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McCarthy EK, Ní Riada C, O'Brien R, Minogue H, McCarthy FP, Kiely ME. Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study. J Hum Nutr Diet 2024. [PMID: 38881396 DOI: 10.1111/jhn.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women. METHODS Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics. RESULTS In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important. CONCLUSIONS Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.
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Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Clodagh Ní Riada
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Roisin O'Brien
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Hannah Minogue
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Tousizadeh S, Mohammadi-Moghadam F, Mohammadian-Hafshejani A, Sadeghi R. Comparison of zinc levels in mothers with and without abortion: A systematic review and meta-analysiss. Heliyon 2024; 10:e30605. [PMID: 38774104 PMCID: PMC11106818 DOI: 10.1016/j.heliyon.2024.e30605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Zinc is an essential trace element involved in different physiological functions. During pregnancy, it plays a crucial role in healthy embryogenesis. Abortion is the most severe problem associated with early pregnancy complications. This study aims to compare the levels of Zn in mothers with and without abortion. Methods This study is a systematic review and meta-analysis of studies published between 1980 and 2022 in PubMed, Science Direct, Pro Quest, Wiley, Web of Science, and Scopus databases. The search was conducted using both main and Mesh keywords, specifically targeting terms related to abortion, pregnancy loss, and zinc. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. All analyses were conducted using Stata 15, and statistical significance was considered at p < 0.05. Results In general, nine studies were included in this analysis. Based on the results of the meta-analysis, the mean difference in the Zn level between mothers with and without abortion is equal to 193.18 (95 % CI; 107.11 to 279.25, P ≤ 0.001). In other words, the level of Zn in the group of mothers without abortion is 193 units higher than the group of mothers with abortion. The investigation into the comparison of Zn levels in mothers with and without abortion did not reveal any indication of publication bias according to both Begg's test (P-value = 0.858) and Egger's test (P-value = 0.270). Conclusion the study findings indicate a significant association between lower levels of Zn in mothers with abortion compared to mothers without abortion. This suggests that a higher level of Zn may have a preventive effect on the occurrence of abortion in pregnant women. The data also highlights the positive role of trace metals, particularly Zn, in influencing pregnancy outcomes and suggests that maintaining adequate levels of Zn may reduce the likelihood of abortion occurrence, along with other contributing factors. It is important to note that further research, including prospective cohort and experimental studies, is needed to provide more substantial evidence and strengthen these findings.
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Affiliation(s)
- Sepideh Tousizadeh
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fazel Mohammadi-Moghadam
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Ramezan Sadeghi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Hong S, Jiang N, Lin G, Wang Q, Xu X, Shi X, Zhou Y, Wen X, Sun B, Wang H, Huang M, Wang J, Wang N, Chen Y, Jiang Q. Association of maternal mineral status with the risk of preterm birth: a retrospective cohort study. Front Nutr 2024; 11:1329720. [PMID: 38798772 PMCID: PMC11122899 DOI: 10.3389/fnut.2024.1329720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background There has been a gradual increase in the proportion of preterm birth in China during the past several decades. Maternal malnutrition is a significant determinant for preterm birth. Nevertheless, comprehensive studies investigating serum mineral levels during pregnancy associated with preterm birth remain scarce. This study aims to assess the associations between maternal serum mineral levels and the risk of preterm birth. Methods This retrospective cohort study of 18,048 pregnant women used data from a tertiary hospital in China from January 2016 to December 2022. Demographic data and serum mineral concentrations in the second and third trimesters of mothers were collected from the hospital information system. Analysis was performed using restricted cubic splines and logistic regression models. Results The proportion of preterm birth in this study was 6.01%. Phosphorus [P for overall = 0.005; P for nonlinear = 0.490; OR (95%CI) = 1.11 (1.04, 1.18)] and chlorine [P for overall = 0.002; P for nonlinear = 0.058; OR (95%CI) = 1.11 (1.03, 1.19)] showed a significant positive correlation with preterm birth in a linear fashion. Furthermore, serum levels of potassium (P for nonlinear <0.001), sodium (P for nonlinear = 0.004), and magnesium (P for nonlinear <0.001) exhibited non-linear relationships with the risk of preterm birth. Conclusion Serum levels of some minerals during pregnancy were associated with the risk of preterm birth among pregnant women. In addition to commonly recognized micronutrients such as folic acid, iron, and vitamin D, healthcare providers should also pay attention to the levels of these minerals during pregnancy.
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Affiliation(s)
- Sumiao Hong
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Nan Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Guankai Lin
- Wenzhou Center for Disease Control and Prevention, Wenzhou, China
| | - Quqing Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoyang Xu
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Xinrui Shi
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - You Zhou
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Xiaoting Wen
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Baochang Sun
- Wenzhou Center for Disease Control and Prevention, Wenzhou, China
| | - Hexing Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Min Huang
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Jiwei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Na Wang
- Department of the Obstetrics, The People's Hospital of Pingyang, Wenzhou, China
| | - Yue Chen
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Qingwu Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
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Abneh AA, Kassie TD, Gelaw SS. The magnitude and associated factors of immediate postpartum anemia among women who gave birth in Ethiopia: systematic review and meta-analysis, 2023. BMC Pregnancy Childbirth 2024; 24:317. [PMID: 38664625 PMCID: PMC11044590 DOI: 10.1186/s12884-024-06495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The immediate postpartum period is a very crucial phase for both the life of the mother and her newborn baby. Anemia is the most indirect leading cause of maternal mortality. However, anemia in the immediate postpartum period is a neglected public health problem in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of immediate postpartum anemia and the pooled effect size of associated factors in Ethiopia. METHODS Searching of published studies done through PubMed, Medline, Cochrane, African index Medicus, List of Reference Index, Hinari, and Google Scholar. This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) godliness. The quality of studies was assessed by using a Newcastle- Ottawa Scale (NOS) assessment tool. Analysis was performed using a random effect model by using STATA 17 version software. Egger's weighted regression and I2 test were used to evaluate publication bias and heterogeneity respectively. RESULTS In this systematic review and meta-analysis, a total of 6 studies were included. The pooled magnitude of immediate postpartum anemia in Ethiopia was 27% (95%CI: 22, 32). Instrumental mode of delivery (OR = 3.14, 95%CI: 2.03, 4.24), mid-upper arm circumference (MUAC) measurement < 23 cm (OR = 3.19, 95%CI: 1.35, 5.03), Antepartum Hemorrhage (OR = 4.75, 95%CI: 2.46, 7.03), postpartum hemorrhage (OR = 4.67, 95%CI: 2.80, 6.55), and no iron/foliate supplementation (OR = 2.72, 95%CI: 1.85, 3.60) were the identified factors associated with developing anemia in the immediate postpartum period. CONCLUSION The overall pooled magnitude of anemia in the immediate postpartum period among Ethiopian women was still a moderate public health problem. Instrumental mode of delivery, mid upper arm circumference (MUAC) measurement < 23 cm, antepartum hemorrhage, postpartum hemorrhage, and no iron/foliate supplementation were the identified factors associated with higher odds of developing anemia among immediate postpartum women in Ethiopia. Therefore, midwives, and doctors, shall focus on prevention of maternal hemorrhage, nutritional advice and counseling including iron /foliate supplementation, and avoid unnecessary instrumental delivery to prevent and reduce anemia related maternal mortality and morbidity in Ethiopia. PROSPERO REGISTRATION CRD42023437414 with registration date on 02/08/2023.
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Affiliation(s)
- Aysheshim Asnake Abneh
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Tadele Derbew Kassie
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Ishaq MU, Kunwar D, Qadeer A, Komel A, Safi A, Malik A, Malik L, Akbar A. Effect of vitamin A on maternal, fetal, and neonatal outcomes: An overview of deficiency, excessive intake, and intake recommendations. Nutr Clin Pract 2024; 39:373-384. [PMID: 38030585 DOI: 10.1002/ncp.11096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Vitamin A imbalance during pregnancy and lactation is a global public health concern with potentially negative consequences for fetuses and neonates. Inadequate vitamin A intake during this critical period can lead to anemia, weakened immune function, night blindness, and increased susceptibility to infections. Conversely, excessive intake of vitamin A can result in birth defects, hypercalcemia, and psychiatric symptoms. This review aims to identify risk factors contributing to vitamin A deficiency in pregnant women and its impact on maternal, fetal, and neonatal outcomes. It also examines the effects of high-dose vitamin A supplementation during pregnancy on offspring health. By analyzing existing literature and recommendations, the review emphasizes the significance of vitamin A in the development of various body systems and organs. It provides a comprehensive overview of the effects of vitamin A during pregnancy and lactation, encompassing deficiencies, excessive intake, and supplementation guidelines. The need for further research in this field is highlighted. In conclusion, maintaining a balanced vitamin A status is crucial during pregnancy to promote better outcomes for fetuses and newborns. Effective monitoring and intervention strategies are essential to address vitamin A deficiency and excess in pregnant women, thereby improving fetal and neonatal health.
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Affiliation(s)
| | - Digbijay Kunwar
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Abdul Qadeer
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Aqsa Komel
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Adnan Safi
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Aqsa Malik
- Department of Medicine, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan
| | - Linta Malik
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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Islam MH, Nayan MM, Jubayer A, Amin MR. A review of the dietary diversity and micronutrient adequacy among the women of reproductive age in low- and middle-income countries. Food Sci Nutr 2024; 12:1367-1379. [PMID: 38455218 PMCID: PMC10916566 DOI: 10.1002/fsn3.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024] Open
Abstract
The dietary quality of women of reproductive age (WRA) is particularly important during preconception, conception, and pregnancy for themselves and their offspring. Poorly diversified diets resulting in inadequate micronutrient consumption may have adverse effects on their health. This narrative review summarizes the findings of studies reporting on dietary diversity and micronutrient intake by WRA in low- and middle-income countries (LMICs). Studies on WRA aged 15-49 years in LMICs, with a sample size of more than 150, report dietary diversity and multiple micronutrient intake based on 24-h dietary recall/food weighed record/food frequency questionnaire, and published between January 2011 and June 2021 were included. The results were compared to the Food and Agriculture Organization (FAO) recommended cut-off for dietary diversity and the Indian Council of Medical Research (ICMR) recommended age- and sex-specific estimated average requirements (EARs) for micronutrient intake. This review includes 35 articles, of which 21 focused on dietary diversity and 14 on micronutrient intake. The results showed that WRA in LMICs had inadequate dietary diversity, with mean food group consumption of only 3.0-4.84, and around 42.3%-90% of women consumed inadequately diversified diets (<5 food groups). Additionally, most studies found that WRA did not consume adequate amounts of essential micronutrients, particularly calcium, iron, zinc, vitamin A, thiamin, riboflavin, folate, and vitamin B12. However, the intake of vitamin C, niacin, and vitamin B6 was above the required levels. In conclusion, this review highlights the common inadequacy of dietary diversity and multiple micronutrient intake among WRA in most LMICs. Effective measures involving improving dietary diversity, food fortification with micronutrients, and supplementation programs could help improve the dietary quality and intake of optimal micronutrients by women in LMICs.
