Inadequate feeding practices and impaired growth among children from subsistence farming households in Sidama, Southern Ethiopia

Dietary selenium intake among Ethiopian children in areas known for selenium spatial variability

Introduction

There is spatial variability of selenium (Se) in soil and crops in Ethiopia. We assessed the Se content of food items, breast milk, and urine among infants in Ethiopia from two areas with contrasting Se concentrations in soils.

Methods

Dietary Se intakes among children (6-23 months) were evaluated using a weighed food record on two non-consecutive days. Also, spot urine samples from children and breast milk samples from their mothers were collected to determine Se concentration. Selenium concentrations in the samples were analyzed using an inductively coupled plasma mass spectrometer (ICP-MS).

Results

Injera (prepared from teff and mixtures of other cereals) with a legume-based stew were the most frequently consumed foods by the children in both areas, followed by pasta. Overall, the Se concentration (mean ± SD) of food items, breast milk (12.2 ± 3.9 μg/L vs. 3.39 ± 1.5 μg/L), and urine samples (22.5 ± 11.5 μg/L vs. 3.0 ± 1.9 μg/L) from East Amhara were significantly higher than the corresponding samples from West Amhara (p < 0.001). The total Se intakes by the study children from East Amhara and West Amhara were 30.2 [IQ 25%, 14.2; IQ 75%, 54.1] and 7.4 [IQR 25%, 4.2; IQ 75%, 10.6] μg day-1, respectively; 31.5% of children from East Amhara and 92% of children from West Amhara were at risk of inadequate Se intakes. Urinary Se excretion accounted for 53 and 39% of daily dietary Se intake in East Amhara and West Amhara, respectively. Dietary Se intake was positively correlated with urinary Se excretion in East Amhara (r = 0.56; p < 0.001) but not among samples from West Amhara (r = 0.16; p ≥ 0.05), suggesting greater physiological Se conservation in a state of deficiency.

Conclusion

There is spatial variability of Se in foods, breast milk, and urine in Ethiopia, suggesting the need for implementation of targeted agronomic interventions that enhance Se concentrations in the edible portion of plant foods.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Mapping underweight in children using data from the five Ethiopia Demographic and Health Survey data conducted between 2000 and 2019: A geospatial analysis using the Bayesian framework

Background and aims

The Sustainable Development Goal is targeted to end all types of malnutrition including underweight by 2030. However, the reduction rate is not as expected to meet the target. Thus, we aimed to investigate the spatiotemporal distributions and drivers of underweight among children aged below 5 years in Ethiopia.

Methods

Geostatistical analysis using the Bayesian framework was conducted to map the spatial and Spatiotemporal distributions of underweight. Data for the primary outcome was obtained from the Ethiopian Demographic and Health Survey 2000–2019. Covariate data were accessed from different credible online sources at high resolutions. Spatial binomial regression was fitted to identify drivers of underweight using the Bayesian approach.

Results

The overall national prevalence of underweight was 44.7, 37.7, 35.4, 25.5, and 23.8% in 2000, 2005, 2011, 2016, and 2019, respectively, with a total reduction rate of 46.8%. Significant spatial clustering of underweight was observed in Northern, Northwestern, Southeastern, Eastern borders, and the border between Oromia and SNNPR regions. Mean annual temperature (mean regression coefficient (β): −0.39; 95% credible interval (95% CrI): −0.63, −0.14), altitude (β:−0.30; 95% CrI: 0.57, −0.05), population density (β:−0.03; 95% CrI: −0.03, −0.02), and distance to water bodies (β:−0.03; 95% CrI: −0.05, −0.004) were negatively associated with being underweight. However, travel time to the nearest cities in minutes (β: 0.09; 95% CrI: 0.03, 0.14) was positively associated with being underweight.

Conclusion

The national prevalence of underweight is reduced slower than expected in Ethiopia, with significant spatial variations across subnational and local levels. Temperature, altitude, population density, and distance to water bodies were negatively associated with underweight, whereas travel time to the nearest cities was positively associated with underweight in Ethiopia. Improving child nutrition through creating awareness and providing clean water should be strengthened.

Suboptimal feeding practices and impaired growth among children in largely food insecure areas of north Wollo, Ethiopia

In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.

Dietary practices and nutritional status of young children in the former ensete monoculture dominated Sidama region, southern Ethiopia: A community based cross-sectional study

Background

Child undernutrition is a challenge in Ethiopia, where morbidity and mortality among children are attributed to it. This study aimed to describe the dietary practices, household food insecurity, and nutritional status of young children in Dale district, Sidama region, southern Ethiopia. We discuss our findings in light of research from the same area 3 to 5 decades ago, and we analyze factors associated with linear growth of young children.

Method

A community-based cross-sectional study design was employed. Children less than two years old and their primary caretakers (n = 903) were included in this study. Among whom 791 children were aged above six months and 742 children out of 791 provided a 24-hour dietary recall. Interviews capturing other dietary practices, food insecurity, socio-demographic characteristics, anthropometric measurements, and haemoglobin assessments were performed for all. The WHO Child Growth Standards were used to calculate anthropometric indices and to describe stunting (length-for-age z-score <-2). Haemoglobin measures below 11g/dl were defined as low haemoglobin levels (anaemia). Multilevel linear regression was used to identify factors associated with length-for-age z-scores.

Result

The prevalence of stunting, wasting, and anaemia was 39.5%, 3.9%, and 61.7%, respectively. The majority of children (97%) ate cereals (maize) during the past 24 hours, and 79.6% of households use maize as the main food. Three fourth (75%) of the total households were food insecure ranging from mild to severe food insecurity. Boys were at higher risk of having lower length-for-age z-score than girls (β -0.53; 95% Confidence Interval (CI): -0.78, -0.27). For each month the children grew older, length-for-age z-score decreased slightly (β -0.06; -0.07, -0.04). Household food insecurity scores (β -0.05; -0.08, -0.01) and children haemoglobin levels, (β 0.21; 0.06, 0.35) were also associated with length-for-age z-score among young children.

Conclusion

Linear growth failure (stunting) was prevalent among young children in the rural Sidama region and the majority of them were also anaemic. Older age, male sex, a lower haemoglobin level in children, and household food insecurity were risk factors of linear growth failure in young children. Maize seems to be the dominant food in this previously ensete dominated area; however, there have been minimal improvements in length-for-age z-score over decades. Strategies to ensure household’s food access and improve the quality of child diets need to be implemented.

