Community knowledge, attitude and practices (KAP) on fluorosis and its mitigation in endemic areas of Ethiopia

Optimum fluoride intake plays an essential role in the prevention of dental caries while fluoride consumption above recommended level interferes with the normal formation of tooth enamel and bones and may increase risk of dental and skeletal fluorosis. The knowledge and practices of endemic communities on etiology of fluorosis will help in its mitigation and prevention. The objective of this study was to investigate the knowledge, attitude and practices of endemic community on fluoride contamination, fluorosis and prevention practices in order to devise coordinated and targeted prevention mechanisms. Focus group discussions (FGD) and key-informant interview were conducted in three dietary areas to collect knowledge, attitude and practices (KAP) of the endemic community in July 2013.The results indicated that health consequences of fluoride contaminated water are fairly understood. None of the discussants mentioned the word “fluoride”. The knowledge and perception of the community on fluoride ingestion is poor. Health extension workers (HEWs) did not teach about fluoride and related health consequences. Dental fluorosis was reported to start at early ages and not commonly perceived as a major problem. However, adolescents worried and felt that they might be singled out when going to other areas. Older people have a skeletal fluorosis, which interferes with their day to day activities. In severely affected people, the teeth were weak and fragile and thus create difficulty in chewing hard foods like unfermented dry flat bread, sugar cane and toasted grains. People prefer rain water rather than water from borehole because of the inconvenient taste of the latter. The endemic communities have no sufficient knowledge and skills on potential sources of fluoride intake, the debilitating effect of high fluoride ingestion, and preventive and mitigatory measures to reduce fluoride intake. The effect of fluoride contamination and mitigatory methods should get sufficient attention by the community, health workers and concerned governmental bodies. The trend of harvesting and using rain water should be encouraged as it reduces fluoride intake. Future studies should focus on information communication on possible fluoride risks, intervention and evaluation studies on defluoridation, rain water harvesting and mitigatory techniques.Keywords: Fluoride, Contamination, Fluorosis, Mitigation, Endemic, Perception and Ethiopian Rift Valle

The effects of dual micronutrient supplementation on thyroid function in school children: An experimental study

Background: The presence of iron and or vitamin A deficiency in children limits the effectiveness of the iodine intervention program in areas where iodine deficiency is endemic. This study was aimed at assessing the role of dual micronutrient supplementation on thyroid function in severe iodine deficient school children age 6-16 years in Ethiopia.Methods: From 2006 to 2007 an experimental study was conducted on 397 children, all with visible goiter grade of which 6.1% and 10.3% vitamin A and iron deficient respectively. A week after baseline data collection and de-worming, all children with visible goitre (n=332) but without iron and vitamin A deficiency were randomly grouped into four, A to D groups. Vitamin A deficient children (n=24) were randomly allocated to group A and group B while anaemic children (n=41) were distributed into group C and group D. Group A received 400mg oral iodized oil and group B received 200,000IU vitamin A plus 400mg oral iodized oil. Group C received 400mg oral iodized oil while group D received 100mg iron sulphate with folic acid and 400 mg oral iodized oil. Iron supplementation was continued two doses per day for six weeks. Vitamin A supplemented group received additional dose at six month. Post intervention data on iodine, vitamin A and iron status were collected at 6 and 11 month.Results: Children supplemented with iron + oral iodized oil capsule had significant goitre reduction than oral iodized oil supplemented group. The mean concentrations of thyroid hormone (T4) and Urinary iodine excretion (UIE) in iron + iodine supplemented group were significantly higher than the iodine alone supplemented group at 6 months after the intervention. Hemoglobin level at baseline in all study subjects and at 11 month after intervention in group D (iron + iodine supplemented group) significantly (P<0.05) correlated with T4 level. The significant goitre reduction in iron + iodine supplemented group than iodine alone supplemented group and significant correlation between level hemoglobin and T4 at baseline and at 11 month after intervention probably indicate that iron and iodine have a functional interaction in thyroid iodine metabolism.Conclusion: Supplementation of iodized oil with Iron is more effective in goitre reduction than iodine alone and this should be taken into consideration by iodine deficiency disorders (IDD) intervention programs

Iodine Deficiency Disorders (IDD) in Burie and Womberma Districts, West Gojjam, Ethiopia

