Ethiopian pre-school children consuming a predominantly unrefined plant-based diet have low prevalence of iron-deficiency anaemia

Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis

CONTEXT

Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive.

OBJECTIVE

The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs).

DATA SOURCES

Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded.

DATA EXTRACTION

Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation.

DATA ANALYSIS

The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55).

CONCLUSION

A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023409483.

Child-Owned Poultry Intervention Effects on Hemoglobin, Anemia, Concurrent Anemia and Stunting, and Morbidity Status of Young Children in Southern Ethiopia: A Cluster Randomized Controlled Community Trial

Cereal-based diets contribute to anemia in Ethiopian children. Eggs have nutrients to boost hemoglobin levels as well as counter concurrent anemia and stunting (CAS) and morbidity status. A community trial, targeting 6-18 months old children, was conducted in Halaba. Two clusters were randomly selected and allocated to intervention (N = 122) and control (N = 121) arms. Intervention group (IG) children received egg-laying hens with caging in a cultural ceremony declaring child ownership of the chickens. Parents promised to feed eggs to the child. Health and agriculture extension workers promoted egg feeding, poultry husbandry, and sanitation to IG families. Control group (CG) had standard health and agriculture education. At baseline, groups were not different by hemoglobin, anemia, CAS, and morbidity status. Mean hemoglobin was 11.0 mg/dl and anemia prevalence was 41.6%. About 11.9% of children had CAS and 52.3% were sick. Using generalized estimating equations, the intervention increased hemoglobin by 0.53 g/dl (ß:0.53; p < 0.001; 95%CI: 0.28-0.79). IG children were 64% (p < 0.001; odds ratio [OR]:0.36; 95%CI: 0.24-0.54) and 57% (p = 0.007; OR: 0.43; 95%CI: 0.21-0.73) less likely to be anemic and have CAS, respectively, than CG, with no difference in morbidity. Child-owned poultry intervention is recommended in settings where anemia is high and animal-source food intake is low.

Educational intervention and livestock ownership successfully improved the intake of animal source foods in 6-23 months old children in rural communities of Northern Ethiopia: Quasi-experimental study

Background

Animal source foods (ASFs) are rich in high-quality proteins, including essential amino acids and highly bioavailable micronutrients vital for child growth and cognitive development. But, the daily consumption of ASFs among 6–23 months old children is very low in Tigray, Northern Ethiopia.

Objective

The study aimed to assess the effectiveness of nutrition education intervention to improve the consumption of ASFs among 6–23 months old children from rural communities with strict religious fasting traditions of avoiding intake of ASFs in Northern Ethiopia.

Methods

A quasi-experimental study was conducted in two food insecure districts namely Samre Seharti (intervention) and Tanqua Abergele (comparison). The mother-child pairs in the intervention group (n = 140) received nutrition education based on the barriers and available resources for optimal consumption of ASFs among children and followed up for nine months. The mother-child pairs in the comparison group (n = 153) received routine nutrition education. The data were collected using a pre-tested structured questionnaire. The baseline and endline data assessment included interviews on socio-demographic and socio-economic status, dietary intake, and child feeding practices. The effectiveness of the intervention was measured using the difference-in-difference (DID) analysis model.

Results

At endline, the consumption of ASFs among children was 19.5 percentage points higher in the intervention group compared with the comparison group (p = 0.008). In addition, there was a significant increase in egg consumption among children in the intervention group (DID of 16.9, p = 0.012) from the comparison group. No child was consuming meat at baseline in both the intervention and comparison arms and it was very low at endline (5.2% vs. 7.9%). Overall, the proportion of children that consumed eggs in the intervention group was higher than in the comparison group in households that owned sheep and goats (4.8% vs. 21.4%, p = 0.050) and chicken (6.3% vs. 43.8%, p = 0.002) after education interventions. However, no statistically significant difference was observed between cow ownership and milk consumption among children (p>0.05).

Conclusions

Age-appropriate educational interventions for mothers and owning small livestock in the household can improve the consumption of ASFs and eventually the minimum diet diversity of children in communities with strict religious traditions of avoiding ASFs during the fasting seasons.

