BackgroundBalanced energy protein (BEP) supplements during pregnancy have shown promise in reducing small-for-gestational-age births and low birth weight in low- and middle-income countries, but practical gaps remain in implementing this supplementation. This formative study assessed the acceptability, adherence, and sharing practices of a ready-to-use BEP supplement among pregnant women in Addis Ababa, Ethiopia.Subjects and methodFrom January to February 2023, 45 pregnant women were purposively selected from nine public health centers and provided a 4-week BEP supply with usage guidance. Thirty-nine participants completed in-depth interviews. The framework analysis focused on acceptability, adherence, and sharing. Adherence was calculated as the proportion of sachets consumed or returned empty; partially used or unopened sachets were considered unconsumed.ResultsAcceptability was high, with positive feedback on texture (32/39, 82.1%), smell (35/39, 89.7%), color (38/39, 97.4%), and ease of consumption (33/39, 84.6%). However, 23/39 participants (59%) found the taste overly sweet, which occasionally led to nausea or reduced intake. Over the one month, supplement consumption ranged from 0 to 30 sachets, with a mean intake of 21.9 (SD = 9.5). High adherence (≥80% consumption) was observed in 25/39 (64.1%) of participants. Intake was facilitated by provider counseling and family support, while fasting, travel, and weight concerns influenced consumption patterns. Sharing was minimal and discouraged through counseling. Most participants expressed willingness to continue supplementation, recommending reduced sweetness.ConclusionPregnant women demonstrated high acceptability and adherence to the BEP supplement. Findings support its feasibility for informing intervention design in the main trial.

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.

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.

This study aimed to assess the prevalence of intestinal parasitic infections among pregnant women in the third trimester who received prior presumptive deworming in 12 health centers in the Amhara region, Ethiopia. This sub-study was part of the parent Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study; a randomized clinical effectiveness study conducted to determine the effectiveness of packages of antenatal interventions to enhance maternal nutrition and infection management on birth outcomes. Three hundred fifty women provided a stool sample in their 3rd trimester for screening using wet mount microscopy. All women had previously received 500 mg of presumptive mebendazole in the 2nd trimester. One in three women (109/350, 31.0%) were found to have a parasitic stool infection after prior deworming and 15% of women reported gastrointestinal symptoms. The most common infections were Giardia lamblia (n = 43, 37.4%), Entamoeba histolytica (n = 40, 34.8%), and Hookworm (n = 25, 21.7%). Six mothers had co-infections with at least two parasites with trophozoites of Giardia lamblia and Entamoeba histolytica co-infection being dominant.

[This corrects the article DOI: 10.1016/j.cdnut.2024.102964.].

BACKGROUND: Understanding healthcare facility preferences-public versus private-is essential for formulating policies that promote universal health coverage (UHC). Various sociodemographic factors influence these preferences. This study examines healthcare facility preferences within the ADDIS-HDSS population in Addis Ababa, Ethiopia. Methods: This analysis is based on the ADDIS-HDSS baseline census conducted in Yeka sub-city, Addis Ababa. We focused on respondents' preferred healthcare facility when household members are ill, and the reasons behind their choice. Multivariable logistic regression was used to analyze the factors influencing preferences. Results: Most households (82.81%) preferred public healthcare facilities, citing affordability as the primary reason (59.31%). The remaining 17.19% preferred private healthcare, mainly due to perceived quality of care (43.06%) and timeliness (37.04%). Larger family size was associated with a reduced likelihood of preferring private facilities (AOR = 0.579, 95% CI: 0.522-0.642), while higher education (AOR = 2.573, 95% CI: 2.194-3.017) and wealthier households (AOR = 16.925, 95% CI: 14.705-19.481) were more likely to prefer private care. Conclusion: The majority of households prefer public healthcare facilities, with affordability, quality, and timeliness as key factors. To achieve UHC in low-income countries, improving service quality and timeliness in public healthcare is critical.

