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Quinn M, Halsey J, Sherliker P, Pan H, Chen Z, Bennett DA, Clarke R. Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: a systematic review. EClinicalMedicine 2024; 67:102366. [PMID: 38169713 PMCID: PMC10758734 DOI: 10.1016/j.eclinm.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Folic acid (pteroylmonoglutamic acid) supplements are highly effective for prevention of neural tube defects (NTD) prompting implementation of mandatory or voluntary folic acid fortification for prevention of NTDs. We used plasma folate levels in population studies by country and year to compare effects of folic acid fortification types (mandatory or voluntary folic acid fortification policies) on plasma folate levels, NTD prevalence and stroke mortality rates. Methods We conducted systematic reviews of (i) implementation of folic acid fortification in 193 countries that were member states of the World Health Organization by country and year, and (ii) estimated population mean plasma folate levels by year and type of folic acid fortification. We identified relevant English language reports published between Jan 1, 1990 and July 31, 2023 using Google Scholar, Medline, Embase and Global Health. Eligibility criteria were observational or interventional studies with >1000 participants. Studies of pregnant women or children <15 years were excluded. Using an ecological study design, we examined the associations of folic acid fortification types with NTD prevalence (n = 108 studies) and stroke mortality rates (n = 3 countries). Findings Among 193 countries examined up to 31 July 2023, 69 implemented mandatory folic acid fortification, 47 had voluntary fortification, but 77 had no fortification (accounting for 32%, 53% and 15% of worldwide population, respectively). Mean plasma folate levels were 36, 21 and 17 nmol/L in populations with mandatory, voluntary and no fortification, respectively (and proportions with mean folate levels >25 nmol/L were 100%, 15% and 7%, respectively). Among 75 countries with NTD prevalence, mean (95% CI) prevalence per 10,000 population were 4.19 (4.11-4.28), 7.61 (7.47-7.75) and 9.66 (9.52-9.81) with mandatory, voluntary and no folic acid fortification, respectively. However, age-standardised trends in stroke mortality rates were unaltered by the introduction of folic acid fortification. Interpretation There is substantial heterogeneity in folic acid fortification policies worldwide where folic acid fortification are associated with 50-100% higher population mean plasma folate levels and 25-50% lower NTD prevalence compared with no fortification. Many thousand NTD pregnancies could be prevented yearly if all countries implemented mandatory folic acid fortification. Further trials of folic acid for stroke prevention are required in countries without effective folic acid fortification policies. Funding Medical Research Council (UK) and British Heart Foundation.
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Affiliation(s)
- Matthew Quinn
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jim Halsey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Hongchao Pan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Tesfay N, Hailu G, Habtetsion M, Woldeyohannes F. Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e077685. [PMID: 37940152 PMCID: PMC10632862 DOI: 10.1136/bmjopen-2023-077685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context. STUDY DESIGN Systematic review and meta-analysis. STUDY PARTICIPANTS A total of 611 064 participants were included in the review obtained from 42 studies. METHODS PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I2 test statistics. Small study effects were checked using Egger's statistical test at a 5% significance level. RESULT The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I2= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases. CONCLUSION The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures. PROSPERO REGISTRATION NUMBER CRD42023413490.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fistum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Gebremichael B, Roba HS, Getachew A, Tesfaye D, Asmerom H. Folate deficiency among women of reproductive age in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0285281. [PMID: 37155667 PMCID: PMC10166565 DOI: 10.1371/journal.pone.0285281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Folate deficiency (FD) can cause adverse health outcomes of public health significance. Although FD is a significant micronutrient deficiency in Ethiopia, concrete evidence is limited. Therefore, this systematic review and meta-analysis was designed to estimate the pooled prevalence of FD among women of reproductive age (WRA). METHODS A systematic literature search was performed using MEDLINE, Embase, CINAHL, Google Scholar, African Journals Online (AJOL), The Vitamin and Mineral Nutrition Information System (VMNIS) of the World Health Organization (WHO), Global Health Data Exchange (GHDx), and institutional repositories of major universities and research centers. Additionally, we scanned the reference lists of relevant articles. Two authors independently selected the studies, extracted the data, and the study risk of bias. Heterogeneity was assessed using the I2 statistic. We used a random-effects model to estimate the pooled mean serum/plasma folate and the pooled prevalence of FD. Begg's and Egger's tests were used to check publication bias. RESULTS Ten studies-nine cross-sectional and one case-control-with a total of 5,623 WRA were included in the systematic review and meta-analysis. Four (WRA = 1,619) and eight (WRA = 5,196) cross-sectional studies were used to estimate the pooled mean serum/plasma folate and prevalence of FD, respectively. The pooled mean serum/plasma folate concentration estimate was 7.14 ng/ml (95% CI: 5.73, 8.54), and the pooled prevalence of FD was estimated to be 20.80% (95% CI: 11.29, 32.27). In addition the meta-regression analysis showed that the sampling technique was significantly associated with mean serum/plasma folate concentration. CONCLUSIONS FD is a significant public health issue among WRA in Ethiopia. Therefore, the public health strategies of the country should focus on promoting the consumption of folate-rich foods, strengthening the coverage of folic acid supplementation and its adherence, and swift translation of the mandatory folic acid fortification into action. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2022-CRD42022306266.
