To improve the health outcomes of its citizens, Ethiopia must take steps to meet SDG3.4 and decrease the number of premature deaths caused by non-communicable diseases (NCDs). NCD deaths are preventable by tackling their risk factors: unhealthy diets, physical inactivity, and air pollution. These risk factors are becoming increasingly prevalent in urban sites and have their origins in fetal life, and focusing prevention policies on pregnancy can yield significant benefits. Pregnancy is a unique opportunity for lifestyle interventions and antenatal care (ANC) has long been a key strategy for health promotion, disease prevention, early diagnosis, and treatment. The high ANC coverage in urban Ethiopia makes it an ideal program to support access and utilization of quality NCD services for prevention and risk reduction in urban populations. Guided by the immediate need for high-quality implementation research and evaluations in real-word settings to tackle the multisectoral and complex challenges of NCD prevention, we will fill the implementation knowledge gaps by developing, implementing, and assessing the impact of a novel prevention program in four diverse urban sites. We will apply user-centered approaches to adapt effective evidence-based WHO guidelines and implementation strategies with beneficiaries and stakeholders. Our approach for achieving behavior change in pregnant women is twofold: i) thorough assessments of women’s environments and environmental risks, as wider determinants of health; ii) integration of implementation strategies into the National Health Information system of Ethiopia. We will provide real-word evidence for the impact of implementation for behavior change, NCD risk reduction and better maternal and child health. ENABLE will support care providers for continuity and quality of overall healthcare and of NCD care and surveillance, and ultimately strengthen the Ethiopian public health system towards better health for all.

Noncommunicable diseases (NCDs) are a major public health problem, resulting in over 70% of global deaths each year; the majority (85%) of deaths occur in low-and middle-income countries. While cost-effective, evidence-based best practices are available, implementation of these interventions has remained a critical challenge, particularly ones targeted at promoting health behaviors among adolescents and youth. Despite the importance, few studies have been undertaken to identify the facilitators and barriers to the implementation of evidence-based interventions that promote healthy behaviors among adolescents and youth in sub-Saharan Africa (SSA). "Reducing nutrition-related noncommunicable diseases in adolescence and youth: From nutrition literacy to fluency" will take a major step towards improving the implementation of evidence-based interventions – nutrition education and SSB policy - that promote healthy behaviors among adolescents and youth in SSA to reduce the impact of NCDs. With the use of a multi-disciplinary approach, innovative design, and cutting-edge tools, the proposed project aims to establish a global alliance to prevent and reduce nutrition-related NCDs among adolescence and youth in SSA region, by shaping individuals’ health behaviors through nutrition literacy and fluency, assessing the impact and performance of the nutrition-related policy and promotion programs, and providing flexible, cost-effective, scalable, reliable, secure and easy-to-use tools. The establishment of an Africa Think Tank for Adolescents and Youth Health, and annual forums will help facilitate continuous engagement with key stakeholders to enhance buy-in, acceptance and relevance of the project outputs. Ultimately, the expected wider effects of this project include improved NCD prevention policy adoption and implementation, improved policies and evidence-informed decision making amongst key stakeholders, and ultimately decreased avoidable mortality due to NCDs.