Estimates of Dietary Mineral Micronutrient Supply from Staple Cereals in Ethiopia at a District Level

Recent surveys have revealed substantial spatial variation in the micronutrient composition of cereals in Ethiopia, where a single national micronutrient concentration values for cereal grains are of limited use for estimating typical micronutrient intakes. We estimated the district-level dietary mineral supply of staple cereals, combining district-level cereal production and crop mineral composition data, assuming cereal consumption of 300 g capita⁻¹ day⁻¹ proportional to district-level production quantity of each cereal. We considered Barley (Hordeum vulgare L.), maize (Zea mays L.), sorghum (Sorghum bicolor (L.) Moench), teff (Eragrostis tef (Zuccagni) Trotter), and wheat (Triticum aestivum L.) consumption representing 93.5% of the total cereal production in the three major agrarian regions. On average, grain cereals can supply 146, 23, and 7.1 mg capita⁻¹ day⁻¹ of Ca, Fe, and Zn, respectively. In addition, the Se supply was 25 µg capita⁻¹ day⁻¹. Even at district-level, cereals differ by their mineral composition, causing a wide range of variation in their contribution to the daily dietary requirements, i.e., for an adult woman: 1–48% of Ca, 34–724% of Fe, 17–191% of Se, and 48–95% of Zn. There was considerable variability in the dietary supply of Ca, Fe, Se, and Zn from staple cereals between districts in Ethiopia.

Consumption of dietary folate estimates and its implication for reproductive outcome among women of reproductive age in Kersa: cross-sectional survey

Background

Dietary folate inadequacy is one the most common micronutrient deficiencies that cause neural tube defect (NTD) among infants in Sub-Saharan African countries. This study aims to determine the dietary intake of folate among women of reproductive age (WRA) of Kersa, Eastern Ethiopia.

Methods

A cross-sectional study took place among voluntary women that were selected from 1140 random households. Using a validated Food Frequency Questionnaire, participant’s weekly dietary intake history of Ethiopian foods and dietary folate intake was worked out. Statistical analysis was done at a 95% confidence interval. Modified Poisson regression was used to identify factors associated with dietary folate consumption.

Result

The estimated median usual intake of folate was 170 μg/d (IQR: 118.3; 252.2) and about 33% of WRA had low folate intake and 73.9% were at risk for folate inadequacy. From the reported food groups, Beans and Peas, Starchy staples, and Vitamin-A rich dark-green leafy vegetables were the top three ranked foods that contributed much of the dietary folate. The following conditions were statistically related to dietary folate inadequacy; women’s age, being in poor wealth index, low dietary diversity, having seasonal employment, and reliance on market food sources.

Conclusions

We found that women’s dietary intake of folate in Kersa is very low and cannot protect their offspring from the risk of having NTD. They could also potentially be predisposed to poor health outcomes. Diversifying and fortification of Ethiopian wheats and salts could decrease the burden of folate deficiency in the country.

Patterns of Dietary Iron Intake, Iron Status, and Predictors of Haemoglobin Levels among Early Adolescents in a Rural Ghanaian District

Introduction

Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents.

Method

One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann–Whitney U test, chi-square (X²) test, exploratory factor analysis, and partial correlation (r) tests.

Results

Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping (X² = 5.7, p < 0.05), times of eating a day (X² = 12.6, p < 0.05), and guardian educational status (X² = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping (β = 0.367, p > 0.05), snacking (β = 0.484, p > 0.05), and junior high school (JHS) education (β = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron (r = −0.234, p < 0.01), iron dietary pattern 2 and dietary iron (r = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C (r = -0.201, p < 0.05), and haemoglobin and ferritin (r = −0.178, p < 0.05).

Conclusion

Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia.

A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia

Background

Anemia is a wide-spread public health problem characterized by a decrease in hemoglobin concentration and/ or red blood cell volume below an established cut-off value. In developing countries including Ethiopia, about half of children are estimated to be anemic. Therefore, the purpose of this study was to determine the pooled prevalence of anemia and its predictor factors among children in Ethiopia.

Method

The studies were identified through explicit and exhaustive search of reputable databases (PubMed, Google scholar, Science Direct, EMBASE, Cochrane library, and the hand search of reference lists of previous prevalence studies to retrieve more related articles. Thirty-nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used. In our analysis, considerable heterogeneity was observed. Therefore, a random effect meta-analysis model was used to estimate the pooled prevalence of anemia. Moreover, the predictor factors of anemia were examined.

Results

The forest plot of 39 included studies revealed that the overall pooled prevalence of anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%). Sub-group analysis showed that the highest anemia prevalence was observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9, 77.8). Also, anemia in children was found to be highest in the age group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status: 1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5 (95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were found to be predictors of anemia among children.

