Co-Coverage of Essential Interventions Across the Health System Continuum of Care for Improving Child Nutrition in Ethiopia.

Abstract

This study aimed to assess the coverage of essential nutrition interventions delivered through the health system and explored the relationship between co-coverage and child- and maternal-level factors, household-level factors, and access to healthcare facilities. We used data from the Ethiopia Food and Nutrition Strategy Baseline Survey, a population-based cross-sectional study conducted between July 2021 and October 2022. The survey was conducted in 10 regions and 2 city administrations of Ethiopia. A total of 7931 women of reproductive age (15-49 years) and children aged 0-59 months (mother-child pairs) were included. We assessed coverage for 16 essential nutrition and health interventions. Our findings show that the coverage of essential nutrition interventions is suboptimal. Notably, interventions delivered during pregnancy and in early infancy had the highest coverage compared to those provided in late childhood. We identified missed opportunities to deliver of nutrition interventions in the corresponding health platforms. Despite 41% of women reporting having four or more antenatal care visits during their last pregnancy, only 17% took 90 or more iron/folic acid tablets. We also found pro-rich and pro-urban inequalities in access for almost all interventions. Among children eligible to receive all 16 interventions (12-59 months), 8% had zero exposure to interventions. Child age, household wealth, maternal education, place of residence, and walking time to the nearest health facility were significantly associated with co-coverage. The observed low coverage, coupled with existing inequities and identified opportunity gaps in intervention delivery, emphasizes the need to better leverage the health system to reduce undernutrition.