracic spine (52.4%), and the rib hump was typically right-sided (61.9%). Cobb angle correlated positively with ATR (r = 0.61) and thoracic loss (r = 0.48), and negatively with age (r = -0.24) and thoracic height (r = -0.46). CONCLUSION:This study shows that scoliosis prevalence within the school population is low, with adolescent idiopathic cases markedly underrepresented compared to other school-based screening reports. These findings suggest that nationwide school screening programs are not recommended. Instead, efforts should prioritize strengthening diagnostic and referral pathways for clinically evident cases to ensure timely access to specialized care.

Abstract Background Group antenatal care (G-ANC) is an alternative model of antenatal care that incorporates clinical assessment and care, participatory learning, and peer support. It gives expectant mothers the opportunity to discuss and share experiences with a group of women of similar gestational age throughout the pregnancy. This pilot study aimed to explore the feasibility of introducing a six-meeting G-ANC model in health posts, the most basic level of the health system in Ethiopia. Methods A qualitative study of G-ANC was conducted at five purposively selected health posts in two zones in the Amhara region of Ethiopia, involving 54 pregnant women aged 15 years and older with a gestational age of less than 20 weeks. Trained research staff moderated 13 in-depth and 7 key informant interviews that were conducted after the second of the six G-ANC meetings. All interviews and discussions were recorded with consent from participants. Transcribed interviews were translated and thematically analyzed using a framework with open code qualitative data analysis software aiding in data sorting, categorization, and coding. Results An adequate number of pregnant women were identified early in pregnancy and recruited to form G-ANC groups for this study. Pregnant women were willing to be enrolled and participate in G-ANC meetings and indicated interest in attending future meetings. Health extension workers (HEWs) demonstrated the ability to facilitate G-ANC meetings effectively. Conclusion Introduction of G-ANC at the health post level appears feasible. None of the major anticipated feasibility challenges, adequate enrollment of eligible women, women’s willingness to participate in successive meetings, and HEW capacity to facilitate, were encountered. Existing community structures were instrumental in achieving adequate enrollment. The training and G-ANC meeting guides enabled HEWs to effectively facilitate the meetings. Preliminary results from this pilot study informed the design of a stepped-wedge cluster randomized trial to evaluate the acceptability and effectiveness of G-ANC at the health post level on increased coverage of antenatal care and facility-based delivery.

BACKGROUND:Suboptimal gestational weight gain (GWG) is associated with adverse pregnancy outcomes; however, evidence on the impact of nutritional interventions on GWG in low-income settings remains limited. OBJECTIVES:This study aims to examine the effectiveness of an enhanced nutrition package (ENP), including a balanced energy protein (BEP) supplement, on GWG compared with routine care. METHODS:We conducted a pragmatic cluster-randomized effectiveness study among pregnant women <24 wk of gestation in rural Amhara, Ethiopia. Twelve health centers were randomized to provide either ENP, including a daily BEP supplement for women with mid-upper arm circumference ≤23 cm, or routine care. GWG and GWG rate (kg/wk) were calculated from enrollment to late pregnancy weight measurement. Intention-to-treat (ITT), cluster-level analysis compared GWG outcomes between study arms. Primary analyses were restricted to women with observed third-trimester weights. Secondary dose-response analysis within the ENP arm examined associations between BEP consumption duration and GWG outcomes. RESULTS:A total of 2392 women were enrolled and randomly assigned (n = 1210 ENP; n = 1189 routine care), with 2170 followed up until birth. In the ENP arm, 37% were eligible for BEP supplementation. ITT analysis showed no differences between arms in GWG rate [diff = -0.006 kg/wk; 95% confidence interval (CI): -0.042 kg/wk, 0.030 kg/wk] or observed GWG (diff = 0.009 kg; 95% CI: -0.687 kg, 0.706 kg). Among BEP-eligible women, GWG outcomes also did not differ between arms (ΔGWG rate = 0.006 kg/wk; 95% CI: -0.027 kg/wk, 0.030 kg/wk); observed ΔGWG = 0.201 kg (95% CI: -0.443 kg, 0.845 kg). In dose-response analysis within the ENP arm, women consuming BEP for 61-90 and >90 d had a higher GWG rate (61-90 d: 0.46 kg/wk, 95% CI: 0.003 kg/wk, 0.090 kg/wk); >90 d: 0.059 kg/wk; 95% CI: 0.018 kg/wk, 0.099 kg/wk) and observed GWG (61-90 d: 0.895 kg, 95% CI: 0.004 kg, 1.786 kg; >90 d: 1.206 kg, 95% CI: 0.331 kg, 2.081 kg) compared with those consuming BEP for <30 d. CONCLUSIONS:The ENP package, including BEP, did not improve GWG compared with routine care in this pragmatic study in the Ethiopian health system. Longer duration of prenatal BEP adherence (≥60 d) may benefit GWG and GWG rates among undernourished women. This trial was registered as ISRCTN15116516.