Effects of Family Demographics and Household Economics on Sidama Children's Nutritional Status

Weight- (WAZ), height- (HAZ), and BMI-for-age (BMIZ) are frequently used to assess malnutrition among children. These measures represent different categories of risk and are usually hypothesized to be affected by distinct factors, despite their inherent relatedness. Life history theory suggests weight should be sacrificed before height, indicating a demonstrable relationship among them. Here we evaluate impact of family composition and household economics on these measures of nutritional status and explore the role of WAZ as a factor in HAZ. Anthropometrics, family demographics, and measures of household economy were collected from Sidama agropastoralist children in a peri-urban village in southwestern Ethiopia (n = 157; 79 girls). Just over half of the sample (50.9%) had z-scores of - 2SD or below on at least one measure, indicating an elevated risk of morbidity/mortality; 30% were at or below - 2SD on two or more measures. We used hierarchical linear regression with random intercept analysis to model WAZ and HAZ. Siblings and crop sales significantly decrease WAZ while electricity, agriculture, and polygyny improve z-scores; however, an interaction between polygyny and siblings indicates negative effects of siblings in polygynous families and positive effects in nonpolygynous ones (adj. R² = 66.5%). For HAZ, agriculture and electricity are positively associated with z-scores whereas siblings have a negative effect; the interaction term again indicates that effects of siblings vary in polygynous and nonpolygynous families (adj. R² = 74.2%). A mediation model exploring the role of weight in height outcomes suggests not only that WAZ has direct effects on HAZ but also that effects of electricity and agriculture on HAZ are partially mediated by WAZ. Our findings indicate that WAZ and HAZ are primarily affected by shared variables, but effects of siblings vary by polygyny status. Long-term outcomes (HAZ) among Sidama children would likely benefit from interventions focused on stabilizing WAZ across family members.

The influence of fasting on energy and nutrient intake and their corresponding food sources among 6-23 months old children in rural communities with high burden of stunting from Northern Ethiopia

BACKGROUND

Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6-23 months old children in Northern Ethiopia.

METHODS

Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set at p < 0.05.

RESULTS

The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p < 0.001).

CONCLUSIONS

Inadequate intake of energy and nutrients was common among 6-23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6-23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.

The Role of Household Structure and Composition in Influencing Complementary Feeding Practices in Ethiopia

While the household in which a child grows up is considered a critical environment that influences nutrition outcomes, there is little research examining the influence of household composition and structure on complementary feeding practices. This study examined the influence of household structure and composition on complementary feeding practices, using the Ethiopian Demographic and Health Survey (EDHS), 2000 to 2016. The composition variables were calculated from the attributes of household members (alters) and the structure variables from their kinship status. A multilevel mixed-effects regression model, specifying survey rounds as the random effect, was used to examine the association between household structure/composition and the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). The average Marginal Effects (MEs) were calculated to facilitate practical interpretation. Children of caregivers with a higher number of alters (degree), unique number of kinship category (effect size), closely related (constraint), and mixed-age alters (age diversity) seemed to increase the probability of meeting the MDD. Degree and effective size decreased the probability of meeting MMF, while constraint increased it. Overall, this study revealed some associations between household structure and composition and complementary feeding practices. Hence, complementary feeding interventions could be adapted to account for the household structure and composition variations.

Infant and young child feeding practices in Ethiopia: analysis of socioeconomic disparities based on nationally representative data

BACKGROUND

Undernutrition among children is a priority area of public health concern in Ethiopia. The purpose of this study was to examine disparities in Infant and Young Child Feeding (IYCF) practices among children 6-23 months.

METHOD

Data were drawn from the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total of 3240 children aged 6-23 months were used for the present analysis. The outcome variable was IYCF practice score (ranging 0-7) which was constructed based on the linear and combined effects of four sets of variables: breastfeeding, avoidance of bottle feeding, diet diversity score and minimum feeding frequency. IYCF practice score was further recoded into three categories. Proportional odds regression was used to assess the determinants of IYCF category.

RESULTS

The proportional odds regression analysis showed that IYCF scores significantly decreased by 5% (Adjusted Odds Ratio (AOR) = 0.95; 95% CI: 0.93-0.97) for every unit increase in the child's age. Households with fathers of primary and secondary and above level education were 1.37 times (95% CI: 1.14-1.66) and 1.67 times (95% CI: 1.26-2.23) more likely to be in the high IYCF category than in the poor IYCF category. The likelihood of being in the high IYCF practice category decreased for non-working mothers by 30% (AOR = 0.70; 95% CI: 0.59-0.83) compared to those working in gainful employment. The chance of being in the high IYCF practice category decreased by 29% for households with no access to radio (AOR = 0.71; 95% CI: 0.59-0.85). Those with medium and rich/richer wealth category were 1.54 times (95% CI: 1.22-1.94) and 1.40 times (95% CI: 1.11-1.75) more likely to belong to high IYCF practice category than being in poor IYCF category. For every unit increase in health service utilization, the chance of falling in higher IYCF category increases by 1.15 times (95% CI: 1.08-1.23). The chance of falling in higher IYCF practice category decreases for rural residents by 37% (AOR = 0.63; 95% CI: 0.47-0.84) compared to those residing in urban areas.

CONCLUSION

For a child, the first two years is the time span during which linear faltering of growth is most prevalent and the period when the process of becoming stunted is almost complete. This study recommends improving access to women for gainful employment, provision of economic support to poor rural women, education and promotion of nutrition messages using most accessible media and boosting the positive role of fathers in child feeding practices.

Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

BACKGROUND

The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia.

METHODS

In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices.

RESULTS

Overall, 17.6% (95% CI: 15.6-19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21-0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16-0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21-4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16-0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44-4.82) was the community-level factors associated with the exclusive breastfeeding practices.

CONCLUSIONS

Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother's employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

Feeding practice, energy, and nutrient intake adequacy among children aged 6-23 months in Southern Ethiopia: a community based cross-sectional study

After 6 months, children require increased food and nutrient intake from complementary food for their growth and development. However, quantitative data on macro and micronutrient intakes from complementary food is limited. Thus, this study is designed to identify the adequacy of energy and micronutrient intake from complementary foods among children aged 6-23 months and to characterize current feeding practice in Southern Ethiopia. A community-based cross-sectional study was conducted from February to March 2016. Simple random sampling was used to recruit 190 mothers/primary caregivers of children aged 6-23 months. A repeated interactive multiple-pass 24-hr recall survey was used to assess' food and nutrient intake of children. Complementary food was low in animal sources, fruits, and vegetables. Most of the children (94.7%) consume grain, roots, and tubers. Vitamin A-rich fruits and vegetables are consumed by 71 (37.8%) children. Very few (1.6%) children consume iron-fortified food. Median protein intake exceeds the estimated requirement from complementary food. Except for vitamin B2 and B6, intake of energy and micronutrient were below world health organization (WHO) recommendations among children aged 9-23 months. In conclusion, infant and young child feeding practices in Butajira district did not conform to recommendations. Intake of energy and micronutrient from complementary food among children aged 6-23 months in Butajira district was inadequate. Consumption of a diverse diet by including animal source food (ASF) such as poultry, organ meat, chicken liver, beef, fruits, and vegetables is needed to fill the nutrient intake gap among the study participant.

Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets

A child's diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In‐depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child's diet. The community regarded carbohydrate‐based meals as food, but considered protein, vitamins and mineral‐based foods as nonessential elements of a child's diet, and important sources of these nutrients were regarded as treats.

Scaled-up nutrition education on pulse-cereal complementary food practice in Ethiopia: a cluster-randomized trial

Background

Improving children’s weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to assess the impact of a 9-month pulse-nutrition education program on improving mothers’ knowledge, attitude, and practices (KAP) towards pulses, as well as its effect on children’s diet diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs).

Methods

A cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midpoint, and end point. ANOVA and descriptive statistics were used to analyzed data.

Results

At baseline and end point, maternal KAP and the dietary diversity score of the children (mean age at end point 18.8 ± 2.9 mo) were assessed. Intervention mothers’ KAP improved (p < 0.001) at midpoint and end point compared to that of the control group, as did frequency of pulse consumption and Dietary Diversity Score (DDS) among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group (p = 0.001).