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Affiliation(s)
- Md. Hafizul Islam
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
| | - Md. Moniruzzaman Nayan
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
- Inspira Advisory and Consulting LimitedDhakaBangladesh
| | - Ahmed Jubayer
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
- Bangladesh Institute of Social Research (BISR) TrustDhakaBangladesh
| | - Md. Ruhul Amin
- Institute of Nutrition and Food Science, University of DhakaDhakaBangladesh
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Kumar R, Oruna-Concha MJ, Balagiannis DP, Niranjan K. Elevated temperature extraction of β-carotene from freeze-dried carrot powder into sunflower oil: Extraction kinetics and thermal stability. J Food Sci 2024; 89:1642-1657. [PMID: 38317411 DOI: 10.1111/1750-3841.16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
β-Carotene, a precursor of vitamin A, can alleviate the deficiency of this vitamin prevalent worldwide. Earlier research studies have addressed the extraction of β-carotene at relatively low temperatures (up to 70°C) due to its perceived instability at higher temperatures, as a result of which extraction rates recorded are relatively low. This study models the net rate of β-carotene extraction by considering both extraction and degradation kinetics. The model developed, which accounts for degradation occurring in solid and extract phases, has been experimentally validated for the extraction of β-carotene from freeze-dried carrot powder into sunflower oil over a range of temperatures 90-150°C. This study also gives insights into the application of sunflower oil as a carrier for β-carotene during cooking and food processing, by monitoring and modeling the thermal degradation and isomerization of β-carotene at temperatures up to 220°C. The modeling of extraction kinetics shows that it is possible to achieve viable extraction rates by employing temperatures in the range (90-150°C) for relatively short times (<5 min). The degradation kinetics shows that almost 75% of the β-carotene can survive heating at 180°C for 10 min-indicating the possibility of using β-carotene enriched edible oils for frying. This study also reports on the formation of three isomers of β-carotene identified using HPLC: trans-, 9-cis, and 13-cis. The reaction network model developed in this study was able to account for the transient variation of the concentration of all three isomers. PRACTICAL APPLICATION: β-Carotene is a precursor of vitamin A and its consumption can potentially alleviate the deficiency of this vitamin prevalent worldwide. This study validates a model for the extraction of β-carotene in sunflower oil, which takes into account extraction as well as degradation occurring during extraction, so that a rational method is available for the design of efficient extractors for this purpose. This paper also establishes the thermal stability of β-carotene under frying conditions by quantifying its thermal degradation as well as isomerization.
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Affiliation(s)
- Rahul Kumar
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | | | | | - Keshavan Niranjan
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
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Uwase A, Nsereko E, Pillay N, Levin J. Dietary diversity and associated factors among pregnant women in the Southern Province of Rwanda: A facility-based cross-sectional study. PLoS One 2024; 19:e0297112. [PMID: 38394158 PMCID: PMC10889653 DOI: 10.1371/journal.pone.0297112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
The inadequate dietary diversity of pregnant women in low- and middle-income countries, including Rwanda, is rising and leading to macro and micronutrient deficiencies. The extent of dietary diversity and the factors contributing to it are unknown in Rwanda. This cross-sectional study, with 612 women who attended antenatal care services in Rwanda's Southern Province, identified determinants of dietary diversity among pregnant women. A multistage sampling scheme was used in which four districts were sampled, thereafter one urban and one rural health centre was sampled in each district and finally, a systematic sample of pregnant women was selected in each sampled health centre. Dietary diversity was measured using Minimum Dietary Diversity for Women (MDD-W), and multiple logistic regression models were fitted to identify factors associated with dietary diversity. Only 44.1% (95% confidence interval (CI) of [40.1%, 48.0%]) of participants had adequate dietary diversity. Approximately 95.4% of participants consumed grains, white roots, and tubers. The food groups that were the least consumed consisted of eggs (n = 99, 16.4%), as well as those consisting of milk and milk products (n = 112, 18.5%). The factors which were positively associated with dietary diversity were owning a radio (adjusted odds ratio [aOR] = 1.90 [95% CI 1.27, 2.85]), maternal education (aOR = 1.85 [95% CI 1.28, 2.65]), having a kitchen garden (aOR = 1.69 [95% CI 1.11, 2.57]) and nutrition knowledge score (aOR = 1.45 [95% CI 1.21, 1.74]) for a five-point increase in nutrition knowledge score. The factors negatively associated with dietary diversity include food insecurity, which reduced the odds of dietary diversity (aOR = 0.19 [0.07, 0.50]) per five-unit increase in food insecurity. Furthermore, the odds of adequate dietary diversity were lower among urban residents than rural residents (aOR = 0.69 [0.47, 1.03]). The household size was associated with dietary diversity with the odds of dietary diversity decreasing by 12% for a five-unit increase in household size (aOR = 0.88 [0.79; 0.99]). 23% had poor nutritional status, indicated by their mid-upper arm circumference (MUAC; < 23 cm). Enhanced nutritional education is needed to improve the nutritional knowledge of this population with particular emphasis on the consumption of animal-source foods. Sensitisation activities promoting ownership of kitchen gardens and radios could improve dietary diversity among Rwanda's pregnant women.
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Affiliation(s)
- Aline Uwase
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Etienne Nsereko
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Nirvana Pillay
- University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Jonathan Levin
- University of Witwatersrand School of Public Health, Pretoria, South Africa
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John C, Poh BK, Jalaludin MY, Michael G, Adedeji I, Oyenusi EE, Akor B, Charles NC, Buthmanaban V, Muhardi L. Exploring disparities in malnutrition among under-five children in Nigeria and potential solutions: a scoping review. Front Nutr 2024; 10:1279130. [PMID: 38249616 PMCID: PMC10796494 DOI: 10.3389/fnut.2023.1279130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Triple burden of malnutrition in children remains a significant public health issue. This scoping review aims to assess the information on undernutrition, micronutrient deficiencies and the quality of complementary feeding in various regions in Nigeria. Methods A literature search was conducted using PubMed and Google Scholar databases from January 1, 2018 to January 31, 2023 to include studies focusing on 0 to 5 years old children in Nigeria, reporting data on nutritional status, nutrient deficiencies, and published in English. Results 73 out of 1,545 articles were included. Stunting remained alarmingly high ranging from 7.2% (Osun, South West) to 61% (Kaduna, North Central), while wasting varied from 1% (Ibadan, South West) to 29% (FCT Abuja, Central) and underweight from 5.9% (Osun, South West) to 42.6% (Kano, North West) respectively. The overall prevalence of anemia and vitamin A deficiency ranged between 55.2 to 75.1 % and 5.3 to 67.6%, respectively. Low rates of achieving minimum dietary diversity and minimum meal frequency were reported across different states depicting the suboptimal quality of complementary feeding. The prevalence of overweight/obesity ranged from 1.5% (Rivers, South South) to 25.9% (Benue, North Central). Conclusion Multiple early childhood malnutrition issues exist with a wide disparity across states in Nigeria, particularly in the Northern region. Targeted nutrition interventions must be implemented to improve the situation.
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Affiliation(s)
- Collins John
- Department of Paediatrics, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Bee Koon Poh
- Nutritional Sciences Programme and Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Godpower Michael
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Idris Adedeji
- Department of Paediatrics, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Elizabeth Eberechi Oyenusi
- Department of Paediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Blessing Akor
- Department of Family Medicine, University of Abuja, Abuja, Nigeria
- Department of Community Medicine, University of Abuja, Abuja, Nigeria
| | - Nkwoala C. Charles
- Department of Human Nutrition and Dietetics, Michael Okpara University of Agriculture, Umudike, Nigeria
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Gebeye LG, Dessie EY, Yimam JA. Predictors of micronutrient deficiency among children aged 6-23 months in Ethiopia: a machine learning approach. Front Nutr 2024; 10:1277048. [PMID: 38249594 PMCID: PMC10796776 DOI: 10.3389/fnut.2023.1277048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Micronutrient (MN) deficiencies are a major public health problem in developing countries including Ethiopia, leading to childhood morbidity and mortality. Effective implementation of programs aimed at reducing MN deficiencies requires an understanding of the important drivers of suboptimal MN intake. Therefore, this study aimed to identify important predictors of MN deficiency among children aged 6-23 months in Ethiopia using machine learning algorithms. Methods This study employed data from the 2019 Ethiopia Mini Demographic and Health Survey (2019 EMDHS) and included a sample of 1,455 children aged 6-23 months for analysis. Machine Learning (ML) methods including, Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), Neural Network (NN), and Naïve Bayes (NB) were used to prioritize risk factors for MN deficiency prediction. Performance metrics including accuracy, sensitivity, specificity, and Area Under the Receiver Operating Characteristic (AUROC) curves were used to evaluate model prediction performance. Results The prediction performance of the RF model was the best performing ML model in predicting child MN deficiency, with an AUROC of 80.01% and accuracy of 72.41% in the test data. The RF algorithm identified the eastern region of Ethiopia, poorest wealth index, no maternal education, lack of media exposure, home delivery, and younger child age as the top prioritized risk factors in their order of importance for MN deficiency prediction. Conclusion The RF algorithm outperformed other ML algorithms in predicting child MN deficiency in Ethiopia. Based on the findings of this study, improving women's education, increasing exposure to mass media, introducing MN-rich foods in early childhood, enhancing access to health services, and targeted intervention in the eastern region are strongly recommended to significantly reduce child MN deficiency.
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Affiliation(s)
- Leykun Getaneh Gebeye
- Department of Statistics, College of Natural Science, Wollo University, Dessie, Ethiopia
| | - Eskezeia Yihunie Dessie
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Jemal Ayalew Yimam
- Department of Statistics, College of Natural Science, Wollo University, Dessie, Ethiopia
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Poix S, Elmusharaf K. The cost of inaction on preconception health in Nigeria: An economic impact analysis. Glob Public Health 2024; 19:2361782. [PMID: 38837785 DOI: 10.1080/17441692.2024.2361782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.
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Affiliation(s)
- Sébastien Poix
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Khalifa Elmusharaf
- Public Health, Applied Health Research, University of Birmingham Dubai, Dubai, United Arab Emirates
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12
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Mohammed F, Abdirizak N, Jibril A, Oumer A. Correlates of minimum dietary diversity among pregnant women on antenatal care follow up at public health facility in Puntland, Somalia. Sci Rep 2023; 13:21935. [PMID: 38081930 PMCID: PMC10713561 DOI: 10.1038/s41598-023-48983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
In Somalia, where a poorly diversified diet is leading to adverse pregnancy and neonatal outcomes, there is a significant dearth of evidence that needs to be studied. Hence, this study was to identify factors associated with minimum dietary diversity among pregnant women in Somalia. A facility-based survey was conducted among 361 pregnant women attending antenatal care (ANC) using a structured questionnaire. Dietary diversity was measured using consumption of 10-food groups. Bivariable and multivariable binary logistic regression analyses were used, along with odds ratios and 95% confidence intervals. About 48.2% (42.9-53.5) of women had an inadequately diversified diet. The risk of having an inadequately diversified diet was higher among rural residents (AOR = 1.20; 0.30-4.75), multigravida (AOR = 2.85; 1.43-5.68), young women (AOR = 2.15; 0.82-5.61), extended families (AOR = 1.19; 0.68-2.10), with infrequent ANC visits (AOR = 4.12; 2.06-8.27), fewer frequent meals (AOR = 1.84; 1.09-3.10) and from food-insecure households (AOR = 3.84; 2.28-6.49) as compared to their counterparts. Consumption of poorly diversified diet was prevalent and associated with dietary diversity was prevalent among women which could be strongly predicted by parity, ante-natal care and food security, which needs to be targeted for interventions.
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Affiliation(s)
- Feiruza Mohammed
- Faculty of Nutrition, University of Health Science, Bossaso, Puntland, Somalia
| | | | - Abdulfetah Jibril
- United Nations High Commissioner for Refugees, Bossaso, Puntland, Somalia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
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13
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Knez M, Stangoulis JCR. Dietary Zn deficiency, the current situation and potential solutions. Nutr Res Rev 2023; 36:199-215. [PMID: 37062532 DOI: 10.1017/s0954422421000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zinc (Zn) deficiency is a worldwide problem, and this review presents an overview of the magnitude of Zn deficiency with a particular emphasis on present global challenges, current recommendations for Zn intake, and factors that affect dietary requirements. The challenges of monitoring Zn status are clarified together with the discussion of relevant Zn bioaccessibility and bioavailability issues. Modern lifestyle factors that may exacerbate Zn deficiency and new strategies of reducing its effects are presented. Biofortification, as a potentially useful strategy for improving Zn status in sensitive populations, is discussed. The review proposes potential actions that could deliver promising results both in terms of monitoring dietary and physiological Zn status as well as in alleviating dietary Zn deficiency in affected populations.
