Ethiopia’s high childhood undernutrition explained: analysis of the prevalence and key correlates based on recent nationally representative data

Objective To examine the contribution of child, maternal and household factors in stunting, wasting and underweight among children under 5 years in Ethiopia. Design Quantitative cross-sectional design based on nationally representative data. Setting Urban and rural areas of Ethiopia. Participants Younger (0–24 months; n 4199) and older age groups (25–59 months; n 5497), giving a total of 9696 children. Results Among the younger age group, 29 % were stunted, 14 % were wasted and 19 % were underweight; and among the older age group, the prevalence of stunting, wasting and underweight was 47, 8 and 28 %, respectively. Being female, intake of multiple micronutrients, household having a piped source of drinking-water, high maternal BMI, higher household wealth and higher maternal education were associated with decreased odds of at least one form of undernutrition in both groups. On the other hand, children who were anaemic, had low birth weight, drank from a bottle, and children of stunted or wasted or working mothers were more likely to be stunted, wasted or underweight in both groups (P\u3c0·05). While most predictors and/or risk factors followed a similar pattern across the two age groups, child factors had higher leverage in the younger than the older group across the three forms of undernutrition. Conclusions Multiple set of factors predicted childhood undernutrition in Ethiopia. The study underscores the importance of intervening in the first 1000 days through promoting maternal education, maternal–child health services, mother’s nutrition and improving intrahousehold food distribution

Effects of maternal iodine supplementation on maternal and infant iodine status and thyroid function and on infant visual information processing

Iodine deficiency is one of the major causes of preventable brain damage in childhood. However, iodine supplementation during early pregnancy and lactation could prevent the ill effects of iodine deficiency. In this study we have assessed the effect of iodine supplementation to lactating mothers on visual information processing (VIP) of their 6-month-old infants in a community-based, randomized, supplementation trial. Mother infant dyads (n = 106) were recruited within the first week after delivery to participate in this study. Study participants were randomly assigned either to receive 225 ug of iodine as potassium iodide capsule (capsule group) daily for 26 weeks or iodized salt (I-salt group) (450 g) weekly for 26 weeks. Lactating women (n = 53) who had 26 weeks old infants were recruited to serve as controls. Mother-infant dyads in the two supplemented groups were not significantly different in any of the biomarkers and anthropometry measurements at baseline. At the end of 26 weeks, maternal thryroxine (T4) decreased in the I-salt group (p < 0.001) but remained the same in the capsule group (p = 0.45), thyroid stimulating hormone (TSH) and triiodothyronine (T3) significantly decreased in both groups but there was no change in thyroglobulin (Tg). Compared to the two treatment groups, TSH was significantly lower in the control group. Maternal goiter rate significantly decreased following iodine supplementation. Infants median (IQR) T4 at 26 weeks was 10.8 (8.7, 13.6) ug/dL, 13.9 (10.6, 17.6) ug/dL and 19.6 (16.4, 25.9) ug/dL in the capsule, I-salt and control groups respectively. And the difference between the three groups was significant (p < 0.001). Compared to baseline, maternal and infant urinary iodine concentration (UIC) increased but breast milk iodine concentration (BMIC) decreased at the end of the 26 weeks. The percentage of infants who showed novelty preference to new stimuli above 0.55 was 26%, 51% and 47% in the capsule, Isalt and control groups respectively (p = 0.024), but other VIP tests did not show any effects of supplementation. In conclusion, iodine supplementation to iodine sufficient or mildly iodine deficient mothers did not show significant effects on infant VIP, T4, TSH or maternal T4, Tg, UIC and BMIC

High variability of iodine in iodized salt and urine from rural households in Sidama zone, Southern Ethiopia: A cross-sectional study.