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Affiliation(s)
- Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Health and Medical Sciences, University of Southern Queensland, Queensland, Australia
| | - Alemeshet Getachew
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tefera AA, Seifu D, Menon M, Talargia F, Belete AM. Red blood cell folate level and associated factors of folate insufficiency among pregnant women attending antenatal care during their first trimester of pregnancy in Addis Ababa, Ethiopia. SAGE Open Med 2022; 10:20503121221118987. [PMID: 36051782 PMCID: PMC9424885 DOI: 10.1177/20503121221118987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Folate is an essential vitamin for de novo DNA synthesis and cell
proliferation. Folate insufficiency at the time of conception and during the
first trimester of pregnancy is associated with unintended pregnancy and
birth outcomes, particularly neural tube defects. Hence, this study aimed to
assess folate status and associated factors of folate insufficiency among
pregnant women attending antenatal care during their first trimester of
pregnancy in Addis Ababa, Ethiopia. Materials and methods: A cross-sectional study was conducted from 8 August 2017 to 3 January 2018 in
Addis Ababa. In this study, 160 participants were enrolled via the
convenience sampling method. Red blood cell folate was measured by the
electrochemiluminescence binding assay method. Data were entered into
Epi-Data version 3.1 and analyzed by SPSS version 22.0. Descriptive
statistics were used to describe demographic characteristics and to
determine the magnitude of folate deficiency. Logistic regression was used
to identify the risk factors for folate deficiency. A
p-value of less than 0.05 was considered statistically
significant. Results: In this study, 44/160 (27%) participants had red blood cell folate level
<400 ng/mL, insufficient to prevent neural tube defect. Multivariate
regression showed that regular vegetable consumption was an independent
determinant factor for red blood cell folate level (adjusted odds ratio:
0.41, confidence interval: 0.18–0.93). Conclusion: This study shows that a large magnitude of the first-trimester pregnant women
had red blood cell folate concentrations below levels that are maximally
protective against neural tube defects. Folic acid supplementation and
supplemental nutrition containing green leafy vegetables should be promoted
during the periconceptional period. In addition, the policymakers should set
rules for mandatory folic acid fortification.
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Affiliation(s)
- Alemu Adela Tefera
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Daniel Seifu
- Division of Biomedical Sciences, Department of Biochemistry, University of Global Health Equity, Kigali, Rwanda
| | - Menakath Menon
- Department of Biochemistry, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feredegn Talargia
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abebe Muche Belete
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
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Berhane A, Belachew T. Effect of Picture-based health education and counselling on knowledge and adherence to preconception Iron-folic acid supplementation among women planning to be pregnant in Eastern Ethiopia: a randomized controlled trial. J Nutr Sci 2022; 11:e58. [PMID: 35912303 PMCID: PMC9305079 DOI: 10.1017/jns.2022.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
The present study examined the effect of picture-based nutrition education on knowledge and adherence to pre-conception iron-folic acid supplement (IFAS) in Ethiopia, a country where there is a high burden of neural tube defects (NTDs) and anaemia. In eastern Ethiopia, a parallel randomised controlled trial design was employed among women planning to get pregnant. The interventional arm (n 122) received a preconception picture-based nutrition education and counselling along with an IFAS and the control arm (n 122) received only a preconception IFAS. The effects of the intervention between-group differences were assessed using a χ 2 and independent sample t-test. Bivariate and multivariable linear regression model was fitted to detect independent variables affecting the outcome. The outcome measures regarding the knowledge and adherence to the IFAS intake during the three months of the intervention period were deteremined. It was observed that large proportion of women in the intervention group (42⋅6 %) had an adherence to IFAS compared to the control group (3⋅3 %); (P < 0⋅0001). Based on bivariate and multivariable linear regression analyses, among NTDs affecting pregnancy, the history of spontaneous abortion and knowledge were independently associated with adherence to the IFAS (P < 0⋅05). Preconception nutrition education with regular follow-ups could be effective in improving knowledge and adherence to the IFAS intake. This intervention is very short, simple, cost-effective and has the potential for adaptation development to a large-scale implementation in the existing healthcare system in Ethiopia to prevent NTDs and adverse birth outcomes among women who plan to get pregnant. This clinical trial was registered on 6 April 2021 under the ClinicalTrials.gov with an identifier number PACTR202104543567379.
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Affiliation(s)
- Anteneh Berhane
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Preconception of folic acid supplementation knowledge among Ethiopian women reproductive age group in areas with high burden of neural tube defects: a community based cross-sectional study. J Nutr Sci 2022; 11:e48. [PMID: 35836692 PMCID: PMC9241059 DOI: 10.1017/jns.2022.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/07/2022] Open
Abstract
Abstract
Periconceptional folic acid supplementation is effective in the prevention of neural tube defects (NTDs). The aim of the present study was to determine the level of knowledge about the benefits of preconceptional folic acid supplementation in a sample of women of childbearing age and its associated factors. A cross-sectional community-based study design was carried out on a total of 441 women of childbearing age. Questionnaires included knowledge of preconception of folic acid supplements and socio-demographic characteristics. The χ2 was used to compare categorical data. Multivariate logistic regression was used to isolate the predictive variables and examined individually by calculating the adjusted odds ratio. Statistical significance is declared as P < 0·05. We found that 35·1 % (n 155) knew preconceptional folic acid supplementation could prevent NTDs, and 3·8 % (n 17) knew the right time to take preconceptional folic acid supplementation and only 1·7 % (n 7) who had a history of NTDs. Attended secondary education (OR 2·7; 95 % CI 1·1, 6·0, P = 0·017), governmental employee (OR 3·5; 95 % CI 2·3, 17·8, P < 0·001), current pregnancy status (OR 3·0; 95 % CI 2·1, 4·2, P = 0·043), history of visiting the antenatal care service during pregnancy (OR 2·9; 95 % CI 1·07, 7·8, P = 0·03), history of taking folic acid supplement (OR 4·5; 95 % CI 2·9, 7·1, P < 0·001) were associated. More than half of the participant women did not know about preconception of folic acid supplements that reduce the risk of NTDs. Identification of the level of knowledge on preconception of folic acid may allow for targeted educational or other interventions to further encourage folic acid use.