Conclusion

In this study, one in three children were anemic in Ethiopia. It is a moderate public health problem in children in this study. Low literacy, low socioeconomic status as well as rural residence of the families and helminthic infection of the children were found to be predictors of anemia in the children. Community and school-based interventions should be strengthened to improve the problem.

Spatial prediction of the concentration of selenium (Se) in grain across part of Amhara Region, Ethiopia

Grain and soil were sampled across a large part of Amhara, Ethiopia in a study motivated by prior evidence of selenium (Se) deficiency in the Region's population. The grain samples (teff, Eragrostis tef, and wheat, Triticum aestivum) were analysed for concentration of Se and the soils were analysed for various properties, including Se concentration measured in different extractants. Predictive models for concentration of Se in the respective grains were developed, and the predicted values, along with observed concentrations in the two grains were represented by a multivariate linear mixed model in which selected covariates, derived from remote sensor observations and a digital elevation model, were included as fixed effects. In all modelling steps the selection of predictors was done using false discovery rate control, to avoid over-fitting, and using an α-investment procedure to maximize the statistical power to detect significant relationships by ordering the tests in a sequence based on scientific understanding of the underlying processes likely to control Se concentration in grain. Cross-validation indicated that uncertainties in the empirical best linear unbiased predictions of the Se concentration in both grains were well-characterized by the prediction error variances obtained from the model. The predictions were displayed as maps, and their uncertainty was characterized by computing the probability that the true concentration of Se in grain would be such that a standard serving would not provide the recommended daily allowance of Se. The spatial variation of grain Se was substantial, concentrations in wheat and teff differed but showed the same broad spatial pattern. Such information could be used to target effective interventions to address Se deficiency, and the general procedure used for mapping could be applied to other micronutrients and crops in similar settings.

Associations of dietary diversity with anaemia and iron status among 5- to 12-year-old schoolchildren in South Africa

OBJECTIVE

To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa.

DESIGN

An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status.

SETTING

KwaZulu-Natal and North West provinces, South Africa.

PARTICIPANTS

Children (n 578) 5- to 12-year-old.

RESULTS

A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of 'vegetables and fruits other than vitamin A-rich' and 'animal-source foods (ASF)' was associated with lower odds of being anaemic (both P = 0·002), and 'organ meats' with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of 'meat, chicken and fish' was associated with lower odds of being anaemic (P = 0·045), and 'vegetables and fruits other than vitamin A-rich', 'legumes, nuts and seeds' and 'ASF' with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively).

CONCLUSION

In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.

Selenium deficiency risks in sub-Saharan African food systems and their geospatial linkages

Selenium (Se) is an essential element for human health. However, our knowledge of the prevalence of Se deficiency is less than for other micronutrients of public health concern such as iodine, iron and zinc, especially in sub-Saharan Africa (SSA). Studies of food systems in SSA, in particular in Malawi, have revealed that human Se deficiency risks are widespread and influenced strongly by geography. Direct evidence of Se deficiency risks includes nationally representative data of Se concentrations in blood plasma and urine as population biomarkers of Se status. Long-range geospatial variation in Se deficiency risks has been linked to soil characteristics and their effects on the Se concentration of food crops. Selenium deficiency risks are also linked to socio-economic status including access to animal source foods. This review highlights the need for geospatially-resolved data on the movement of Se and other micronutrients in food systems which span agriculture-nutrition-health disciplinary domains (defined as a GeoNutrition approach). Given that similar drivers of deficiency risks for Se, and other micronutrients, are likely to occur in other countries in SSA and elsewhere, micronutrient surveillance programmes should be designed accordingly.

Under-five anemia and its associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia: systematic review and meta-analysis

BACKGROUND

Anemia is the most common hematologic disorder of children in the globe. There are fragmented and inconclusive study findings on under-five anemia in Ethiopia. Understanding the distribution of anemia is an important step for program planners and policymakers. Therefore, this systematic review was aimed to assess the pooled prevalence of anemia and associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia.

METHODS

We searched through African journals of online, Google Scholar, CINHAL, PubMed, Web of Science, Cochrane library, and Scopus. Reviewers used standardized format to extract the data. The data was exported to Stata version 11 software for analysis after extracted by Microsoft excel. The DerSimonian-Laird random-effect model was used to assess the pooled prevalence of under-five anemia. Variation between studies (heterogeneity) was assessed by I2 statistic test. Publication bias was assessed by the Egger test.

