Total aflatoxins in complementary foods produced at community levels using locally available ingredients in Ethiopia

This study was conducted to determine the occurrence and levels of total aflatoxins in complementary foods (CFs) and their ingredients. A total of 126 samples collected from 20 Districts from Amhara, Tigray, Oromia, and Southern Nations Nationalities and Peoples (SNNP) regions were analysed for levels of total aflatoxins using enzyme linked immunosorbent assay (ELISA). Aflatoxins were detected in 62 out of 66 pre-milling samples with mean range of 0.3-9.9 mu g/kg. Aflatoxins were also detected in 19 out of 20 post-production CFs and in all of the one-month stored CFs at households and grain banks, with a mean range of 0.5-8.0, 3.6-11.3, and 0.2-12.4 mu g/kg, respectively. Overall, 3 out of 126 samples exceeded the maximum limit (10 mu g/kg). Although most aflatoxin levels were below the maximum limit and thus considered to be safe for consumption, more effort should be implemented to reduce contamination, as these CFs are intended for consumption by young children

The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial

Abstract Background Presumably bundling/co-packaging of zinc with ORS encourages the combined use of the products for diarrhea treatment; however, empirical evidences are scarce. The purpose of this work is to evaluate whether co-packing using a plastic pouch can enhance the joint adherence to the treatment or not. The study also compares the cost effectiveness (CE) of two co-packaging options: ‘central’ and ‘health center (HC)’ level bundling. Methods This cluster-randomised controlled trial was conducted in 2015 in eight districts of Ethiopia. Thirty two HCs were randomly assigned to one of the following four intervention arms: (i) ‘Central bundling’ (zinc and ORS bundled using a pouch that had instructional message, distributed to HCs); (ii) ‘HC level bundling’ (zinc, ORS and a similar pouch distributed to the HCs and bundled by health workers); (iii) ‘Bundling without message’ (zinc, ORS and plain pouch distributed and bundled by the health workers); and, (iv) ‘Status quo’ (zinc and ORS co-administered without bundling). In each of the four arms, 176 children 6–59 months of age, presented with acute diarrhea were enrolled. Twelve days after enrollment, level of adherence was assessed. A composite scale of adherence was developed and modeled using mixed effects linear regression analysis. The unit costs associated with the arms were estimated using secondary data sources. Incremental CE analysis was made by taking the cost and level of adherence in fourth arm as a base value. Results The follow-up rate was 95.6 %. As compared with the ‘status quo’ arm, the joint adherences in the ‘central’ and ‘HC level’ bundling arms raised substantially by 14.8 and 15.7 percentage points (PP), respectively (P < 0.05). No significant difference was observed between ‘bundling without message’ and the ‘status quo’ arms. The unit cost incurred by the ‘central bundling’ is relatively higher (USD 0.658/episode) as compared with the ‘HC level bundling’ approach (USD 0.608/episode). The incremental CE ratio in the ‘central bundling’ modality was two times higher than in the ‘HC based bundling’ approach. Conclusion Bundling zinc with ORS using a pouch with instructional messages increases adherence to the treatment. ‘HC level bundling’ is more CE than the ‘central bundling’ approach

Protein Quality of Amaranth Grains Cultivated in Ethiopia as Affected by Popping and Fermentation Complementary Food

Abstract The effect of popping and fermentation on protein quality of three different varieties of amaranth grains cultivated in Ethiopia was evaluated. Total lysine content of the grains was higher than that of commonly available cereals but close to that of legumes. Methionine and cysteine contents in the grains were also higher than that found in cereal and legume proteins. Percentage of total indispensable amino acids, excluding tryptophan, was 43% -49%, which was higher than WHO reference pattern (31%). Popping resulted in 36% and 37% reduction in total lysine and cysteine contents, respectively, whereas fermentation reduced cysteine, lysine and methionine contents by 16%, 20% and 20%, respectively. From the free amino acids, histidine was the major indispensable amino acid but threonine was not detected. During popping, all free amino acids, except threonine, were reduced. On the other hand, fermentation significantly increased (p &lt; 0.01) most amino acids except arginine, which was significantly decreased (p &lt; 0.01), and tyrosine and glutamic acid, for which no change was observed. Popping decreased in vitro protein digestibility (IVPD) by 8.3% -17.1% while fermentation increased IVPD by 4.8% -7.5%. Substitution of amaranth for wheat and/or maize during complementary food formulation could contribute much to the daily requirements of indispensable amino acids of young children