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Sisay BG, Tamirat H, Sandalinas F, Joy EJM, Zerfu D, Belay A, Mlambo L, Lark M, Ander EL, Gashu D. Folate Deficiency Is Spatially Dependent and Associated with Local Farming Systems among Women in Ethiopia. Curr Dev Nutr 2022; 6:nzac088. [PMID: 35669042 PMCID: PMC9154233 DOI: 10.1093/cdn/nzac088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Folate is essential for the synthesis and integrity of DNA, normal cell formation, and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD)-affected pregnancies. Folate status is largely dependent on dietary intakes. Objectives We aimed to explore the spatial distribution of biomarkers of folate status and their association with farming systems among nonpregnant WRA in Ethiopia. Methods Serum and RBC folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA were investigated and its relation with the dominant local farming system was explored. Results The median serum folate and RBC folate concentrations were 12.3 nmol/L and 567.3 nmol/L, respectively. The national prevalence of folate deficiency using homocysteine concentration as a metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD-affected pregnancies. Folate nutrition was spatially dependent at distances of ≤ 300 km. A marked variability in folate concentration was observed between farming systems: greater RBC folate concentration (median: 1036 nmol/L) was found among women from the Lake Tana fish-based system, whereas the lowest RBC folate concentration (median: 386.7 nmol/L) was observed in the highland sorghum chat mixed system. Conclusions The majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD-affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country.
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Affiliation(s)
- Binyam G Sisay
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hasset Tamirat
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Edward J M Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dilenesaw Zerfu
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adamu Belay
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Liberty Mlambo
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
| | - Murray Lark
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
| | - E Louise Ander
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United Kingdom
| | - Dawd Gashu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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Trend and burden of neural tube defects among cohort of pregnant women in Ethiopia: Where are we in the prevention and what is the way forward? PLoS One 2022; 17:e0264005. [PMID: 35180245 PMCID: PMC8856542 DOI: 10.1371/journal.pone.0264005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Neural tube defect is one of the top five most serious birth defects in the world. In Ethiopia an accurate estimate of the trend and burden of neural tube defects is still unknown. There hasn’t been much research done on the prevalence and trend of neural tube defects in Eastern Ethiopia. To complement previous efforts of studies, the purpose of this study is to estimate the trend and burden of neural tube defects in Eastern Ethiopia as well as to investigate the epidemiological implications of the findings. Methods A facility-based retrospective cohort study was carried out from cohort pregnant women who delivered in selected hospitals. File records of all babies who were found to have neural tube defects could be reached between 2017 and 2019. A structured checklist was used to collect data. The incidence of each case was calculated by dividing the number of cases per year by the total number of live births in each hospital. To determine the linear trend of neural tube defects over time, linear trend of Extended Mantel-Haenszel chi-square was performed. Data were presented using frequencies and percentages. Data were analyzed using SPSS for windows version 25. Results A total of 48,750 deliveries were recorded during the three years of the study considered for analyses with 522 women having neural tube defect giving an incidence rate of 107.5 per 10,000 live births in the three years. The most common types of neural tube defects found in the area were anencephaly and spina bifida accounting for 48.1% and 22.6%, respectively. The distribution of neural tube defects varied across the study hospitals, with Adama Medical College Hospital having the highest proportion (46.6%). Over half of the mothers (56.7%) live in cities. Mothers in the age group 25–34 (46.9%) and multigravida mothers had higher proportions (64.4%).of neural tube defects. None of the mothers took folic acid before conception, and only 19% took iron folic acid supplementation during their pregnancy. Conclusion and recommendation The findings showed that an increasing trend and burden of neural tube defects and preconception folic acid supplementation is insignificant in the region which showed that where we are in the prevention of neural tube defects. The finding suggests that preconception folic acid supplementation in conjunction with health care services should be considered to reduce the risk of neural tube defects in the region. Aside from that, intensive prevention efforts for long-term folate intake through dietary diversification and appropriate public health interventions are required. Furthermore, data must be properly recorded in order to address disparities in neonatal death due to neural tube defects, and the determinants of neural tube defects should be investigated using large scale prospective studies with biomarkers.
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Inadequacy of nutrient intake among adolescent girls in south central Ethiopia. J Nutr Sci 2021; 10:e90. [PMID: 34733502 PMCID: PMC8532068 DOI: 10.1017/jns.2021.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 11/08/2022] Open
Abstract
Adolescent undernutrition is a major public health problem in Ethiopia. Inadequate dietary intake of nutrients is the major determinants of undernutrition. However, the adequacy of dietary intake among adolescents was not sufficiently explored. The present study aims to estimate the inadequacy of nutrient intake among adolescent girls in south central Ethiopia. A community-based cross-sectional study was conducted. We assess food and nutrient intake using repeated multiple-pass 24-h dietary recall. The study was conducted in Damot Gale district, Woliyta zone, Southern Ethiopia. Data were collected from 288 female adolescents. The majority of adolescent girls consumed cereals (96⋅9 %) and roots/tubers (75⋅3 %). However, only less than 1 % of them consumed flesh food. The mean energy, carbohydrate, protein and dietary fibre intake of the adolescent girls per day was 1452⋅7 ± 356⋅3 kcal, 305⋅6 ± 72⋅4 g, 35⋅7 ± 13⋅3 g and 18⋅6 ± 8⋅4 g, respectively. The median fat intake was 13⋅3 g (IQR 8⋅8, 19⋅8). The contribution of carbohydrate, protein and fat for the total energy was 80, 10 and 8 %, respectively. The prevalence of inadequate intake of protein was 60⋅9 %. The prevalence of inadequate intake of iron for early adolescents and late adolescents was 82 and 53 %, respectively. The prevalence of inadequate intake of folate was 83⋅9 % and zinc was 58 %. The prevalence of inadequate intake was greater than 90 % for vitamin B12, vitamin C and calcium. The present study found an alarmingly high prevalence of inadequate intake of some nutrients among adolescent girls of Damot Gale district.
