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

Adherence to '5-2-1-0' guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012-2017

OBJECTIVE

Overweight and obesity constitute a new challenge in low-income and middle-countries. The obesity prevention programme, called '5-2-1-0', promotes healthy eating habits, physical activity and limited screen time among young people.This study aimed to assess adherence to the '5-2-1-0' recommendations and to study multiple risky behaviours among adolescents in nine countries in sub-Saharan Africa.

METHODS

Meta-analyses with a random effect were used to calculate overall prevalence. Non-random patterns of the co-occurrence of the four risky behaviours were explored using observed/expected prevalence ratios. Data came from the Global School-based Health Survey and 18 314 adolescents were considered.

RESULTS

Among the participants, 12.7% (95% CI 7.5% to 19.0%) had overweight and 3.2% (95% CI 1.1% to 6.1%) had obesity. In almost all countries studied, girls were more affected by overweight and obesity than boys.While only 0.2% (95% CI 0.1% to 0.4%) of the adolescents fully complied with the recommendations, 4.8% (95% CI 3.1% to 6.9%), 28.4% (95% CI 22.4% to 34.8%), 43.8% (95% CI 41.9% to 45.8%) and 17.0% (95% CI 11.8% to 23.0%), respectively, combined 1, 2, 3 and 4 risky behaviours among the four '5-2-1-0' criteria. The most observed combination was found for co-occurrence of three risky behaviours: insufficient fruit/vegetables consumption, physical activity and non-zero consumption of sugar-sweetened beverages.

CONCLUSION

In conclusion, the insufficient adherence to '5-2-1-0' recommendations and the high prevalence of the co-occurrence of risky behaviours underscore the need to strengthen health interventions and programmes to prevent obesity among adolescents in sub-Saharan Africa.

Iron Deficiency in Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Internalizing and Externalizing Disorders, and Movement Disorders

This article reviews the role of iron in brain development and function, with a focus on the association between iron deficiency (ID) and neuropsychiatric conditions. First, we describe how ID is defined and diagnosed. Second, the role of iron in brain development and function is summarized. Third, we review current findings implicating ID in a number of neuropsychiatric conditions in children and adolescents, including attention deficit hyperactivity disorder and other disruptive behavior disorders, depressive and anxiety disorders, autism spectrum disorder, movement disorders, and other situations relevant to mental health providers. Last, we discuss the impact of psychotropic medication on iron homeostasis.

Development of the Ethiopian Healthy Eating Index (Et-HEI) and evaluation in women of reproductive age

Ethiopia announced its first food-based dietary guidelines (FBDGs) on 15 March 2022. The present study aims to develop and evaluate the Ethiopian Healthy Eating Index (Et-HEI) based on the FBDG. Data were collected from 494 Ethiopian women of reproductive age sampled from households in five different regions. The Et-HEI consists of eleven components, and each component was scored between 0 and 10 points, the total score ranging from 0 to 110, with maximum adherence to the FBDG. The Et-HEI score was evaluated against the Minimum Dietary Diversity for Women (MDD-W) and the probability of nutrient adequacy. The average Et-HEI score for women of reproductive age was 49 out of 110. Adherence to the recommendations for grains, vegetables, legumes, fat and oils, salt, sugar and alcohol contributed the most to this score. Most women had low scores for fruits, nuts and seeds, and animal-sourced foods, indicating low intake. The Cronbach's alpha coefficient, indicating the reliability of the Et-HEI to assess its diet quality, was 0⋅53. The low mean Et-HEI score agreed with a low mean score of the MDD-W (3⋅5 out of 10). Also, low nutrient adequacies confirmed poor adherence to nutrient-dense components of the FBDG. The Et-HEI was not associated with the intake of vitamin B12, vitamin C and calcium in this study population. Women who completed secondary school and above had relatively lower Et-HEI scores. The newly developed Et-HEI is able to estimate nutrient adequacy while also assessing adherence to the Ethiopian FBDG though there is room for improvement.