Iodine is essential for the synthesis of thyroid hormones which regulate the metabolic processes of most cells and play important roles in human growth and development. Iodine deficiency has long been one of the most common nutritional problems in the world. Ethiopia, particularly the study population (Sidama) has a history of severe iodine deficiency. The purpose of the study was to assess urinary iodine concentration, level of goiter in mothers and school-age children and household salt iodine concentration in households 10 months after launch of the national salt iodization program. A cross-sectional study was conducted on a randomly selected sample of women and schoolchildren. Goiter was assessed by palpation. Concentrations of iodine in salt, urine and water were analyzed by inductively coupled plasma mass spectrometry (ICP-MS).The study included 193 mothers and 76children. The median (IQR) urinary iodine concentration (UIC) was 143 (84, 202) μg/L in the mothers and 187 (102, 278) μg/L in the children. Mothers’ UIC ranged from 17 to 767.2 μg/L and children’s UIC ranged from 19 to 739 μg/L. Goiter prevalence was high in both mothers (76%) and children (79%). The median household salt iodine concentration (SIC) was 8.1 (4.3, 13.4) ppm (mg/kg) with a range of 0 to 42 ppm. None of the water samples contained iodine above the detection limit of 1 μg/L. Despite the launchof the salt iodization program in Ethiopia, 94% of the study participants were not aware that they used iodized salt and 88% did not know the benefits of iodized salt. The major source of iodine for this population was iodized salt; however, the salt at household level contained minimal but variable amounts of iodine.Low concentration of iodine in salt may be further compounded by storage, handling and cooking techniques.The high variability of salt iodine concentration (SIC) was also reflected in the UIC of the mothers and children

Chronic inflammation was a major predictor and determinant factor of anemia in lactating women in Sidama zone southern Ethiopia: A cross-sectional study

Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected for measuring hemoglobin, iron biomarkers, zinc, selenium, and inflammation markers. The median (IQR) hemoglobin (Hb) was 132 (123, 139) g/L. Of the women, 19% were anemic and 7% had iron deficiency anemia; 31% were iron deficient and 2% had iron overload. Also, 8% had functional iron deficit, 6% had acute inflammation, 13% had chronic inflammation, and 16% had tissue iron deficiency. The majority (78%) of the women had low plasma zinc out of which more than 16% were anemic. Hb was positively associated with plasma iron and plasma zinc and negatively associated with transferrin receptor (TfR) and α-1-acid glycoprotein (AGP). Plasma iron, AGP, TfR, hepcidin and plasma zinc were significant predictors of maternal anemia. Additionally MUAC and level of education were associated positively with maternal hemoglobin. This study showed that maternal anemia was associated with multiple factors including nutritional deficiencies, inflammation and limited education

Excessive intake of iodine and low prevalence of goiter in school age children five years after implementation of national salt iodization in Shebedino woreda, southern Ethiopia

Background Iodine is a trace element required for the synthesis of thyroid hormones. The multiple effects of iodine deficiency on human health are called iodine deficiency disorders (IDDs). IDDs have been common nutritional problems in Ethiopia. In 2012, Ethiopia launched a national salt iodization program to address IDDs. The objective of this study was to assess the effects of this program after 5 years by measuring urinary iodine concentration (UIC) and prevalence of goiter in school age children as well as household salt iodine concentration (SIC). Methods A school-based cross-sectional design was employed. After ethical approval, 408 children from eight randomly selected primary schools provided urine samples. UIC was analyzed by inductively coupled plasma mass spectrophotometry (ICP-MS). A 10 g salt sample was collected from each household of a sampled child. SIC was analyzed with a digital electronic iodine checker (WYD, UNICEF) and goiter was assessed by palpation. Results The mean (±SD) age of the children was 9 ± 2 years. The prevalence of goiter was 4.2% and no child had grade 2 goiter. The median (IQR) UIC was 518 (327, 704) μg/L and UIC ranged from 3.1 to 2530 μg/L. Of the salt samples, 15.6% were not adequately iodized (\u3c 15 ppm), 39.3% were adequately iodized (≥15 to ≤40 ppm), and 45.1% were \u3e 40 ppm. SIC ranged from 4.2 to 195 ppm. Of the mothers, 92% said iodized salt prevents goiter and 8% mentioned prevents mental retardation. Conclusions In 2017 iodine deficiency was no longer a public health problem in the study area. However, the high variability in UIC and SIC and excessive iodine intake are of great concern. It is vital to ensure that salt is homogenously iodized at the production site before being distributed to consumers

Iodine supplementation of lactating women and assessment of infant visual information processing and maternal and infant thyroid function: A randomized trial