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Mekonen HK, Berhe Y, Berihu BA, Teka H, Hadgu A, Gebregziabher L, Berhe EH, Magana T, Mulugeta A. A silent epidemic of major congenital malformations in Tigray, northern Ethiopia: hospital-based study. Sci Rep 2021; 11:21035. [PMID: 34702882 PMCID: PMC8548534 DOI: 10.1038/s41598-021-00240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
Congenital malformations are defects of the morphogenesis of organs or body during the pregnancy period and are identifiable at pre- or postnatal. They are identified as the major cause of child mortality worldwide. There is a need to understand the prevalence of congenital malformations in Tigray and Ethiopia in general as surveillance data are lacking. Hence, this study was designed to investigate the burden of major congenital malformations in the Tigray Region, Northern Ethiopia. Hospital-based cross-sectional study was conducted to identify neonates with major congenital anomalies in the labor ward admitted at six major public hospitals of Tigray region, Ethiopia between January 2018 and 2019. All newborns/neonates delivered in all study hospitals during the study period were considered as the study population. The prevalence of major congenital anomalies and the distribution of each type of major congenital anomalies within total birth were calculated. Data on maternal, and newborn demographic characteristics was collected. Statistical analysis was done using SPSS and p value < 0.05 was considered significant. A total of 12,225 births and terminations were recorded in the six hospitals during the study period. Of total 12,225 births and terminations examined, 383 births had major congenital malformations and the overall prevalence of congenital malformations was 3.13% of the total births examined. Congenital anomalies (CAs) of the central nervous system specifically neural tube defects (NTDs) were the commonest anomalies in this study, found in 68.7% (263NTDs/383 CAs) of the neonates with CAs. The overall prevalence of NTDs was 2.15% (263/12,225 births) of the total births examined. Maternal factors such as women 20 years of age or younger (p < 0.0001) and women older than 35 years of age (p < 0.0001), abortion history (p < 0.0001), gravidity above 4 (p = 0.005), were more likely associated with an increased risk of babies with congenital anomalies. Fetal factors including gestational ages below 28 weeks (p < 0.0001) and above 40 weeks (p < 0.0001) were strongly associated with an increased risk of babies with congenital anomalies. However, these associated factors were not resulted from multivariable logistic regression analysis. Thus, the result might be affected by possible confounding factors. This study has shown a high prevalence of major congenital anomalies in the study community. Of the total congenital anomalies observed, most of neonates are affected with neural tube defects, a birth defect with well–established evidence having folic acid deficiency or insufficiency is the predominant cause of spina bifida and anencephaly. This just screams urgency to implement effective/mandatory/ programs to get all women of reproductive age an adequate folic acid to prevent spina bifida and anencephaly.
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Affiliation(s)
- Hayelom Kebede Mekonen
- College of Health Sciences, School of Medicine, Division of Biomedical Institute, Department of Anatomy, Mekelle University, Mekelle, Ethiopia. .,School of Medicine, Department of Anatomy and Neurobiology, Postdoctoral Fellow at University of Maryland Baltimore, Baltimore, USA.
| | - Yibrah Berhe
- College of Health Sciences, School of Medicine, Department of Gynaecology & Obstetrics, Mekelle University, Mekelle, Ethiopia
| | - Birhane Alem Berihu
- College of Health Sciences, School of Medicine, Division of Biomedical Institute, Department of Anatomy, Mekelle University, Mekelle, Ethiopia
| | - Hale Teka
- College of Health Sciences, School of Medicine, Department of Gynaecology & Obstetrics, Mekelle University, Mekelle, Ethiopia
| | - Abera Hadgu
- College of Health Sciences, School of Medicine, Department of Pharmacology, Mekelle University, Mekelle, Ethiopia
| | - Letekirstos Gebregziabher
- College of Health Sciences, School of Public Health, Department of Biostatistics, Mekelle University, Mekelle, Ethiopia
| | - Etenat Halefom Berhe
- College of Social Sciences & Languages, Department of Geography & Environmental Studies, Mekelle University, Mekelle, Ethiopia
| | - Tony Magana
- College of Health Sciences, School of Medicine, Department of Neurosurgery, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- College of Health Sciences, School of Public Health, Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
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Teshome F, Kebede Y, Girma K, Birhanu Z. A survey on women's awareness of iron and folic acid intake during preconception period and its associated factors in Manna District, Oromia region, Southwest Ethiopia. Nurs Open 2021; 9:950-958. [PMID: 34415662 PMCID: PMC8859085 DOI: 10.1002/nop2.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022] Open
Abstract
Aim This study aimed to assess pregnant women's awareness of iron and folic acid intake during the preconception period and associated factors. Design A cross‐sectional study. Methods This study was conducted on 636 pregnant women in Manna District, Oromia region, Southwest Ethiopia. Women's awareness of iron and folic acid intake during the preconception period was measured using a pre‐tested structured questionnaire. Descriptive, binary and multivariable logistic regression analyses were carried out. Results Of the total of 623 participants, 6.7% of them had an awareness of iron and folic acid intake during preconception period. Women's husband who had formal education, women who had ≥four ANC visits and women who were at distance of <30 min from the nearest health facility were significant predictors of pregnant women's awareness iron and folic acid intake during the preconception period. Conclusions Women's awareness of iron and folic acid intake during the preconception period was very low. Husband educational status, frequency of ANC visits and distance from health facility were predictors of women's awareness of iron and folic acid intake during the preconception period.
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Affiliation(s)
- Firanbon Teshome
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Kasahun Girma
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Shiferaw MY, Awedew AF, T/Mariam TL, Aklilu AT, Akililu YB, Andualem AM. Multiple site neural tube defects at Zewuditu Memorial Hospital, Addis Ababa, Ethiopia: a case report. J Med Case Rep 2021; 15:429. [PMID: 34399841 PMCID: PMC8369642 DOI: 10.1186/s13256-021-02913-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neural tube defects are common group of central nervous system anomalies of complex etiology and major public health importance worldwide. The occurrence of multiple neural tube defects, however, is an extremely rare event and has never been reported in Ethiopia so far. This study gives an insight into how the embryogenesis, management, and postoperative complications of multiple neural tube defects differ from the ordinary single neural tube defects on the basis of up-to-date existing literature. CASE PRESENTATION This paper highlights a case of an 8 days old female black race Ethiopian neonate who was brought by her mother with the chief complaint of lower back and lower neck swelling since birth. The findings were a 5 × 4 × 5 cm sized ulcerated placode at the mid-lumbosacral area and a 1.5 × 1.5 × 1 cm sized fluctuant, nontender, transilluminating mass with overlying unruptured defect dysplastic skin at the cervicothoracic junction. With a diagnosis of multiple neural tube defects secondary to unruptured cervicothoracic meningocele and ruptured lumbosacral myelomeningocele, single-stage repair of the defects was done with good outcome. CONCLUSION There is insufficient evidence as to the exact mechanism of development of multiple neural tube defects. Similarly, whether patients with multiple neural tube defects had increased risk of post repair hydrocephalus compared with patients who have single neural tube defect is unknown. Hence, more research on the embryogenesis, management, and long-term outcome of multiple neural tube defects in particular and single neural tube defects in general should be done to better help patients with this costly and crippling problem. Lastly, the practice of folic acid supplementation is very low in resource-limited countries such as Ethiopia and, hence, should be improved.