RESULT

From 561 studies, 16 articles were included in this review. The pooled prevalence of under-five anemia in Ethiopia was 44.83%. In subgroup analysis, the higher pooled prevalence of anemia was observed from children's age less than 2 years old (50.36%) (95% CI 39.53, 61.18). Poor dietary diversity OR = 1.71 (1.10, 2.68), stunting OR = 2.59 (2.04, 3.28), food insecurity OR = 2.87 (1.25, 6.61), and not dewormed OR = 2.34 (1.77, 3.09) were predictors of under-five anemia.

CONCLUSION

The magnitude of under-five anemia in this study was extremely high. Therefore, increased coverage of supplementation and fortification programs, periodic deworming, feeding diversified food, supplement food for those who are stunted, and securing food in the households may all alleviate under-five anemia.

Health status and nutritional development of adopted Ethiopian children living in southern Spain: A prospective cohort study

OBJECTIVE

The first aim of this study was to evaluate the health status and anthropometrical development of adopted children from Ethiopia living in southern Spain. A second aim was to evaluate the association between these parameters and adherence to the Mediterranean dietary pattern.

METHODS

The study sample included 53 adopted children from Ethiopia and a matched sample of 54 native-born children. A physical examination of the children, including height and weight, was conducted in Ethiopia at the time of entry into the adoption process. Height and weight were re-measured at the first day of adoption and 6, 12, and 24 mo after adoption. After 2 y of follow-up, another physical examination was performed, including the KIDMED test, to measure adherence to the Mediterranean diet.

RESULTS

Skin and digestive conditions were the most prevalent disorders in Ethiopian children before adoption and at the end of follow-up. Baseline anthropometric characteristics indicated a low wasting prevalence (7.5%); however, stunted growth was more prevalent (35.8%). After 6 mo, the weight-for-age of Ethiopian children was restored (change from baseline P < 0.001), and not significantly different from the Spanish children at 1-y after adoption. Height-for-age also increased from baseline (P < 0.001. A higher KIDMED score was associated with increased weight-for-age (r = 0.279; P = 0.045) and height-for-age (r = 0.385; P = 0.004).

CONCLUSIONS

This prospective study of adopted Ethiopian children confirmed a rapid growth development that occurred from the beginning of the adoption process and continued after the 2-y of follow-up. A higher adherence to the Mediterranean diet was associated with better growth development, which reinforces the importance of a balanced and adequate diet in growing children.

Iron deficiency and anemia in adolescent girls consuming predominantly plant-based diets in rural Ethiopia

Rapid physical growth and the onset of menstruation during adolescence can increase the risk of iron deficiency (ID) and related adverse effects. However, little is known about the risk of anemia and ID among adolescent girls in Ethiopia. Therefore, we aimed to determine the prevalence of ID, low iron stores, and anemia and characterize selected risk factors in Huruta, Arsi Zone, Oromia Region, Ethiopia. A cross-sectional study was conducted among non-pregnant adolescent girls (15–19 years of age; n = 257). Data on household socio-demographic characteristics, anthropometric measurements, and women’s dietary diversity score (WDDS) were collected. Hemoglobin (Hb) and serum ferritin (SF), C-reactive protein (CRP), and α−1-acid-glycoprotein (AGP) concentrations were measured. Diets were predominantly plant-based, with a low consumption of animal source foods, fruits, and dark-green leafy vegetables. Only 4% of the adolescent girls had adequate dietary diversity (WDDS ≥5), and 35% were underweight. The prevalence of anemia (Hb <11 g/dL, 8.7%) and clinical ID (SF <15 µg/L, 8.7%) was low, but 41% had marginal iron stores (SF <50 µg/L). The low prevalence of ID, despite a predominantly plant-based diet is atypical and calls for adapted strategies to address low iron stores in this and other similar settings of Ethiopia.

Provision of low-iron micronutrient powders on alternate days is associated with lower prevalence of anaemia, stunting, and improved motor milestone acquisition in the first year of life: A retrospective cohort study in rural Ethiopia