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Affiliation(s)
- Marija Knez
- College of Science and Engineering, Flinders University, GPO Box 2100, AdelaideSA5001, Australia
- Center of Research Excellence in Nutrition and Metabolism, University of Belgrade, Institute for Medical Research, National Institute of the Republic of Serbia, 11000Belgrade, Serbia
| | - James C R Stangoulis
- College of Science and Engineering, Flinders University, GPO Box 2100, AdelaideSA5001, Australia
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14
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Bekele TH, van Rooijen M, Gerdessen JC, Brouwer ID, Feskens EJM, Trijsburg L, Alemayehu D, de Vries JHM. Developing feasible healthy diets for Ethiopian women of reproductive age: a linear goal programming approach. Public Health Nutr 2023; 26:2096-2107. [PMID: 37448219 PMCID: PMC10564607 DOI: 10.1017/s1368980023001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/08/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference. DESIGN Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet. SETTINGS Five regions are included in the urban and rural areas of Ethiopia. PARTICIPANTS Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019. RESULTS Women's mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet's cost. CONCLUSION The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.
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Affiliation(s)
- Tesfaye Hailu Bekele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Maike van Rooijen
- Group Operations Research and Logistics, Wageningen University and Research, Wageningen, The Netherlands
| | - Johanna C Gerdessen
- Group Operations Research and Logistics, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Edith JM Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Laura Trijsburg
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Jeanne HM de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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15
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Hardido TG, Mikamo AA, Legesse CT. Adherence to Iron-Folic Acid Among Pregnant Women Attending Antenatal Care in Southern Ethiopia, 2022. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:431-437. [PMID: 37638333 PMCID: PMC10457636 DOI: 10.1089/whr.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
Background Among the micronutrient deficiencies, iron and folic acid are the most common and frequently occur in pregnant women. So, the objective of this study was to assess the adherence to iron and folic acid among pregnant women booking antenatal services in the study area. Materials and Methods A facility-based cross-sectional study design was used from January to April 2022. A structured questionnaire was used to collect data using systematic sampling techniques to approach 339 pregnant women. Data were entered and analyzed using SPSS software version 20. A descriptive analysis was performed. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were used, and statistical significance was reported at p-values <0.05 with 95% confidence. Results In this study, 339 (99%) pregnant women participated. The mean age of the respondents was 28.04 years old, with a standard deviation of 5.3 years. The rate of adherence to iron and folic acid supplementation (IFAS) in pregnant women was 62.8%. Mothers under 19 years old (adjusted odds ratio [AOR] = 0.025; 95% CI [0.003-0.218]), daily (AOR = 0.127; 95% CI [0.028-0.568]), and those with a history of miscarriage (AOR = 0.276; 95% CI [0.086-0.891]) were less likely to be using IFAS. However, greater knowledge of IFAS was positively correlated with use of the supplements (AOR = 5.56; 95% CI [1.23-8.34]). Conclusions In this study, the adherence rate with IFAS of pregnant women in the study area was 62.8%. This indicates that one in four women is not in compliance with IFAS. Appropriate counseling and health education should be provided to pregnant women to improve compliance.
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Affiliation(s)
- Temesgen Geta Hardido
- School of Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Adisu Ashiko Mikamo
- School of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Cherinet Tilahu Legesse
- School of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
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16
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Alamirew SK, Lemke S, Stadlmayr B, Freyer B. Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia. Nutrients 2023; 15:3369. [PMID: 37571306 PMCID: PMC10420930 DOI: 10.3390/nu15153369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.
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Affiliation(s)
- Simegn Kassa Alamirew
- Institute of Development Research (IDR), University of Natural Resources and Life Sciences, Vienna, 1190 Vienna, Austria; (S.L.); (B.S.)
| | - Stefanie Lemke
- Institute of Development Research (IDR), University of Natural Resources and Life Sciences, Vienna, 1190 Vienna, Austria; (S.L.); (B.S.)
| | - Barbara Stadlmayr
- Institute of Development Research (IDR), University of Natural Resources and Life Sciences, Vienna, 1190 Vienna, Austria; (S.L.); (B.S.)
| | - Bernhard Freyer
- Division of Organic Farming, University of Natural Resources and Life Sciences, Vienna, 1190 Vienna, Austria;
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Dzakovich MP, Debelo H, Albertsen MC, Che P, Jones TJ, Simon MK, Zhao ZY, Glassman K, Ferruzzi MG. Trait stacking simultaneously enhances provitamin A carotenoid and mineral bioaccessibility in biofortified Sorghum bicolor. Food Funct 2023. [PMID: 37449680 DOI: 10.1039/d2fo03606a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Vitamin A, iron, and zinc deficiencies are major nutritional inadequacies in sub-Saharan Africa and disproportionately affect women and children. Biotechnology strategies have been tested to individually improve provitamin A carotenoid or mineral content and/or bioaccessibility in staple crops including sorghum (Sorghum bicolor). However, concurrent carotenoid and mineral enhancement has not been thoroughly assessed and antagonism between these chemical classes has been reported. This work evaluated two genetically engineered constructs containing a suite of heterologous genes to increase carotenoid stability and pathway flux, as well as phytase to catabolize phytate and increase mineral bioaccessibility. Model porridges made from transgenic events were evaluated for carotenoid and mineral content as well as bioaccessibility. Transgenic events produced markedly higher amounts of carotenoids (26.4 μg g-1 DW) compared to null segregants (4.2 μg g-1 DW) and wild-type control (Tx430; 3.7 μg g-1 DW). Phytase activation by pre-steeping flour resulted in significant phytate reduction (9.4 to 4.2 mg g-1 DW), altered the profile of inositol phosphate catabolites, and reduced molar ratios of phytate to iron (16.0 to 4.1), and zinc (19.0 to 4.9) in engineered material, suggesting improved mineral bioaccessibility. Improved phytate : mineral ratios did not significantly affect micellarization and bioaccessible provitamin A carotenoids were over 23 times greater in transgenic events compared to corresponding null segregants and wild-type controls. A 200 g serving of porridge made with these transgenic events provide an estimated 53.7% of a 4-8-year-old child's vitamin A estimated average requirement. These data suggest that combinatorial approaches to enhance micronutrient content and bioaccessibility are feasible and warrant further assessment in human studies.
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Affiliation(s)
- Michael P Dzakovich
- Plants for Human Health Institute, North Carolina State University, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
- USDA-ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave., Houston, TX 77030, USA.
| | - Hawi Debelo
- Plants for Human Health Institute, North Carolina State University, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
| | | | - Ping Che
- Corteva Agriscience, 8305 NW 62nd Ave., Johnston, IA 50131, USA
| | - Todd J Jones
- Corteva Agriscience, 8305 NW 62nd Ave., Johnston, IA 50131, USA
| | - Marissa K Simon
- Corteva Agriscience, 8305 NW 62nd Ave., Johnston, IA 50131, USA
| | - Zuo-Yu Zhao
- Corteva Agriscience, 8305 NW 62nd Ave., Johnston, IA 50131, USA
| | | | - Mario G Ferruzzi
- Plants for Human Health Institute, North Carolina State University, 600 Laureate Way, Kannapolis, North Carolina 28081, USA
- Arkansas Children's Nutrition Center, Section of Developmental Nutrition, University of Arkansas for Medical Sciences, 15 Children's Way, Little Rock, AR 72202, USA.
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18
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Asfaw A, Behailu M, Oumer A, Gebremariam T, Asefa K. Factors associated with recent iodine intake level among household food handlers in Southwest Ethiopia: a cross-sectional study. BMC Womens Health 2023; 23:354. [PMID: 37403023 DOI: 10.1186/s12905-023-02516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Iodine deficiency is a global public health threat, affecting an estimated two billion people. The median urinary iodine concentration is more reliable in determining recent iodine intakes and the risks of iodine deficiency. Therefore, this study was aimed to identify the factors associated with recent iodine intake level using median urinary iodine concentration as an indicator among household food handlers in southwest Ethiopia. METHODS A community-based survey was conducted with selected households using a pretested interviewer-administered questionnaire in southwest Ethiopia. A 20-gram sample of table salt and a 5 ml causal urine samples were also collected and analyzed using rapid test kit and a Sandell-Kolthoff reaction, respectively. A salt iodine concentration above 15 ppm was classified as adequately iodized and a median urinary iodine concentration between 100 and 200µgl- 1 was considered as adequate iodine intake. A bivariable and multivariable logistic regression model was fitted. Crude and adjusted odds ratios with their 95% confidence levels were reported. Associations with a p-value ≤ 0.05 were used to declare statistical significance. RESULTS A total of 478 women were included, with a mean age of 33.2 (± 8.4 years). Only 268 (56.1%) of the households had adequately iodized salt (> 15 ppm). The median urinary iodine concentration (interquartile range) was 87.5 µg l- 1 (45.6-107.6). In a fitted multivariable logistic regression model (p-value = 0.911), illiterate women (AOR = 4.61; 95% CI: 2.17, 9.81), poorly iodized salt in the household (AOR = 25.0; 95% CI: 13-48), salt purchased from open market (AOR = 1.93; 95% CI: 1.0, 3.73) and women who do not read the label during purchasing the salt (AOR = 3.07; 95% CI: 1.31, 7.17) were important predictors of the risk of Iodine deficiency. CONCLUSION Despite public health efforts to improve iodine intake, its deficiency is still a major public health problem among southwest Ethiopian women.
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Affiliation(s)
- Agize Asfaw
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia.
| | - Mifta Behailu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Tigist Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Kenzudin Asefa
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
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19
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Madrid L, Vyas KJ, Kancherla V, Leulseged H, Suchdev PS, Bassat Q, Sow SO, El Arifeen S, Madhi SA, Onyango D, Ogbuanu I, Scott JAG, Blau D, Mandomando I, Keita AM, Gurley ES, Mahtab S, Akelo V, Sannoh S, Tilahun Y, Varo R, Onwuchekwa U, Rahman A, Adam Y, Omore R, Lako S, Xerinda E, Islam KM, Wise A, Tippet-Barr BA, Kaluma E, Ajanovic S, Kotloff KL, Hossain MZ, Mutevedzi P, Tapia MD, Rogena E, Moses F, Whitney CG, Assefa N. Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network. Lancet Glob Health 2023; 11:e1041-e1052. [PMID: 37271162 PMCID: PMC10282076 DOI: 10.1016/s2214-109x(23)00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. FINDINGS Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Kartavya J Vyas
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Parminder S Suchdev
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dianna Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Adama M Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | | | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Uma Onwuchekwa
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Yasmin Adam
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Amy Wise
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sara Ajanovic
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Rogena
- Department of Pathology, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Francis Moses
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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20
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Bekele TH, Trijsburg L, Brouwer ID, de Vries JH, Covic N, Kennedy G, Alemayehu D, Feskens EJ. Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review. Adv Nutr 2023; 14:895-913. [PMID: 37182739 PMCID: PMC10334157 DOI: 10.1016/j.advnut.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).
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Affiliation(s)
- Tesfaye Hailu Bekele
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
| | - Laura Trijsburg
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Jeanne Hm de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Namukolo Covic
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Gina Kennedy
- Knowledge Leadership, Global Alliance for Improved Nutrition, Washington, DC, United States
| | - Dawit Alemayehu
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Edith Jm Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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21
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Fite MB, Tura AK, Yadeta TA, Oljira L, Wilfong T, Mamme NY, Asefa G, Gurmu DB, Habtu W, Waka FC, Demiss NT, Woldeyohannes M, Tessema M, Alemayehu D, Hassen TA, Motuma A, Roba KT. Co-occurrence of iron, folate, and vitamin A deficiency among pregnant women in eastern Ethiopia: a community-based study. BMC Nutr 2023; 9:72. [PMID: 37353841 DOI: 10.1186/s40795-023-00724-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND It is well known that the magnitude of undernutrition in Ethiopia is unacceptably high. The burden of co-occurrence of iron, folate, and vitamin A deficiency, on the other hand, has received less attention. Thus, in this study, we looked at the prevalence of iron, folate, and vitamin A deficiency in pregnant women in eastern Ethiopia. METHODS A community-based cross-sectional study was conducted among 397 pregnant women in Haramaya district, eastern Ethiopia. An interview-assisted questionnaire and blood serum were collected from pregnant women using standard techniques and shipped to an EPHI for micronutrient analysis. Factors associated with the co-occurrence of iron, folate, and vitamin A deficiency were identified using binary and multiple logistic regressions. RESULTS According to this study, 81.6% of the participants were deficient in at least one micronutrient, and 53.53.2% were deficient in two or more. Women who did not receive iron-folic acid supplementation (AOR = 2.44; 95% CI = 1.52-3.92), did not attend Antenatal care (ANC) follow up (AOR = 2.88; 95% CI = 1.81-4.61), and reported low consumption of diversified diet (AOR = 2.18 (95% CI = 1.35-3.51) had a higher risk of co-occurrence of iron, folate, and vitamin A deficiency. CONCLUSION This study found that more than half of pregnant women were in multiple micronutrients, indicating a major public health issue. In addition to the IFA supplementation programs that are already in place, there is a need for multiple micronutrient supplementation.