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Affiliation(s)
- Mestet Yibeltal Shiferaw
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalel Fentahun Awedew
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegazeab Laeke T/Mariam
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenezer Tirsit Aklilu
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemisirach Bizuneh Akililu
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aemiro Mazengia Andualem
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Jemal S, Fentahun E, Oumer M, Muche A. Predictors of congenital anomalies among newborns in Arsi zone public hospitals, Southeast Ethiopia: a case-control study. Ital J Pediatr 2021; 47:143. [PMID: 34193221 PMCID: PMC8243734 DOI: 10.1186/s13052-021-01093-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background Congenital anomaly is a partial or complete structural and/or functional defect during intrauterine life. Globally, major congenital anomalies account for 6% of all newborns among which about 94% of cases occurred in developing countries. In spite of its public health importance, very limited studies are reported in Ethiopia, and hardly any study in Arsi Zone. Objectives To determine the predictors of congenital anomalies among newborns in Arsi Zone Public Hospitals, Southeast Ethiopia. Methods A multi-center institutional-based case-control study was conducted in 418 (105 cases and 313 controls) of newborns in Arsi Zone Public Hospitals. Descriptive analysis, binary and multivariable logistic regressions were implemented. Results In this study, women who have been drinking alcohol during pregnancy were 3.48 times more prone to have newborns with congenital anomalies than their counterparts (AOR = 3.48; 95% CI: 1.38, 8.74). The likelihood of having a newborn with congenital anomalies was six and four times higher for women who had a maternal illness (AOR = 6.10; 95%CI: 2.39, 15.57) and chewing khat during pregnancy (AOR = 4; 95%CI: 1.49, 10.65), respectively. Moreover, the lack of folic acid supplementation and pesticides during pregnancy were 3.25 and 4.76 times more likely to experience a newborn with congenital anomalies, respectively. Conclusion Alcohol drinking, maternal illness, khat chewing, and chemical exposure during pregnancy had a significant association with the occurrence of congenital anomalies. While, taking folic acid supplements had a protective effect. Health experts and the community should take these factors into consideration and act accordingly.
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Affiliation(s)
- Sudi Jemal
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Engidaw Fentahun
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Abebe Muche
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia.
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Birhanie MW, Adekunle AO, Arowojolu AO, Dugul TT, Mebiratie AL. Micronutrients Deficiency and Their Associations with Pregnancy Outcomes: A Review . NUTRITION AND DIETARY SUPPLEMENTS 2020. [DOI: 10.2147/nds.s274646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Bitew ZW, Worku T, Alebel A, Alemu A. Magnitude and Associated Factors of Neural Tube Defects in Ethiopia: A Systematic Review and Meta-Analysis. Glob Pediatr Health 2020; 7:2333794X20939423. [PMID: 32743026 PMCID: PMC7376379 DOI: 10.1177/2333794x20939423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 01/30/2023] Open
Abstract
Neural tube defects remain a major problem in developing countries, but there are limited comprehensive national reports to date in Ethiopia. Therefore, this study aimed to assess the prevalence of neural tube defects and associated factors in Ethiopia. Electronic databases and other sources were used to retrieve studies. Fifteen out of 862 studies were included in the final analysis. The estimated pooled prevalence of neural tube defects among children in Ethiopia was 63.3 cases per 10 000 children. The pooled prevalence of spinal bifida, anencephaly, and encephalocele was 41.09, 18.90, and 1.07 per 10 000 children, respectively. Previous family history and unplanned pregnancy were risk factors for neural tube defects. Folic acid supplementation during the first trimester of pregnancy was found to be protective. Neural tube defects are widespread in Ethiopia. Hence, fortification of food with folic acid or folic acid supplementation during childbearing age is recommended.
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Affiliation(s)
| | | | | | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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16
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Necho M, Belete A, Tsehay M, Zenebe Y. A meta-analysis of depressive symptoms among Ethiopian prisoners and a narrative description of its associated factors: a country based systematic review and meta-analysis study. BMC Psychiatry 2020; 20:281. [PMID: 32503475 PMCID: PMC7275530 DOI: 10.1186/s12888-020-02662-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/11/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The burden of depression in prisoners is increasing and factors such as co-existence of medical illness, lack of social support and longer duration of sentences are contributing to it. However, no pooled evidence on the magnitude and factors of depression in prisoners existed in Ethiopia. The current meta-analysis was therefore aimed to have aggregate evidence on the magnitude and factors of depression in prisoners of Ethiopia. METHODS A search of databases on PubMed, Scopus, and EMBASE was carried out systematically. Besides, grey literature sources were extensively investigated. Moreover, the reference lists of the articles selected were searched. Random effects and quality-effects models were used to describe the pooled prevalence of depressive symptoms with 95% CI. We also detect heterogeneity between studies using Cochran's Q- statistic and the Higgs I2 test. A sensitivity analysis was also implemented. Publication bias was checked with Egger's test and funnel plots visually. RESULTS Among 232 papers identified through the specified database searches only 17 full-text articles were assessed for eligibility and only nine (9) studies fulfilled the prespecified criteria and incorporated in the final meta-analysis. The pooled prevalence of Depressive symptoms among prisoners was 53.40%(95% CI: 41.33, 65.46). The pooled prevalence of Depressive symptoms in prisoners was 41.9% in Southwest Ethiopia, 44.43% in North West of Ethiopia, 59.05% in Addis Ababa, and 72.7% Southern Ethiopia. Besides, the pooled Depression symptoms prevalence among prisoners was 51.24% as measured with PHQ-9 and 56.15% with BDI-II. Besides, studies that utilized a relatively large sample size (≥350) yields a smaller pooled prevalence of Depression symptoms, 51.93% than those which utilized smaller sample sizes (< 350); 54.13%. CONCLUSION The pooled magnitude of depression in prisoner's population is very high, 53.40%. This pooled effect size for the Depression symptoms was significantly higher in the southern region of the country than in the southwest region. Besides, the pooled prevalence was significantly higher as measured by the BDI-II tool than by PHQ-9. Also, studies that utilized a larger sample size provided a significantly lower pooled magnitude of symptoms of depression than studies that utilized a smaller sample size.
