Micronutrient deficiencies in Ethiopia and their inter-relationships

A nationwide study on the prevalence of xerophthalmia was carried out in 6,636 children aged 6 months to 6 years in all the Regions of Ethiopia except Eritrea and Tigrai which were excluded for security reasons. Bitot's spots were observed in 1.0% of all children with higher prevalence in the pastoral (1.6%) and cropping (1.1%) agro-ecological zones than in the cash- crop (0.4%) and ensete ('false banana', Ensete ventricosum (Welw.) Cheesman) (0.0%) zones. Conjunctival xerosis and Bitot's spots were twice as common in boys than in girls and this was seen in all age groups. One case of corneal xerosis and two cases of corneal scar (0.03%) were also found. Serum retinol levels were deficient (It is estimated that there are three quarters of a million blind persons in Ethiopia. Results of a study of the 721 pupils in the six schools for the blind showed that 70% of the blindness was due to corneal opacity or shrinkage of the eye ball. Measles was implicated as a cause of blindness in 40% of the children while a further 13% regarded "mitch" as the predisposing factor. Mitch is an Amharic term used to describe a wide range of vague illness with fever and measles possibly comprising a large proportion of these cases.A nationwide study on 35,635 school children and 19,158 household members showed that the prevalence of gross goitre was 30.6% and 18.7% respectively while that of visible goitre was 1.6% and 3.2% respectively. Prevalence was significantly higher in females than in males and increased with age more in females than in males. Prevalence increased with increasing altitude. Based on an epidemiological model, the numbers of people suffering from various iodine deficiency disorders have been estimated.In Melkaye village of Hararge Region, a high prevalence of symptoms of vitamin A deficiency were found in 240 children examined: night blindness, 28.7%; Bitot's spots 6.7%; corneal xerosis 0.83%; corneal ulceration/keratornalacia 6.3%; and corneal scars 5.8%. Of the children studied, 30.2% had deficient serum retinol levels (In a study of 14,740 children in Shoa Region of Central Ethiopia, goitre, xerophthalmia (Bitot's spots) and clinical anaemia were observed in 34.2%, 0.91% and 18.6% respectively of the children. Based on a sample of 344 children, the median of most biochemical parameters was within the normal range except for haemoglobin, mean corpuscular haemoglobin concentration (MCHC) and urinary iodine excretion where the median was lower, and mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and immunoglobulins G and M where it was higher. Many significant correlations were observed and these were used as the basis for the formulation of hypothethes. The anaemia found was not nutritional in origin but due to the effect of infestation with intestinal parasites and malaria.The effect of vitamin A supplementation on the treatment of goitre with iodized oil was assessed in a series of studies in Shoa Region. Iodized oil supplementation significantly reduced goitre size in those who had grade IB goitre (observable when neck extended). After 4 and 7/8 weeks post-treatment, concentrations of thyroxin and that of urinary iodine excretion increased significantly, while those of total triiodothyronine and thyrotropin decreased significantly. Vitamin A supplementation increased serum levels of retinol and retinol-binding protein at weeks 4 and 7/8 but had no effect on goitre size or parameters of iodine metabolism.In a similar study on anaemia, supplementation with iron and folic acid significantly increased levels of haemoglobin, haematocrit, red blood cell count, serum iron, transferrin saturation, ferritin and mean corpuscular haemoglobin concentration and significantly decreased levels of total iron binding capacity and transferrin at 4 and 7/8 weeks posttreatment. Only the increase in red blood cell count and decrease in mean corpuscular volume were significantly greater in those supplemented with vitamin A than those who were not supplemented.In the Gurage area in Central Ethiopia, cultivation, harvesting, yield and processing of ensete were studied in 60 households in six villages. Ensete was propagated vegetatively and has a six-year growing cycle in which it was transplanted three or four times. The yield of ensete food ("ko'cho") was 9.5 tons/yr/ha (6.1 MJ/m 2/yr). Except for cassava, the energy yield of ensete was higher than that from all other crops grown in Ethiopia while the protein yield (11.4 g/m 2/yr) was higher than that of all crops except banana and Irish potato although the protein density is very low (12 g/kg). The pseudostem and corm provide a starchy pulp which is fermented and can be stored for up to 5-7 years in an earthen pit. It can then be prepared for consumption in a variety of ways which have been studied in detail. The mean intake of ensete was 0.55 kg/day and provided 68% of total energy intake, 20% of protein, 28% of iron but no vitamin A. Energy intake from all food consumed was extremely low in Gurage, being only 60% of requirements

