Making a Case for Calcium Supplementation for Prevention of Pregnancy Hypertension in Ethiopia.

Objectives: Calcium supplementation significantly reduces the risk of pre-eclampsia, a major cause of maternal death and pre-term birth. The World Health Organization recommends preventive elemental calcium supplementation for all pregnant women living in areas with low calcium intake. Currently, no intake data is available in Ethiopia to inform the policy decision to include calcium supplementation in the existing antenatal care program. We used data from the 2011 Ethiopian National Food Consumption Survey (ENFCS) to identify regions with low dietary calcium intake and to determine factors associated with calcium intake. Methods: Nationally and regionally representative ENFCS data from 7549 women of 15-45 y, weighted for relative population sizes,) were analyzed. ANOVA was used to determine which regions were consuming low calcium levels (defined as <900 mg). Univariate general linear model was used to identify determinants of calcium intake. Results: All regions were found to consume below 900 mg of calcium per day, with women in the Afar region consuming the highest levels (416.87±1.002 mg; p<0.05). Women with a higher educational status, socio-economic status, and those living in rural areas were associated with higher calcium consumption (p<0.05). The mean intake of women below the age of 30 y (276.06 ±1.00 mg) was significantly higher than women between 30-40 y (251.77±1.00 mg) and above 40y (262.42±1.002 mg) (p<0.05). Conclusions: Calcium supplementation is recommended for antenatal care in all regions of Ethiopia. Improving women's education and socioeconomic status may help to increase the calcium intake of women.

The Prevalence of Zinc Deficiency among Vulnerable Populations in Ethiopia.

Objectives: Widespread zinc deficiency is likely to exist in developing countries where staple diets are predominantly plant based and intakes of animal source foods are low. In Ethiopia, there are no data which reflect the current prevalence of zinc deficiency at the national and regional levels. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional prevalence of Zinc deficiency among children 6-59 months old and non-pregnant women 15-49 years of age. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates of zinc deficiency. The prevalence of zinc deficiency will be determined by measuring serum zinc in venous blood samples using Atomic Absorption Spectrophotometry (AAS). Time of day for blood sampling, time of last meal, time of centrifugation, and other appropriate variables will be collected to assist in interpretation of data. The zinc deficiency cut-off defined by WHO is <70 μg/dL for all target groups will be used to analyze the results. Acute phase proteins alpha-1-acid-glycoprotein (AGP) and C-reactive protein (CRP) will be measured by immunoassay technique to account for the effects of inflammation when interpreting zinc deficiency. Results: The national and regional prevalence of zinc deficiency will be presented among children 6-59 months and non-pregnant women 15-49 years of age with and without inflammation in Ethiopia. Conclusions: This survey will provide national and regional data for zinc supplementation and fortification programs in Ethiopia.

The Proportion of Households with Adequately Iodized Salt in Ethiopia.

Objectives: According to the Ethiopia Demographic and Health Survey 2011, the proportion of households using iodized salt (>15 parts per million [PPM]) was 15.4%. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional proportions of households using adequately iodized (>15 ppm) salt in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates. Samples of salt (20 gram) usually consumed will be collected from approximately 4,000households for qualitative testing using the rapid test kit. Salt samples will be sent to the Ethiopian Health and Nutrition Institute Laboratory where iodometric titration will be conducted. Results: The national and regional proportions of households with adequately iodized (>15 ppm) salt will be presented. Conclusions: This survey will provide national and regional data for monitoring and evaluating the progress of the Universal Salt Iodization (USI) program in Ethiopia.

Overview of the Ethiopian National Food Consumption Survey (NFCS): Implications for Fortification Programsv.

Objectives: NFCS was developed in response to a request by the Federal Ministry of Health to obtain evidence to inform the National Fortification Strategy (NFS). This is one of the first nationally and regionally representative surveys to be conducted using individual-level 24-hour dietary recall data. Methods: Approved survey protocols were used to collect information from 324 enumeration areas. The target population was young children (6-35 months), their closest female caregiver (15- 49 years) and (in 30% of urban households) their closest male caregiver (19-45 years of age). Data collection included 24-hour dietary recall, anthropometry and household characteristics. Results: Data were collected from 8267 households, 8079 children, 8133 women, and 380 men. In the NFCS 27% of children and 20% of women nationally, and 62% of children, 52% of women, 41% of men living in urban centers reported consuming potentially fortifiable wheat. The consumption of oil was much higher, with 70% and 50% of children and women nationally, respectively, and 82%, 72% and 66% of children, women and men living in urban centers. Geometric mean intake of wheat and oil (in consumers) was 28.3 g and 3.6 g per day for children; 64.8 g and 8.7 g per day for women; 53.0 g and 9.0 g per day for urban men, respectively. Conclusions: These data are being used to develop the NFS and number of other diet-related strategies and programs. Hence, it provides an extensive resource to inform and guide nutrition policy, strategy, educational messages and program development for many coming years.

Daily Dietary Intake of Zinc is positively Associated With Height-for-Age Z-score (Haz) among Ethiopian Children 6-35 Months of Age.

Objectives: In Ethiopia, 44% of children under five years-of-age are stunted (i.e., height-for-age (HAZ) below -2SD). This is considered a major public health concern by the Ethiopian Ministry of Health’s National Nutrition Plan. Future efforts to reduce stunting depend largely on understanding the local determinants of stunting. Zinc deficiency is a recognized risk factor for stunting in this age group and we hypothesized this was also true in Ethiopia. Our objectives were to determine the association between daily dietary zinc intake (DDZI) and HAZ and to also identify determinants of DDZI among children 6-35 months of age. Methods: We used regionally representative data from the 2011 Ethiopian National Food Consumption Survey, weighted for relative population sizes (N=6752 children). Univariate general linear models served to assess the association between HAZ and DDZI and to identify determinants of DDZI. Models included potential socioeconomic, demographic and physiological confounders. Results: DDZI was positively associated with HAZ (p<0.0001). Socio-economic status, maternal education, and maternal age were positively associated with DDZI, while the number of children under 5 years-of-age in a household was negatively associated with DDZI (p<0.0001). Children from the Amhara and SNNPR regions, and those reportedly sick in the previous 2 weeks were most likely to report low DDZI (p<0.0001). Conclusions: Low height-for-age remains a major public health problem in Ethiopia. Our findings suggest that height-for-age is associated with low zinc intake in Ethiopia, providing evidence for Ethiopia’s National Nutrition Plan to emphasize increased consumption of zinc rich foods in young children.