Magnitude and associated factors of anemia among adolescent girls in Ethiopia: a systematic review and meta-analysis

Background

In Ethiopia, there are primary studies on adolescent anemia with imprecise and inconclusive findings. Besides, there was no meta-analysis pooled the magnitude and associated factors of anemia among adolescent girls in Ethiopia. Estimating the pooled magnitude and associated factors of anemia among adolescent girls is helpful for evidence-based interventions in Ethiopia.

Methods

The authors used a preferred reporting item for systematic reviews and meta-analysis (PRISMA). We included articles and survey reports published until May 2021 using searching engines of Google, Google Scholar, PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature. To assess the quality of studies, we used Newcastle–Ottawa quality assessment scale for non-randomized. Two authors independently assessed the quality of the studies. We computed the pool magnitude and odds ratio of the associated factors with their 95%CI using Comprehensive Meta-Analysis software. Publication bias assessed using funnel plots and Egger’s test.

Result

In this review, we included a total of 15 studies with 9,669 adolescent girls. Using the random-effects model, the pooled magnitude of anemia among the Ethiopian adolescent girls was 19.1% (95%CI: 16.1%, 24.6%). The associated factors were attained menarche (adjusted odds ratio (AOR) = 1.96), ≥ 5 days of blood flow during menses (AOR = 6.21), food insecurity (AOR = 1.48), inadequate diet diversity score (AOR = 2.81), presence of intestinal parasite (AOR = 3.51), low body mass index (AOR = 2.49), and rural residence (AOR = 1.79).

Conclusion

The pooled magnitude of anemia among adolescent girls in Ethiopia was 19.1% depicting a mild public health problem; while attained menarche, ≥ 5 days’ blood flow during menses, food insecurity, inadequate diet diversity score, intestinal parasites, low body mass index, and rural residence were the associated factors. Hence, addressing health and nutrition wellness of adolescent girls should be center of concern in health, nutrition, agriculture, research, strategies and policies in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00942-y.

Prevalence and associated factors of anemia among adolescent girls in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Anemia is the reduction of red blood cells in size and numbers and an indicator of both poor nutrition and poor health. It is a major global public health problem. Anemia in adolescents and young adults can have negative effects on their cognitive performance and growth. In Ethiopia, previous studies yielded variable prevalence. This review aimed to determine the pooled prevalence of adolescent girls' anemia and associated factors in Ethiopia.

METHODS

We searched for studies reporting anemia and associated factors among adolescent girls as reported in peer reviews publications in Ethiopia from 1988 to 2021 from PubMed, Google Scholar, Web of Science, Science Direct, Cochrane Library, and Worldwide Science database. The search strategy identified 309 cross-sectional studies. After screening for potentially eligible articles, we identified 37 publications for full text review, following which 10 publications were included in the final review. Using data from the review, we performed meta-analysis to produce pooled estimates and assess the prevalence of anemia and associated risk factors. Data were extracted using a standardized data extraction format prepared in Microsoft Excel™ and transferred to Stata ™ Version 14.0 for management and further analysis. To identify the source of heterogeneity, subgroup analysis using sample size and study setup was computed, and I2 test was used to declare the presence or absence of significant heterogeneity during subgroup analysis. A random-effect meta-analysis model was used to estimate the pooled prevalence of adolescent girls' anemia. Moreover associated factors for adolescent anemia were assessed too.

RESULTS

The overall pooled prevalence of anemia among adolescent girls' in Ethiopia was 23.02% (95% CI: 17.21to 28.84). In the subgroup analysis, studies that have a higher sample size than mean have a higher pooled prevalence (27.35%) (95% CI: 21.42 to 33.28) compared to their counterparts. Age being 15-19 (OR: 2.13; 95% CI: 1.52 to 2.96), living in rural areas (OR: 2.05; 95% CI: 1.66 to 2.54), and low dietary diversity (OR: 1.35; 95% CI: 1.00 to 2.34), were the identified factors associated with anemia among adolescent girls'.

CONCLUSION

The pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Being in 15-19 years, rural residence, and low dietary diversity score were found to be the significant factors of anemia among adolescent girls in Ethiopia.