Background:Measuring household economic status is crucial, as it is a key determinant of health. In low-income settings, no single measure of economic status is universally accepted. This study aims to assess the agreement between a single-item tool for measuring socioeconomic status (SES) and the wealth index. Methods:The Addis Health and Demographic Surveillance System (Addis-HDSS), based in Addis Ababa, Ethiopia, collects data on various socioeconomic indicators, including income, expenditure, and asset ownership. In this study, a single question, "Does your family's income cover basic needs?" was used as a proxy for SES. The percent agreement with the wealth index was calculated, and significance was assessed using the Pearson chi-square test. Scale reliability was evaluated using Cronbach's alpha (α). Results:Data from 30,533 households showed strong agreement (α = 0.925) between self-reported income adequacy and wealth for both lower and higher wealth groups. The highest agreement was found between the lowest wealth index and "very low" income adequacy (93.84%) and between the highest wealth index and "high" income adequacy (89.47%) (p < 0.001). Conclusion:The single-item SES measure showed good agreement with the wealth index in an urban setting. This simple tool can effectively identify vulnerable populations for targeted health interventions. Further research is needed to assess its applicability in other contexts.

Background:Access to sanitation and healthy housing conditions are essential for public health, reducing the spread of diseases and improving overall well-being. However, millions of people, particularly in low-income countries, still lack access to basic sanitation and housing facilities. This study assessed household sanitation and crowding status in a rapidly developing urban area of Addis Ababa. Methods:Data were extracted from the household census conducted from December 2022 to January 2023 at the Addis-HDSS site. Availability of basic sanitation facilities was defined as the presence of privately owned sanitation facilities within the household. Household crowding was measured by the number of occupants per bedroom. Multivariable logistic regression was used to identify factors associated with access to sanitation facilities (STATA/SE 14.2). A p-value of <0.05 was considered statistically significant. Results:The study included 30,533 households. Overall, 76.37% (95% CI: 74.86-77.2) lacked access to basic sanitation facilities. Most households (67.42%) lived in overcrowded housing. Educational status of the household head and household size were significantly associated with sanitation access. Households with college-educated heads were more likely to have access to basic sanitation (AOR 2.52, 95% CI: 2.27-2.79), while overcrowded households were less likely to have such access (AOR 0.06, 95% CI: 0.040-0.063). Conclusions:A large proportion of households lacked basic sanitation facilities and lived in overcrowded housing, which increases the risk of infectious disease transmission. Improving sanitation and housing conditions is crucial for reducing health risks and improving public health outcomes.

Background:Mental illness is the second leading cause of disease burden globally, following cardiovascular diseases. Over 25% of people worldwide will experience mental illness at some point, and low-income countries contribute 12% of the global disease burden. However, data on mental disorders are scarce in low-income countries, leading to insufficient attention to mental illness prevention and treatment. This study assesses the prevalence of mental illness and its associated factors in Addis Ababa. Methods:This study was conducted in the Addis Health and Demography Surveillance System (Addis HDSS) in Yeka sub-city, Addis Ababa, using a structured questionnaire. The prevalence of reported mental illness was calculated with 95% confidence intervals (CIs), and logistic regression was employed to examine factors such as age, sex, chronic illness, physical disability, and wealth index associated with mental illness. Results:A total of 107,494 respondents participated, with 44.6% men. The average age was 29.23 ± 18.97 years. The reported prevalence of mental illness was 1.1% (95% CI: 1.1-1.2), with 50.7% of those affected being men. Mental illness was more common in individuals aged 65 years and older. The odds of reported mental illness were higher in men (AOR 1.24; 95% CI 1.12-1.39), in those with physical disabilities (AOR 10.12; 95% CI 8.64-11.84), and in those with chronic illness (AOR 2.35; 95% CI 1.22-4.54). Conclusion:This study adds to the limited data on mental illness prevalence in the community, highlighting it as a significant health burden. The results emphasize the need for healthcare planning focused on mental health and increased community awareness. Particular attention should be given to vulnerable groups, including the elderly, those with physical disabilities, and those with chronic illnesses.