Background: Smoking is one of the maladaptive coping behaviors found in military settings. Some of the motives for military personnel to smoke include reducing stress and meeting social needs. Active smoking is associated with various cancers and aggravates acute and chronic diseases, potentially compromising soldiers' health and combat readiness. Objective: This study identified the prevalence and determinants of cigarette smoking and factors associated with smoking among Ethiopian military personnel. Methods: A descriptive cross-sectional study was conducted among active-duty military personnel recruited from both the Ground Force and the Air Force of the National Defense Forces of Ethiopia. The study enrolled 522 participants. Data were collected using a structured questionnaire and analyzed with SPSS version 24. A bivariate and a multivariable binary logistic regression were performed to investigate factors associated with cigarette smoking. Results: A total of 502 military personnel participated in the study, yielding a response rate of 96.2%. Of these, 89 (17.7%) were women and 413 (82.3%) were men. The median age (interquartile range) was 25.0 (IQR: 22.0-34.0) years. At the time of the study, 39 participants (7.8%) (95% CI: 5.6%-10.4%) of the respondents reported currently smoking (daily or occasionally). Sex-specific prevalence was 8.0% (n=32) among males and 6.7% (n=6) among females. Twenty-three participants (4.6%) reported smoking a cigarette every day, of whom 21 (4.2%) were classified as heavy smokers. The mean (+/- standard deviation) age of cigarette smoking initiation was 18.4 +/- 5.9 years. After controlling for potential confounders, current alcohol consumption was significantly associated with cigarette smoking, with an AOR of 5.27 (95% CI: 2.13-13.05). Conclusion: The magnitude of cigarette smoking among Ethiopian military personnel was lower than that of military populations in other countries, yet it exceeded the rates reported for the general Ethiopian population, both overall and when stratified by sex. Targeted prevention strategies and early cessation intervention programs are essential to protect military personnel's health and maintain operational combat readiness. [Ethiop. J. Health Dev. 2026; 40(1)]

The Ethiopian military implements health promotion interventions to improve and maintain fitness, health, and military readiness. However, distinct organizational features of military forces can affect the health of their members. This study aimed to explore facilitators and barriers to implementing health promotion interventions within Ethiopian military settings and develop a conceptual model based on the findings. A grounded theory approach was used in this qualitative study. We identified 26 participants among health experts engaged in health promotion and disease prevention interventions in Ethiopian military health facilities and health departments. Data were collected using face-to-face interviews with key open questions, which were recorded, transcribed verbatim in Amharic, and translated into English. The English transcripts were analyzed using open, axial, and selective coding with a constant comparative method, leading to the identification of a core category and the development of a conceptual model. ATLAS.ti was used to manage and code the data. This study involved 26 experts (21 males and 5 females) working on health promotion interventions in a military context. Five key categories emerged as facilitators: organizational, structural, professional, collaborative, and military factors. Barriers were grouped into three categories: organizational, professional, and military factors. Key facilitators included information sharing, the proximity of health personnel at lower levels, sharing best experiences, trainings, working with a shared understanding and with partners, the chain of command, living in mass, and being young. Major barriers included resource constraints, staff turnover, the demanding nature of military work, living in mass, deployment in desert environments, and peer influence. The successful implementation of health promotion interventions in military settings is influenced by the dynamic interaction of organizational, structural, professional, collaborative, and military factors. This study identified key facilitators and barriers to health promotion interventions in the military context. The chain of command and the presence of health personnel at lower levels emerged as key facilitators, while resource constraints were important barriers. These findings, along with the conceptual model developed, provide valuable guidance for policymakers and practitioners involved in health promotion efforts within the Ethiopian military context.