Menstrual abnormality, maternal illiteracy, and household factors as main predictors of anemia among adolescent girls in Ethiopia: Systematic review and meta-analysis

Background:

Adolescent girls are more likely to develop anemia as a result of physical and physiological changes that place a greater strain on their nutritional needs. Primary studies, on the other hand, may not be sufficient to provide a complete picture of anemia in adolescent girls and its major risk factors.

Objective:

The study aimed to describe the pooled prevalence of adolescent girls’ anemia and the factors that contribute.

Methods:

We conducted a systematic review of observational studies using the databases CINAHL (EBSCO), PubMed, Science Direct, Cochrane Library, and Google Scholar. The Newcastle-Ottawa Scale was used to assess the quality of the articles, and studies of fair to good quality were included. We pooled anemia prevalence among adolescents and odds ratio estimates for risk factors. Subgroup analysis employing sample size and study setup was computed to determine the source of heterogeneity, and the I2 test was used to identify the existence or absence of substantial heterogeneity during subgroup analysis. The pooled prevalence of adolescent girls’ anemia was calculated using a random-effects meta-analysis model.

Results:

The overall pooled prevalence of anemia among adolescent girls in Ethiopia was 23.03% (95% confidence interval: 17.07, 28.98). Low dietary diversity (odds ratio: 1.56; 95% confidence interval: 1.05, 2.32), illiterate mothers (odds ratio: 1.45; 95% confidence interval: 1.13, 1.86), household size greater than five (odds ratio: 1.65; 95% confidence interval: 1.14, 2.38), food-insecure households (odds ratio: 1.48; 95% confidence interval: 1.21, 1.82), and menstrual blood flow more than 5 days (odds ratio: 6.21; 95% confidence interval: 1.67, 23.12) were the identified factors associated with anemia among adolescent girls.

Conclusion:

The pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Therefore, to combat the burden of anemia among adolescent girls offering nutritional education is crucial. Iron supplementation is also recommended for adolescent females who have a menstrual cycle that lasts longer than 5 days.

The structure of nutrition of Russian students as a risk factor for the development of nutritional diseases

The paper analyzes the literature data on the peculiarities of nutrition of students studying in higher educational institutions of various regions of Russia, and the risks of developing food-related diseases. They are largely associated with the adaptation of students to study at a university, the lack of self-organization skills and a lack of  knowledge in matters of rational nutrition. The actual nutrition of  students, on the one hand, is characterized by a lack of macronutrients and micronutrients intake, on the other hand, by excessive consumption of substances that contribute to the development of obesity. The results of numerous studies show a general pattern of unbalanced nutrition of students in terms of the ratio of saturated and polyunsaturated fatty acids, insufficient consumption of dietary fiber, full-fledged proteins, and  excessive intake of simple carbohydrates. Dietary fiber deficiency can  lead to changes in the composition of the microbiocenosis of the digestive tract, a deficiency of omega-3 fatty acids, and consequently, the imbalance of fatty acid composition of the blood cell membrane. 20–40 % of Russian students show signs of severe hypovitaminosis, especially calciferol, which is caused not only by its deficiency in the diet, but also by physical, geographical, climatic and seasonal factors. The analysis of the content of the main minerals in students shows a sufficient content of calcium in the body, an excess of sodium and a lack of magnesium, potassium and  iron, which is due to both the composition of the food consumed and the peculiarities of the accumulation and excretion of these ions. An analysis of the actual nutrition of students shows the need for counseling young people, especially in the first years of study. The introduction of an educational program on optimal nutrition is possible through the practice of curatorial work during the adaptation of the first-year students to student’s life. 

A community-based randomized controlled trial providing weekly iron-folic acid supplementation increased serum- ferritin, -folate and hemoglobin concentration of adolescent girls in southern Ethiopia

Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10-19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47-49% of adolescents had marginal iron store (< 50 µg/l). Hb, SF, and SFol concentrations increased in the intervention group, but not in the control group (P < 0.05). Marginal iron store decreased from 49 to 12% after 3-months of WIFAS; whereas, the proportion of adolescents with elevated SF (> 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P < 0.001). WIFAS intervention for three-months was effective in reducing iron and folate deficiency in adolescent girls. Future studies should evaluate the long-term impact of intermittent WIFAS.