Introduction Maternal undernutrition and inflammation in utero may significantly impact the neurodevelopmental potential of offspring. However, few studies have investigated the effects of pregnancy interventions on long-term child growth and development. This study will examine the effects of prenatal nutrition and infection management interventions on long-term growth and neurodevelopmental outcomes of offspring.Methods The Enhancing Nutrition and Antenatal Infection Treatment (‘ENAT’) study (ISRCTN15116516) was a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. The study enrolled 2399 pregnant women who were randomised to receive routine care, an enhanced nutrition package (iron and folic acid, monthly household supply of iodised salt, and micronutrient-fortified balanced energy protein supplement for undernourished women), an enhanced infection management package (genitourinary tract infection screening and treatment, and enhanced deworming), or both packages. In the present Longitudinal Infant Development and Growth study, a subset of 480 children of mothers from ENAT will be recruited equally from each of the four study arms and visited at 12, 18, and 24 months of postnatal age. We will evaluate a range of domains and deploy multiple measures to assess child neurodevelopment, including resting electroencephalography and visual evoked potentials, Hammersmith Infant Neurological Examination, eye-tracking, Bayley Scales of Infant and Toddler Development (Bayley-III), and Magnetic Resonance Imaging (MRI).Discussion This study will advance understanding of the impact of nutrition and inflammation in pregnancy on long-term offspring neurodevelopment. This study aims to fill a critical knowledge gap on the benefits of prenatal interventions to promote the health of mothers and their offspring.Ethics and dissemination This study was 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 local and international stakeholders.Trial registration number NCT06296238.

BACKGROUND: Accurate population-based data is essential for evidence-based public health decision-making. Monitoring health events and evaluating interventions through a population-based platform enables timely decisions in rapidly growing urban areas. Such platforms are rare in African countries. This paper outlines the procedures for establishing the Addis Health and Demographic Surveillance System (Addis-HDSS). METHODS: The Addis-HDSS, located in Yeka sub-city of Addis Ababa, Ethiopia, conducted its first census from December 3, 2022, to January 18, 2023. Each enumeration area was identified and mapped digitally. All households in the study area were visited and geocoded. The baseline census gathered data on sociodemographic status, housing conditions, economic status, and selected health-related factors. RESULTS: A total of 30,533 households and a population of 107,494 were recorded. The response rate was 99.1%, reflecting high community engagement. The average household size was 3.5, and the sex ratio was 81 males to 100 females. The population structure resembled a typical lowincome country profile. CONCLUSION: Establishing an urban HDSS was feasible with reasonable effort due to the presence of a digital map and the willingness of the urban population. This surveillance system will be an asset to generate reliable urban health and demographic information by providing an unbiased sampling frame for health-related studies. The HDSS will also be used to test the effectiveness of population-based public health interventions.

BackgroundAntenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries.MethodsA randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies.DiscussionThis study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women.Trial registrationClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.

BACKGROUND: Self-rated health (SRH) status is a subjective assessment of one's health condition and can serve as a reliable indicator of a community's overall health. This study aimed to evaluate the SRH status of communities and its association with socio-demographic and health-related variables at the population level. METHODS: Data were obtained from the Addis Health and Demographic Surveillance System. SRH was assessed through a single question: "In general, would you say that your health is excellent, very good, good, fair, or poor?" These five categories were transformed into two groups: "Good SRH" and "Poor SRH." Bivariate and multivariate logistic regression analyses examined associations between SRH status and sociodemographic and health-related characteristics. RESULTS: A total of 46,483 adults (aged 18 and above) were included in the study. Of these, 4,377 (9.42%) participants reported poor SRH status. Male sex (OR 0.87; 95% CI: 0.80 - 0.94), higher educational level (OR 1.90; 95% CI: 1.67 - 2.17), and the highest wealth index (OR 1.76; 95% CI: 1.55 - 2.00) were significantly associated with good SRH status, while older age (OR 0.15; 95% CI: 0.12 - 0.18) and the presence of any chronic illness (OR 0.08; 95% CI: 0.07 - 0.09) were directly and significantly associated with poor SRH status. CONCLUSION: Poor SRH status was more prevalent among females, older individuals, those with lower education, lower wealth index, and those with chronic illnesses. These findings highlight the need for robust health facilities and support systems for women and the elderly population.

