95 research outputs found
Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis
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Modeling the Potential Impact of Fortification Programs on Dietary Micronutrient Intakes among Young Children and Women of Reproductive Age in Low- and Middle-income Countries: Case Studies from Cameroon and Zambia
No full textABSTRACTIn low- and middle-income countries (LMICs), the prevalence of inadequate micronutrient intake and micronutrient deficiency is high, particularly among women and young children. Sub-Saharan Africa is disproportionally affected by micronutrient deficiencies (MNDs) and the progress towards sustained reduction in MNDs has been limited. In recent years, large-scale food fortification has gained traction in LMICs, including sub-Saharan African countries, to address micronutrient deficiency. Given the long-term effort and investment that is needed to implement and sustain fortification programs, dietary intake data should be used in overall planning of fortification programs to make informed judgments about the appropriateness of the food vehicle, and the types and amounts of the specific nutrients to be added. Simulation studies provide insights about the potential contributions of food fortification to micronutrient intakes and, alongside information on program costs, can provide an efficient way of comparing hypothetical fortification scenarios that can then be translated into nutrition policies and practices. However, the usefulness of simulation modeling studies depends on the validity of dietary requirements applied and assumptions taken into consideration.
Zinc Nutrient Reference Values (NRVs) set by several expert groups differ widely. The effects of these differences on the predicted impacts and on the cost-effectiveness of zinc fortification programs have not been fully explored. In the first study, we estimated the prevalence of inadequate zinc intake and the predicted impact and cost-effectiveness of zinc fortification programs using NRVs published by different authorities based on data from a nationally representative nutrition survey among children and women in Cameroon. The distribution of usual zinc intakes was estimated using the National Cancer Institute (NCI) method. Prevalence of total zinc intake below the estimated average requirement (i.e. dietary requirement) and prevalence of “absorbable zinc intake” below the physiological requirement were estimated using NRVs from 4 expert groups: World Health Organizations (WHO), Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG) and European Food Safety Authority (EFSA). The estimated prevalence of inadequate zinc intake varied substantially ranging from 10% (IZiNCG-physiological requirement) to 81% (EFSA-physiological requirement) among children, and from 9.4% (WHO-physiological requirement) to 94% (IOM-physiological requirement) among women. These differences observed in the prevalence of inadequate intake translated to differences in the estimated benefits and cost-effectiveness of zinc fortification programs. Therefore, depending on the NRVs applied, assessments will differ regarding the need for, and the benefits and cost-effectiveness of, zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.
Snack products that are voluntarily fortified with micronutrients are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so the potential impacts on population micronutrient intake adequacy are uncertain. In the second study, we predicted the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake among children and women of reproductive age (WRA) based on nationally representative data in Cameroon. We estimated usual nutrient intake distributions using the NCI method and simulated the impacts of biscuit fortification on prevalence of micronutrient intake (vitamin A (VA), folate, vitamin B-12, iron, and zinc) below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs. In the absence of LSFF programs, biscuits fortified with retinol (600μg/100g), folic acid (300μg/100g), and zinc (8mg/100g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2 and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when the impact of existing national VA-fortified oil, and folic acid and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impacts on dietary inadequacy among WRA, with or without LSFF programs. Given observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients among children in urban areas, but only in the absence of LSFF programs.
Zambia has been implementing mandatory sugar fortification with VA, however the contribution of VA-fortified sugar to VA intakes and status has not been directly assessed. In the third study, we predicted the potential impacts of sugar fortification with VA on prevalence of VA inadequacy, and examine its association with plasma and breast milk retinol among lactating women based on baseline data from a randomized trial from Mkushi District in rural Zambia. We simulated VA intake under various sugar fortification scenarios: 3.1 and 8.8 mg/kg (measured median fortification levels of VA in sugar from previous studies), 10 mg/kg (minimum legal requirement) and 15 mg/kg (minimum legal requirement at factory level). We applied the NCI’s bivariate model to examine associations of usual intake of sugar and dietary VA with plasma and breast milk retinol concentrations measured by high performance liquid chromatography.