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Affiliation(s)
- Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tara Wilfong
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Newas Yusuf Mamme
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gemechu Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Demiraw Bikila Gurmu
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wossene Habtu
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feyissa Challa Waka
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Nahom Tefera Demiss
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Meseret Woldeyohannes
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dawit Alemayehu
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aboma Motuma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
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22
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Biete A, Gonçalves VSS, Crispim SP, Franceschini SCC, Carmo AS, Pizato N. Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6063. [PMID: 37372650 DOI: 10.3390/ijerph20126063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/29/2023]
Abstract
Combined deficiencies of nutrients such as iron and folic acid intake during pregnancy are related to nutritional deficiencies risk, such as anemia. The objective of this study was to analyze the association between risk factors (sociodemographic, dietary and lifestyle) and the intake of iron and folate by pregnant women followed up in Primary Health Care (PHC) in the Federal District, Brazil. A cross-sectional observational study was carried out with adult pregnant women of different gestational ages. A semi-structured questionnaire was applied by researchers trained to collect sociodemographic, economic, environmental, and health data. Two nonconsecutive 24-hour recalls (24hr) were carried out to collect data about food consumption. Multivariate linear regression models were used to analyze the association between sociodemographic and dietary risk factors and the consumption of iron and folate. The mean daily energy intake was 1726 kcal (95% CI 1641-1811), with 22.4% (95% CI 20.09-24.66) derived from ultra-processed foods (UPFs). The mean iron and folate intake were 5.28 mg (95% CI 5.09-5.48) and 193.42 µg (95% CI 182.22-204.61), respectively. According to the multivariate model, the highest quintile of ultra-processed foods intake was associated with lower iron (β = -1.15; IC 95%: -1.74; 0.55; p < 0.001) and folate intake (β = -63.23; IC 95%: -98.32; -28.15; p < 0.001). Pregnant women with high school degree presented higher iron intake (β = 0.74; IC 95%: 0.20; 1.28; p = 0.007) and folate intake (β = 38.95; IC 95%: 6.96; 70.95; p = 0.017) compared to pregnant women with elementary school degree. Folate consumption was also associated with the second gestational period (β = 39.44; IC 95%: 5.58; 73.30; p = 0.023) and pregnancy planning (β = 26.88; IC 95%: 3.58; 50.18; p = 0.024). Further research is warranted to enhance evidence on the relationship between the role of processed foods and micronutrients intake to strengthen the nutritional quality of diet of pregnant women attended in Primary Health Care.
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Affiliation(s)
- Amanda Biete
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
| | - Vivian S S Gonçalves
- Graduate Program in Public Health, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
| | - Sandra P Crispim
- Department of Nutrition, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Sylvia C C Franceschini
- Graduate Program in Nutrition Sciences, Department of Nutrition and Health, Federal University of Viçosa, Viçosa 36570-900, Brazil
| | | | - Nathalia Pizato
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
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23
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Chen G, Weiskirchen S, Weiskirchen R. Vitamin A: too good to be bad? Front Pharmacol 2023; 14:1186336. [PMID: 37284305 PMCID: PMC10239981 DOI: 10.3389/fphar.2023.1186336] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Vitamin A is a micronutrient important for vision, cell growth, reproduction and immunity. Both deficiency and excess consuming of vitamin A cause severe health consequences. Although discovered as the first lipophilic vitamin already more than a century ago and the definition of precise biological roles of vitamin A in the setting of health and disease, there are still many unresolved issues related to that vitamin. Prototypically, the liver that plays a key role in the storage, metabolism and homeostasis of vitamin A critically responds to the vitamin A status. Acute and chronic excess vitamin A is associated with liver damage and fibrosis, while also hypovitaminosis A is associated with alterations in liver morphology and function. Hepatic stellate cells are the main storage site of vitamin A. These cells have multiple physiological roles from balancing retinol content of the body to mediating inflammatory responses in the liver. Strikingly, different animal disease models also respond to vitamin A statuses differently or even opposing. In this review, we discuss some of these controversial issues in understanding vitamin A biology. More studies of the interactions of vitamin A with animal genomes and epigenetic settings are anticipated in the future.
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Affiliation(s)
- Guoxun Chen
- College of Food Science and Technology, College of Biomedicine and Health, Huazhong Agricultural University, Wuhan, China
| | - Sabine Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital Aachen, Aachen, Germany
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24
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Breton-Larrivée M, Elder E, Legault LM, Langford-Avelar A, MacFarlane AJ, McGraw S. Mitigating the detrimental developmental impact of early fetal alcohol exposure using a maternal methyl donor-enriched diet. FASEB J 2023; 37:e22829. [PMID: 36856720 DOI: 10.1096/fj.202201564r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Fetal alcohol exposure at any stage of pregnancy can lead to fetal alcohol spectrum disorder (FASD), a group of life-long conditions characterized by congenital malformations, as well as cognitive, behavioral, and emotional impairments. The teratogenic effects of alcohol have long been publicized; yet fetal alcohol exposure is one of the most common preventable causes of birth defects. Currently, alcohol abstinence during pregnancy is the best and only way to prevent FASD. However, alcohol consumption remains astoundingly prevalent among pregnant women; therefore, additional measures need to be made available to help protect the developing embryo before irreparable damage is done. Maternal nutritional interventions using methyl donors have been investigated as potential preventative measures to mitigate the adverse effects of fetal alcohol exposure. Here, we show that a single acute preimplantation (E2.5; 8-cell stage) fetal alcohol exposure (2 × 2.5 g/kg ethanol with a 2h interval) in mice leads to long-term FASD-like morphological phenotypes (e.g. growth restriction, brain malformations, skeletal delays) in late-gestation embryos (E18.5) and demonstrate that supplementing the maternal diet with a combination of four methyl donor nutrients, folic acid, choline, betaine, and vitamin B12, prior to conception and throughout gestation effectively reduces the incidence and severity of alcohol-induced morphological defects without altering DNA methylation status of imprinting control regions and regulation of associated imprinted genes. This study clearly supports that preimplantation embryos are vulnerable to the teratogenic effects of alcohol, emphasizes the dangers of maternal alcohol consumption during early gestation, and provides a potential proactive maternal nutritional intervention to minimize FASD progression, reinforcing the importance of adequate preconception and prenatal nutrition.
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Affiliation(s)
- Mélanie Breton-Larrivée
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Elizabeth Elder
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Lisa-Marie Legault
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Alexandra Langford-Avelar
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Amanda J MacFarlane
- Agriculture, Food, and Nutrition Evidence Center, Texas A&M University, Texas, Fort Worth, USA.,Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Serge McGraw
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada.,Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Canada
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25
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Schoeman J, Kellerman IM, Rogers PC, Ladas EJ, Lombard CJ, Uys R, Kruger M. Prevalence of vitamin and iron deficiencies at cancer diagnosis at two pediatric oncology units in South Africa. Pediatr Hematol Oncol 2023; 40:752-765. [PMID: 36940097 DOI: 10.1080/08880018.2023.2188920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
This study investigates the prevalence of vitamin and iron deficiencies at cancer diagnosis. Newly diagnosed children between October 2018 and December 2020 at two South African pediatric oncology units (POUs) were assessed for nutritional and micronutrient status (Vit A, Vit B12, Vit D, folate, and iron). A structured interview with caregivers provided information regarding hunger and poverty risks. There were 261 patients enrolled with a median age of 5.5 years and a male-to-female ratio of 1:0.8. Nearly half had iron deficiency (47.6%), while a third had either Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. Significant associations existed between moderate acute malnutrition (MAM) and low levels of Vit A (48.4%; p = .005), Vit B12 (29.6%; p < .001), and folate (47.3%; p = .003), while Vit D deficiency was associated with wasting (63.6%) (p < .001). Males had significantly lower Vit D levels (respectively, 40.9%; p = .004). Folate deficiency was significantly associated with patients born at full term (33.5%; p = .017), age older than five years (39.8%; p = .002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P = .032); as well as having food insecurity (46.3%; p < .001), or hematological malignancies (41.3%; p = .004). This study documents the high prevalence of Vit A, Vit D, Vit B12, folate, and iron deficiency in South African pediatric cancer patients, demonstrating the need to include micronutrient assessment at diagnosis to ensure optimal nutritional support for macro-and micronutrients.
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Affiliation(s)
- Judy Schoeman
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Ilde-Marié Kellerman
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paul C Rogers
- Division of Pediatric Oncology/Hematology/BMT, BC Children's Hospital and University of BC, Vancouver, Canada
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Medical Irving Center, Columbia University, New York, New York, USA
| | - Carl J Lombard
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ronelle Uys
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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26
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Serum concentration of zinc, copper, iron, and its associated factors among pregnant women of small-scale farming in western Ethiopia. Sci Rep 2023; 13:4197. [PMID: 36918569 PMCID: PMC10014993 DOI: 10.1038/s41598-023-30284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
Micro-nutrients are required in small amounts to maintain growth and cell functioning to complete the life cycle through reproductions. However, pregnant women in developing countries like Ethiopia are vulnerable to multiple micro-nutrient deficiencies. Therefore, this study aimed at assessing the serum level of metals and associated factors like dietary diversity, and health-related problems in pregnant women among small-scale farming in Kellem Wellega, western Ethiopia. A cross-sectional laboratory-based study was conducted from June to August 2021 on 417 pregnant women attending antenatal care at rural healthcare facilities. Data was collected by using per-tested structured questionnaires via face-to-face interviews. The data analysis was conducted using SPSS version 24.0, and multivariate logistic regression analysis was performed to determine the association between predictor and outcome variables. A statistically significant was considered at p value < 0.05 for all the analyses. Our study findings showed that 62.1, 80.9, and 71.9% of the participants were deficient in iron, zinc, and copper micro-nutrient levels, respectively. Pregnant women who could not have formal education were 3.24 (AOR = 3.24, 95% CI 1.33-7.91) and 3.98 (AOR = 3.98, 95% CI 1.2-13.15) times more likely to show zinc and copper deficiency than those who attended secondary school and above, respectively. Furthermore, pregnant women involved only in farming activities were 0.57 (AOR = 0.57, 95% CI 0.36-0.91) and 4.33 (AOR = 5.72, 95% CI 2.34-13.97) times more likely to be exposed to iron and zinc deficiency than those who were engaged in other activities. This study revealed that pregnant women with low income were 6.36 times more likely to be exposed to zinc micro-nutrient deficiencies than those with high-income participants (AOR = 6.36, 95% CI 1.47-27.61). Additionally, those participants who ate a varied diet between 1 and 4 items per day were 2.26 (AOR = 2.26, 95% CI 1.43-3.59) and 2.77 (AOR = 2.77, 95% CI 1.6-4.61) times more likely to suffer zinc and copper micro-nutrient insufficiency than those who consumed 5-10 items per day. Finally, pregnant women who developed diarrhea in the past three months were 1.82 (AOR = 2.77, 95% CI 1.14-2.92) and 2.52 (AOR = 2.52, 95% CI 1.3-4.91) times more likely to be exposed to iron and copper deficiency than those who never show the symptoms, respectively. This study identified low concentrations of zinc, iron, and copper in the blood serum of pregnant women of small-scale farmers.