Conclusions

NE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for complementary food may be an effective way to improve the health of children in Ethiopian communities.

Trial registration

Clinicaltrials.gov #NCT02638571.

Date of registration: 12/18/2015.

Prospectively registered.

Drivers of stunting reduction in Ethiopia: a country case study

BACKGROUND

Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y.

OBJECTIVES

The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level.

METHODS

This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000-2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken.

RESULTS

National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls' education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls' education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction.

CONCLUSIONS

Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.

Disparities in the prevalence and risk factors of anaemia among children aged 6–24 months and 25–59 months in Ethiopia

Despite global efforts made to address anaemia, the prevalence remains high in most Sub-Saharan African countries. In Ethiopia, anaemia poses a very strong public health concern. The purpose of the present study was to examine the key risk factors related to anaemia among children aged 6–24 months (younger age group) and 25–59 months (older age group). We used the 2016 Ethiopian Demographic and Health Survey data, collected from 11 023 mothers with under five children. Ordered logistic regression modelling was used for assessing risk factors of childhood anaemia. The results suggest that the prevalence of anaemia was 72 % in the younger and 49 % in the older age groups. The risk factors for anaemia in the younger age group were morbidity (odds ratio (OR) 1⋅77; CI 1⋅21, 2⋅60), having no piped water source (OR 1⋅76; CI 1⋅07, 3⋅01) and no toilet facility (OR 1⋅60; CI 1⋅07, 2⋅38). The key risk factors for anaemia in the older age group were no micronutrient intake (OR 1⋅69; CI 1⋅23, 2⋅31), having a young mother (15–24 years old) (OR 1⋅35; CI 0⋅84, 1⋅91) and a non-working mother (OR 1⋅50; CI 1⋅15, 1⋅96). Anaemia also varied by region, place of residence and economic factors. Multiple factors contributed to the high prevalence of anaemia. Given the structural problem that the country has intervention strategies should consider the unique characteristics of regions and rural residences where the prevalence of anaemia is above the national average.

Magnitude and determinants of complementary feeding practices in Ethiopia: A systematic review and meta-analysis

Background & aim

Concurrent estimates on the magnitude and evidence on the determinants of complementary feeding (CF) practices in Ethiopia are currently disparate. Hence, this systematic review and meta-analysis assessed the magnitude and determinants of CF among children age 6–23 months in Ethiopia.

Methods

Studies from various databases published until July 2018 were identified, selected, extracted and assessed for risk of bias by two authors independently. A random-effects model was used to pool the prevalence and odds ratios (ORs).

Results

26 studies with 17, 383 children were included. The pooled prevalence estimate of timely initiated CF, minimum dietary diversity (DD), minimum meal frequency and minimum acceptable diet were 61.0%, 18.0%, 56.0%, and 10.0% respectively. The pooled prevalence of timely initiation and minimum DD were higher in Northern Ethiopia. On the other hand, except for the minimum meal frequency, all the three core indicators of CF were better in urban than rural settings. Child age, maternal and/or paternal education, paternal involvement, maternal DD, antenatal and postnatal care, and place of delivery were the main determinants that can increase appropriate CF practices.

Conclusion

The reported estimates of the prevalence of core CF indicators in Ethiopia remained poor. Therefore, the authors would like to acknowledge the effort that has been done by the minister of health and its partners including Alive & Thrive to improving CF practices in the country, however, these programs should be done more thoroughly, and scaled up by applying and adapting tested, proven approaches and tools in contexts.

Undernutrition and associated factors among urban children aged 24-59 months in Northwest Ethiopia: a community based cross sectional study

Background

Globally, in every three preschool children one is affected by malnutrition. In Ethiopia, child undernutrition continues to be a serious public health problem. Data are scarce, especially in 24-59 months age children. We aimed at estimating under nutrition and its associated factors among children 24–59 months age in Aykel Town, Northwest Ethiopia.

Methods

A community based cross-sectional study was conducted among children aged 24–59 months in Aykel Town from January to February 2017. A total of 416 children were included in to the study using a systematic random sampling technique. Data were collected by interview and anthropometric measurements. Multivariable analysis was performed to identify the predictors of stunting, wasting and underweight.

Results

The prevalence of stunting, wasting and underweight were 28.4, 10 and 13.5%, respectively. Children from low birth order; 1^st (AOR = 8.60, 95%CI: 2.40, 3.70) and 2nd -4th (AOR = 5.80, 95%CI: 1.80, 18.90), from large family size (AOR = 3.67, 95%CI: 1.92, 7.00), and had meal frequency < 3/day (AOR = 5.09, 95%CI: 2.96, 8.74) were at a higher risk of stunting. Children who had not fed on cow milk (AOR = 5.50, 95%CI: 2.30, 13.00), and from mothers who had poor hand washing practice (AOR = 11.00, 95%CI: 4.30, 27.9) were more likely to be wasted. Children who had not fed on cow milk (AOR = 2.90, 95%CI: 1.40, 6.00), breast fed for less than 24 months (AOR = 2.60, 95%CI: 1.35, 5.00), consumed foods from less than four food groups (AOR = 6.30, 95%CI: 1.70, 23.00), and were from mothers’ who had poor hand washing practice (AOR = 2.50, 95%CI: 1.30, 4.70) had higher odds of being underweight.

Conclusion

Stunting, wasting and underweight are high among children aged 24–59 months in Aykel Town. Poor child feeding and maternal hygienic practices were identified as risk factors of undernutrition. Educating mothers/care givers on the advantages of proper child feeding and maintaining hygienic practices at critical times is valuable in improving the nutritional status of children.

Predictors of inappropriate complementary feeding practice among children aged 6 to 23 months in Wonago District, South Ethiopia, 2017; case control study

Background

Inappropriate complementary feeding practice could result in child illness, sub-optimal growth and development. Evidence shows a huge burden of inappropriate complementary feeding practice from global to national level. But studies regarding predictors of inappropriate complementary feeding practices were scarce especially in the study area. Therefore, the aim of this study was to determine predictors and community level factors associated with inappropriate complementary feeding practice among children age 6 to 23 months in Wonago district, South Ethiopia.

Methods

A community based unmatched case-control study design complemented by a qualitative and dietary data was employed among children in Wonago district from April- 07 to June- 06, 2017. A total of 372 study subjects were enrolled to the study by stratified sampling technique. Data were checked, coded and entered to Epi data and exported to SPSS for analysis. Univariate, bivariable and multivariable logistic regressions analyses were applied. A p- value < 0.05 was considered as statistical significant level.

Results

Paternal household decision making on feeding(AOR = 4.65, 95% CI = (1.69, 12.81)), family priority to elders during feeding(AOR = 2.35, 95% CI = (1.08, 5.14)), absence of nearby health facility(AOR = 4.15, 95% CI = (1.63, 10.55)), unplanned pregnancy (AOR = 3.45, 95% CI = (1.21, 9.85)), missing ANC(AOR = 2.71, 95% CI = (1.48, 4.96)) and missing EPI service utilization (AOR = 2.43, 95% CI = (1.34, 4.38)) were independent predictors of inappropriate complementary feeding practices. Whereas; lack of awareness, short birth spacing practice, poverty and feeding culture were community related factors. The nutrient density of complementary foods were below WHO desired density level except for energy, protein and vitamin C.