Our model predicted that sugar fortification with VA at 3.1 mg/kg, 8.8 mg/kg, 10 mg/kg and 15 mg/kg would reduce the prevalence of VA inadequacy by 7 (SE:6), 24 (SE:14), 30 (SE:15) and 47 (SE:18) percentage points, respectively, without increasing the risk of retinol intake above the UL. Usual sugar intake and usual VA intake were not associated with plasma retinol (β = 0.003; 95% CI: -0.015, 0.020) or with breastmilk retinol concentrations (β = 0.012; 95% CI: -0.002, 0.026). Usual VA intake from other foods sources was significantly associated with the log of breast milk retinol in µmol/ L (β = 0.001; 95% CI: 0.0002, 0.002), but not with plasma retinol (β = -0.0001; 95% CI: -0.001, 0.001). In Zambia, sugar fortification has the potential to reduce dietary VA inadequacy. However, the impacts on VA intakes and any improvements in VA status are likely to be limited if the program is not implemented as planned. Even if target fortification levels are achieved (10 mg/kg), sugar fortification alone is unlikely to eliminate dietary VA inadequacy among lactating women in Zambia.
Together, the three studies from the dissertation provide evidence on the effect of using different zinc reference values on the predicted benefits and cost-effectiveness of zinc fortification programs, and the impacts of voluntary snack food fortification and mandatory sugar fortification on prevalence of inadequate intake. These findings have important implications with regard to planning and evaluation of fortification programs in LMIC contexts.
Khat Chewing Practice and Associated Factors among Adults in Ethiopia: Further Analysis Using the 2011 Demographic and Health Survey.
No full textBackgroundKhat chewing has become a highly prevalent practice and a growing public health concern in Ethiopia. Although there have been many small scale studies, very limited national information has been available in the general population. This study aimed to identify factors associated with khat chewing practice among Ethiopian adults.MethodsThe study used the 2011 Ethiopian demographic and health survey data. The survey was cross-sectional by design and used a multistage cluster sampling procedure. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to quantify the predictors.ResultsThe overall khat chewing prevalence was 15.3% (95% CI: 14.90-15.71). Regional variation was observed with the highest in Harari [(53.2% (95% CI: 43.04-63.28)] and lowest in Tigray regional state [(1.1% (95% CI: 0.72-1.66)]. Multivariable analysis showed that Islam followers were 23.8 times more likely to chew khat as compared to Orthodox followers. Being a resident in Oromiya, South Nation, Nationalities and People (SNNP), Gambella, Harari and Dire Dawa regions had 1.9, 1.6, 3.1, 5.2 and 3.5 times higher odds of chewing khat as compared to Addis Ababa residents, respectively. Adults in the age group 45-49 years were 3.6 times more likely to chew khat as compared to 15-19 years. The middle and richest wealth quintiles were 1.3 and 1.5 times more likely to chew khat, respectively, as compared to the poorest category. Rural residents had 1.3 odds of chewing khat than urban residents. Those individuals who had occupation in sales, agriculture, service sector, skilled and unskilled manual workers were 1.6, 1.3, 2.4, 1.7 and 2.3 times more likely to chew khat, respectively, as compared to those who have no occupation. Females were 77% less likely to chew khat as compared to males. Formerly married and those experienced in child death had 1.4 and 1.2 times higher odds to chew khat as compared with those never married and never had child death, respectively. Those who attended mass media were 1.4 times more likely to chew khat compared with not attended.ConclusionKhat chewing is a public health concern in Ethiopia. The highest wealth quintiles, older age group, rural residence, child death, formerly married, males, regions of Oromiya, SNNP, Gambella, Harari and Dire Dawa and Islamic followers had statistically significant association with khat chewing. Due attention needs to be given for these factors in any intervention procedures
Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian Demographic and Health Survey
No full textPrevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study
No full textAdherence to WHO breastfeeding guidelines among HIV positive mothers in Southern Ethiopia: implication for intervention
No full textDemewoz Haile,1 Tesfaye Setegn,2 Sibhatu Biadgilign31Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Bale Goba, Ethiopia; 2Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 3Independent Public Health Research Consultants, Addis Ababa, Ethiopia Background: Breastfeeding reduces major causes of infant mortality and morbidity. On the other hand, it is a major mode of vertical HIV transmission. In developing countries like Ethiopia, HIV positive mothers are advised to continue breastfeeding up to 12 months. But there is scarce literature regarding the mothers' adherence to continued breastfeeding recommendations. Therefore, the objective of this study is to assess HIV positive mothers' adherence to the infant feeding recommendations of the new World Health Organization (WHO) guidelines for HIV-exposed infants aged ≥6 months. Methods: A cross-sectional study was conducted in health institutions with antiretroviral therapy and prevention of mother to child transmission facilities in Sidama Zone, Southern Ethiopia. Health institutions were considered as clusters and cluster sampling technique was employed. A total of 184 HIV positive mothers with their infants registered at respective health institutions were recruited and assessed for their infant breastfeeding practices. Descriptive statistics (frequency, mean, median, and standard deviation) were computed to describe the breastfeeding practices of HIV positive mothers. Result: Almost all (181 [98.4%]) of the HIV-exposed infants were “ever breastfed”. Among those mothers who had ever breastfed, 158 (87.3%) initiated breastfeeding within an hour of delivery and 157 (85.8%) had fed their babies colostrum while 31 (16.8%) gave prelacteal food to their infants. The prevalence of continued breastfeeding at 1 year was (54.5%) (46.9% for urban mothers and 75% for rural mothers). Seventy-one percent (70.9%) of HIV positive mothers practiced “on demand” breastfeeding. Twenty nine percent of infants aged 6–11 months and 47.8% of infants aged ≥12 months were no longer breastfed. The mean (± standard deviation) duration of breastfeeding was 7.8 (±3.1) months (95% confidence interval: 6.9–8.7). Conclusion: The 2010 WHO guidelines and recommendations on breastfeeding duration for HIV positive mothers was not adhered to after 6 months of age. Promotion and counseling of optimal breastfeeding practice for HIV positive mothers based on the updated WHO guideline is an appropriate intervention. However, further research is recommended to evaluate the acceptance of the new 2010 WHO guideline by the health professionals and HIV positive mothers. Keywords: HIV-exposed, infants, breastfeeding, initiatio
Prevalence of khat chewing practice among adults across administrative region, residence and gender in Ethiopia, 2011.
No full text<p>Prevalence of khat chewing practice among adults across administrative region, residence and gender in Ethiopia, 2011.</p
Map to show the distribution of khat chewing practice in Ethiopian Zones, 2011.
No full text<p>Map to show the distribution of khat chewing practice in Ethiopian Zones, 2011.</p
Differences in spatial distributions of iron supplementation use among pregnant women and associated factors in Ethiopia: evidence from the 2011 national population based survey
No full textAbstract
Background
Iron supplementation during pregnancy prevents against low birth weight, incidence of prematurity and postpartum hemorrhage. However, the coverage of iron supplementation is still low in Ethiopia. This study aimed to investigate the spatial variations and associated factors of iron supplementation during pregnancy using the 2011 national demographic and health survey data.
Methods
This study used secondary data from the 2011 Ethiopian demographic and health survey. The survey was cross sectional and used a multistage cluster sampling procedure. A logistic regression statistical model using adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify the associated factors. Getis-Ord G-statistic was used to identify high and low hotspot areas of iron tablet supplementation during pregnancy.
Results
The coverage of iron tablet supplementation was 17.1% [95%CI: (16.3\u201317.9)] with the highest coverage of 38.9% [95%CI: (32.4--46.1)] in Addis Ababa followed by Tigray regional state with 33.8% [95%CI: (29.9\u201338.00)]. The lowest coverage was found in Oromiya regional state at 11.9% [95%CI: (10.7\u201313.0)]. Multivariable analysis showed that mothers who were aware of the\ua0Community Conversation Program had 20% [AOR\u2009=\u20091.2; 95% CI: (1.04\u20131.4)] higher odds of taking iron tablets. The odds of taking iron tablets was 2.9 times [AOR\u2009=\u20092.9; 95% CI: (2.3\u20133.7)] higher among those who took deworming tablets. Those mothers who attended the minimum four antenatal visits recommended by WHO were 3.9 times [AOR\u2009=\u20093.9; 95% CI: (3.3\u20134.6)] more likely and those mothers in the age group 31\u201349 years were 2.9 times [AOR\u2009=\u20092.9; 95% CI: (1.1\u20137.4)] more likely to use iron tablets as compared to those mothers who did not attend antenatal care and mothers in the age group less than 20\ua0years. Mothers having a family size of 10 and above had 32% [AOR\u2009=\u20090.68; 95% CI: (0.49\u20130.97)] lower odds of taking iron tablets during pregnancy. The spatial analysis found that only northern, central and eastern parts of Ethiopia were identified as hotspots of iron supplementation.
Conclusion
Iron supplementation use was not equally distributed in Ethiopia, with relatively higher prevalence in Tigray, Addis Ababa and Harari regional states. Attention should be given to younger age mothers, mothers with large family size and mothers who reside in areas with low coverage of iron tablet distribution. Promotion of antenatal care services based on the WHO standard can be used as an intervention for improving iron supplementation during pregnancy
Socio-medical determinants of timely breastfeeding initiation in Ethiopia: Evidence from the 2011 nation wide Demographic and Health Survey
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