How Salt Iodization Using Knapsack Hampers Universal Salt Iodization (USI) in Ethiopia.

Objectives: To determine the effect of Knapsack on quality of Salt iodization and USI program in Ethiopia. Methods: Samples of Iodized salt were collected in two different times with two different groups of experts and were tested and analysed indipendatly. The samples were collected during joint monitoring visit at afar salt processing sites and during routine monitoring at semera check point. Results: It was found that the coffecient of Variation (CoV) were 80.4% and 101.1%, adequately iodized salt wwere only 38.46% and 35% and the range were 99.3 ppm and 262.2 ppm. Conclusions: The Coefficient of Variation (CoV) beyond 20% is unacceptable and the method of processing providing the CoV beyond 20% will be concidered unacceptable. Therefore, Use of knapsack for salt iodization should be discontinued and mechanisms that could improve the sustainalbe supply of Iodized salt to the country should be given in due consideration.

Adequacy of Iron and Zinc Contents and Estimated Bioavailability in Commercially Available Complementary Foods in Ethiopia.

Objectives: Evaluate the adequacy of iron and zinc contents and estimated bioavailability of complementary foods (CFs) processed in Ethiopia. Methods: Seven locally-produced fortified and non-fortified cereal-based CFs were purchased from supermarkets in Addis Ababa, Ethiopia. Iron and zinc contents were determined by atomic absorption spectrometry and results were compared with recommendations for fortified CFs. Phytate particularly myo-inositol hexaphosphate (IP6) was determined using high-performance anion-exchange chromatography. Iron and zinc bioavailability was estimated by calculating IP6-to-mineral molar ratios. Results: Iron and zinc contents of CFs were in the range of 5.85-22.31 and 0.80-12.07 mg/100g DM, respectively. The contribution to iron and zinc requirement assuming a daily intake of CF equal to the recommendations (i.e. 40 and 60 g for the 6-11 and the 12-23 month-old children, respectively) was 21-81% and 6-97% for 6-11 months and 50-100% and 10-100% for 12-23 month-old children respectively. With IP6 content in the range of 235-893 mg / 100 g DM, the molar ratios of [IP6]:[Fe](0.89-7.07) and [IP6]:[Zn] (1.93-30.63) were above the recommendations for most CFs analyzed. Conclusions: All CFs analyzed had iron content below the recommendation for 6-11 month-old children but 5 out-of 7 CFs contained adequate iron for 12-23 month-old children. Regarding zinc, only 2 out-of 7 CFs could contribute to more than 80% of the requirement for both age groups. Mineral-to-phytate molar ratios also predicted low bioavailability. Therefore, manufacturers need to consult nutritionists to define proper fortification of processed CFs and for further modification of their processing methods to improve mineral bioavailability, so that children meet their daily nutrient requirements.

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.

Can local Diets Meet the Nutrient Adequacy of Young Children in Ethiopia? Evidence from the National Food Consumption Survey.

Objectives: Infants from 6 months onwards need energy- and nutrient dense complementary foods. This is a challenge in Ethiopia, where monotonous diets of poor nutrient density are fed to young children. We used data of the National Food Consumption Survey to determine nutrient adequacy of young children's diet and develop local food-based complementary feeding recommendations (CFR). Methods: Representative data were used on food intakes of children 12-23 months, from four regions. Linear goal programming (Optifood) was applied to develop population specific local foodbased CFR based on local foods and identify critical nutrients, for which local foods cannot meet recommendations. Results: Data were available from 1544 children. 40-47 different foods were frequently consumed by(>5%of children) and >85% still received breast milk. Portion sizes were small: 62-73% of the consumed foods were eaten in daily portion sizes below 15 gram. Foods consumed in larger quantities (>100 gram) differ per region. Dairy Milk was consumed in large quantities in each region. Wheat was consumed in all regions but in moderate quantities (25 grams per day in SNNP to >100 gram in Tigray). Due to low overall intakes micronutrient deficiencies are likely. Promising foods to contribute to micronutrient intake are chickpeas (iron), millet (iron and calcium) and teff (iron), but there are no local foods with meaningful zinc contents. Conclusions: The findings indicate that improved CFR can probably meet the nutrient requirements of some nutrients in Ethiopian young children. However, additional interventions will be required to meet requirements of zinc and probably others.

Household Utilization of Iodized Bouillon Cubes Affects Iodine Intake in Senegal.