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Development of the Ethiopian Healthy Eating Index (Et-HEI) and evaluation in women of reproductive age. J Nutr Sci 2023; 12:e9. [PMID: 36721718 PMCID: PMC9879874 DOI: 10.1017/jns.2022.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023] Open
Abstract
Ethiopia announced its first food-based dietary guidelines (FBDGs) on 15 March 2022. The present study aims to develop and evaluate the Ethiopian Healthy Eating Index (Et-HEI) based on the FBDG. Data were collected from 494 Ethiopian women of reproductive age sampled from households in five different regions. The Et-HEI consists of eleven components, and each component was scored between 0 and 10 points, the total score ranging from 0 to 110, with maximum adherence to the FBDG. The Et-HEI score was evaluated against the Minimum Dietary Diversity for Women (MDD-W) and the probability of nutrient adequacy. The average Et-HEI score for women of reproductive age was 49 out of 110. Adherence to the recommendations for grains, vegetables, legumes, fat and oils, salt, sugar and alcohol contributed the most to this score. Most women had low scores for fruits, nuts and seeds, and animal-sourced foods, indicating low intake. The Cronbach's alpha coefficient, indicating the reliability of the Et-HEI to assess its diet quality, was 0⋅53. The low mean Et-HEI score agreed with a low mean score of the MDD-W (3⋅5 out of 10). Also, low nutrient adequacies confirmed poor adherence to nutrient-dense components of the FBDG. The Et-HEI was not associated with the intake of vitamin B12, vitamin C and calcium in this study population. Women who completed secondary school and above had relatively lower Et-HEI scores. The newly developed Et-HEI is able to estimate nutrient adequacy while also assessing adherence to the Ethiopian FBDG though there is room for improvement.
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Zinc deficiency among pregnant women around Lake Awasa, Hawassa City, Ethiopia: a cross-sectional analysis. J Nutr Sci 2022; 11:e102. [PMID: 36452399 PMCID: PMC9705700 DOI: 10.1017/jns.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Zinc deficiency (ZD) during pregnancy has far-reaching consequences on the mother, fetus and subsequent child survival. Therefore, the present study aimed to assess the prevalence and associated factors of ZD among pregnant women around Lake Awasa, Hawassa City, Ethiopia. To this end, a facility-based cross-sectional study was conducted on 333 randomly sampled pregnant women from 08 April to 08 May 2021. The socio-economic, dietary intake, water, sanitation and hygiene, obstetric, and maternal health data were collected through face-to-face interviews. Moreover, on-spot blood and stool samples were taken. Descriptive statistics and binary and multivariable logistic regression analysis were conducted. The prevalence of ZD was 58⋅6 % (95 % CI 53⋅31, 63⋅89). The poorest (AOR = 3⋅28; 95 % CI 1⋅26, 8⋅50) and poor (AOR = 2⋅93; 95 % CI 1⋅14, 7⋅54) wealth quintiles, four of more family size (AOR = 1⋅84, 95 % CI 1⋅10, 3⋅35), poor dietary diversity (AOR = 4⋅11; 95 % CI 2⋅11, 7⋅62), not eating snacks (AOR = 3⋅40; 95 % CI 1⋅42, 8⋅15), not consuming fish (AOR = 3⋅53; 95 % CI 1⋅65, 7⋅56) and chicken (AOR = 2⋅53; 95 % CI 1⋅31, 4⋅88) at least once a month, and intestinal parasitic infection (AOR = 2⋅78; 95 % CI 1⋅52, 5⋅08) predicted zinc deficiency. In conclusion, ZD is a public health problem among pregnant women around Lake Awasa. The present study demonstrated that poor socio-economic status, large family size, poor nutritional practices and intestinal parasitic infection determine the zinc status in the present study area. The findings suggest the need for further analysis to deepen the understanding about ZD and consideration of livelihood in interventions to prevent and control ZD among pregnant women in Hawassa City, Ethiopia.
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Key Words
- AOR, adjusted odds ratio
- CI, confidence interval
- COR, crude odds ratio
- Ethiopia
- Hawassa City
- IBM, International Business Machine
- IZiNCG, International Zinc Nutrition Consultative Group
- Lake Awasa
- N, total number participants
- Pregnant Women
- UNICEF, United Nations International Children's Emergency Fund
- WASH, Water, sanitation and hygiene
- WHO, World Health Organization
- ZD, zinc deficiency
- Zinc Deficiency
- sd, standard deviation
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29
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Maykondo BK, Horwood C, Haskins L, Mapumulo S, Mapatano MA, Kilola BM, Mokanisa MB, Hatloy A, John VM, Bitadi PMBW. A qualitative study to explore dietary knowledge, beliefs, and practices among pregnant women in a rural health zone in the Democratic Republic of Congo. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:51. [DOI: 10.1186/s41043-022-00333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
A nutritious and healthy diet during pregnancy is essential for the health of both mother and baby. Inadequate dietary intake during pregnancy contributes to maternal malnutrition and can have lifelong effects on the health of the child. Maternal malnutrition is common in many low-income countries, including the Democratic Republic of Congo (DRC). Kwango province, DRC, has a high prevalence of malnutrition among all population groups, including macro and micronutrient deficiencies among pregnant women. The study aimed to explore the dietary knowledge and practices of a pregnant woman in this area.
Methods
This study adopted a qualitative approach using in-depth interviews (IDIs) with pregnant women and key informants, and focus group discussions (FGDs) with fathers and grandmothers in the community, to explore women’s knowledge and practice about diet during pregnancy. Data were collected between January and April 2018. IDIs were conducted with pregnant women who were recruited at antenatal clinics during their second and third trimesters. IDIs were undertaken with selected key informants, who were health workers providing care to pregnant women, and included doctors, nurses, nutritionists, and community health workers. All IDIs and FGDs were audio-recorded, transcribed verbatim, and translated to English. The triangulation method and thematic analyses were used.
Results
Overall, women showed good general knowledge about nutrition and the need for increased and varied foods during pregnancy, but little technical knowledge about nutrients and sources of nutrition. Healthcare facilities, media, NGOs, and family members were the main sources of nutritional information. However, women were unable to put this knowledge into practice, primarily due to poverty and poor access to a variety of foods. The Popokabaka community accessed food from farming, fishing, and the market, although purchasing food was frequently unaffordable. Cassava flour was the most common daily food. Food taboos, traditional practices, and late ANC attendance were identified as factors that influenced dietary practices.
Conclusions
Various social, economic, and environmental factors within the local community influenced dietary practices among pregnant women in rural DRC. A comprehensive approach is required to improve nutrition, and address food insecurity, cultural practices and improve the health outcomes of both mother and child.
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Businge CB, Musarurwa HT, Longo-Mbenza B, Kengne AP. The prevalence of insufficient iodine intake in pregnancy in Africa: a systematic review and meta-analysis. Syst Rev 2022; 11:231. [PMID: 36303220 PMCID: PMC9615360 DOI: 10.1186/s13643-022-02072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Fortification of foodstuffs with iodine, mainly through iodization of salt, which commenced in several African countries after 1995 is the main method for mitigating iodine deficiency in Africa. We assessed the degree of iodine nutrition in pregnancy across Africa before and after the implementation of national iodine fortification programs (CRD42018099434). METHODS Electronic databases and gray literature were searched for baseline data before implementation of population-based iodine supplementation and for follow-up data up to September 2020. R-metamedian and metamean packages were used to pool country-specific median urinary iodine concentration (UIC) estimates and derived mean UIC from studies with similar features. RESULTS Of 54 African countries, 23 had data on iodine nutrition in pregnancy mostly from subnational samples. Data before 1995 showed that severe iodine deficiency was prevalent in pregnancy with a pooled pregnancy median UIC of 28.6 μg/L (95% CI 7.6-49.5). By 2005, five studies revealed a trend towards improvement in iodine nutrition state in pregnancy with a pooled pregnancy median UIC of 174.1 μg/L (95% CI 90.4-257.7). Between 2005 and 2020 increased numbers of national and subnational studies revealed that few African countries had sufficient, while most had mildly inadequate, and some severely inadequate iodine nutrition in pregnancy. The pooled pregnancy median UIC was 145 μg/L (95% CI 126-172). CONCLUSION Improvement in iodine nutrition status in pregnancy following the introduction of fortification of foodstuffs with iodine in Africa is sub-optimal, exposing a large proportion of pregnant women to the risk of iodine deficiency and associated disorders. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099434.
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Affiliation(s)
- Charles Bitamazire Businge
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Private Bag x1 WSU, Mthatha, 5117, South Africa.
| | - Hannibal Tafadzwa Musarurwa
- Department of Biological Sciences, Faculty of Health Sciences, Walter Sisulu University, Private Bag x1 WSU, Mthatha, 5117, South Africa
| | | | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.,Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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The association between altitude and serum folate levels in Tibetan adults on the Tibetan plateau. Sci Rep 2022; 12:17886. [PMID: 36284137 PMCID: PMC9596477 DOI: 10.1038/s41598-022-22968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/21/2022] [Indexed: 01/20/2023] Open
Abstract
This study investigated the relationship between residence altitude and serum folate levels in healthy Tibetans living on the Tibetan Plateau. Participants were selected from those who underwent physical examinations at our health center between November 2019 and February 2020. Demographic characteristics and medical histories were collected, and fasting blood was tested for serum folate and other hematological indicators. The relationship between altitude and serum folate levels was analyzed using a multivariable linear regression model. Serum folate levels were associated with altitude (β = - 0.44; 95% confidence interval [CI] - 0.71; - 0.16), hemoglobin (β = - 0.01; 95% CI - 0.03; - 0.00), red blood cells (β = - 0.72; 95% CI - 1.18; - 0.27), hematocrit (β = - 0.07; 95% CI - 0.12; - 0.02), high-density lipoprotein cholesterol (β = 2.67; 95% CI 1.35; 3.98), and sex (β = 0.68; 95% CI 0.12; 1.23). Multivariate linear regression analysis revealed that altitude was negatively associated with serum folate levels. After adjusting for confounding factors, serum folate levels decreased by 0.33 ng/mL per each 500-m increase in altitude (β = - 0.33; 95% CI - 0.6; - 0.05; P = 0.022). Altitude was negatively associated with serum folate levels in Tibetan adults. The relationship between altitude and folate levels should be further explored in populations of different races and disease states. Further large-scale prospective studies should illustrate the causality of this relationship.
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Santos M, Moreira H, Cabral JA, Gabriel R, Teixeira A, Bastos R, Aires A. Contribution of Home Gardens to Sustainable Development: Perspectives from A Supported Opinion Essay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013715. [PMID: 36294295 PMCID: PMC9603381 DOI: 10.3390/ijerph192013715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 05/07/2023]
Abstract
Home gardening has a long history that started when humans became sedentary, being traditionally considered an accessible source of food and medicinal plants to treat common illnesses. With trends towards urbanization and industrialization, particularly in the post-World War II period, the importance of home gardens as important spaces for growing food and medicinal plants reduced and they began to be increasingly seen as decorative and leisure spaces. However, the growing awareness of the negative impacts of agricultural intensification and urbanization for human health, food quality, ecosystem resilience, and biodiversity conservation motivated the emergence of new approaches concerning home gardens. Societies began to question the potential of nearby green infrastructures to human wellbeing, food provisioning, and the conservation of traditional varieties, as well as providers of important services, such as ecological corridors for wild species and carbon sinks. In this context. and to foster adaptive and resilient social-ecological systems, our supported viewpoint intends to be more than an exhaustive set of perceptions, but a reflection of ideas about the important contribution of home gardens to sustainable development. We envision these humble spaces strengthening social and ecological components, by providing a set of diversified and intermingled goods and services for an increasingly urban population.