BACKGROUND: Low-and middle-income countries face a double burden of malnutrition. However, comprehensive, population-based nutritional assessments are rare, particularly across all age groups. This study aimed to assess the prevalence of malnutrition across different age groups in Addis Ababa Health and Demographic Surveillance Site (Addis-HDSS), Addis Ababa, Ethiopia. METHODS: A community-based cross-sectional survey was conducted from December 2022 to January 2023 in Addis Ababa, involving residents of the Addis-HDSS sites. Mid- upper arm circumference (MUAC) was used to assess nutritional status for individuals aged 6 months to 64 years. Descriptive statistics were analyzed using STATA version 14, employing previously published age-specific cutoff points to define underweight, overweight, and obesity. RESULTS: A total of 37,364 individuals aged 6 months to 64 years participated. Among children aged 6-59 months, 4.2% had moderate acute malnutrition (95% CI: 3.7-4.9), and 3.0% had severe acute malnutrition (95% CI: 2.5-3.6). Overweight prevalence was 22.3% (95% CI: 20.3-24.3) in children aged 59 years, 25.9% (95% CI: 23.4-28.5) in adolescents aged 10-14 years, and 12.7% (95% CI: 11.5-14.0) in late adolescents aged 15-19 years. Among adults aged 20-64 years, 6.3% were underweight (95% CI: 6.0-6.6), 19.3% overweight (95% CI: 18.8-19.7%), and 21.5% obese (95% CI: 21.0-22.0). CONCLUSIONS: This study highlights a double burden of malnutrition in Addis Ababa, with overweight and obesity more prevalent than underweight, especially in adolescents and adults. It underscores the need for interventions targeting both undernutrition and overnutrition, emphasizing better diets and physical activity to curb nutrition-related diseases.

Background:Chronic non-communicable diseases (NCDs) are a global health challenge, causing millions of deaths annually and contributing significantly to the global disease burden. Despite their prevalence in low- and middle-income countries (LMICs), NCDs receive limited global health financing. Ethiopia, like other LMICs, is experiencing a rising burden of NCDs. This study aimed to assess the self-reported prevalence of chronic NCDs and identify associated sociodemographic factors. Methods:A population-based cross-sectional study was conducted at the Addis Health Demographic Surveillance System (Addis-HDSS) site in Addis Ababa, Ethiopia. All adults (≥18 years) living in the Addis-HDSS sites were included. Data were collected using a structured electronic questionnaire on self-reported NCDs and sociodemographic variables. Binomial regression model was used to identify sociodemographic factors associated with self-reported NCDs. Results:Overall, 11.5% (95% CI: 11.3%-11.7%) of adults reported at least one NCD. The most prevalent conditions were hypertension (5.9%; 95% CI: 5.7%-6.1%) and diabetes mellitus (3.4%; 95% CI: 3.3%-3.5%). Older age (Adjusted Incidence Rate Ratio (AIRR): 5.47; 95% CI: 5.17-5.79), no formal education (AIRR: 1.58; 95% CI: 1.45-1.72), being formerly married (AIRR: 2.68; 95% CI: 2.47-2.91), and higher wealth quintiles (AOR: 1.16; 95% CI: 1.07-1.26) were statistically significant risk factors associated with NCDs. Conclusion:This study highlights the high burden of chronic NCDs among adults in Addis Ababa. The findings highlight the importance of addressing NCDs as a significant public health challenge. Expanding access to early prevention, diagnosis, and care is critical in urban settings.