Inappropriate complementary feeding contributes to growth faltering, anaemia, and cognitive impairments. Limited programmatic evidence exists on the effectiveness of low-iron micronutrient powders (MNPs) on anaemia and motor development when provided every other day in the first year of life. This study used an existing demonstration project to evaluate associations between exposure of low-iron MNPs, anaemia, and motor development of infants in Southern Ethiopia. Using a retrospective cohort design, 200 infants aged 9 to 12 months (98 MNP exposed; 102 unexposed) were recruited, and data on socio-economic characteristics, anthropometric measures, dietary diversity scores (DDS), haemoglobin concentrations, and motor development acquisition were collected, and MNP exposed and unexposed groups were compared. Logistic regressions were run to identify predictors of acquisition of motor development milestones. Sociodemographic characteristics and dietary diversity scores were similar between MNP exposed and unexposed groups. Provision of low-iron (6 mg) MNP every other day, for 3 months, was associated with reduced risk of anaemia and stunting and increased achievement of motor development. After adjusting for age, infants exposed to MNPs had a higher likelihood of standing alone (AOR = 3.1; 95% CI [1.53, 6.46]) and walking alone (4.9; 95% CI [2.12, 11.37]) than unexposed ones. Exposure to MNPs, DDS, stunting, and mothers education were associated with acquisition of motor development milestones. Provision of low-iron dose MNPs on alternate days is associated with lower prevalence of anaemia, stunting, and increased motor development achievements. Integrating routine monitoring of motor development milestones with growth monitoring and anaemia screening can inform nutrition interventions to support optimal brain development.

Complementary Feeding of Sorghum-Based and Corn-Based Fortified Blended Foods Results in Similar Iron, Vitamin A, and Anthropometric Outcomes in the MFFAPP Tanzania Efficacy Study

BACKGROUND

Fortified blended foods (FBFs) are micronutrient-fortified food aid products containing cereals and pulses. It has been suggested to reformulate FBFs to include whey protein concentrate, use alternative commodities (e.g., sorghum and cowpea), and utilize processing methods such as extrusion to produce them. The Micronutrient Fortified Food Aid Pilot Project (MFFAPP) efficacy study was designed to test the efficacy of complementary feeding of newly formulated FBFs.

OBJECTIVES

The aim of this study was to test the effectiveness of 5 newly formulated FBFs in combating iron deficiency anemia and vitamin A deficiency compared with traditionally prepared corn-soy blend plus (CSB+) and no intervention. A secondary aim was to determine the impact on underweight, stunting, wasting, and middle-upper arm circumference.

METHODS

A 20-wk, partially randomized cluster study was completed. Two age groups (aged 6-23 and 24-53 mo) with hemoglobin status <10.3 g/dL, and weight-for-height z scores >-3 were enrolled and assigned to diet groups. Biochemical and anthropometric measurements were collected at 0, 10, and 20 wk.

RESULTS

Both hemoglobin concentrations and anemia ORs were significantly improved in all intervention groups except for CSB+ and the no-intervention groups at week 20. Only extruded corn-soy blend 14 and the no-intervention age groups failed to significantly decrease vitamin A deficiency risk (P < 0.04). There were no consistent significant differences among groups in anthropometric outcomes.

CONCLUSIONS

FBFs reformulated with sorghum, cowpea, corn, and soy significantly improved anemia and vitamin A deficiency ORs compared with week 0 and with no intervention. Although newly formulated FBFs did not significantly improve vitamin A deficiency or anemia compared with CSB+, CSB+ was the only FBF not to significantly improve these outcomes over the study duration. Our findings suggest that newly formulated sorghum- and cowpea-based FBFs are equally efficacious in improving these micronutrient outcomes. However, further FBF refinement is warranted. This trial was registered at clinicaltrials.gov as NCT02847962.

Maximising benefits and minimising adverse effects of micronutrient interventions in low- and middle-income countries

Micronutrient deficiencies are widespread and disproportionately affect women and children in low- and middle-income countries (LMIC). Among various interventions, food fortification and supplementation with micronutrients have been proven to be cost-effective. The aim of the present paper is to review existing literature to assess risks of excessive intake in LMIC to then highlight programmatic changes required to maximise benefits of micronutrient interventions while minimising risks of adverse effects. While very few LMIC have national food consumption surveys that can inform fortification programmes, many more are implementing mandatory fortification programmes. The risks of inadequate micronutrient intakes were common, but risks of excessive intakes were also present for iodine, vitamin A, folic acid and iron. Excessive salt consumption, high concentrations of iodine in ground-water and excessive levels of iodisation were linked with excessive iodine intake. For vitamin A, overlapping interventions were the main risk for excessive intake; whereas for iron, contamination with iron from soil and screw-wares of millers and high iron concentration in drinking-water increased the risk of excessive intake, which could be further exacerbated with fortification. Before implementing micronutrient interventions, adherence to the basic principles of documenting evidence confirming that the deficiency in question exists and that fortification will correct this deficiency is needed. This can be supported with dietary intake assessments and biochemical screening that help diagnose nutrient deficiencies. Targeting micronutrient interventions, although programmatically challenging, should be considered whenever possible. Moreover, closer monitoring of appropriate fortification of foods and overlapping interventions is needed.