INTRODUCTION:Maternal undernutrition and infections during pregnancy may influence birth and long-term child development outcomes. Characterising the micronutrient, metabolomic and microbiome profiles of pregnant women and infants may elucidate the underlying biology of adverse birth outcomes and early child development in the first 1000 days. METHODS AND ANALYSIS:The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study was a 2×2 factorial, randomised clinical effectiveness study conducted in Amhara, Ethiopia from August 2020 to June 2022. We cluster-randomised pregnant women (n=2399) to receive either a nutrition intervention (iron-folic acid (IFA), iodised salt and balanced energy-protein supplementation for women with mid-upper arm circumference <23 cm) or routine care (IFA only), and individually randomised women to an infection control intervention (genitourinary tract infection screening-treatment and screening-treatment of stool parasites) or routine care (syndromic approach). Participants were followed until 1 month postpartum. A subset of 532 women-infant dyads were consecutively enrolled in the biospecimen substudy from July 2021 to August 2022. Specimens were collected at enrolment (<24 weeks) and antenatal care follow-up (third trimester), and 1-6 months postdelivery. A subset of ENAT mother-infant dyads (n=462) was enrolled in the Longitudinal Infant Development and Growth study that followed infants until 24 months postpartum, from February 2023 to June 2024. We will determine the impact of ENAT interventions on micronutrient status, inflammation biomarkers and metabolomic and microbiome profiles. We will also determine the association of these profiles with birth outcomes and infant neurodevelopment. ETHICS AND DISSEMINATION:These studies were approved by the Institutional Review Boards of Addis Continental Institute of Public Health (ACIPH/IRB/002/2022) and Mass General Brigham (2023P000461). Results will be disseminated to international stakeholders via peer-reviewed journals and locally via strategic dissemination sessions. TRIAL REGISTRATION NUMBERS:ISRCTN15116516 and NCT06296238.

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.

Background:Adequate antenatal care (ANC) and facility-based delivery are linked to improved maternal and neonatal outcomes. Adequate ANC attendance and facility birth rates are increasing in Ethiopia but remain well below national goals and global recommendations. Group ANC (G-ANC), when implemented at higher-level facilities, is associated with improved quality and experience of ANC and increased ANC retention and facility-based delivery. The objectives of this study are to evaluate the acceptability, feasibility, and effectiveness of G-ANC delivered by health extension workers at the health-post level compared to conventional ANC on ANC attendance and facility-based delivery. Methods:Group ANC will be piloted in five purposively selected health posts. The study design is a stepped-wedge trial to be conducted in 36 health posts within the catchment of six health centers, with randomization of the order of the intervention introduction done at the health-center level (clusters). The design includes three time periods: a six-month control period with no G-ANC implementation, followed by another six-month period when G-ANC will be introduced in half (n=18) of the study health posts, then a final six-month period when G-ANC will be implemented in the remaining 18 health posts. Each health post will form one cohort and conduct six monthly G-ANC meetings on a fixed day/time. The study will use quantitative and qualitative data collection approaches. The study has "pause and reflect" points designed for intervention iteration before rolling out to the next set of sites. The primary outcomes are the proportion of women with at least four ANC visits and the proportion who delivered in a health facility. Qualitative research will be conducted using in-depth interviews with pregnant women, health workers, facility managers, and regional health managers. The study will enroll 770 women across all phases. Conclusions:The study will inform decision-makers locally and globally on whether G-ANC is a feasible service delivery model at the health-post level. Effectiveness of G-ANC at increasing ANC retention and facility-based delivery and its acceptability to pregnant women and health extension workers will be reported. Registration NCT05054491, ClinicalTrials.gov (September 23, 2021).