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Affiliation(s)
- Mogesie Necho
- Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia.
| | - Asmare Belete
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Mekonnen Tsehay
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Yosef Zenebe
- grid.467130.70000 0004 0515 5212Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
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Prevalence of Hyperhomocysteinaemia and Associated Factors among Ethiopian Adult Population in a 2015 National Survey. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9210261. [PMID: 32420383 PMCID: PMC7201487 DOI: 10.1155/2020/9210261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022]
Abstract
Hyperhomocysteinaemia (HHcy) is an independent risk factor for major cardiovascular diseases, but data on the prevalence and predictors of HHcy in low- and middle-income countries like Ethiopia are scant. The aim of this study was to estimate the prevalence of HHcy and associated risk factors in the Ethiopian adult population. A cross-sectional survey on risks of noncommunicable diseases (NCDs) using the STEPwise approach to surveillance (STEPS) survey was conducted between April and June 2015. A total of 4,175 study participants were surveyed. Serum homocysteine (Hcy) and metabolic profile were determined using Cobas Integra 400 Plus and CardioChek PA analyzer, respectively. Factors associated with HHcy were determined using logistic regression. The mean serum tHcy concentration was 14.6 μmol/L, with 16.4 μmol/L in males and 13.4 μmol/L in females. Overall, 38% had HHcy, with figures in males (49%) higher than females (30%). Increased age, being male, and high blood pressure and/or taking blood pressure medication, as well as low consumption of fruit and/or vegetables, were independent risk factors for HHcy. In conclusion, the prevalence of HHcy among the adult Ethiopian population is alarmingly high. Improving diets through the promotion of fruit and vegetable consumption is needed to reduce the risk of NCDs.
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Dixon M, Kancherla V, Magana T, Mulugeta A, Oakley GP. High potential for reducing folic acid-preventable spina bifida and anencephaly, and related stillbirth and child mortality, in Ethiopia. Birth Defects Res 2019; 111:1513-1519. [PMID: 31424635 DOI: 10.1002/bdr2.1584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/15/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent surveillance studies in Ethiopia show an epidemic of spina bifida and anencephaly, two major neural tube birth defects that are severe and life-threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid-based interventions to prevent spina bifida and anencephaly. METHODS Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid-preventable spina bifida and anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births. RESULTS Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid-preventable spina bifida and anencephaly-affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under-five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal- and 6.8% for under-five mortality. CONCLUSIONS Spina bifida and anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large-scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under-five mortality.
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Affiliation(s)
- Meredith Dixon
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Tony Magana
- Department of Neurosurgery, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Godfrey P Oakley
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
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Bekele KK, Ekanem PE, Meberate B. Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. BMC Pediatr 2019; 19:254. [PMID: 31340768 PMCID: PMC6657112 DOI: 10.1186/s12887-019-1624-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cleft lip and palate deformities are considered one of the most common birth defects of the head and neck that pose significant medical, psychosocial and financial burdens on the affected individuals and families, especially in low income communities. The etiology and pathogenesis of cleft lip and palate is complex and is known to involve genetic and/or environmental factors. Objective To assess the patterns of anatomical cleft lip and palate deformities among neonates in Mekelle and Ayder Comprehensive Specialized hospitals, Tigray, Northern Ethiopia. Methods A hospital-based retrospective study was conducted from May 2017 to June 2017 at Mekelle and Ayder Comprehensive Specialized hospitals, both in Mekelle city. Data was collected from all medical charts of neonates registered from 2011 to 2016 and analyzed using SPSS version 21.0 and OpenEpi software. Results were presented using tables and graphs; Chi-square test was used to look for an association between variables, odds ratio to determine the strength of association of selected variables using multinomial logistic regression model, while Fisher Exact (Clopper-Pearson) was used to compare yearly prevalence. Results Of 37,152 neonatal charts analyzed, 119 (0.32%) cases were identified as having cleft deformities. 38.7, 17.6, and 43.7% of this figure had cleft lips, cleft palates and both cleft lip and palate respectively. 46 (38.7%) neonates had lateral patterns of cleft lip deformities with 56.5% located unilaterally on the right and 43.5% unilaterally on the left. Of 52 (43.7%) neonates with cleft lip and palate deformities, 40.4% were located bilaterally while 38.5 and 21.2% were located unilaterally on the left and right, respectively. Associated malformations were: cardiac (3.4%), central nervous system (1.7%) and limb deformities (5.9%). The overall prevalence of cleft deformities was found to be 3.11 per 1000 live births. Conclusion The study showed a higher prevalence of cleft deformities than that reported in Addis Ababa and some other African countries. A higher occurrence of left unilateral pattern of cleft lip and palate was observed whereas a higher right unilateral pattern of cleft lip was identified. The higher prevalence of cleft lip and palate recorded in this region of Ethiopia may reflect an environmental impact.