Iodine deficiency disorders (IDD) affect millions of people in developing countries mainly due to dietary iodine deficiency and aggravating factors that affect the bioavailability of iodine in the body. Iodine deficiency disorder is one of the public health problems of Ethiopia. Recent findings show that both endemic and non-endemic areas have high goiter rates. Burie and Womberma districts are two of the endemic goiter areas in the country. The etiology of goiter in these areas is not fully studied so far. The objective of this cross-sectional community based study was to assess the magnitude and causes of goiter. The study was conducted in July 2010. The sample size was determined by assuming 50% prevalence of total goiter rate, 5% error, 95% confidence interval, design effect of 1(random) and 5% of non-response rate. A two-stagerandom sampling (sub-district and village) was used to select children aged 6-12 years and their  biological mothers from10 randomly selected villages in each of the districts. Overall, 403 households participated in the study. The  assessment was conducted using palpation of thyroid size, urinary iodine level determination, household level interview and Focus Group Discussion (FGD). The study revealed a total goiter prevalence rate of 54% and 30.1% in children and their biological mothers, respectively. More than 64% of the children were severely iodine deficient. The major cause for goiter as revealed by urinary iodine level and concentration of iodized salt is dietary iodine deficiency. There are no goitrogenic foods such as cassava; however, goitrogenic chemicals such as Dichlorodiphenyltrichloroethane (DDT) and 2,4-Dichlorophenoxyacetic acid (2,4-D) were widely used. The study areas are known for surplus produce of cereals, legumes and chilli. In order to reverse the problem, immediate and sustainable distribution of iodated salt/oil capsule, prohibition of direct application of pesticides on foods and awareness creation on adverse effects of IDD and benefits of iodine nutrition is highly recommended.Key words: Goiter, Goitrogenic factors, Pesticides, Gojja

Iodine deficiency in primary school children and knowledge of iodine deficiency and iodized salt among caretakers in Hawassa Town: Southern Ethiopia

Background: More than two billion individuals worldwide have inadequate iodine intake and the adverse consequences of iodine deficiency are widely observed.Objective: To assess the iodine status of primary school children and the knowledge of iodine deficiency disorders among their caretakers.Methods: A cross-sectional study was conducted in Hawassa Town, Southern Ethiopia. The study participants were school children (n=116) aged 7-9 years. A two-stage sampling method was used to select participants. Goiter and urinary iodine concentration were measured in the children to evaluate their iodine status. Socioeconomic characteristics, dietary patterns and caretaker knowledge of iodine deficiency were assessed by using questionnaires. Household salt iodine concentration was also measured.Results: Total goiter rate was 13.6% and was significantly associated with age [AOR=13.4 (3.2-55.7)]. Eighty two percent of the children had urinary iodine concentration below 50 ìg/L, indicating the presence of moderate iodine deficiency. None of the households were using adequately iodized salt. More than half of the respondents did notknow about the importance of iodized salt. Conclusion: The observed degree of iodine deficiency in children and the limited knowledge about iodine in an urban area such as Hawassa stress the urgent need for implementing interventions to combat iodine deficiency. [Ethiop. J. Health Dev. 2012;26(1):30-35

COMMUNITY KNOWLEDGE, ATTITUDE AND PRACTICES (KAP) ON FLUOROSIS AND ITS MITIGATION IN ENDEMIC AREAS OF ETHIOPIA

ABSTRACT Optimum fluoride intake plays an essential role in the prevention of dental caries while fluoride consumption above recommended level interferes with the normal formation of tooth enamel and bones and may increase risk of dental and skeletal fluorosis. The knowledge and practices of endemic communities on etiology of fluorosis will help in its mitigation and prevention. The objective of this study was to investigate the knowledge, attitude and practices of endemic community on fluoride contamination, fluorosis and prevention practices in order to devise coordinated and targeted prevention mechanisms. Focus group discussions (FGD) and key-informant interview were conducted in three dietary areas to collect knowledge, attitude and practices (KAP) of the endemic community in July 2013.The results indicated that health consequences of fluoride contaminated water are fairly understood. None of the discussants mentioned the word "fluoride". The knowledge and perception of the community on fluoride ingestion is poor. Health extension workers (HEWs) did not teach about fluoride and related health consequences. Dental fluorosis was reported to start at early ages and not commonly perceived as a major problem. However, adolescents worried and felt that they might be singled out when going to other areas. Older people have a skeletal fluorosis, which interferes with their day to day activities. In severely affected people, the teeth were weak and fragile and thus create difficulty in chewing hard foods like unfermented dry flat bread, sugar cane and toasted grains. People prefer rain water rather than water from borehole because of the inconvenient taste of the latter. The endemic communities have no sufficient knowledge and skills on potential sources of fluoride intake, the debilitating effect of high fluoride ingestion, and preventive and mitigatory measures to reduce fluoride intake. The effect of fluoride contamination and mitigatory methods should get sufficient attention by the community, health workers and concerned governmental bodies. The trend of harvesting and using rain water should be encouraged as it reduces fluoride intake. Future studies should focus on information communication on possible fluoride risks, intervention and evaluation studies on defluoridation, rain water harvesting and mitigatory techniques