Animal Source Food Consumption in Young Children from Four Regions of Ethiopia: Association with Religion, Livelihood, and Participation in the Productive Safety Net Program

Introduction: Child undernutrition remains a challenge globally and in the geographically diverse country of Ethiopia. Improving dietary diversity and consumption of animal source foods are important for improving child nutrition and corresponding health outcomes. Objective: The objective of the study was to identify household and community factors associated with consumption of animal source foods among 6 to 36-month-old children from four regions of Ethiopia. Methods: A cross-sectional survey using multistage probability sampling in eight geographic zones and four regions of Ethiopia took place in 2015 with parents/caretakers of 6 to 36-month-old children. Data was collected on demographic information, proxy indicators of socioeconomic status, and food consumed by the child the day before the survey. Results: Increased child age, pastoral livelihood, Muslim religion, and participation in the Productive Safety Net Program were associated with increased consumption of animal source foods. Odds of animal source foods consumption increased by 8% with each 3-month age increase. Children from pastoralist households were the most likely to have consumed animal source foods in the preceding 24 hours as compared with those in agro-pastoralist households (0.21 times as likely) or those in agriculturalist/farming households (0.15 times as likely). The odds of consumption of animal source foods for families with food aid or safety net support was 1.7 times greater among those receiving traditional support from the Productive Safety Net Program and 4.5 times greater for those in the direct support arm of the program. Conclusions: The findings illustrate the importance of accounting for local context and community characteristics, such as livelihood and religion, when undertaking programming designed to improve diversity of children’s diets through increasing animal source foods. In addition, the Productive Safety Net Program may be a critical determinant of dietary diversity for young children in these regions.

Selenium inadequacy hampers thyroid response of young children after iodine repletion

Selenium (Se) is an integral component of iodothyronine deiodinase, glutathione peroxidase and thioredoxin reductase enzymes and thus is important for normal thyroid function. This study investigated the influence of Se inadequacy on thyroid response of iodine-replete young children. Serum thyroxine (T₄), triiodothyronine (T₃), thyroglobulin (Tg), thyroid stimulating hormone (TSH), and Se were analyzed in 54-60 mo old children (n = 628) from the Amhara region of Ethiopia before salt iodization was commenced; analyses were repeated (n = 555) 15 mo after iodized salt became available. Iodized salt coverage increased from 12.2% to 91.6% of households. Median urinary iodine concentration (UIC) among children increased from 9 μg/l to 167 μg/l (p < 0.001). In addition, all thyroid indices except T₃ showed significant improvement (p < 0.05). Nearly, half of the study children (49.1%) had Se inadequacy (serum Se < 70 μg/l). Serum Se was significantly correlated with T₃ (r = 0.38, p < 0.001), T₄ (r = 0.15, p < 0.001), TSH (r=-0.205, p < 0.001) and Tg (r= -0.11, p < 0.01) concentrations 15 mo after iodine repletion; baseline serum Se and T₄(r= -0.22, p < 0.01) were inversely correlated. Despite adequate iodine status, children with low serum Se had lower serum T₄ (p = 0.003) and T₃(p < 0.001) but higher TSH concentration (p = 0.003). In the partial least square regression model, Se was among the latent variables significantly explaining T₄ and T₃. Results of the present study suggest that Se inadequacy negatively affects the thyroid metabolism of iodine-replete children and may present a substantial public health concern thus emphasize the need to consider correction of Se status for normal thyroid function as well as for benefits from its diverse biological roles.

Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Anemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia.

METHODS

Published articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg's institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression test statistic.

RESULTS

Of the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10).

CONCLUSION

The pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.