Conclusions

Inappropriate complementary feeding practice was related to household feeding cultures, health service access and utilization and community related factors like awareness, poverty and low birth spacing. Complementary foods were found to have lower nutrient density than desired by WHO. Promoting community’s health service utilization and increasing awareness regarding complementary feeding were recommended.

Biofortified Maize Can Improve Quality Protein Intakes among Young Children in Southern Ethiopia

Quality protein maize (QPM) varieties are biofortified, or nutritionally improved, to have higher lysine and tryptophan levels to increase quality protein intakes particularly among young children. This study assesses adequacy of children’s protein intakes in Ethiopia, where QPM is being promoted, accounting for protein quality and seasonal dietary changes, and estimates potential increases in intakes if QPM replaced conventional maize in diets. Diets of randomly sampled children aged 12–36 months in rural southern Ethiopia (n = 218) were assessed after harvest during relative food security and 3–4 months later during relative food insecurity using 24-h weighed food records. Diets were analyzed for protein adequacy, accounting for protein quality using the protein digestibility corrected amino acid score (PDCAAS) method, and potential improvements from QPM substitution were estimated. Stunting was prevalent (38%) at the first assessment. Across seasons, 95–96% of children consumed maize, which provided 59–61% of energy and 51–55% of total protein in 24 h. Dietary intakes decreased in the food insecure season, though children were older. Among children no longer breastfeeding, QPM was estimated to reduce inadequacy of utilizable protein intakes from 17% to 13% in the food secure season and from 34% to 19% in the food insecure season. However, breastfed children had only 4–6% inadequate intakes of utilizable protein, limiting QPM’s potential impact. Due to small farm sizes, maize stores from home production lasted a median of three months. Young Ethiopian children are at risk of inadequate quality protein intakes, particularly after breastfeeding has ceased and during food insecurity. QPM could reduce this risk; however, reliance on access through home production may result in only short-term benefits given the limited quantities of maize produced and stored.

Gender and household structure factors associated with maternal and child undernutrition in rural communities in Ethiopia

Addressing maternal and child undernutrition is a priority for the National Nutrition Program of Ethiopia. In a cross-sectional design, we selected mother-child pairs (n = 630) from Halaba, south Ethiopia (n = 413, two communities) and Zeway, Oromiya region (n = 217, one community). These communities were previously included in a project to improve agricultural practices. We aimed to estimate the level of maternal and child undernutrition in the two study sites and compare findings to regional/national reports. We also examined associations with gender, household-structure and nutrition/health related variables. Households were selected using simple random sampling based on list of households obtained from local health posts. Mothers were interviewed via questionnaire. Anthropometric measurements were taken from mothers-child pairs. Maternal undernutrition (% BMI<18.5) ranged from moderate (14% Zeway) to high (22% Halaba). In the children, stunting and underweight were very high (54% and 42% stunting, 36% and 21% underweight, in Halaba and Zeway, respectively). Up to 95% of Halaba and 85% of Zeway mothers reported “same as usual” or “less than usual” consumption patterns during their most recent pregnancy compared to periods of non-pregnancy. Mothers reported (61% in Halaba, 18% in Zeway) abstaining from consumption of certain nutritious foods for cultural reasons. Gender and socio-economic-demographic structure of the households, including imbalance of power, control of farm produce, physiological density, household size and dietary habits during pregnancy showed significant associations with maternal and child undernutrition (p<0.05). The levels of child and maternal undernutrition, particularly in children, were unexpected and of concern, given that a national nutrition program has been in place since 2008. The study provides insights for policy makers to improve women’s education, reproductive health services for better family planning, and strengthen nutrition/health programs designed to target vulnerable segments of the population in these and other rural communities and districts with similar structure and demographics in Ethiopia.

Complementary feeding practices and associated factors in Damot Weydie District, Welayta zone, South Ethiopia

Background

Each year, more than millions of under-five children die due to under-nutrition, and many of these deaths are associated with inappropriate feeding practices. This study aimed to assess complementary feeding practices in Damot Weydie District, South Ethiopia.

Methods

A community-based cross-sectional study was conducted among four-hundred and one mothers who had children aged 6–23 months in Damot Weydie District. A pretested structured questionnaire was used to collect data using a face-to-face interview. Data were entered into Epi-Data version 3.1 and analysis was done by using Statistical Package for Social Sciences (SPSS) version 20. Multivariable logistic regressions were conducted to determine independent factors associated with complementary feeding practices.

Results

More than half (50.6%) of children were given complementary foods at six months of age. Only 8.5% of young children aged 6–23 months were fed with appropriate complementary foods. The proportion of mothers who reported that they know that a baby of 6–23 months old should be fed two or three times was only 75.8%. Government-employed mothers (adjusted odds ratio (AOR) = 0.14(0.04, 0.50) and mothers who attended postnatal care (AOR = 0.19(0.05, 0.70) were less likely to practice inappropriate complementary feeding. Mothers having children with birth intervals less than 35 months were more likely to practice inappropriate complementary feeding when compared to mothers of children with birth intervals greater than 35 months (AOR = 2.67 (1.22, 5.83).

Conclusions

Considerable proportions of infants and young children were not appropriately fed with complementary foods as per WHO recommendations. Being a government employee mother, attending postnatal care and having a child with birth interval greater than 3 years were associated with appropriate complementary feeding. Therefore, it is important to encourage postnatal care utilization and incorporate complementary feeding advice during postnatal visits. It is critical to raise the awareness of the community about optimal complementary feeding practices with special attention to unemployed and less educated mothers. Additionally, inter-sectoral collaboration should be strengthened to increase the variety of food groups available.

Caregiver-infant's feeding behaviours are associated with energy intake of 9-11 month-old infants in rural Ethiopia

Inappropriate complementary feeding, both in quantity and quality, is a major determinant of undernutrition. However, little is known about how infant-caregiver's feeding behaviours affect infants' energy intake. Therefore, the objective of this study was to characterize infant-caregiver feeding behaviours and investigate their association with infants' energy intake. The study involved 106 mother-child pairs recruited from seven randomly selected kebeles of Mecha district, West Gojam, Ethiopia. The feeding styles were assessed through observations of 1-day, in-home, feeding episodes that were videotaped and coded into self-feeding, responsive, active, distracting, and social feeding behaviours. Infants' haemoglobin and anthropometric measurements were taken. The association between feeding behaviour scores and energy intake per meal was investigated. The mean food intake of the infants was very low (11.4 ± 7.0 g/kg body weight per meal) compared to the minimum theoretical gastric capacity (30 g/kg body weight per meal). Infants' haemoglobin concentration was negatively associated with energy intake (ρ = 0.178, p = .03). Infants' responsive and active positive feeding styles were positively associated with energy intakes (ρ = 0.258 and 0.432, p = .004 and p < .001, respectively) as well as caregivers' responsive positive feeding styles (ρ = 0.237, p = .007). Both haemoglobin concentrations and feeding styles were associated with infant's energy intake. Anaemia prevention and control measures should be reinforced. Current nutrition education programmes should give emphasis on ways to effectively incorporate culturally adapted responsive feeding messages in this and similar settings.

Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings

The rapid pace of fetal development by far exceeds any other stage of the life span, and thus, environmental influences can profoundly alter the developmental course. Stress during the prenatal period, including malnutrition and inflammation, impact maternal and fetal neurodevelopment with long-term consequences for physical and mental health of both the mother and her child. One primary consequence of maternal malnutrition, inflammation, and other sources of prenatal stress is a poor birth outcome, such as prematurity or growth restriction. These phenotypes are often used as indications of prenatal adversity. In fact, the original evidence supporting the fetal programming hypothesis came from studies documenting an association between birth phenotype and the development of subsequent physical and mental health problems. Fetal growth restriction in both term and preterm infants is associated with neonatal morbidities and a wide variety of behavioral and psychological diagnoses in childhood and adolescence, including attention-deficit/hyperactivity disorder, anxiety, depression, internalizing and thought problems, poor social skills, and autism spectrum disorder. Improving maternal-child health requires interventions that begin before pregnancy and continue throughout gestation and into the postpartum period. Such interventions might include supporting pregnancy intention, maternal nutrition, health/medical care, mental health, and providing social support. This article discusses the impact of maternal nutrition and inflammation during preconception and pregnancy among women living in low-resource settings, with an emphasis on key knowledge gaps that need to be addressed to guide program and policy decisions at local, regional and global levels.

Neurodevelopment: The Impact of Nutrition and Inflammation During Infancy in Low-Resource Settings

Infancy and early childhood (ie, birth through age 24 months) represent a period of life with both exquisite opportunity and vulnerability for neurodevelopment. This is due to rapid brain development, both anatomic and functional, as well as to high nutrient requirements during a time of dependence on human milk and complementary foods. Complex interactions exist among nutrition, social, and physical environments and exposures. The newborn brain also reflects maternal exposures that occurred as the product of many interacting forces during gestation. Connections between nutrient use and acute and chronic inflammation are increasingly recognized, but the evidence base linking both nutrition and inflammation to neurodevelopment is relatively modest and quite limited for this young age group specifically. This article provides an overview of key interactions of nutritional requirements relevant to brain development and function; nutritional vulnerabilities related to maternal nutritional status and function; and the impact of environmental exposures and inflammation on nutrient homeostasis and neurodevelopment during this critical developmental window.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

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

Changes in breastfeeding and nutritional status of Nigerian children between 1990 and 2008, and variations by region, area of residence and maternal education and occupation

BACKGROUND

Inadequate breastfeeding practices contribute to malnutrition in young children.

AIMS AND OBJECTIVES

This study examined changes in breastfeeding practices and the nutritional status of children (0-35 months, n = 37154) using data from the nationally-representative Nigerian Demographic and Health Surveys for 1990-2008.

METHODS

The study estimated the relative changes in the proportion of children meeting recommended breastfeeding practices and the anthropometric indices of the children during the study period, by region, place of residence, maternal education and maternal occupation.

RESULTS

In each study year, over 97% of the children were ever breastfed. The proportion of infants breastfed within 1 hour and 1 day of birth increased from 34% to 45.8%, and from 63.8% to 82.3%, respectively. Overall, breastfeeding for ≥ 12 months changed from 88.9% to 95.2%, an increase of 7%; however, an increase of 14% was observed in the northern region (from 86.1% to 97.8%) while a decline of 7% was observed in the southern region (from 97.1% to 89.9%). Over the study period, the prevalence of all the assessed indicators of malnutrition (stunting, wasting and underweight) increased in the northern region while the southern region experienced a decline in all except severe wasting. In both urban and rural areas, stunting and wasting increased, while underweight declined. Children of non-formally educated and unemployed mothers were more malnourished in all the study years.

CONCLUSION

Improvement in some breastfeeding practices did not result in improvement in the nutritional status of Nigerian children during 1990-2008, particularly in northern Nigeria and among socially disadvantaged mothers. Improving maternal education and employment, and integrating messages on techniques and benefits of optimal infant feeding with other maternal and child healthcare services could be beneficial.

Anemia and undernutrition among children aged 6-23 months in two agroecological zones of rural Ethiopia

BACKGROUND

Child malnutrition during the first 1,000 days, commencing at conception, can have lifetime consequences. This study assesses the prevalence of anemia and undernutrition among children aged 6-23 months in midland and lowland agroecological zones of rural Ethiopia.

METHODS

Cross-sectional data examining sociodemographic, anthropometry, hemoglobin levels, and meal frequency indicators were collected from 216 children aged 6-23 months and their mothers randomly selected from eight rural kebele (villages).

RESULTS

Of 216 children, 53.7% were anemic, and 39.8%, 26.9%, and 11.6% were stunted, underweight, and wasted, respectively. The prevalence of anemia was higher in the lowland agroecological zone (59.5%) than the midland (47.6%). Among those children who were stunted, underweight, and wasted, 63.5%, 66.7%, and 68.0% were anemic, respectively. Child anemia was significantly associated with the child not achieving minimum meal frequency, sickness during the last 2 weeks before the survey, stunting and low body mass index, and with maternal hemoglobin and handwashing behavior. The prevalence of stunting was higher in the lowland agroecological zone (42.3%) than the midland (36.2%). The predictors of stunting were age and sex of the child, not achieving MMF, maternal body mass index, and age. As maternal height increases, the length for age of the children increases (P=0.003).

CONCLUSION

The overall prevalence of anemia and undernutrition among children aged 6-23 months in these study areas is very high. The prevalence was higher in the lowland agro-ecological zone. Health information strategies focusing on both maternal and children nutrition could be sensible approaches to minimize stunting and anemia.

Suboptimal Feeding Practices and High Levels of Undernutrition Among Infants and Young Children in the Rural Communities of Halaba and Zeway, Ethiopia

BACKGROUND

Good nutrition and appropriate child feeding are vital in early stages of child development, particularly in the first 1000 days of life.

OBJECTIVE

To assess the adoption of infant and young child feeding practices of World Health Organization, dietary intake, and level of undernutrition in children <2 years of age.

METHODS

Baseline cross-sectional study was conducted (January-June 2013) in purposively selected rural communities of Halaba and Zeway, Ethiopia (N = 383 mother-child pairs, randomly selected).

RESULTS

Overall prevalence of stunting, wasting, and underweight was 45%, 9%, and 28% in Halaba, and 33%, 7%, and 15% in Zeway, respectively; higher levels of stunting (54% in Halaba and 36% in Zeway) were observed in 6 to 24 months; stunting and underweight, but not wasting, differed by age ( P < .001) in Halaba. Median dietary diversity score in both communities was 2 with 61% to 65% of children consuming 0 to 2 food groupings. Except protein in all age and iron in 12 to 24 months, median intake of energy, iron, zinc, and calcium (and associated nutrient densities) was below the estimated needs that should come from complementary foods in both communities (in subsample). Early initiation of breast-feeding and exclusive breast-feeding was 63% and 86% in Halaba and 92% and 93% in Zeway, respectively ( P < .001). Children receiving minimum acceptable diet were 6% and 9% in Halaba and Zeway, respectively.

CONCLUSIONS

The high levels of stunting and suboptimal feeding practices as well as low dietary diversity scores, energy, and nutrient intake in both communities, particularly in Halaba, indicate a need to improve/strengthen nutrition strategies for complementary feeding children in these areas.

Health Extension Workers’ Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated With Mothers’ Knowledge and Child Stunting in Rural Ethiopia

Background:

Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feeding (IYCF) and their child’s nutritional status.