Assessment of aflatoxin exposure among young children in Ethiopia using urinary biomarkers

The direct measurement of biomarkers of exposure in biological fluids such as urine has become important for assessing aflatoxin exposure in humans as it is the only tool that integrates exposures from various routes. For this reason, a study was conducted to assess aflatoxin exposure among young children in Ethiopia using urinary biomarkers. A cross-sectional study was conducted in ten Woredas (Districts) from Amhara and Tigray regional states of Ethiopia including 200 children (aged 1-4years). A total of 200 urine samples were collected from 200 children and assessed for the levels of aflatoxin B-1 (AFB(1)), aflatoxin B-2 (AFB(2)), aflatoxin G(1) (AFG(1)), aflatoxin G(2) (AFG(2)) and aflatoxin M-1 (AFM(1)) using a validated LC-MS/MS method. Aflatoxins were detected in 34/200 (17%) of the urine samples whereby four out of five analysed aflatoxins were detected. AFM(1) was detected in 14/200 (7%) of the urine samples in a range of 0.06-0.07ng/mL. AFB(2), AFG(2) and AFG(1) were detected in respectively 9/200 (4.5%), 6/200 (3%) and 5/200 (2.5%) of the urine samples whereas AFB(1) was not detected in any of the samples. In this study, there was no association between the different malnutrition categories (stunted, wasting and underweight) and aflatoxin exposure. However, the biomarker analysis showed a clear exposure of young children to aflatoxins. Therefore, awareness to the public is important to prevent potential health consequences of aflatoxins

Assessment of caregiver’s knowledge, complementary feeding practices, and adequacy of nutrient intake from homemade foods for children of 6-23 months in food insecure woredas of Wolayita zone, Ethiopia

Complementary feeding should fill the gap in energy and nutrients between estimated daily needs and amount obtained from breastfeeding from 6 month onwards. Homemade complementary foods, however, are often reported for inadequacy in key nutrients despite reports of adequacy for energy and proteins. The aim of this study was to assess caregiver’s complementary feeding knowledge, feeding practices, and to evaluate adequacy daily intakes from homemade complementary foods for children of 6 – 23 months in food insecure woredas of Wolayita zone, Ethiopia.A cross sectional study assessing mothers/caregiver’s knowledge and complementary feeding practice, adequacy of daily energy and selected micronutrient intakes using weighed food record method. Multi-stage cluster sampling method was also used to select 68 households.Caregivers had good complementary feeding knowledge. Sixty (88.2%) children started complementary feeding at 6 months and 48 (70.6%) were fed 3 or more times per day. Daily energy intake however was significantly lower (P<0.05) than estimated daily needs, with only 151.25, 253.77 and 364.76 (kcal/day)for 6–8, 9–11 and 12–23 months, respectively. Similarly, Ca and Zn intakes (mg/day) were below the daily requirements (p=0.000), with value of 37.76, 0.96; 18.83, 1.21; 30.13, 1.96; for the 6-8, 9-11 and 12-23 months, respectively. Significant shortfall in daily intake of Fe (p=0.000) was observed among the 6-8 and 9-11months (3.25, 4.17mg/day, respectively), even accounting for high bioavailability.The complementary foods were energy dense. Daily energy, Ca, Zn and Fe (except 12 – 23 months) intake, however, was lower than estimated daily requirements

Gender differences in nutritional status and determinants among infants (6–11 m) : a cross-sectional study in two regions in Ethiopia

Background: A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia. Methods: We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815. Results: Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12). Conclusion: In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed

Additional file 3: of The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial

The code book for the dataset supporting the conclusions of the article. (XLSX 12 kb

Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling

Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.</p