Nutrition-specific and nutrition-sensitive factors associated with mid-upper arm circumference as a measure of nutritional status in pregnant Ethiopian women: Implications for programming in the first 1000 days

Mid-upper arm circumference (MUAC) is a widely used measure of nutritional status in pregnant women. In Ethiopia, a significant proportion of pregnant women have poor nutritional status, as indicated by low MUAC. This study aimed to assess the nutritional status of pregnant Ethiopian women using MUAC and examine the association with nutrition-specific and nutrition-sensitive factors. The study was conducted in three rural districts in the Oromia region of Ethiopia, where pregnant women were recruited as part of a longitudinal birth cohort study. The study population consisted of women between 12-32 weeks of gestation, and detailed household socio-demographics, agricultural production, women's health, morbidity, and diets were collected. The prevalence of low MUAC (< 23 cm) was found to be 41% in the study population. Wealth quintile was found to be associated with decreased risk of low MUAC, while trimester was associated with increased risk of low MUAC. Altitude-adjusted anemia was the only significant factor amenable to nutrition-specific interventions, which was associated with increased risk of low MUAC. Household food insecurity, distance to the clinic, and season of recruitment were significant factors amenable to nutrition-sensitive actions, which were associated with higher odds of low MUAC. Literacy and numeracy were also found to be significantly associated with lower odds of low MUAC. The study highlights the importance of addressing underlying determinants of fetal and child nutrition and development through multisectoral actions. Nutrition-specific interventions, such as improving maternal diets and access to healthcare during pregnancy, are essential for alleviating malnutrition. Nutrition-sensitive interventions, such as improving access to nutritious foods and education, are also crucial for enhancing the effectiveness of nutrition investments. The study's findings have implications for programming in the first 1000 days, a critical period for fetal and child development. The National Nutrition Program of the Government of Ethiopia has included a menu of nutrition-specific actions to improve the nutritional status of vulnerable populations. Nutrition-sensitive actions, such as improving access to safe drinking water, hand-washing, and sanitation practices, are also being implemented to affect nutrition-specific actions such as reduced infections and optimal dietary diversity. The study's findings suggest that a combination of nutrition-specific and nutrition-sensitive actions is necessary to improve the nutritional status of pregnant women in Ethiopia. The study's results have significant implications for the development of effective nutrition programs in Ethiopia. Understanding the factors associated with low MUAC in pregnant women will allow for better planning of multisectoral programs and better targeting and utilization of resources. The study's findings highlight the importance of addressing the underlying determinants of fetal and child nutrition and development through multisectoral actions.