Prevalence and Factors Associated with Undernutrition among Exclusively Breastfeeding Women in Arba Minch Zuria District, Southern Ethiopia: A Cross-sectional Community-Based Study

BACKGROUND: In developing countries, women are generally vulnerable to undernutrition especially during lactation because of inadequate nutrient intake. The purpose of this study was to assess the prevalence of underweight, associated factors and mean dietary intake of selected nutrients among lactating women in Arba Minch Zuriya districts, Gamo Gofa, EthiopiaMETHODS: Multistage cluster sampling technique was used to select 478 exclusively breastfeeding women. Data was collected by using structured questionnaire, and weight and height measurements. Mean intake of calories, calcium, iron, zinc and vitamin A was assessed by using 24-hour recall method on subsample of 73 subjects and compared against the Ethiopian and African food composition tables. Logistic regression analysis was used to evaluate the association between various independent variables and maternal underweight.RESULTS: The prevalence of underweight was 17.4%. Maternal underweight significantly associated with short birth to pregnancy interval, high workload burden, household food insecurity, less access to nutrition information and low level of women educational status.CONCLUSIONS: A significant proportion of women suffered from undernutrition and the mean intake of calories, calcium and zinc were below the recommended level for lactating women. Hence, to improve nutritional status of lactating women, strategies should focus on nutrition counseling, improvement in women’s access to labour saving technologies and effective household food security interventions.

Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross- sectional study

Background: Inadequate nutrition during the first two years of life may lead to childhood morbidity and mortality, as well as inadequate brain development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer sufficient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. Therefore this study aimed to identify the factors associated with nutritional status of infants and young children (6-23 months) in Filtu town, Somali Region, Ethiopia.Methods: A cross-sectional community-based study was conducted. Simple random sampling was employed to select 214 infants for the study. Univariable and multivariable logistic regressions models were used in the statistical analysis. The strength of association was measured by odds ratios with 95 % confidence intervals. Both the crude (COR) and adjusted odds ratios (AOR) are reported.Results: The prevalence of wasting, stunting and underweight among infants and young children were 17.5 % (95 % CI: 12.91-23.22), 22.9 % (95 % CI: 17.6-28.9) and 19.5 % (95 % CI: 14.58-25.3) respectively. The multivariable logistic regression model showed that breastfeeding was independently associated with reduced odds of wasting (AOR = 0.38(95 % CI: 0.14-0.99)). Diarrhea in the past 15 days (AOR = 2.13 (95 % CI: 1.55-4.69)) was also associated with increased odds for wasting. The independent predictors of reduced odds for stunting were dietary diversity score ≥4 (AOR = 0.45(95 % CI: 0.21-0.95)) and introduction of complementary feeding at 6 months (AOR = 0.25 (95 % CI: 0.09-0.66)). Bottle feeding was associated with increased odds of stunting (AOR = 3.83 (95 % CI: 1.69-8.67)). Breastfeeding was associated with reduced odds of underweight (AOR = 0.24 (95 % CI: 0.1-0.59)), while diarrheal disease in the past 15 days was associated with increased odds of underweight (AOR = 3.54 (95 % CI: 1.17-7.72)).Conclusion: Under nutrition is a public health problem among infants and young children in Filtu town, Somali region Ethiopia. Breastfeeding was associated with lower odds of wasting and underweight while diarrheal disease was associated with higher odds of wasting and underweight. Low dietary diversity scores, inappropriate age of complementary feeding initiation and bottle feeding were identified to be significant predictors of stunting. Those factors should be considered for any intervention aimed to reduce under nutrition among infants and young children in Filitu town, Somali region, Ethiopia.Peer reviewedNutritional Science

Multi-mycotoxin profiling in maize reveals prevalence of Fusarium mycotoxins in South and West Ethiopia

Multi-mycotoxin exposure data are missing to guide risk assessment and legislation in Ethiopia. This study therefore aimed to determine mycotoxin contamination levels in maize samples from 176 randomly selected household storages in three agro ecological zones of South (Sidama zone) and West (Jimma zone) Ethiopia, and to examine the post-harvest practices and household processing. Liquid chromatography coupled to tandem mass spectrometry was used to quantify 23 mycotoxins. The majority of the households regularly consumed maize (more than once per day). More (77%) samples in Sidama were contaminated with Fusarium mycotoxins deoxynivalenol than in Jimma (29%) (P0.05). In Sidama, only one sample was contaminated with the Aspergillus mycotoxin aflatoxin B2 and another sample with aflatoxin B1. From all samples, 40% were contaminated with 3-5 types of Fusarium mycotoxins and only 4% of the samples were contaminated with 6-8 types of mycotoxins. After the harvested maize was dried on the field, the majority of respondents in Jimma reported that they removed the maize within one day, which was less practiced in Sidama. The majority of households in Sidama, and some in Jimma, reported that they dried maize before storage, mainly using the sun. Close to two third of the study participants in the two zones reported that they applied the chemical dichloro-diphenyl-trichloroethane (DDT) during maize storage. All households in both zones reported that they sorted visible mouldy maize grains before preparation of maize flour while most of them kept the mouldy maize for animal feed. Protective strategies of Fusarium mycotoxin contamination, with special focus on deoxynivalenol and zearalenone, should be well promoted in the study areas as they are possible human and animal health threats