Objective:

The objective of this study was to evaluate mothers’ and HEWs’ knowledge of key IYCF practices and to investigate whether mothers’ knowledge and HEWs’ KSE are associated with stunting in young children (aged 12-23 months).

Methods:

This cross-sectional study used face-to-face interviews to assess the IYCF knowledge of HEWs (n = 96) and mothers of 12- to 23-month-old children (n = 122) in Mecha district, West Gojam, Ethiopia. The association between HEWs’ KSE and children’s length-for-age z scores (LAZ) was investigated.

Results:

Stunting (50%), underweight (34%), and wasting (10%) were highly prevalent. Less than half (45%) of the mothers had access to nutrition education through the health extension program, but those who had, had better knowledge of IYCF practices and thus lower rates of stunting ( P < .001). However, key IYCF practices were not well understood by the HEWs and this affected their KSE. The gap in KSE was negatively associated with LAZ ( r = −.475, P < .001) and remained significant even after adjusting for maternal height, socioeconomic status, and maternal education ( r = −.423, P = .002).

Conclusion:

Health extension workers’ KSE is associated with child stunting. Future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.

Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries

Background:

The question whether diets composed of local foods can meet recommended nutrient intakes in children aged 6 to 23 months living in low- and middle-income countries is contested.

Objective:

To review evidence of studies evaluating whether (1) macro- and micronutrient requirements of children aged 6 to 23 months from low- and middle-income countries are met by the consumption of locally available foods (“observed intake”) and (2) nutrient requirements can be met when the use of local foods is optimized, using modeling techniques (“modeled intake”).

Methods:

Twenty-three articles were included after conducting a systematic literature search. To allow for comparisons between studies, findings of 15 observed intake studies were compared against their contribution to a standardized recommended nutrient intake from complementary foods. For studies with data on intake distribution, %< estimated average requirements were calculated.

Results:

Data from the observed intake studies indicate that children aged 6 to 23 months meet requirements of protein, while diets are inadequate in calcium, iron, and zinc. Also for energy, vitamin A, thiamin, riboflavin, niacin, folate, and vitamin C, children did not always fulfill their requirements. Very few studies reported on vitamin B6, B12, and magnesium, and no conclusions can be drawn for these nutrients. When diets are optimized using modeling techniques, most of these nutrient requirements can be met, with the exception of iron and zinc and in some settings calcium, folate, and B vitamins.

Conclusion:

Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.

Determinants of stunting reduction in Ethiopia 2000 - 2011

The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0-59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height-for-age z-scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6 months, 6-23 months, and 24-59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children < 6 months of age, only mother's height was both a significant predictor of HAZ and showed a progressive, albeit non-significant, increase from 2000 to 2011. In children 6-23 months of age, only mother's use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24-59 months of age a consistent and progressive change is seen in child's diarrhea, fever, mother's education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child's age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5 years of age include markers of child health, mother's nutritional status, mother's educational level, and environmental hygiene.

Scale up of nutrition and health programs in Ethiopia and their overlap with reductions in child stunting

The prevalence of stunting in Sub-Saharan Africa has changed little since 2000, and the number of stunted children has increased. In contrast, Ethiopia is an example where the national stunting prevalence and number of stunted children have decreased consistently. We compare regional differences and temporal patterns in stunting with large-scale program coverage to identify where and when programs may have led to reductions in stunting. Data from three national demographic and health surveys and population statistics illustrate, at the regional level, where and when the prevalence and number of stunted children changed since 2000. Reports from large-scale nutrition and health programs were used to identify ecologic associations between geographic program coverage and reductions in stunting. From 2000 to 2005, the decline in the national stunting prevalence was mainly a result of reductions in Oromiya, SNNP and Tigray. Few nutrition programs had high coverage during this time, and economic growth may have contributed to stunting reduction by increasing household wealth and investments in sanitation. From 2005 to 2011, declines in stunting prevalence in Amhara, SNNP, Somali and Oromiya were largely responsible for national reductions. Numerous programs were implemented at scale and could have plausibly improved stunting. While ecologic relationships suggest that economic growth and large-scale programs may have contributed to the reduction in stunting in Ethiopia, stunting did not decrease in all regions despite increased program coverage expansion of the health system. Additional impact evaluations are needed identify the most effective programs to accelerate the reduction in the prevalence and number of stunted children. © 2016 John Wiley & Sons Ltd.

Assessment of the WHO Stunting Framework using Ethiopia as a case study

Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the 'WHO framework') that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country-level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhoea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts. © 2016 John Wiley & Sons Ltd.

Dietary diversity predicts dietary quality regardless of season in 6–12-month-old infants in south-west Ethiopia

Objective

Simple, cost-effective and convenient instruments like food group-based scores are proposed to assess micronutrient adequacy of children in developing countries. We assessed the predictive ability and seasonal stability of a dietary diversity score (DDS) to indicate dietary quality of infants.

Design

A 24 h dietary recall assessment was carried out on a sample of 320 and 312 breast-fed infants aged 6–12 months during harvest (HS) and pre-harvest (PHS) seasons, respectively, in Ethiopia. DDS was calculated based on seven food groups, while mean micronutrient density adequacy (MMDA) was calculated for eight micronutrients. Multiple linear regression models were used to assess the relationship between DDS and MMDA, and differences in nutrient intake between the two seasons. A receiver-operating characteristic curve analysis was performed to derive DDS cut-offs that maximized sensitivity and specificity of assessing dietary quality.

Setting

The study was conducted in the catchment of the Gilgel Gibe Field Research Centre of Jimma University, south-west Ethiopia.

Results

The mean (sd) DDS for HS and PHS was 2·1 (0·94) and 2·3 (1·1), respectively. The DDS was associated with MMDA (β=0·045, P<0·0001 in HS; β=0·044, P<0001 in PHS). A DDS of ≤2 food groups best predicted ‘low’ MMDA (<50 %) with 84 % and 92 % sensitivity, 36 % and 43 % specificity, and 47 % and 51 % correct classification for the HS and PHS, respectively.

Conclusions

DDS is predictive of dietary quality of breast-fed infants. The study supports the use of DDS to indicate inadequate intakes of micronutrients by breast-fed infants in different seasons.

Anemia and Micronutrient Status of Women of Childbearing Age and Children 6-59 Months in the Democratic Republic of the Congo

Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low (<5%); RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC), children 6–23 months (23% in SK; 20% in KC), and children 24–59 months (25% in SK; 27% in KC). The rate of biochemical zinc deficiency among Congolese women and children requires attention.

Child Wasting in Emergency Pockets: A Meta-Analysis of Small-Scale Surveys from Ethiopia

Child undernutrition is a major public health concern in Ethiopia (stunting national prevalence: 44%; wasting: 10%), despite the overall improvement in child health status during the last decade. Hundreds of small-scale surveys are conducted in Ethiopia's emergency pockets under ENCU's supervision. We reviewed the evidence from small-scale surveys conducted between 2008 and 2013 with two objectives: to provide a summary estimate of wasting prevalence from emergency pockets and to examine reasons for variation in prevalence estimates. We created a dataset by combining data from the Complex Emergency Database, the Famine Early Warning System Network and the Armed Conflict Location Event Data. We conducted a meta-analysis of small-scale surveys using a random effects model with known within-study heterogeneity. The influence of survey covariates on estimated prevalence was investigated with meta-regression techniques. We included 158 surveys in the analysis. A high degree of heterogeneity among surveys was observed. The overall estimate of wasting prevalence was 10.6% (95% CI 9.8-11.4), with differences among regions and between residents and refugees. Meta-regression results showed that vaccination coverage, child mortality, diarrhea prevalence and food insecurity are significantly associated with wasting prevalence. Child care and displacement status were not. Aggregated analysis of small-scale surveys provides insights into the prevalence of wasting and factors explaining its variation. It can also guide survey planning towards areas with limited data availability.

Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross- sectional study

Background

Inadequate nutrition during the first two years of life may lead to childhood morbidity and mortality, as well as inadequate brain development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer sufficient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. Therefore this study aimed to identify the factors associated with nutritional status of infants and young children (6–23 months) in Filtu town, Somali Region, Ethiopia.

Methods

A cross-sectional community-based study was conducted. Simple random sampling was employed to select 214 infants for the study. Univariable and multivariable logistic regressions models were used in the statistical analysis. The strength of association was measured by odds ratios with 95 % confidence intervals. Both the crude (COR) and adjusted odds ratios (AOR) are reported.

Results

The prevalence of wasting, stunting and underweight among infants and young children were 17.5 % (95 % CI: 12.91-23.22), 22.9 % (95 % CI: 17.6-28.9) and 19.5 % (95 % CI: 14.58-25.3) respectively. The multivariable logistic regression model showed that breastfeeding was independently associated with reduced odds of wasting (AOR = 0.38(95 % CI: 0.14-0.99)). Diarrhea in the past 15 days (AOR = 2.13 (95 % CI: 1.55-4.69)) was also associated with increased odds for wasting. The independent predictors of reduced odds for stunting were dietary diversity score ≥4 (AOR = 0.45(95 % CI: 0.21-0.95)) and introduction of complementary feeding at 6 months (AOR = 0.25 (95 % CI: 0.09-0.66)). Bottle feeding was associated with increased odds of stunting (AOR = 3.83 (95 % CI: 1.69-8.67)). Breastfeeding was associated with reduced odds of underweight (AOR = 0.24 (95 % CI: 0.1-0.59)), while diarrheal disease in the past 15 days was associated with increased odds of underweight (AOR = 3.54 (95 % CI: 1.17-7.72)).

Conclusion

Under nutrition is a public health problem among infants and young children in Filtu town, Somali region Ethiopia. Breastfeeding was associated with lower odds of wasting and underweight while diarrheal disease was associated with higher odds of wasting and underweight. Low dietary diversity scores, inappropriate age of complementary feeding initiation and bottle feeding were identified to be significant predictors of stunting. Those factors should be considered for any intervention aimed to reduce under nutrition among infants and young children in Filitu town, Somali region, Ethiopia.

Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia

Background

Causes of child undernutrition are diverse and change in space and time. Investigating current determinants of undernutrition remains vital to design an effective intervention strategy. The study assessed prevalence of undernutrition and its associated factors among children living in Addis Ababa, Ethiopia.

Methods

A community based cross-sectional study was conducted in 459 school age children and their parents or caregivers living in Lideta sub-city, Addis Ababa, Ethiopia. Participants were selected using a multi-stage simple random sampling technique. Height and weight of children was measured and their parents or care givers were interviewed for factors associated with undernutrition.

Results

About 31% (n = 141) of the children were undernourished (19.6% stunted, 15.9% underweight). Being male, higher birth order (>2), larger family size (6–8), low meal frequency (≤3 times) in a day prior to the survey and mud floor house were significantly associated with undernutrition. Similarly, the risk of underweight increased significantly with an increase in age, birth order, family size and also the absence of hand washing facilities. The odds of undernutrition was lower in children born to 20–30 years old mothers compared to those born to mothers younger than 20 years.

Conclusions

Undernutrition is prevalent among school age children living in Lideta sub city, Addis Ababa. Policy makers should consider school age children in their nutrition policy documents and implement screening program and intervention strategy.

Use of Pulse Crops in Complementary Feeding of 6-23-Month-Old Infants and Young Children in Taba Kebele, Damot Gale District, Southern Ethiopia

Poor complementary feeding practices contribute to infants and young children (IYC) malnutrition, with lack of protein-containing food and micronutrients as major concerns. A cross-sectional survey was conducted to assess the dietary diversity, nutrient contents and use of pulse crops in complementary feeding at Taba kebele, Southern Ethiopia. A questionnaire was used to collect socio-demographic and dietary diversity data from a random sample of 128 mother-child pairs. A one day weighed food record assessed IYC median nutrient intake. Focus group discussion explored mothers' perceptions and use of pulse crops in complementary food preparation. Dietary diversity assessment found that 43.7% consumed pulses, and only 18.7% consumed meat and 26.6% eggs. Focus group discussion showed that mothers had little interest in incorporating pulses into complementary foods. Raising awareness of mothers/caregivers on food diversification and promoting the inclusion of pulses in food preparation for infants and young children are vital to nutritional status of IYC.

Context for food-based approaches for improved feeding of infants and children in Ethiopia

BACKGROUND

Regardless of efforts by the health sector and partner organizations, maternal and child malnutrition is still a challenge in Ethiopia.

OBJECTIVE

To describe the context of current infant and child feeding patterns in Ethiopia.

METHODS

Feeding patterns, diet content and quality, and nutritional outcomes and feeding practices of mothers of young children are described from literature review of a number of field studies.

RESULTS

Protein and energy deficiencies and multiple micronutrient deficiencies are common. Breastfeeding is often prolonged until 2 years of age, with introduction of small amounts of poor-quality complementary foods. Vitamin A and iodine deficiencies have also been problems. Focus group discussions showed that mothers did not believe that animal-source foods are needed.by young children or schoolchildren. However, the Health Extension Program led by the Federal Ministry of Health promotes optimal child feeding as one of the health extension packages.

CONCLUSIONS

Continued use of germination and fermentation of cereals should be encouraged to increase bioavailability of trace elements. Use of fat in the diet would increase energy density. To improve the situation, extension education, including nutrition and agricultural expertise delivered in aformat understandable to mothers about appropriate complementary feeding, including animal-source foods, is urgently needed, with expansion of governmental and nongovernmental resources.

Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study

BACKGROUND

For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food.

AIMS AND OBJECTIVES

A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0-<6 months with regard to food intake.

METHODS

Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n  =  196). An ANCOVA test was performed on age of the infant with mothers' height and weight as covariates.

RESULTS

Prevalence of stunting (infants' length-for-age Z-score (LAZ) <-2SD) was 39%, wasting (WLZ <-2SD) 2%, and underweight (WAZ <-2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (-1.13, 0.12) and WAZ (-0.41, 0.13) than infants not being exclusively breastfed (-1.59, 0.11, and -0.97, 0.11, respectively). There was no overall significant association between breastfeeding practice and WLZ.

CONCLUSION

Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation.