Background: Nutrition during pregnancy has lifelong impacts on the mother and fetus. In Ethiopia, nearly a third of pregnant women experience undernutrition. When designing nutrition interventions during pregnancy, it is important to understand existing dietary per-spectives and practices in local communities. Objectives: To explore the processes that shape dietary perspectives and practices during pregnancy in rural West Gojjam and South Gondar Zones of the Amhara region in Ethiopia. Methods: From October to November 2018, we conducted 40 in-depth interviews with pregnant women (n = 16), family members (n = 12), and healthcare providers (n = 12) using a semistructured interview guide. Interviews were conducted in Amharic, transcribed in Amharic, and translated into English. We used a thematic analysis approach to organize data per the predefined topic areas and identify emerging themes, as well as barriers and enablers to healthy nutrition during pregnancy. Results: Pregnant women and their family members recognized the benefits of a diversified diet to promote the health of the mother and the fetus. However, participants reported low dietary diversity because of limited access to nutritious foods and particular perspectives on food restrictions during pregnancy. The common practice of religious fasting also limited pregnant women's dietary intake. Women reported restricting their food intake in later pregnancy because of loss of appetite, as well as concerns about having a large infant, which might complicate delivery. Intake of locally made alcoholic drinks (Tella) was reported among pregnant women because participants thought it had low levels of alcohol that would not harm the fetus. Conclusions: Although participants understood the importance of a healthy and diverse diet in pregnancy, we identified several barriers and perspectives regarding nutrition during pregnancy. Low income and lack of access to diverse foods, particularly in certain seasons, religious fasting, intentional food restrictions to limit the size of the infant, and alcohol use were commonly reported. Locally appropriate counseling and interventions should be developed, with an emphasis on increasing access to and consumption of diverse foods.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

To assess community access to adequately iodized salt in rural Amhara, Ethiopia. We collected market and household salt samples from December 2020-January 2021 in West Gojam and South Gondar, Amhara, Ethiopia. A total of 24 salt samples were collected from markets randomly chosen in proximity to six rural health centers prior to the Enhancing Nutrition and Antenatal infection Treatment (ENAT study). 12 salt samples were unpackaged salt sold in open markets and 12 samples were packed samples procured from local shops. Household salt samples were also collected among mothers consecutively enrolled in the ENAT study over a one-month period at baseline. Quantitative assessment of iodine content was performed by iodometric titration at a central referral laboratory. In addition, a rapid qualitative salt assessment (MBI rapid test, Chennai, India) was done for 238 randomly selected households in walking proximity to the study health centers. The MBI test used rapid qualitative colorimetric methods, to test for adequacy of iodization (no color change: 0 ppm, light purple: <15 ppm, dark purple >15 ppm). The median iodine titration level for local market salt was 37.1 ppm (range: 14.3–116.4). Fifteen (62.5%) samples were at recommended levels (15–40 ppm), 8(33.3%) were >40 ppm and one sample <15 ppm. The median iodine titration test for household samples was 42.7 ppm (range: 10.1–89.8); with 19 (33.3%) samples at the recommended levels, 33(57.9%) >40 ppm, and 5(8.8%) of samples <15 ppm. On the other hand, among the community based, household-level samples (n = 238) tested by MBI rapid kits, 8(3.4%) had no iodization, 116 (48.7%) were inadequately iodized (<15 ppm), and 114(47.9%) were >15 ppm. There is heterogeneity in the level of iodization in salts available in the markets in Amhara, with the majority of samples were iodized >15 ppm; though almost 40% were above WHO recommended levels. At the household level, iodine content in nearly half of community-based samples were inadequate. Standardization of quality of market salt and optimal storage of iodized salt to prevent degradation at the household level are needed. Bill & Melinda Gates Foundation.