Objectives: To prevent iodine deficiency, Senegal mandated the iodization of all salt produced, imported or distributed. There has been a dramatic increase in use of bouillon, which is claimed to contain iodine in Senegal. We undertook this survey to better understand the extend of bouillon cube use in the context of salt iodization. Methods: A nationwide cross-sectional stratified cluster sample household-level survey was conducted to measure urinary iodine concentration in women 15-45 years and children 6-12 years, iodized salt and bouillon consumption, and iodine concentration in salt available in households. In all, 3,768 households were surveyed including 7,980 women and 6,309 children. Results: Only 56% of households surveyed had iodized salt. Average iodine concentration in salt was 22ppm. Average per capita daily household consumption was 4.79 g salt (5.01g urban, 4.60g rural; P<0.001) and 3.98 g bouillon cube (4.29g urban, 3.74g rural; P< 0.05). Median urinary iodine concentration in children was 104.42μg/l (141.25μg/l urban, 82.63μg/l rural) and 92.20μg/l for women (114.73μg/l urban, 72.95μg/l rural). Conclusions: This study shows that household consumption of bouillon cubes is high in Senegal; mean UI seems to be adequate in urban setting but insufficient in rural areas, suggesting a lower intake of iodine from iodized salt/bouillon cube. Adequate iodine concentration in bouillon cube could be an avenue to tackle IDD in Senegal; however, further research is warranted on current content and bioavailability of iodine in bouillon cube as well as feasibility of iodization of bouillon cube as complement to iodized salt in Senegal to guide decisions.

Variation of Serum Selenium (Se) in Children from Amhara Region, Ethiopia. Will Low Se Affect the Success of Salt Iodization in Ethiopia.

Objectives: To assess Se status of 54-60 month-old children in the Amhara region, Ethiopia Methods: Serum from 280 children from five zones of the Amhara regional state, Ethiopia, was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Results: The mean serum Se concentration was 65.89±38.4 μg/L (median: 54.54 μg/L). Individual values ranged from 10.66-255.45 μg/L. Overall, 77% of the study children were below the recommended cutoff. The mean serum Se varied by administrative zones (p<0.05). Mean serum Se concentrations from West Gojjam 44.13±11.37 μg/L; East Gojjam 60.03±26.06 μg/L; and South Gonder 61.76±24.34 μg/L were below the cutoff while mean Se concentrations for South Wollo 153.95±50.47 μg/L; Wagehmera 179.95±46.87 μg/L were adequate;. Means for children from East and West Gojjam and South Gonder were not different (p=0.42) from each other but they were different (p < 0.05) from means of children from South Wollo and Wagehmera. In addition, mean Se concentrations for children from South Wollo and Wagehmera were different (P<0.05) from each other. Conclusions: Our data illustrate the variability of serum Se in children by zones. Although, Ethiopia is making progress with salt iodization, low Se status in some areas may hamper iodine metabolism and success of the salt iodization program.

Designing Rigorous Program Evaluations to Assess the Impact on Child Growth of Integrated IYCN Programs in Burkina Faso and Ethiopia.

Objectives: The Micronutrient Initiative and academic partners have designed two program impact evaluations of Infant and Young Child Nutrition (IYCN) interventions in Ethiopia and Burkina Faso. The programs include enhanced behavioral change interventions on IYCN, improved quality of local complementary feeding, provision of Multiple Micronutrient Powders (MNPs) to children 6 to 23 months, and ensuring an integrated preventive and community-based management of moderate acute malnutrition. The objective is to critically review key elements for consideration in the design of future IYCN program evaluations. Methods: Evaluation designs were based on 1) selection of primary and secondary outcome indicators based on the Program Impact Pathways (PIP), 2) Considerations for assignment of intervention and comparison groups; 3) Considerations on designs in the context of integrated programs; 4) Ability to monitor adverse events within a program. Results: Following PIP, both impact and process indicators were identified. In Ethiopia, a matched-control cluster design and in Burkina Faso a cluster randomized matched-control design was used with repeated cross-sectional surveys. Sample size calculations took into account the selection of age-appropriate cohorts for the different impact indicators, and a population based sampling scheme. Following recent discussions around the safety of iron-containing supplements in young children without iron deficiency, the evaluations also included practical methods to assess potential adverse events in program settings. Conclusions: The complexity of measuring impact on child nutrition in an integrated programmatic context is often underestimated, leading to evaluations with inconclusive results or impacts that are difficult to attribute to program. Careful design could help avoid such pitfalls.