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Affiliation(s)
- Konjit K Bekele
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
| | - Peter E Ekanem
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia.
| | - Berhanu Meberate
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
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Bationo F, Songré-Ouattara LT, Hama-Ba F, Baye K, Hemery YM, Parkouda C, Lingani-Sawadogo H, Diawara B, Humblot C. Folate Status of Women and Children in Africa – Current Situation and Improvement Strategies. FOOD REVIEWS INTERNATIONAL 2019. [DOI: 10.1080/87559129.2019.1608558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Fabrice Bationo
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
- Food and nutrition research in the global south/Institut de Recherche pour le Développement, University of Montpellier/Montpellier SupAgro, Montpellier, France
| | - Laurencia Toulsoumdé Songré-Ouattara
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
| | - Fatoumata Hama-Ba
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
| | - Kaleab Baye
- Center for Food Sciences and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Youna M. Hemery
- Food and nutrition research in the global south/Institut de Recherche pour le Développement, University of Montpellier/Montpellier SupAgro, Montpellier, France
| | - Charles Parkouda
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
| | - Hagrétou Lingani-Sawadogo
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
| | - Bréhima Diawara
- Département Technologie Alimentaire, Institut de Recherche en Sciences Appliquées et Technologies/Centre National de la Recherche Scientifique et Technique, Ouagadougou, Burkina Faso
| | - Christèle Humblot
- Food and nutrition research in the global south/Institut de Recherche pour le Développement, University of Montpellier/Montpellier SupAgro, Montpellier, France
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Berihu BA, Welderufael AL, Berhe Y, Magana T, Mulugeta A, Asfaw S, Gebreselassie K. High burden of neural tube defects in Tigray, Northern Ethiopia: Hospital-based study. PLoS One 2018; 13:e0206212. [PMID: 30427877 PMCID: PMC6235279 DOI: 10.1371/journal.pone.0206212] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Neural tube defects are the major causes of fetal loss and considerable disabilities in infants. Currently, there is no significant research on the incidence of Neural tube defects in the Tigray region of Ethiopia. Objective To determine the incidence and clinical pattern of the Neural Tube Defects. Methods A hospital-based cross-sectional study was conducted from October 2016 to June 2017. All pregnancy outcomes were examined for any externally visible birth defects and neurological integrity by trained midwives under the supervision of senior obstetrics and gynecology and a neurosurgeon. Data were collected using a survey tool to collect maternal and newborn demographic data and a checklist developed to capture newborns with Neural Tube Defects. Data were analyzed using SPSS version 20. The prevalence of NTDs was calculated per 10,000 births. Result Out of the 14,903 births during the study period, a total of 195 infants were born afflicted with Neural Tube Defects. The burden of infants with anencephaly and spina bifida was 66.4 and 64.4 per 10, 000 births, respectively. The overall incidence rate of NTDs in this study was 131 per 10, 000 births of which 23% were liveborn and 77% were stillborn. The highest burden of Neural Tube Defects was observed in Adigrat Hospital from Eastern Zone of Tigray (174 per 10,000 births) and Lemlem Karl Hospital from Southern Zone of Tigray (304 per 10,000 births) compared to Kahsay Abera Hospital from Western Zone (72.8 per 10,000 births) and Sihul Hospital from North Western Zone of Tigray (69.8 per 10,000 births). Conclusion and recommendation Assuming that the non folic acid preventable rate should be 5 per 10,000 births, our prevalence rate is 131 per 10,000 births, and then we have a rate or an epidemic that is 26 times what it should be. This just emphasizes the urgency to implement effective programs to get all women of reproductive age to have adequate folic acid to prevent all of folic acid-preventable spina bifida and anencephaly, which would prevent 96% (125/130) of spina bifida and anencephaly in the Tigray Provence.
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Affiliation(s)
- Birhane Alem Berihu
- Department of Anatomy, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- * E-mail:
| | - Abadi Leul Welderufael
- Department of pediatrics and child health, School of medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe
- Department of Obstetrics and Gynecology, School of medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tony Magana
- Department of Surgery, School of medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of nutrition, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Selemawit Asfaw
- Department of nutrition, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - kibrom Gebreselassie
- Department of Surgery, School of medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Rogers LM, Cordero AM, Pfeiffer CM, Hausman DB, Tsang BL, De‐Regil LM, Rosenthal J, Razzaghi H, Wong EC, Weakland AP, Bailey LB. Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues. Ann N Y Acad Sci 2018; 1431:35-57. [PMID: 30239016 PMCID: PMC6282622 DOI: 10.1111/nyas.13963] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/06/2018] [Accepted: 08/15/2018] [Indexed: 01/21/2023]
Abstract
Inadequate folate status in women of reproductive age (WRA) can lead to adverse health consequences of public health significance, such as megaloblastic anemia (folate deficiency) and an increased risk of neural tube defect (NTD)-affected pregnancies (folate insufficiency). Our review aims to evaluate current data on folate status of WRA. We queried eight databases and the World Health Organization Micronutrients Database, identifying 45 relevant surveys conducted between 2000 and 2014 in 39 countries. Several types of folate assays were used in the analysis of blood folate, and many surveys used folate cutoffs not matched to the assay. To allow better comparisons across surveys, we attempted to account for these differences. The prevalence of folate deficiency was >20% in many countries with lower income economies but was typically <5% in countries with higher income economies. Only 11 surveys reported the prevalence of folate insufficiency, which was >40% in most countries. Overall, folate status data for WRA globally are limited and must be carefully interpreted due to methodological issues. Future surveys would benefit from using the microbiologic assay to assess folate status, along with assay-matched cutoffs to improve monitoring and evaluation of folic acid interventions, thus informing global efforts to prevent NTDs.