Multi-mycotoxin profiling in maize reveals prevalence of Fusarium

Multi-mycotoxin exposure data are missing to guide risk assessment and legislation in Ethiopia. This study therefore aimed to determine mycotoxin contamination levels in maize samples from 176 randomly selected household storages in three agro ecological zones of South (Sidama zone) and West (Jimma zone) Ethiopia, and to examine the post-harvest practices and household processing. Liquid chromatography coupled to tandem mass spectrometry was used to quantify 23 mycotoxins. The majority of the households regularly consumed maize (more than once per day). More (77%) samples in Sidama were contaminated with Fusarium mycotoxins deoxynivalenol than in Jimma (29%) (P0.05). In Sidama, only one sample was contaminated with the Aspergillus mycotoxin aflatoxin B-2 and another sample with aflatoxin B-1. From all samples, 40% were contaminated with 3-5 types of Fusarium mycotoxins and only 4% of the samples were contaminated with 6-8 types of mycotoxins. After the harvested maize was dried on the field, the majority of respondents in Jimma reported that they removed the maize within one day, which was less practiced in Sidama. The majority of households in Sidama, and some in Jimma, reported that they dried maize before storage, mainly using the sun. Close to two third of the study participants in the two zones reported that they applied the chemical dichloro-diphenyl-trichloroethane (DDT) during maize storage. All households in both zones reported that they sorted visible mouldy maize grains before preparation of maize flour while most of them kept the mouldy maize for animal feed. Protective strategies of Fusarium mycotoxin contamination, with special focus on deoxynivalenol and zearalenone, should be well promoted in the study areas as they are possible human and animal health threats

Dietary mycotoxins exposure and child growth, immune system, morbidity, and mortality : a systematic literature review

The aim of this study was to systematically review associations between dietary mycotoxins exposure and child growth and morbidity of children aged 5 years or younger. Peer-reviewed literature was searched in MEDLINE, EMBASE, COCHRANE, CINAHL, Web of Science, and PsycINFO. Experimental and observational studies were considered. The exposures were dietary mycotoxins during pregnancy, lactation and childhood, and mycotoxins concentrations in the diet, breast milk, urine, and blood. From a total of 4869 references, 86 full-text papers were extracted of which 50 were included in this review. The methodological quality and risk of bias were evaluated and quality of the collective evidence was assessed using GRADE. Uncertainty remains whether mycotoxins exposure affects child growth, immunity and mortality and the overall quality of the evidence is very low. Overall however, we cannot rule out a possible association between dietary mycotoxins, in particular, AF and FUM and child malnutrition. Our analyses were limited by the reporting quality, difference in findings, heterogeneity of outcomes, mycotoxins detection methods, and the observational nature of most studies. Robust study designs with adequate sample size, use of validated biomarkers of exposure and assessment of co-occurrence of mycotoxins and their synergistic effects are required to provide the further evidence regarding a potential effect of dietary mycotoxins exposure on child growth and immunity

Mycotoxins exposure of lactating women and its relationship with dietary and pre/post-harvest practices in rural Ethiopia

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future

Essential descriptors for mycotoxin contamination data in food and feed

Mycotoxin food contamination data is scattered, isolated, and poorly described. Reporting mycotoxin contamination data in a standardized manner is essential for collaborative research and integrated large-scale data analysis. The present study aimed to complement the existing European Food Safety Authority (EFSA) and Global Environment Monitoring System (GEMS) mycotoxin contamination data descriptors for application in low- and middle-income countries in particular. A three-round Delphi process was followed to establish a consensus on the missing descriptors. An invitation letter was first sent to 34 mycotoxin experts of an international collaboration of MYTOX-SOUTH®, of which 12 finally participated in the study. The response rate was 29.4% (10/34) in the Delphi I, 75% (9/12) in the Delphi II, and 83.3% (10/12) in the Delphi III rounds. The majority of the Delphi study participants were professors from 6 universities. Twenty-two descriptors (17 study level, 1 sample level, and 4 assay level) were proposed and were mainly related to pre and post-harvest periods of a food/feed sample. The pre-defined (>70% in the Delphi II and > 80% in the Delphi III) agreement among participants was achieved for all the proposed descriptors. The existing descriptors from EFSA (33) and GEMS (25) with the new proposed MYTOX-SOUTH® (22) descriptors, in total 80 descriptors, were arranged as study, sample, and assay categories and organized as a data submission template. Pre-testing of the template on three mycotoxin researchers indicated that the average time to fill out the form for a sample was 42 min. The current format helps mycotoxin contamination data to become more informative, reusable, and applicable especially to data from low- and middle-income countries. The above-proposed descriptors will help GEMS to provide technical cooperation with countries wishing to initiate and strengthen food contaminant monitoring programs. Similarly, the descriptors from the current study will be useful for EFSA as it regularly updates the Standard Sample Description. A standardized global reporting format for mycotoxin contamination data will enable national authorities to perform mycotoxins exposure and risk assessments and share data for international benchmarking. Standardized reporting and sharing of mycotoxin contamination data should be further advocated in ongoing research and become common practice in authorities, companies, academia, and other entities working on mycotoxin in food and feed