The goitre rate, its association with reproductive failure, and the knowledge of iodine deficiency disorders (IDD) among women in Ethiopia: Cross-section community based study

<p>Abstract</p> <p>Background</p> <p>Iodine deficiency is severe public health problem in Ethiopia. Although urinary iodine excretion level (UIE) is a better indicator for IDD the goitre rate is commonly used to mark the public health significance. The range of ill effect of IDD is however beyond goitre in Ethiopia. In this study the prevalence of goitre and its association with reproductive failure, and the knowledge of women on Iodine Deficiency were investigated.</p> <p>Methods</p> <p>A cross-section community based study was conducted during February to May 2005 in 10998 women in child bearing age of 15 to 49 years. To assess the state of iodine deficiency in Ethiopia, a multistage "Proportional to Population Size" (PPS) sampling methods was used, and WHO/UNICEF/ICCIDD recommended method for goitre classification.</p> <p>Results</p> <p>Total goitre prevalence (weighted) was 35.8% (95% CI 34.5–37.1), 24.3% palpable and 11.5% visible goitre. This demonstrates that more than 6 million women were affected by goitre.</p> <p>Goitre prevalence in four regional states namely Southern Nation Nationalities and People (SNNP), Oromia, Bebshandul-Gumuz and Tigray was greater than 30%, an indication of severe iodine deficiency. In the rest of the regions except Gambella, the IDD situation was mild to moderate. According to WHO/UNICEF/ICCIDD this is a lucid indication that IDD is a major public health problem in Ethiopia. Women with goitre experience more pregnancy failure (X²= 16.5, p < 0.001; OR = 1.26, 1.12 < OR < 1.41) than non goitrous women. Similarly reproductive failure in high goitre endemic areas was significantly higher (X²= 67.52; p < 0.001) than in low. More than 90% of child bearing age women didn't know the cause of iodine deficiency and the importance of iodated salt.</p> <p>Conclusion</p> <p>Ethiopia is at risk of iodine deficiency disorders. The findings presented in this report emphasis on a sustainable iodine intervention program targeted at population particularly reproductive age women. Nutrition education along with Universal Salt Iodization program and iodized oil capsule distribution in some peripheries where iodine deficiency is severe is urgently required.</p

Post-harvest management and associated food losses and by-products of cassava in southern Ethiopia

Improved (high yield and disease resistant) cassava varieties were introduced into Ethiopia around the onset of the twenty-first century, as a potential food security crop. At present, limited information is available from the country on post-production aspects of the value chain (VC) and related food losses. The lack of such data prevents policymakers and VC actors from taking steps towards improving VC efficiencies, which can have a significant impact on livelihoods and food security. The focus of this study was to examine the prevailing post-harvest practices in the cassava VC in southern Ethiopia and quantify the extent of food losses and associated by-products in the framework of the recently developed ‘food loss and waste protocol’. The majority of the cassava in the study area was processed into dry chips and milled into a composite flour with teff and maize to prepare the staple bread (injera). ‘Critical loss points’ were during sun-drying (4%) and stockpiling at farm and marketplace (30–50%). Insect pest damage was primarily responsible for food losses at farm and market level. The most important insect species infesting dry cassava were identified during the survey. As far as the by-products were concerned, the ratio of leaf:wood (stem and stump):starchy root on a dry matter basis at harvest was 1:6:10. Further emphasis should be on improving processing and storage technologies to reduce food losses and the better recovery and utilisation of by-products, especially the leaves of cassava, which could be a potential source of protein in human diets

Familial tendency and dietary association of goitre in Gamo-Gofa, Ethiopia

Objective: To assess the familial tendency and dietary association of goitre.Design: Ciaectional study with descripEve and analytical components.Setting: Goma-Gofa, south Ethiopia.Subjects: Five hundred and ninety seven elementary school children aged 6-18 years and their biological parents.Results: Prevalence of goitre was found to be 51.7% of which 21.7% was visible goitre. The mean urinary iodine extraction levels indicated adequate dietary intake of iodine by the study group. A significant association (p&lt;0.001) was established for familial tendency of goitre between parents and their children. Consumption of Iurlleko (Moringa stenopetala), a leafy vegetable common in the study area, of more than two times per day was signifkantly (p&lt;0.005) associated with causation of goitre.Conclusion: These results strongly suggest that goitre prevalence in Gamo-Gofa, Ethiopia is due to familial tendency as well as dietary factors