Zinc deficiency in infants and children: a review of its complex and synergistic interactions

Zinc deficiency is estimated to contribute to over half a million deaths per year in infants and children under 5 years of age. This paper reviews the features of mild-to-moderate zinc deficiency, which include growth faltering, deficits in immune function and altered integrity and function of the gastro-intestinal tract. Sub-clinical features include oxidative stress and a pro-inflammatory state. The homeostatic response to low dietary zinc intake by increasing absorption is limited, especially if the source of zinc is of poor bioavailability, and conservation of endogenous intestinal losses is a critical component of adaptation. Owing to low zinc intakes, older breastfed infants, especially those of low birthweight, are predictably at risk of zinc deficiency if complementary food choices are unfortified and/or low in zinc. Host factors such as young age, poor intra-uterine zinc accretion owing to poor maternal status and/or prematurity, and gastro-intestinal dysfunction also potently predispose to zinc deficiency. Environmental enteropathy, which is prevalent in low-resource settings, may substantially impair zinc absorption and/or increase endogenous losses, and thus lead to relatively high zinc requirements. Emerging evidence highlights common features between chronic inflammation and zinc deficiency, and each may exacerbate the other. More investigations of zinc homeostasis in populations in low-resource settings are needed to better quantify absorption capacity and losses. Effective preventive strategies must address potentially higher zinc requirements as well as the underlying context that perpetuates a vicious cycle of zinc deficiency and multiple adverse outcomes.

Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial

BACKGROUND

Strategies to improve infant and young child nutrition in low- and middle- income countries need to be implemented at scale. We contextualised and packaged successful strategies into a feasible intervention for implementation in rural Tanzania. Opportunities that can optimise delivery of the intervention and encourage behaviour change include mothers willingness to modifying practices; support of family members; seasonal availability and accessibility of foods; established set-up of village peers and functioning health system. The primary objective of the study is to evaluate the effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth as compared to routine health education.

METHODS/DESIGN

A parallel cluster randomised controlled trial will be conducted in rural central Tanzania in 9 intervention and 9 control villages. The control group will receive routine health education offered monthly by health staff at health facilities. The intervention group will receive a nutrition education package in addition to the routine health education. The education package is comprised of four components: 1) education and counselling of mothers, 2) training community-based nutrition counsellors and monthly home visits, 3) sensitisation meetings with health staff and family members, and 4) supervision of community-based nutrition counsellors. The duration of the intervention is 9 months and infants will be recruited at 6 months of age. Primary outcome (linear growth as length-for-age Z-scores) and secondary outcomes (changes in weight-for-length Z-scores; mean intake of energy, fat, iron and zinc from complementary foods; proportion of children consuming 4 or more food groups and recommended number of semi-solid/soft meals and snacks per day; maternal level of knowledge and performance of recommended practices) will be assessed at baseline and ages 9, 12 and 15 months. Process evaluation will document reach, dose and fidelity of the intervention and context at 8 and 15 months.

DISCUSSION

Results of the trial will provide evidence of the effectiveness of the nutrition education package in community settings of rural Tanzania. They will provide recommendations for strengthening the nutrition component of health education in child health services.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02249754, September 25, 2014.

Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.

Absorbed zinc and exchangeable zinc pool size are greater in Pakistani infants receiving traditional complementary foods with zinc-fortified micronutrient powder

Adequacy of zinc intake from breast milk alone becomes marginal in relation to infant requirements by around 6 mo of age. Simple and cost-effective strategies are needed at the population level to ensure adequate intakes of zinc in infants and toddlers in populations at risk of zinc deficiency. We determined the amount of absorbed zinc (AZ) from a micronutrient powder (MNP) without and with 10 mg of zinc (MNP+Zn) added to local complementary foods used in Pakistan and the impact on the exchangeable zinc pool (EZP) size. As a nested study within a large, prospective, cluster randomized trial, 6-mo-old infants were randomly assigned to receive MNP or MNP+Zn. Stable isotope methodology was applied after ∼3 and 9 mo of use to measure AZ from MNP-fortified test meals of rice-lentils (khitchri) and EZP. Nineteen infants per group completed the first metabolic studies and 14 and 17 infants in the MNP and MNP+Zn groups, respectively, completed the follow-up studies. AZs were (mean ± SD) 0.1 ± 0.1 and 1.2 ± 0.5 mg at the first point for the MNP and MNP+Zn groups, respectively (P < 0.001); results were nearly identical at the follow-up measurement. EZP did not differ between groups at the first measurement but was less in the MNP group (3.7 ± 0.6 mg/kg) than in the MNP+Zn group (4.5 ± 1.0 mg/kg) at the second measurement (P = 0.01). These data confirm that the MNP+Zn in khitchri were well absorbed and after 1 y of home fortification, zinc status assessed by EZP was significantly better for the MNP+Zn group. Additional field studies may be necessary to ascertain the adequacy of this dose for infants at high risk of deficiency. This trial was registered at ClinicalTrials.gov as NCT00705445.

Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia

Introduction

The period from birth to two years of age is a “critical window” of opportunity for the promotion of optimal growth, health and behavioral development of children. Poor child feeding patterns combined with household food insecurity can lead to malnutrition which is a major public health problem in developing countries like Ethiopia.

Methods

A community based cross-sectional study that involved 575 participants from rural Sidama was conducted from February to March 2011. A two-stage stratified sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics.

Results

Only 14.4% of mothers fed their children optimally. Prevalence of stunting was higher for infants aged 6 to 8 months (43%) than for those in 0-5 months (26.6%) or 9-23 months (39%) category. Women who did not receive antenatal care(ANC) during pregnancy were 1.5 times more likely to practice pre-lacteal feeding and 2.8 and 1.9 times more likely to feed their children below minimum dietary diversity and minimum meal frequency, respectively (P=0.01). Mothers older than 18 years during the birth of index child were 86% less likely to feed their child below minimum meal frequency than their younger counterparts (P=0.01). Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01).

Conclusion

The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ANC attendance should be strengthened through extensive use of the Health Extension Workers to reduce the level of child stunting in the study area.

Nutrient intakes from complementary foods consumed by young children (aged 12–23 months) from North Wollo, northern Ethiopia: the need for agro-ecologically adapted interventions

Objective

To characterize current feeding practices and to evaluate the adequacy of energy and nutrient intakes of young children in subsistence farming rural households in North Wollo, Ethiopia.

Design

A cross-sectional study examining sociodemographic status, anthropometry, breast-feeding and complementary feeding practices using two in-home non-consecutive 24 h recalls.

Settings

Two rural villages in the highlands and lowlands of Gobalafto district, North Wollo.

Subjects

Seventy-six young children aged 12–23 months, thirty-nine from the lowlands and thirty-seven from the highlands.

Results

About 33 % of the children, ∼46 % in the highlands and 24 % in the lowlands (P = 0·05), were stunted. Complementary diets were low in animal products, fruits and vegetables. Cereals and legumes were the major sources of energy, protein, Ca, Fe, Zn and vitamin A. Legumes with potentially toxic components (grass pea, broad beans) and low nutrient-dense beverages such as tea were frequently consumed. Intakes of energy, Ca, Zn, vitamin A and vitamin C from complementary foods were below WHO recommendations assuming average breast-milk intakes. In contrast, Fe and protein intakes and densities met WHO recommendations. Although vitamin C intakes and densities were higher (P < 0·05) for the lowlands, they remained far below WHO recommendations.

Conclusions

Interventions promoting the WHO guiding principles for complementary feeding practices and behaviours that take the agro-ecological contexts into account are needed here. Furthermore, specific recommendations should be formulated to discourage the consumption of grass pea, broad beans and low nutrient-dense beverages such as tea.