Objectives: This study aims to assess the feasibility, acceptability, and sustainability of the family-led postnatal care model. Design: The study applied a post-intervention mixed-method design drawing on cross-sectional survey, data review from registers and checklists, and in-depth interviews and key-informant interviews from February to April 2023. Setting: The study was conducted in four health centers and catchment areas in Adaa District, Oromia Region, Ethiopia. Participants: The quantitative survey included 110 postnatal women. The qualitative components included in-depth interviews with postnatal women, husbands/partners, and family members and key-informant interviews with midwives/nurses, health extension workers, home care kit custodians, and health managers. Intervention: Family-led postnatal care is a self-care innovation for postnatal women and newborns during their first week of life. In the model, a midwife or nurse invites family members to attend the discharge and assesses the mother and newborn using a pictorial checklist. The checklist is given to the families with guidance on retrieving a home care kit (containing blood pressure monitor, thermometer, and health-education booklet) from a volunteer community custodian. At home, families use the checklist and kit to assess the health of the postnatal mother and newborn for six days, returning the completed checklist and kit to the custodian afterwards. Main outcome measures: The outcome measures are feasibility, acceptability, and sustainability of the family-led postnatal care model. Results: Participants at facility and community levels felt that family-led postnatal care was feasible and acceptable due to the easy-to-use materials for varied literacy levels, its influence on spouses/partners and families to support mothers, and its empowerment of women to recognize signs that require care-seeking. All health centers continued the family-led postnatal care model, and most kits were functional six months after the end of project support. Conclusions: Our results indicate that family-led postnatal care is a promising approach that can be tested and scaled in other settings. Trial registration: ClinicalTrials.gov ([NCT05563974][1]). ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05563974 ### Clinical Protocols ### Funding Statement This study (ARC-012) was funded by the Gates Foundation through a grant to Jhpiego/Antenatal Postnatal Research Collective (ARC) (INV-003543), the entity responsible for initiating and managing the study. The funding body had no role in the design of the study, or collection, analysis, or interpretation of the data and was not involved in writing the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study obtained ethical approval from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB No. 21096) and the Addis Continental Institute of Public Health Institutional Ethical Review Board (IRB No. 0029). All participants gave informed consent before taking part in the study I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The de-identified data that support the findings of this study are available on figshare using this DOI 10.6084/m9.figshare.28572035. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05563974&atom=%2Fmedrxiv%2Fearly%2F2025%2F03%2F11%2F2025.03.11.25323725.atom

Background: The World Health Organization (WHO) recently developed the Global Scales for Early Development (GSED) tool to address the lack of a population-level metric for early childhood development globally. This paper describes learning from the first experience with the translation, adaptation, and implementation of the GSED tool in Ethiopia. Methods: WHO guidelines were followed to translate and adapt the GSED tool to Amharic. Two Ethiopian child health experts were trained as GSED Master Trainers. The tool was forward translated by two independent translators with previous experience in child development assessment, consensus was obtained, and the back translation was reviewed/approved by the WHO. The GSED app was programmed in Amharic and piloted for 40 children aged 6–36 months, followed by its implementation by trained study nurses in a child development study in Bahir Dar. Results: Minor adaptations were made to terminologies and certain items were rephrased in the short and long forms. Modifications were made to physical objects used in the long form to make the items culturally appropriate and familiar. Local examples were used where necessary. The tool was administered to 364 children aged 6–36 months with an average administration time of 50–60 min. Quality control assessments by master trainers showed high agreement with assessments by trained study nurses throughout the study (average agreement: 91%). This study demonstrated the high acceptability and feasibility of the GSED tools. Conclusions: Local adaptations were required to contextualize the GSED tool for the Ethiopian setting. The preliminary experience with the GSED tool in Ethiopia is positive, with high-competency trained staff and ease of administration.