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Affiliation(s)
- Mário Santos
- Laboratory of Fluvial and Terrestrial Ecology, Innovation and Development Center, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
- Laboratory of Ecology and Conservation, Federal Institute of Education, Science and Technology of Maranhão, Rua do Comercio, 100, Buriticupu 65393-000, MA, Brazil
- CITAB—Centre for the Research and Technology of Agro-Environment and Biological Sciences, Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro) and Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Correspondence: ; Tel.: +351-259350000
| | - Helena Moreira
- CITAB—Centre for the Research and Technology of Agro-Environment and Biological Sciences, Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro) and Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
- CIDESD—Research Center in Sports Sciences, Health Sciences and Human Development, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - João Alexandre Cabral
- Laboratory of Fluvial and Terrestrial Ecology, Innovation and Development Center, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environment and Biological Sciences, Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro) and Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Ronaldo Gabriel
- CITAB—Centre for the Research and Technology of Agro-Environment and Biological Sciences, Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro) and Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
| | - Andreia Teixeira
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
| | - Rita Bastos
- Laboratory of Fluvial and Terrestrial Ecology, Innovation and Development Center, University of Trás-os-Montes e Alto Douro, 5000-911 Vila Real, Portugal
- CIBIO/InBIO/BioPolis, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, 4485-661 Vairão, Portugal
| | - Alfredo Aires
- CITAB—Centre for the Research and Technology of Agro-Environment and Biological Sciences, Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro) and Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Department of Agronomy, School of Agrarian and Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal
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Njiru H, Njogu E, Gitahi MW, Kabiru E. Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial. BMJ Open 2022; 12:e063615. [PMID: 36691203 PMCID: PMC9462084 DOI: 10.1136/bmjopen-2022-063615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Iron deficiency is the most prevalent micronutrient deficiency in pregnancy globally responsible for nearly 120 000 maternal deaths per year and a fifth of maternal mortality. Over 46% of pregnant women in Africa and 62% of pregnant women in Kenya are anaemic. Anaemia has severe economic and health consequences. Daily iron and folic acid supplementation (IFAS) is an efficacious strategy recommended in pregnancy to reduce the risk of anaemia and improve maternal and neonatal survival. However, most pregnant women do not consume IFAS as recommended. Limited knowledge on IFAS, its benefits and its connection with anaemia, and mitigation of its side effects lead to poor consumption. The main objective of this trial is to determine the effectiveness of public health education on uptake of antenatal IFAS. METHODS AND ANALYSIS A stepped wedge cluster randomised trial with antenatal clinics as units of randomisation. Twelve clusters will be randomised to receive the intervention and levels of IFAS uptake compared with preintervention period. The 9-month trial will enrol 1205 pregnant women. The primary outcome will be the proportion of pregnant women effectively taking up IFAS measured through self-reports, residual pill count and inspection of pill reminder cards. Routine clinical data on haemoglobin counts and fetal growth monitoring will also be used. Descriptive and bivariate analysis will be conducted in Stata using Pearson's χ2 test for association, and multivariate logistic regression to identify determinants of uptake. The potential public health benefits will be estimated using the number needed to treat and the preventable fraction. ETHICS AND DISSEMINATION Ethical approval was granted by Kenyatta University Ethics Review Committee (PKU/2443/11575). The research permit is obtained from Kenya National Commission for Science, Technology and Innovation (NACOSTI/P/22/16168). Findings will be disseminated through peer-reviewed publications and public health conferences. TRIAL REGISTRATION NUMBER PACTR202202775997127.
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Affiliation(s)
- Haron Njiru
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
| | - Eunice Njogu
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Mary W Gitahi
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
| | - Ephantus Kabiru
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
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Tefera AA, Seifu D, Menon M, Talargia F, Belete AM. Red blood cell folate level and associated factors of folate insufficiency among pregnant women attending antenatal care during their first trimester of pregnancy in Addis Ababa, Ethiopia. SAGE Open Med 2022; 10:20503121221118987. [PMID: 36051782 PMCID: PMC9424885 DOI: 10.1177/20503121221118987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Folate is an essential vitamin for de novo DNA synthesis and cell
proliferation. Folate insufficiency at the time of conception and during the
first trimester of pregnancy is associated with unintended pregnancy and
birth outcomes, particularly neural tube defects. Hence, this study aimed to
assess folate status and associated factors of folate insufficiency among
pregnant women attending antenatal care during their first trimester of
pregnancy in Addis Ababa, Ethiopia. Materials and methods: A cross-sectional study was conducted from 8 August 2017 to 3 January 2018 in
Addis Ababa. In this study, 160 participants were enrolled via the
convenience sampling method. Red blood cell folate was measured by the
electrochemiluminescence binding assay method. Data were entered into
Epi-Data version 3.1 and analyzed by SPSS version 22.0. Descriptive
statistics were used to describe demographic characteristics and to
determine the magnitude of folate deficiency. Logistic regression was used
to identify the risk factors for folate deficiency. A
p-value of less than 0.05 was considered statistically
significant. Results: In this study, 44/160 (27%) participants had red blood cell folate level
<400 ng/mL, insufficient to prevent neural tube defect. Multivariate
regression showed that regular vegetable consumption was an independent
determinant factor for red blood cell folate level (adjusted odds ratio:
0.41, confidence interval: 0.18–0.93). Conclusion: This study shows that a large magnitude of the first-trimester pregnant women
had red blood cell folate concentrations below levels that are maximally
protective against neural tube defects. Folic acid supplementation and
supplemental nutrition containing green leafy vegetables should be promoted
during the periconceptional period. In addition, the policymakers should set
rules for mandatory folic acid fortification.
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Affiliation(s)
- Alemu Adela Tefera
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Daniel Seifu
- Division of Biomedical Sciences, Department of Biochemistry, University of Global Health Equity, Kigali, Rwanda
| | - Menakath Menon
- Department of Biochemistry, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feredegn Talargia
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abebe Muche Belete
- Department of Biomedical Science, Debre Berhan University, Debre Berhan, Ethiopia
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Ranjith A, Puri S, Vohra K, Khanam A, Bairwa M, Kaur R, Yadav K. Ideal Dose of Iron in Multiple Micronutrient Supplement: A Narrative Review of Evidence. Cureus 2022; 14:e28688. [PMID: 36199654 PMCID: PMC9526876 DOI: 10.7759/cureus.28688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/08/2022] Open
Abstract
Anemia is a significant public health problem in low- and middle-income countries (LMICs). The co-existence of other micronutrient deficiencies and iron deficiency among pregnant women may be the reason for the inability to control anemia through iron and folic acid (IFA) supplementation. Multiple micronutrient supplementation (MMS) in pregnancy may help to overcome this problem. However, the recent World Health Organization (WHO) guidelines on MMS supplementation in pregnancy raised concerns regarding the adequacy of a 30mg iron dose in the MMS supplements in LMICs. The review summarized the literature to answer this question. Though most studies showed a comparable effect of MMS with 30mg iron and IFA with 60mg iron on maternal anemia outcomes, anemia persisted in the third trimester in both groups. There is a need to consider the use of a higher iron dose in MMS, especially in LMICs, to combat the problem of anemia, alongside correcting other micronutrient deficiencies.
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Saha S, Puwar T, Shah K, Pandya A, Wanjari MB, Saxena D. Non-iron Deficiency Anemia in Rural Indian Women: A Cross-Sectional Study. Cureus 2022; 14:e28565. [PMID: 36185907 PMCID: PMC9520231 DOI: 10.7759/cureus.28565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Anemia is an important public health concern, affecting almost 25% of the global population. In India, these statistics are even more worrisome with more than half of the children, non-pregnant and pregnant women being affected by the disease. Though the major cause of anemia is iron deficiency, other causes cannot be neglected considering the magnitude of the problem. The present study was designed to estimate the prevalence of non-iron deficiency anemia (NIDA) in Devbhoomi Dwarka District of Gujarat. Methods For this cross-sectional study, total of 258 mothers (antenatal and postnatal) were enrolled from 27 primary health centers. Apart from demographic details and obstetric history, hemoglobin and ferritin levels were measured from the participant’s blood after obtaining consent. Clinical information such as the history of recent illness and fever were also noted through questionnaires. Prevalence was anemia was calculated using a standard threshold of blood hemoglobin and NIDM was defined using ferritin levels. Results As per hemoglobin levels, anemia was present in 65.9% of the mothers, which was relatively higher in antenatal women (90%) as compared to postnatal women (57%). Ferritin levels showed that out of this total anemic mothers, 61.8% (105/258) have normal ferritin levels indicating the presence of non-iron deficiency. Trimester-wise analysis of anemia in AN showed that NIDM prevalence increases with increasing trimester in contrast to IDA where a considerable reduction was found with iron supplementation. Conclusion The study indicated that two out of every three women were anemic and only one out of four were anemic with depleted iron storage. These findings have important policy implications as in India the anemia control programs address only iron deficiency anemia and not NIDA. The development of a framework for diagnosis and appropriate treatment can be recommended for integration into national guidelines.
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Girma A, Genetu A, Ayalew E, Getachew D. Determinants of dietary practice among pregnant women at the public hospitals in Bench-Sheko and Kaffa Zones, Southwest Ethiopia. BMC Nutr 2022; 8:88. [PMID: 36002906 PMCID: PMC9400258 DOI: 10.1186/s40795-022-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The frequency of poor dietary practice due to inappropriate dietary habits is higher during pregnancy compared to any other stage of the life cycle. Suboptimal dietary practices during pregnancy can increase the risk of intrauterine growth restriction, low birth weight, anemia, prenatal and infant mortality, and morbidity. Therefore, this study aimed to determine the dietary practice and associated factors among pregnant women at the public hospitals of Bench-Sheko and Kaffa zone. METHODOLOGY An institutional-based cross-sectional study design was conducted among 566 pregnant women who attended antenatal care at the public hospitals of the Bench-Sheko and Kaffa zones. A systematic random sampling technique was employed to select the study units. The data were entered into Epi Data 3.1 and exported to Statistical Package for Social Science (SPSS) version 21 software for further analysis. Both Binary and Multivariable logistic regression analyses were used to examine the association between dependent and independent variables. The Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) with 95% Confidence interval (CI) were calculated and the variable with P-value < 0.05 was considered statistically significant. RESULT According to this study, only 23.7% (95% CI: 20.1, 27.4) of the study participants had a good dietary practice. The urban residents (AOR = 2.64; 95% CI:1.18, 5.92), monthly income of > 2000ETB (AOR = 2.47; 95% CI: 1.31,4.65), having nutrition information (AOR = 2.5; 95% CI: 1.14,5.52), good dietary knowledge (AOR = 2.79; 95% CI: 1.48,5.27), mothers occupation of employer (AOR = 1.88; 95% CI: 1.04,3.42) and a family size < 5 (AOR = 3.37; 95% CI: 1.32,8.65) were determinate of dietary practice. CONCLUSION Generally, the prevalence of good dietary practice is suboptimal in the study area. Urban residency, monthly income > 2000ETB, good dietary knowledge, having nutrition information, family size < 5, and government employed mothers were the predictors of the good dietary practice in the Bench-Sheko and Kaffa zone. Therefore, providing in-service training for health professionals and assigning nutritionist to each public hospital should be done to provide health and nutrition education; and strengthen the existed nutrition counseling service for pregnant women. Moreover, the government should create sustainable income-generating activities for pregnant women.
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Affiliation(s)
- Abel Girma
- School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia.
| | - Amare Genetu
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Ermias Ayalew
- Departements of Nursing, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dawit Getachew
- School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Demsash AW, Chereka AA, Kassie SY, Donacho DO, Ngusie HS, Tegegne MD, Melaku MS, Wubante SM, Hunde MK. Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey. BMC Nutr 2022; 8:77. [PMID: 35953835 PMCID: PMC9367059 DOI: 10.1186/s40795-022-00573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Inadequate micronutrients in the diet and vitamin A deficiency are worldwide public health problems. In developing regions, many preschool children are undernourished, become blind every year and died before the age of 23 months. This study was aimed to explore the spatial distribution of vitamin A rich foods intake among children aged 6–23 months and identify associated factors in Ethiopia. Methods Ethiopian Mini Demographic and Health Survey 2019 dataset with a total 1407 children aged 6–23 months was used. Data management and processing were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for mapping and spatial visualization of the distribution. Spatial scan statistics was performed using SaTScan version 9.5 software for Bernoulli-based model. Multilevel mixed effect logistic regression model was employed to identify associated factors. Results Overall, 38.99% (95% CI: 36.46–41.62) of children aged 6– 23 months took vitamin A rich foods. Poor intake of vitamin A rich foods was significantly clustered Dire Dawa city, Somali and Harari regions of Ethiopia. Children aged 6–23 months lived in the primary cluster were 70% (RR = 1.70, P-value < 0.001) more likely to intake vitamin A rich foods than children lived outside the window. In the multilevel mixed effect logistic regression analysis, Primary educational status (AOR:1.42, 95% CI: 1.05, 1.93) and higher educational status (AOR:3.0, 95% CI: 1.59, 5.65) of mother, Dire Dawa (AOR:0.49, 95% CI: 0.22, 1.12) city, Afar (AOR: 0.16, 95% CI: 0.07, 0.36), Amhara (AOR: 0.37, 95% CI: 0.19, 0.71) and Somali (AOR: 0.02, 95% CI: 0.003, 0.08) regions of Ethiopia, children aged 13–23 months (AOR: 1.80, 95% CI: 1.28, 2.36), Mothers’ exposure to media (AOR: 1.41, 95% CI: 1.04, 1.92) were statistically significant factors for vitamin A rich foods intake among children aged 6–23 months. Conclusions Only 4 out of ten children took vitamin A rich foods which is too low compared to the national target and significantly clustered in Ethiopia. Mother’s educational status, Region, Child age and Mother’s media exposure are significant factors vitamin A rich foods intake. Stakeholders should strengthen mothers’ education status, creating awareness for mothers on child feeding and using locally available natural resource to produce vitamin A rich foods.