Iodine deficiency is one of the major causes of brain damage in childhood. However, iodine supplementation during early pregnancy and lactation can prevent the ill effects of iodine deficiency. This study evaluated maternal and infant thyroid function and infant visual information processing (VIP) in the context of maternal iodine supplementation. A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were enrolled within the first 10 days after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 μg iodine) daily for 26 weeks or iodized salt weekly for 26 weeks. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. At baseline, neither mothers nor infants in the two groups were significantly different in any of the biomarkers or anthropometric measurements. Maternal TSH and goiter prevalence significantly decreased following iodine supplementation. The percentage of infants who preferentially remembered the familiar face was 26% in the capsule and 51% in the I-salt groups. Infant sex, length for age Z score, BMIC, maternal education and household food security were strong predictors of novelty quotient. In conclusion supplementation daily for six months with an iodine capsule or the use of appropriately iodized salt for an equivalent time was sufficient to reduce goiter and TSH in lactating women. Higher BMIC and LAZ as well as better household food security, maternal education, and male sex predicted higher novelty quotient scores in the VIP paradigm

Urinary Aflatoxin M1 Concentration and Its Determinants in School-Age Children in Southern Ethiopia

Aflatoxins are mycotoxins that can contaminate grains, legumes, and oil seeds. These toxic compounds are an especially serious problem in tropical and sub-tropical climates. The objective of this study was to raise awareness of aflatoxin exposure among primary school children in Shebedino woreda, southern Ethiopia, by measuring urinary aflatoxin M1 (AFM1). The study employed a cross-sectional design and systematic random sampling of children from eight schools in the district. The mean ± SD age of the children was 9.0 ± 1.8 years. Most (84.6%) households were food insecure with 17.9% severely food insecure. Urinary AFM1 was detected in more than 93% of the children. The median [IQR] concentration of AFM1/Creat was 480 [203, 1085] pg/mg. Based on a multiple regression analysis: DDS, consumption of haricot bean or milk, source of drinking water, maternal education, and household food insecurity access scale scores were significantly associated with urinary AFM1/Creat. In conclusion, a high prevalence of urinary AFM1 was observed in this study. However, the relation between AFM1 and dietary intake was analyzed based on self-reported dietary data; hence, all of the staple foods as well as animal feeds in the study area should be assessed for aflatoxin contamination

Iron deficiency was not the major cause of anemia in rural women of reproductive age in Sidama zone, southern Ethiopia: A cross-sectional study

Background Anemia, which has many etiologies, is a moderate/severe public health problem in young children and women of reproductive age in many developing countries. The aim of this study was to investigate prevalence of iron deficiency, anemia, and iron deficiency anemia using multiple biomarkers and to evaluate their association with food insecurity and food consumption patterns in non-pregnant women from a rural area of southern Ethiopia. Methods A cross-sectional study was conducted in 202 rural women of reproductive age in southern Ethiopia. Anthropometrics and socio-demographic data were collected. A venipuncture blood sample was analyzed for hemoglobin (Hb) and for biomarkers of iron status. Biomarkers were skewed and were log transformed before analysis. Mean, median, Pearson\u27s correlations and ordinary least-squares regressions were calculated. Results Median (IQR) Hb was 138 (127, 151) g/L. Based on an altitude-adjusted (1708 m) cutoff of 125 g/L for Hb, 21.3% were anemic. Plasma ferritin was \u3c15 μg/L in 18.6% of the women. Only one woman had α-1-acid glycoprotein (AGP) \u3e1.0 g/L; four women (2%) had \u3e 5 mg/L of C-reactive protein (CRP). Of the 43 women who were anemic, 23.3% (10 women) had depleted iron stores based on plasma ferritin. Three of these had elevated soluble transferring receptors (sTfR). Hemoglobin (Hb) concentration was negatively correlated with sTfR (r = -0.24, p = 0.001), and positively correlated with ferritin (r = 0.17, p = 0.018), plasma iron (r = 0.15, p = 0.046), transferrin saturation (TfS) (r = 0.15, p = 0.04) and body iron (r = 0.14, p = 0.05). Overall prevalence of iron deficiency anemia was only 5%. Conclusion Iron deficiency anemia was not prevalent in the study population, despite the fact that anemia would be classified as a moderate public health problem

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018

Abstract Objective: The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali. Design: Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018. Setting: Urban and rural areas of Mali. Participants: A total of 8908 children participated, with 3999 in the younger age group (0–24 months) and 4909 in the older age group (25–59 months). Results: In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group. Conclusions: This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition

Frequency of consumption by women of foods commonly available in Sidama zone, southern Ethiopia (n = 202).

<p>Frequency of consumption by women of foods commonly available in Sidama zone, southern Ethiopia (n = 202).</p