Introduction We aimed to determine the impact of antenatal interventions to optimise maternal nutrition and infection management on birth outcomes in Ethiopia.Methods We conducted a pragmatic, open-label, 2×2 factorial randomised clinical effectiveness study among pregnant women enrolled <24 weeks gestation in 12 rural health centres in Amhara, Ethiopia. Eligible health centres were randomised to deliver an enhanced nutrition package (ENP) (iron-folic acid, iodised salt and targeted micronutrient fortified balanced energy protein (BEP) supplementation for undernourished women) or routine nutrition care (iron-folic acid only). Individual women were randomised to receive an enhanced infection management package (EIMP) (genitourinary tract infection screening-treatment and enhanced deworming) or routine infection care (syndromic management). The primary outcomes were birth weight and length; secondary outcomes were gestational age, preterm delivery, small-for-gestational-age, low birth weight, stillbirth, newborn weight-for-age and length-for-age z-scores, newborn head circumference, and maternal anemia. Analysis was intention to treat.Results From August 2020 to December 2021, 2392 women were randomised (604 ENP+EIMP, 600 ENP alone, 593 EIMP alone and 595 neither package) and followed until June 2022, with 2170 pregnancy outcomes analysed (565 ENP+EIMP, 549 ENP, 525 EIMP, 531 neither). In the ENP arm, 427 (36%) women were eligible for BEP and consumed on average 74 days. The prevalence of genitourinary tract infection was low (4.9%), while parasitic stool infections were common (31%). There was no difference in birth weight (ENP vs not-ENP: adjusted mean difference −4 g (−83 to 75); EIMP vs not-EIMP: 18 g (−35 to 70); ENP+EIMP vs neither: 14 g (−81 to 109)) or birth length (ENP: −0.3 cm (−1.1 to 0.5); EIMP: 0.2 cm (−0.1 to 0.5); ENP+EIMP: −0.1 cm (−1.2 to 1.1)) between study arms. In the ENP+EIMP group, the stillbirth rate was lower compared with the arm receiving neither package (7.1/1000 vs 24.7/1000 births; adjusted relative risk: 0.29 (0.09 to 0.94)). The packages did not significantly affect other secondary outcomes.Conclusions In this pragmatic study implemented within the Ethiopian health system, enhanced nutrition and infection packages did not affect birth weight or length. While stillbirth rates were lower in the group receiving both packages, these findings need to be supported by additional studies.Trial registration number ISRCTN15116516.

Urinary Tract Infections (UTIs) in pregnant women can lead to pyelonephritis and preterm birth. We assessed UTI prevalence, etiology, antimicrobial resistance, and associated risk factors among pregnant women receiving antenatal care in rural Amhara, Ethiopia. 604 pregnant women were screened for UTI at ≤ 24 weeks gestational age from August 2020 to June 2022. Urine culture, dipstick, and antibiotic sensitivity testing were completed. We conducted descriptive statistics for prevalence and logistic regression to examine UTI risk factors. UTI prevalence was 3.5% (21/604, 95%CI = 2.0%-4.9%), among which 43% were symptomatic and 57% were asymptomatic. Common uropathogens were Escherichia coli (57.1%), Klebsiella pneumoniae (14.3%), and Enterococcus faecalis (14.3%). Among all isolates, resistance was high for ampicillin (66.7%) and amoxicillin-clavulanate (40.0%). The majority of isolates (76.2%) were susceptible to nitrofurantoin, cotrimoxazole, and cefpodoxime. Maternal age > 20 years was a protective factor against UTI (OR = 0.27, 95% CI = 0.10-0.77; ref < 20 years). Urine dipstick (nitrite or leukocyte esterase) had low sensitivity (37.5%) but higher specificity (93.9%) to identify positive culture. This study emphasizes the high resistance to first-line antibiotics used in pregnancy and the need for accurate, low-cost UTI screening methods in LMICs.