Nutritional blindness in Tigrai Region, northern Ethiopia

Abstract: A cross-sectional study was conducted in October, 1993 to determine the prevalence of vitamin A deficiency in Agebe Woreda in Tigrai `Kellel' (Region) of Ethiopia. A total of 678 children aged between 6 months and 6 years were examined for signs of xerophthalmia. In 7.8% of the children a history of night blindness (XN) was reported. Bitot's spots were seen in 3.4% of the children with a higher prevalence rate in males than in females (P<0.01). Anthropometric measurements were made on 662 of the children. There was a higher prevalence of stunting (42.6%) than wasting (8.0%) with an additional 11.3% of the children being both stunted and wasted. No association was observed between morbidity and occurrence of sign of xerophthalmia. The woreda is a mono-crop area and has been affected by recurrent drought. On the basis of the cut-off points set by WHO and the International Vitamin A Consultative Group, the problem of vitamin A deficiency in the Woreda is of public health significance. Urgent and continued intervention programmes (mainly supplementation with mega-dose of vitamin A and food diversification through intensive health education as well as horticultural development) are highly recommended. [Ethiop. J. Health Dev. 1997;11(2):157-162

Urinary iodine excretion in relation to goiter prevalence in households of goiter endemic and nonendemic regions of Ethiopia

Abstract: A base line survey of goitre prevalence, among population of five endemic and four nonedemic regions of Ethiopia was carried out prior to the distribution of iodated salt. Urine samples were collected from 327 subjects selected by systematic random sampling from endemic and 276 subjects in sites taken as nonendemic. The lowest mean urinary iodine excretion (UIE) value was recorded in Bure (22 jJgi/day) and the highest in Alemmaya ( 148 jJgi/day). The highest total giotre rate (% TGR) was recorded in Sawla (55.6%) and the lowest (0.6%) in Yabello. Iodine content of drinking water was in the range 0. 0.4- 48.5 jJgi. Iodine content of water source was correlated positively (r = 0.8399) with the mean UIE in all study sites. The relationship between UIE and TGR, however, indicates that sites considered as nonendemic seem to be affected by iodine deficiency. The present study results urge the need for intervention in controling Iodine deficiency disorders (IDD). [Ethiop. J. Health Dev.1995;9(2):111-116

Effect of concurrent vitamin A and iodine deficiencies on the thyroid-pituitary axis in rats

OBJECTIVE: Deficiencies of vitamin A and iodine are common in many developing countries. Vitamin A deficiency (VAD) may adversely affect thyroid metabolism. The study aim was to investigate the effects of concurrent vitamin A and iodine deficiencies on the thyroid-pituitary axis in rats. DESIGN: Weanling rats (n = 56) were fed diets deficient in vitamin A (VAD group), iodine (ID group), vitamin A and iodine (VAD + ID group), or sufficient in both vitamin A and iodine (control) for 30 days in a pair-fed design. Serum retinol (SR), thyroid hormones (FT(4), TT(4), FT(3), and TT(3)), serum thyrotropin (TSH), pituitary TSHbeta mRNA expression levels, and thyroid weights were determined at the end of the depletion period. MAIN OUTCOME: Compared to the control and ID groups, SR concentrations were about 35% lower in the VAD and VAD + ID groups (p < 0.001), indicating moderate VA deficiency. Comparing the VAD and control groups, there were no significant differences in TSH, TSHbeta mRNA, thyroid weight, or thyroid hormone levels. Compared to the control group, serum TSH, TSHbeta mRNA, and thyroid weight were higher (p < 0.05), and FT4 and TT4 were lower (p < 0.001), in the VAD + ID and ID groups. Compared to the ID group, TSH, TSHbeta mRNA, and thyroid weight were higher (p < 0.01) and FT(4) and TT(4) were lower (p < 0.001) in the VAD + ID group. There were no significant differences in TT3 or FT3 concentrations among groups. CONCLUSION: Moderate VAD alone has no measurable effect on the pituitary-thyroid axis. Concurrent ID and VAD produce more severe primary hypothyroidism than ID alone

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

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia.

INTRODUCTION: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses. METHODS: We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses. RESULTS: There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services. CONCLUSION: We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period. TRIAL REGISTRATION NUMBER: ISRCTN12040912