Extrinsic iron from soil contributes to Hb regeneration of anaemic rats: implications for foods contaminated with soil iron

Contamination of foods with extrinsic (soil) Fe is common in developing countries. However, the bioavailability of this extrinsic Fe and the extent to which it contributes to Fe nutrition remains unknown. The present study compared the bioavailability of laboratory- and field-threshed teff (Eragrostisis tef (Zucc) Trotter) to evaluate the bioavailablity of extrinsic soil Fe that resulted from the traditional threshing of the staple grain. Using sequential extraction, Fe was fractionated and its solubility was evaluated. The contribution of the additional extrinsic (soil) Fe to the Hb regeneration of Fe-depleted rats was evaluated using a rat Hb depletion–repletion assay. Weanling male Wistar rats (n24) were fed Fe-deficient diet for 21 d, and were then repleted for 14 d with diets: either laboratory-threshed teff (35 mg Fe/kg;n 8), field-threshed teff (35 mg intrinsic Fe/kg+ 120 mg soil Fe/kg;n 8), or FeSO4(control;n8). Fe content of field-threshed teff (29·4 mg/100 g) was four times greater than that of the laboratory-threshed (6·7 mg/100 g) teff (P<0·05). Soil contamination significantly increased the exchangeable, acid-soluble and reducible fractions obtained after sequential extraction. The relative biological value of the field-threshed teff (88 %) was higher than that of the laboratory-threshed (68 %) teff (P<0·05). Soil Fe can contribute to Hb regeneration in Fe-deficient rats. Considering that contamination of foods with soil is common in Ethiopia and other developing countries, it needs to be accounted for in the design and implementation of fortification programmes to prevent excessive intakes. Human studies are needed to confirm the present findings.

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’s 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 <15 μg/L in 18.6% of the women. Only one woman had α-1-acid glycoprotein (AGP) >1.0 g/L; four women (2%) had > 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 transferrin 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.

Are Low Intakes and Deficiencies in Iron, Vitamin A, Zinc, and Iodine of Public Health Concern in Ethiopian, Kenyan, Nigerian, and South African Children and Adolescents?

OBJECTIVE

To perform a systematic review to evaluate iron, vitamin A, zinc, and iodine status and intakes in children and adolescents (0-19 years) in Ethiopia, Kenya, Nigeria, and South Africa.

METHOD

Both national and subnational data published from the year 2005 to 2015 were searched via MEDLINE, Scopus, and national public health websites. For each micronutrient and country, status data from relevant studies and surveys were combined into an average prevalence and weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes.

RESULTS

This review included 55 surveys and studies, 17 from Ethiopia, 11 from Kenya, 12 from Nigeria, and 16 from South Africa. The WAVG prevalence of anemia ranged from 25% to 53%, iron deficiency from 12% to 29%, vitamin A deficiency (VAD) from 14% to 42%, zinc deficiency from 32% to 63%, and iodine deficiency from 15% to 86% in children aged 0 to 19 years from 4 countries. Generally, children <5 years had higher prevalence of anemia (32%-63%), VAD (15%-35%), and zinc deficiency (35%-63%) compared to children aged 5 to 19 years. Studies with intake data indicated that inadequate intakes ranged from 51% to 99% for zinc, 13% to 100% for iron, and 1% to 100% for vitamin A. Households failing to consume adequately iodized (>15 ppm) salt ranged from 2% in Kenya to 96% in Ethiopia.

CONCLUSION

With large variation within the 4 African countries, our data indicate that anemia and vitamin A, zinc, and iodine deficiencies are problems of public health significance. Effective public health strategies such as dietary diversification and food fortification are needed to improve micronutrient intake in both younger and older children.

Safety and benefits of antenatal oral iron supplementation in low-income countries: a review

The World Health Organization recommends universal iron supplementation of 30-60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of malaria and other infectious diseases. We reviewed the evidence on the safety and efficacy of antenatal iron supplementation in low-income countries. We found no evidence that daily supplementation at a dose of 60 mg leads to increased maternal Plasmodium infection risk. On the other hand, recent meta-analyses found that antenatal iron supplementation provides benefits for maternal health (severe anaemia at postpartum, blood transfusion). For neonates, there was a reduced prematurity risk, and only a small or no effect on birth weight. A recent trial showed, however, that benefits of antenatal iron supplementation on maternal and neonatal health vary by maternal iron status, with substantial benefits in iron-deficient women. The benefits of universal iron supplementation are likely to vary with the prevalence of iron deficiency. As a consequence, the balance between benefits and risks is probably more favourable in low-income countries than in high-income countries despite the higher exposure to infectious pathogens.

Energy and nutrient intake of infants and young children in pastoralist communities of Ethiopia

OBJECTIVE

Nutrient intake from complementary foods often is suboptimal in subsistent farming households of developing countries, but little is known about this in pastoralist communities. The aim of this study was to estimate the energy and nutrient intake of children ages 6 to 23 mo living in pastoralist communities of Ethiopia.