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Affiliation(s)
| | - Alex Ayenew Chereka
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Dereje Oljira Donacho
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Habtamu Setegn Ngusie
- Health Informatics Department, College of Health Science, Mattu University, Mettu, Ethiopia
| | - Masresha Derese Tegegne
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sisay Maru Wubante
- Health Informatics Department, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Kenate Hunde
- Lifelong Learning and Community Development Department, College of Education and Behavioral Scieence , Mattu University, Mettu, Ethiopia
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Eleraky L, Issa R, Maciel S, Mbwana H, Rybak C, Frank J, Stuetz W. Anthropometrics, Hemoglobin Status and Dietary Micronutrient Intake among Tanzanian and Mozambican Pigeon Pea Farmers. Nutrients 2022; 14:nu14142914. [PMID: 35889871 PMCID: PMC9318270 DOI: 10.3390/nu14142914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.
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Affiliation(s)
- Laila Eleraky
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
| | - Ramula Issa
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
- Faculty of Health Sciences, Lúrio University, Nampula 3100, Mozambique;
| | - Sónia Maciel
- Faculty of Health Sciences, Lúrio University, Nampula 3100, Mozambique;
| | - Hadijah Mbwana
- Department of Human Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro 3006, Tanzania;
| | - Constance Rybak
- Leibniz Centre for Agricultural Landscape Research (ZALF), 15374 Müncheberg, Germany;
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
| | - Wolfgang Stuetz
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
- Correspondence: ; Tel.: +49-711-459-24265; Fax: +49-711-459-23386
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Abstract
OBJECTIVE To clarify nutrient supplementation usage and primary source of information among pregnant women in China. DESIGN This cross-sectional study used information on nutrient supplementation and primary source of information collected via face-to-face interviews. Data on the usage of folic acid, Ca/vitamin D, Fe, vitamins, DHA and other dietary supplements were collected. Primary source of information was categorised as family/relatives, friends/co-workers, the Internet, books/magazines, television/radio, doctors, other people and oneself. SETTING Maternal and Child Health Hospital in Chengdu, China. PARTICIPANTS One thousand eighty-one Chinese pregnant women aged ≥20 years with singleton pregnancies. RESULTS In all three trimesters of pregnancy, usage was highest and most stable for folic acid (81·7 %), followed by vitamins (vitamin A, B-group vitamins, vitamin C and multivitamins; 75·0 %), whereas Ca/vitamin D (51·4 %) and Fe (18·1 %) usage was low, potentially indicating a deficiency risk. All supplementation usage percentages increased with pregnancy duration (P < 0·05). Notably, approximately 10 % of the pregnant women in our study did not use any nutrient supplementation, and this was especially common in early pregnancy. More than 50 % of the women reported getting information on nutrient supplementation from family members, and about 30 % reported getting this information from doctors. CONCLUSIONS Among pregnant women in China, awareness about nutrient supplementation increases as the pregnancy progresses, but some types of nutrient supplementation (such as Ca/vitamin D and Fe) remain at low levels. It is necessary to pay more attention to the health education of pregnant women in China, and the influence of family members should be emphasised.
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Amos A, Razzaque MS. Zinc and its role in vitamin D function. Curr Res Physiol 2022; 5:203-207. [PMID: 35570853 PMCID: PMC9095729 DOI: 10.1016/j.crphys.2022.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Zinc is an essential mineral with an important relationship with vitamin D. Studies have found that reduced blood zinc levels could predict vitamin D deficiency in adolescent girls, while zinc supplementation increased vitamin D levels in postmenopausal women. In vitro studies using human peritoneal macrophages have found that zinc induced the release of calcitriol (1,25-dihydroxycholecalciferol). Zinc also acts as a cofactor for vitamin D functions, as the transcriptional activity of vitamin D-dependent genes relies on zinc to exert pleiotropic functions, including mineral ion regulation. Vitamin D could also induce zinc transporters to regulate zinc homeostasis. Together, zinc and vitamin D in adequate concentrations help maintain a healthy musculoskeletal system and beyond; however, deficiency in either of these nutrients can result in various disorders affecting almost all body systems. This brief article will focus on the role of zinc in vitamin D functions.
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Saville NM, Kharel C, Morrison J, Harris-Fry H, James P, Copas A, Giri S, Arjyal A, Beard BJ, Haghparast-Bidgoli H, Skordis J, Richter A, Baral S, Hillman S. Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women's groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal. Trials 2022; 23:183. [PMID: 35232469 PMCID: PMC8886560 DOI: 10.1186/s13063-022-06043-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes. METHODS This non-blinded cluster-randomised controlled trial in the plains of Nepal has two study arms: (1) Control: routine antenatal care (ANC); (2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants, including women in 54 non-contiguous clusters (mean 2582; range 1299-4865 population) in Southern Kapilbastu district, are eligible if they consent to menstrual monitoring, are resident, married, aged 13-49 years and able to respond to questions. After 1-2 missed menses and a positive pregnancy test, consenting women < 20 weeks' gestation, who plan to reside locally for most of the pregnancy, enrol into trial follow-up. Interventions comprise two home-counselling visits (at 12-21 and 22-26 weeks' gestation) with iron folic acid (IFA) supplement dosage tailored to women's haemoglobin concentration, plus monthly PLA women's group meetings using a dialogical problem-solving approach to engage pregnant women and their families. Home visits and PLA meetings will be facilitated by auxiliary nurse midwives. The hypothesis is as follows: Haemoglobin of women at 30 ± 2 weeks' gestation is ≥ 0.4 g/dL higher in the intervention arm than in the control. A sample of 842 women (421 per arm, average 15.6 per cluster) will provide 88% power, assuming SD 1.2, ICC 0.09 and CV of cluster size 0.27. Outcomes are captured at 30 ± 2 weeks gestation. Primary outcome is haemoglobin concentration (g/dL). Secondary outcomes are as follows: anaemia prevalence (%), mid-upper arm circumference (cm), mean probability of micronutrient adequacy (MPA) and number of ANC visits at a health facility. Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/day) and dietary iron (mg/day), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator. Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation, we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression. DISCUSSION Findings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy. TRIAL REGISTRATION ISRCTN 12272130 .
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Affiliation(s)
- Naomi M Saville
- Institute for Global Health, University College London (UCL), London, UK.
| | | | - Joanna Morrison
- Institute for Global Health, University College London (UCL), London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Philip James
- Department of Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Andrew Copas
- Institute for Global Health, University College London (UCL), London, UK
| | - Santosh Giri
- HERD International, Thapathali, Kathmandu, Nepal
| | | | | | | | - Jolene Skordis
- Institute for Global Health, University College London (UCL), London, UK
| | - Adam Richter
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sushil Baral
- HERD International, Thapathali, Kathmandu, Nepal.,Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - Sara Hillman
- Institute for Women's Health, University College London (UCL), London, UK
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Global, Regional, and National Estimates of Nutritional Deficiency Burden among Reproductive Women from 2010 to 2019. Nutrients 2022; 14:nu14040832. [PMID: 35215481 PMCID: PMC8877546 DOI: 10.3390/nu14040832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/30/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
Women of reproductive age (15–49 years) are often considered a vulnerable population affected by nutritional deficiencies, impairing their health and that of their offspring. We briefly introduced (a) the incidence and disability-adjusted life years (DALYs) trends from 2010 to 2019 and (b) the correlation between sex differences and income levels and nutritional deficiencies of reproductive women firstly. Notably, the burden of overall nutritional deficiencies among reproductive women remained generally stable from 2010 to 2019, whereas the iodine and vitamin A deficiencies as a subcategory were associated with increased incidence rates and DALYs, respectively. A significant increasing trend occurred in South Asia, Southeast Asia, and Turkey for incidence, and Western Sub-Saharan Africa and Zimbabwe had a strong increase for DALYs. Further analysis of the correlation between nutritional deficiency incidence and economic capacity showed that they were not correlated with the income of women themselves, as was the result of income difference with men. The results of this study will help to identify gaps in nutritional deficiency burden among reproductive women and facilitate the development of regional or national responses. Compared with economic capital, macroscopic political guarantees and social and cultural capital are important measures to remedy the nutritional deficiencies of reproductive women.
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Ashraf S, Ashraf S, Ashraf M, Farooq I, Akmal R, Imran MA, Kalsoom L, Ashraf S, Rafique S, Ghufran M, Akram MK, Sohaib-Ur-Rehman, Nadeem MF, Matti N, Siddiqui UN, Humayun A, Saboor QA, Ahmad A, Ashraf M, Izhar M. Clinical efficacy of iodine complex in SARS-CoV-2-infected patients with mild to moderate symptoms: study protocol for a randomized controlled trial. Trials 2022; 23:58. [PMID: 35045888 PMCID: PMC8767036 DOI: 10.1186/s13063-021-05848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus-infected millions globally. Despite a wide range of advised options for the treatment of COVID-19, a single strategy to tackle this pandemic remains elusive, thus far. That is why we are conducting a clinical trial to find out the efficacy of iodine complex to clear a viral load of severe respiratory syndrome coronavirus-2 (SARS-CoV-2) along with a reduction in time taken to alleviate symptoms. Method The proposed study is a placebo-controlled, add-on, randomized trial using parallel group designs. This is a closed-label and adaptive with sample size reassessment, multi-centered design with a 1:1:1:1 allocation ratio and superiority framework. It will be conducted in Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic, and Doctors Lounge, Lahore, Pakistan. This study will have three arms of mild to moderately symptomatic COVID-19 patients (50 patients in each) which will receive ionic-iodine polymer complex with 200 mg of elemental iodine: interventional arm A will have encapsulated, arm B will receive suspension syrup form, arm C will get throat spray, while arm X will be standard care with placebo. Data will be collected on self-constructed, close-ended questionnaires after obtaining written consent. Data will be analyzed using SAS version 9.4. COVID-19 patients will be monitored by RT-PCR and HRCT (high-resolution computed tomography) chest. In addition to these, the duration of the symptomatic phase and mortality benefits will be analyzed in both groups. Discussion The study is designed to measure the superior efficacy of the iodine complex as an add-on in treating COVID-19-positive patients with mild to moderate symptoms. This combination is hypothesized to improve various parameters like rapid viral load reduction, clinical and radiological improvement, lower mortality, and reduction in hospitalization. The trial will aid in devising a better strategy to cope with COVID-19 in a relatively inexpensive and accessible way. The implications are global, and this could prove itself to be the most manageable intervention against COVID-19 especially for patients from limited-resource countries with deprived socioeconomic status. Trial registration ClinicalTrials.govNCT04473261. Registered on July 16, 2020.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Shoaib Ashraf
- Department of Pathophysiology, Riphah International, Lahore, Pakistan.
| | - Moneeb Ashraf
- Department of Pharmacology, Mayo Hospital, Kingedward Medical University, Lahore, Pakistan.