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Affiliation(s)
- Lisa M. Rogers
- Evidence and Programme Guidance, Department of Nutrition for Health and DevelopmentWorld Health OrganizationGenevaSwitzerland
| | - Amy M. Cordero
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Christine M. Pfeiffer
- National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | | | | | | | - Jorge Rosenthal
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Hilda Razzaghi
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
| | - Eugene C. Wong
- National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaGeorgia
- Oak Ridge Institute for Science and EducationOak RidgeTennessee
| | | | - Lynn B. Bailey
- Foods and Nutrition DepartmentUniversity of GeorgiaAthensGeorgia
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Women's Awareness and Associated Factors on Preconception Folic Acid Supplementation in Adet, Northwestern Ethiopia, 2016: Implication of Reproductive Health. J Nutr Metab 2018; 2018:4936080. [PMID: 30116639 PMCID: PMC6079494 DOI: 10.1155/2018/4936080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/17/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Preconception folic acid supplementation is the provision of folate for reproductive age group women who have a plan to be pregnant. According to different studies, in African countries, there is poor utilization of preconception folic supplementation. So this study aimed at assessing women's awareness on preconception care and its associated factors in Adet, Northwestern Ethiopia. Methods A community-based cross-sectional study was conducted from March 1 to April 1, 2016, among 422 reproductive age group women. Systematic random sampling was used to get the study unit, and the data were collected using pretested structured questionnaire via face-to-face interview. The collected data were entered, cleaned, checked using EpiData version 3.1, and finally analyzed using SPSS version 20. Descriptive summary of the data was presented in terms of percentage and frequency. Binary and multiple logistic regressions were used in order to identify predictors using odds ratio at 95% confidence interval. Result In this study, a total of 422 reproductive age group women participated with a response rate of 100%. Of a total of 422 participants, 67 (15.9%) of the women had good awareness on preconception folic acid supplementation. Women's awareness on preconception folic acid supplementation was affected by having a chronic health problem, monthly household income, educational status, and a history of family planning use. Women who were educated (AOR 4.77, CI 1.85-6.98), had a history of family planning use (AOR 3.89, CI 1.77-8.55), had a chronic health problem (AOR 3.47, CI 2.68-5.98), and had a better monthly income (AOR 2.6, CI 2.05-6.76) had good awareness than their counterparts. Conclusion and Recommendation This study concluded that women's awareness on preconception folic acid supplementation was low. This finding suggests that there is a need to give emphasis and deliver health education about preconception folic acid supplementation for women.
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Micronutrient Status and Dietary Intake of Iron, Vitamin A, Iodine, Folate and Zinc in Women of Reproductive Age and Pregnant Women in Ethiopia, Kenya, Nigeria and South Africa: A Systematic Review of Data from 2005 to 2015. Nutrients 2017; 9:nu9101096. [PMID: 28981457 PMCID: PMC5691713 DOI: 10.3390/nu9101096] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 11/16/2022] Open
Abstract
A systematic review was conducted to evaluate the status and intake of iron, vitamin A, iodine, folate and zinc in women of reproductive age (WRA) (≥15–49 years) and pregnant women (PW) in Ethiopia, Kenya, Nigeria and South Africa. National and subnational data published between 2005 and 2015 were searched via Medline, Scopus and national public health websites. Per micronutrient, relevant data were pooled into an average prevalence of deficiency, weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. This review included 65 surveys and studies from Ethiopia (21), Kenya (11), Nigeria (21) and South Africa (12). In WRA, WAVG prevalence of anaemia ranged from 18–51%, iron deficiency 9–18%, and iron deficiency anaemia at 10%. In PW, the prevalence was higher, and ranged from 32–62%, 19–61%, and 9–47%, respectively. In WRA, prevalence of vitamin A, iodine, zinc and folate deficiencies ranged from 4–22%, 22–55%, 34% and 46%, while in PW these ranged from 21–48%, 87%, 46–76% and 3–12% respectively. Inadequate intakes of these micronutrients are high and corresponded with the prevalence figures. Our findings indicate that nationally representative data are needed to guide the development of nutrition interventions and public health programs, such as dietary diversification, micronutrient fortification and supplementation.
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Dessie MA, Zeleke EG, Workie SB, Berihun AW. Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study. BMC Pregnancy Childbirth 2017; 17:313. [PMID: 28934941 PMCID: PMC5609063 DOI: 10.1186/s12884-017-1506-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neural tube defects are among the most common birth defects, contributing to miscarriage, infant mortality, severe congenital abnormalities and serious disabilities. It is burdensome to patients, caregivers, healthcare systems and society. It could be reduced if women consume a folic acid supplement before and during the early weeks of pregnancy. This study assesses folic acid usage and associated factors for the prevention of neural tube defects among pregnant women in Ethiopia. METHODS Institution based cross-sectional study was conducted on 417 systematically sampled, consented pregnant women that visited Adama hospital medical college for antenatal care during August to November 2014. Pretested interviewer administered questionnaire was used to collect socio-demographic, obstetric characteristics and folic acid usage of women. RESULT About 48.4% of women took a folic acid supplement at different period of pregnancy; but, only 1.92% of women took the supplement at a protective period against neural tube defects. Age, the early timing of antenatal registration, was a preconception consulted, previous unsuccessful pregnancies and level of folic acid awareness were significantly associated with folic acid usage for prevention of neural tube defects. CONCLUSIONS Folic acid usage during the protective period against neural tube defects among women in Ethiopia is very low, so healthcare plan to improve intake of folic acid is required.
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Affiliation(s)
- Meselech Ambaw Dessie
- Department of Anatomy, School of Medicine, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ejigu Gebeye Zeleke
- Department of Biostatic and Epidemiology, Institute of public health, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shimelash Bitew Workie
- Department of Biostatic and Epidemiology, school of public health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Ayanaw Worku Berihun
- Department of Anatomy, School of Medicine, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gebreamlak B, Dadi AF, Atnafu A. High Adherence to Iron/Folic Acid Supplementation during Pregnancy Time among Antenatal and Postnatal Care Attendant Mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression. PLoS One 2017; 12:e0169415. [PMID: 28129344 PMCID: PMC5271309 DOI: 10.1371/journal.pone.0169415] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. Methods Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. Result More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%—64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. Conclusion Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.
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Affiliation(s)
| | - Abel Fekadu Dadi
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Azeb Atnafu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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