METHOD

As part of the Ethiopian National Food Consumption Survey, 24-h dietary recall data were collected through in-home interviews from a nationally representative sample. In the present study, we report on the feeding characteristics, energy and nutrient intake of infants and young children (ages 6-23 mo) living in pastoralist communities (N = 896) of Ethiopia. Energy and nutrient intakes were estimated and compared with estimated needs from complementary foods. The nutrient density of the complementary diets was compared with desired densities.

RESULTS

About one-third of the children were stunted. Diets were predominantly dairy and cereal-based. The dietary diversity score was low (2 ± 1.2). Consumption of nutrient-dense foods such as animal source foods (other than milk), vitamin A-rich fruits and vegetables was very low. Energy intake from complementary foods were inadequate. Multiple micronutrient deficiencies including thiamin, niacin, iron, zinc, and calcium and in some instances vitamins A and C were observed in young children. The number of micronutrients for which intake was found deficient increased with child's age.

CONCLUSION

Energy and nutrient intakes from complementary foods are inadequate in pastoralist communities of Ethiopia. Interventions that improve knowledge and practice of complementary feeding are needed in this setting.

Simulated effects of home fortification of complementary foods with micronutrient powders on risk of inadequate and excessive intakes in West Gojjam, Ethiopia

Home fortification of complementary foods (CFs) with multiple micronutrient powders (MNPs) is being scaled up in various countries, but little is known about the prevailing complementary feeding practices and the type and nutrient gaps to be filled with MNPs. The present study evaluated the complementary feeding practices of young children and simulated the risk of inadequate and excessive intakes associated with home fortification with MNPs. We have assessed the sociodemographic status, anthropometry, and complementary feeding practices of young children (N = 122) in Mecha district, rural Ethiopia. Using a 2-day, quantitative 24-hr recall, usual intakes of energy, protein, iron, zinc, and calcium were estimated. The risks of inadequate and excessive iron and zinc intakes with or without home fortification scenarios were assessed. The simulations considered intakes from CFs assuming average breast milk contributions and additional nutrients provided by the MNPs. Stunting was highly prevalent (50%) and was associated with a lower dietary diversity (P = .009) and nutrient intakes from the CFs. Median energy, zinc, and calcium intakes were below the estimated needs from CFs; protein needs were met. Median dietary iron intake appeared adequate, but 76%, 95% CI [68%, 84%], of children had inadequate intake (assuming low bioavailability), whereas another 8%, 95% CI: [3%, 13%], had excessive intakes. Simulation of daily and alternative day's fortification with MNP decreased the prevalence of inadequate iron and zinc intake but significantly increased the risk of excessive intakes that remained unacceptably high for iron (>2.5%). Untargeted MNP interventions may lead to excessive intakes, even in settings where poor complementary feeding practices are prevalent.

Stunting, selenium deficiency and anemia are associated with poor cognitive performance in preschool children from rural Ethiopia

BACKGROUND

Anthropometric characteristics and iron status affect cognitive performance in children. In addition, selenium can influence cognitive outcomes; protection of the brain from oxidative stress and its role in thyroid hormone metabolism are putative mechanisms.

METHODS

To investigate their association with cognitive performance, anthropometric indicators, iron biomarkers, and serum selenium of children (n = 541) of 54-60mo of age from rural Ethiopia were assessed. Cognitive assessment was conducted with the administration of two reasoning subtests of the Wechsler Preschool and Primary Scale of Intelligence and the school readiness test.

RESULTS

Stunting was found in 41.4 % of children, 28.7 % were underweight, and 6.3 % were wasted. The mean score of stunted children was lower than that of non-stunted children on non-verbal reasoning (7.0 ± 3.2vs7.9 ± 3.1; p = 0.01) and the school readiness tests (4.3 ± 2.2 vs 3.3 ± 2.1; p < 0.001). Compared to non-anemic children, anemic children had lower score for the verbal reasoning test (9.5 ± 1.7 vs 8.9 ± 2.2; p = 0.02). However, except for hemoglobin, none of the iron biomarkers had significant associations with the cognitive score of the study children (p > 0.05). Selenium deficient children had lower scores on all cognitive tests than normal children (p < 0.05).

CONCLUSION

The present study finding linking chronic undernutrition and micronutrient deficiency to cognitive deficits suggests the need for designing effective intervention programmes to control for protein energy malnutrition and micronutrient deficiency and address cognitive development in children.