| | - Iqra Farooq
- Department of Paediatric Surgery, Children Hospital, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Sahara Medical College, Narowal, Pakistan
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Larab Kalsoom
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Biochemistry, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sundas Rafique
- Department of Oncology, Mayo Hospital, Kingedward Medical University, Lahore, Pakistan
| | - Muhammad Ghufran
- ESACHS (Empresa de Servicio Externo de la Asociación Chilena de Seguridad), Santiago, Chile
| | - Muhammad Kiwan Akram
- Department of Animal Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sohaib-Ur-Rehman
- Department of Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Muhammad Faisal Nadeem
- The University of Strasbourg, Alsace, France.,University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Nazish Matti
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Uzma Nasim Siddiqui
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ali Ahmad
- Department of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire (CHU) Sainte Justin/University of Montreal, Montreal, Canada.
| | - Muhammad Ashraf
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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Nigussie E, Ferede A, Markos M. Diversified dietary intake and associated factors among pregnant mothers attending antenatal care follow-up in public health facilities of Dire Dawa, Eastern Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000002. [PMID: 36962246 PMCID: PMC10022029 DOI: 10.1371/journal.pgph.0000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Poor diversity dietary intake has great significance to women, pregnancy outcome and on her fetus or the growing and development of their baby collectively. Uncertainty of studies to examine whether pregnant women have been utilizing diversity dietary in their frequent intake and this has changed nutritional status. Therefore, this study aims to assess diversified dietary intake and associated factors among pregnant mothers attending antenatal care follow-up in public health facilities of Dire Dawa, Eastern Ethiopia. A facility-based cross-sectional study was conducted among 453 pregnant mothers randomly selected from the antenatal care unit at public health facilities from November 1-30/2020. Study subjects were selected with a systematic random sampling method from randomly selected antenatal care unity of health facilities in Dire Dawa Administration. A structured questionnaire and anthropometric measurements were used to collect data. Data were entered with kobo software and exported to Statistical Package for Social Science statistical software version 20 for analysis. Binary and multiple logistic regression models were used to declare the significance of independent variables at P<0.05. This study shows 55% (95% CI = (50-59.5) were inadequate diversified dietary intake. Having lower monthly income (Adjusted Odds Raito [AOR] = 4.4, Confident interval [95%CI] = 1.3-14.6), elementary educational status of mothers (AOR = 3.8, 95%CI = 1.5-9.9), consumption of two meals per day (AOR = 16.6, 95% CI = 2.04-135.8), didn't get antenatal care counseling (AOR = 2.2, 95% CI = 1.1-2.8) were significantly associated with diversified dietary. The result revealed that around 55% of respondents had inadequate dietary diversity. low household income, had less maternal education level and, consuming two meals per day, and no information about dietary diversity has contributed to inadequate dietary diversity. Accordingly, go forward in the right side of those variables were the core recommendation of this study.
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Affiliation(s)
- Efrata Nigussie
- Public Health Expert at Ohio State Global One Health initiative, Dire Dawa City Administration, Dire Dawa, Ethiopia
| | - Abebe Ferede
- Department of Public Health, School of Health Science, Arsi University, Asella, Ethiopia
| | - Melese Markos
- Department of Public Health, College of Health and Medical Science, Wachemo University Durame Campus, Durame, Ethiopia
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Potential Role of African Fermented Indigenous Vegetables in Maternal and Child Nutrition in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF FOOD SCIENCE 2021; 2021:3400329. [PMID: 34957295 PMCID: PMC8695012 DOI: 10.1155/2021/3400329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
Hunger and malnutrition continue to affect Africa especially the vulnerable children and women in reproductive age. However, Africa has indigenous foods and associated traditional technologies that can contribute to alleviation of hunger, malnutrition, and communicable and noncommunicable diseases. The importance of African indigenous vegetables is undeniable, only that they are season-linked and considered as "food for poor" despite their high nutritional contents. The utilization of African indigenous vegetables (AIVs) is hindered by postharvest losses and antinutrients affecting the bioavailability of nutrients. In Africa, fermentation is among the oldest food processing technologies with long history of safe use. Apart from extending shelf life and improving food organoleptic properties, fermentation of African indigenous vegetables (AIVs) is known to improve food nutritional values such as proteins, minerals, vitamins, and other beneficial phytochemicals. It can also increase bioavailability of various vitamins, minerals, and phytochemicals and increase synthesis of vital blood pressure regulators thus protecting against cardiovascular diseases and cancer and further helping fight certain malnutrition deficiencies. Some lactic acid bacteria (LAB) involved in food fermentation are known to produce exopolysaccharides with cholesterol-lowering, immunomodulator, antioxidant, and anticancer properties. Fermented foods (vegetables) are superior in quality and safety since most microorganisms involved in fermentation are good starter cultures that can inhibit the growth of foodborne pathogens and detoxify harmful compounds in foods. Thus, fermented foods can boost growth and well-being in children and women due to their higher nutritional contents. Therefore, fermentation of AIVs can contribute to the attainment of food and nutrition security especially among women and children who rely on these vegetables as a staple source of micronutrients and income. These benefits have a positive impact on the implementation of the second sustainable development goals and African Union agenda 2063. This review is aimed at shedding light on the potential of African fermented indigenous vegetables in combating maternal and child malnutrition in Sub-Sahara Africa.
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Girma Tilahun A, Molla Kebede A, Ejigu AG. Dietary Practice and Associated Factors Among Pregnant Women at Public Health Institution in Mizan-Aman Town, Southwest Ethiopia. Nutr Metab Insights 2021; 14:11786388211057796. [PMID: 34819735 PMCID: PMC8606983 DOI: 10.1177/11786388211057796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background: A poor dietary intake of key macronutrients and micronutrients adversely affects pregnancy outcomes and neonatal health. The occurrence of dietary inadequacy during pregnancy is higher compared to any other stage of the life cycle. Therefore, this study aimed to assess dietary practice and associated factors among pregnant women. Methods: A facility-based cross-sectional study design was conducted among 378 pregnant women from March to May 2021 at the public health institution of Mizan-Aman town, southwest Ethiopia. A systematic random sampling technique was used to reach the study participants. The short food-frequency questionnaires and nutrition-behaviors checklist measurement were used to assess the dietary practice. Nine questions were applied to assess the dietary attitudes of the respondents. After the summation of the score, the respondent was categorized as favorable attitude if their score was > the median and unfavorable attitude if their score was ⩽ to the median of the score. The data were entered into Epi Data 3.1 and exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Variables of P-value <.25 during bivariate logistic regression analysis were considered for multivariate analysis. Finally variables with an adjusted odds ratio of P-value <.05 along with a 95% Confidence interval (CI) were declared statistically significant. Results: The overall magnitude of good dietary practice among pregnant women was 25.1% (95% CI: 20.9, 29.71%). In multivariate logistic regression analysis, the variables having television/radio (AOR = 4.2, 95% CI: 1.8, 10.2), household food security (AOR = 3.1, 95% CI: 1.0, 9.9), good dietary knowledge(AOR = 4.1, 95% CI: 1.98, 8.6), favorable dietary attitude (AOR = 4.34, 95% CI: 1.2, 8.7), monthly income of 1000 to 2000 Ethiopian birr (AOR = 3.7, 95% CI: 1.3,11.2) and >2000 Ethiopian birr (AOR = 7.0;95% CI: 3.3,15.4) were significantly associated with good dietary practice. Conclusion: The dietary practice among pregnant women was very low. The factors like having television/radio, good dietary knowledge, household food security, favorable dietary attitude, and monthly income of 1000 to 200 and greater than 2000 Ethiopian birr were significantly associated with the good dietary practice of pregnant women.
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Affiliation(s)
- Abel Girma Tilahun
- Schooll of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Abebaw Molla Kebede
- Schooll of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Amare Genetu Ejigu
- Department of Midwifery, College of Medicine and Health science, Mizan Tepi University, Mizan-Aman, Ethiopia
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Consumption of dietary folate estimates and its implication for reproductive outcome among women of reproductive age in Kersa: cross-sectional survey. BMC Nutr 2021; 7:69. [PMID: 34776012 PMCID: PMC8591879 DOI: 10.1186/s40795-021-00476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dietary folate inadequacy is one the most common micronutrient deficiencies that cause neural tube defect (NTD) among infants in Sub-Saharan African countries. This study aims to determine the dietary intake of folate among women of reproductive age (WRA) of Kersa, Eastern Ethiopia. Methods A cross-sectional study took place among voluntary women that were selected from 1140 random households. Using a validated Food Frequency Questionnaire, participant’s weekly dietary intake history of Ethiopian foods and dietary folate intake was worked out. Statistical analysis was done at a 95% confidence interval. Modified Poisson regression was used to identify factors associated with dietary folate consumption. Result The estimated median usual intake of folate was 170 μg/d (IQR: 118.3; 252.2) and about 33% of WRA had low folate intake and 73.9% were at risk for folate inadequacy. From the reported food groups, Beans and Peas, Starchy staples, and Vitamin-A rich dark-green leafy vegetables were the top three ranked foods that contributed much of the dietary folate. The following conditions were statistically related to dietary folate inadequacy; women’s age, being in poor wealth index, low dietary diversity, having seasonal employment, and reliance on market food sources. Conclusions We found that women’s dietary intake of folate in Kersa is very low and cannot protect their offspring from the risk of having NTD. They could also potentially be predisposed to poor health outcomes. Diversifying and fortification of Ethiopian wheats and salts could decrease the burden of folate deficiency in the country.
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Gebremedhin T, Aschalew AY, Tsehay CT, Dellie E, Atnafu A. Micronutrient intake status and associated factors among children aged 6-23 months in the emerging regions of Ethiopia: A multilevel analysis of the 2016 Ethiopia demographic and health survey. PLoS One 2021; 16:e0258954. [PMID: 34679088 PMCID: PMC8535338 DOI: 10.1371/journal.pone.0258954] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6-23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6-23 months in the emerging regions of Ethiopia. METHODS Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6-23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors. RESULTS In this analysis, 37.3% (95% CI: 34.3-40.3) of children aged 6-23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4-2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3-3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2-2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3-4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0-3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1-0.9) was the community-level factors that decrease micronutrient intake. CONCLUSIONS Micronutrient intake among children aged 6-23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6-23 months.
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Affiliation(s)
- Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mattar G, Haddarah A, Haddad J, Pujola M, Sepulcre F. New approaches, bioavailability and the use of chelates as a promising method for food fortification. Food Chem 2021; 373:131394. [PMID: 34710689 DOI: 10.1016/j.foodchem.2021.131394] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/24/2023]
Abstract
Food fortification has been used for many years to combat micronutrient deficiencies; the main challenge with food fortification is the combination of a bioavailable, affordable fortificant with the best (food) vehicle as a carrier to reach at-risk populations. This paper considers mineral deficiencies, especially iron, food fortification, target populations, and the use of chelates in food fortification, as well as different types of mineral-chelate complexes, advantages and limitations of previous trials, methods used for analysis of these complexes, bioavailability of minerals, factors influencing it, and methods particularly those in vitro for predicting outcomes. Three innovative methods (encapsulation, nanoparticulation, and chelation) were explored, which aim to overcome problems associated with conventional fortification, especially those affecting organoleptic properties and bioavailability; but often lead to the emergence of new limitations (for example instability, impracticality and high costs) requiring further research.
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Affiliation(s)
- Ghadeer Mattar
- Departament d'Enginyeria Agroalimentària i Biotecnologia, Universitat Politècnica de Catalunya, Campus del Baix Llobregat, Carrer Esteve Terradas 8, 08860, Castelldefels, Barcelona, Spain; octoral School of Sciences and Technology, Lebanese University, Rafic Hariri Campus, Hadath, Lebanon
| | - Amira Haddarah
- octoral School of Sciences and Technology, Lebanese University, Rafic Hariri Campus, Hadath, Lebanon
| | - Joseph Haddad
- octoral School of Sciences and Technology, Lebanese University, Rafic Hariri Campus, Hadath, Lebanon
| | - Montserrat Pujola
- Departament d'Enginyeria Agroalimentària i Biotecnologia, Universitat Politècnica de Catalunya, Campus del Baix Llobregat, Carrer Esteve Terradas 8, 08860, Castelldefels, Barcelona, Spain
| | - Franscesc Sepulcre
- Departament d'Enginyeria Agroalimentària i Biotecnologia, Universitat Politècnica de Catalunya, Campus del Baix Llobregat, Carrer Esteve Terradas 8, 08860, Castelldefels, Barcelona, Spain.
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