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 Prevalence of Iron Deficiency Anemia (IDA) and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: In Ethiopia, there are no data which reflect the current prevalence of iron deficiency (ID) or iron deficiency anemia (IDA) at national or regional levels. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional prevalence of ID and IDA among children 6-59 months old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The prevalence of ID will be determined by measuring serum ferritin (SF) and soluble transferrin receptor (sTfR) from venous blood samples using an automated electrochemiluminescence immunoassay (ELISA) and immuno-turbidimetry technique. Iron deficiency will be defined by SF<12.0 μg/L and sTfR>6.0 mg/L for children 6-59 months of age and SF<15.0 μg/L and sTfR>5.33 mg/L for non-pregnant women. Acute phase proteins alpha-1-acidglycoprotein (AGP) and C-reactive protein (CRP) will be measured to account for the effects of inflammation. The prevalence of anemia will be determined from hemoglobin levels in venous blood samples using a Hemocue® photometer. Anemia will be defined as hemoglobin <11.0 and <12.0 g/dL for children 6-59 months of age and non-pregnant women, respectively. IDA will be defined as either: 1) low serum ferritin levels and low hemoglobin (anemia) or 2) elevated sTfR (iron deficiency) and low hemoglobin (anemia). Results: The national and regional prevalence of iron deficiency and IDA will be presented with and without inflammation among children 6-59 months and non-pregnant women 15-49 years of age in Ethiopia. Conclusions: This survey will provide national and regional data for anemia control and fortification programs in Ethiopia.

Assessment of Status of Infant and Young Child Feeding (IYCF) Practice, Policy and Programs: Achievements and Gaps, in Ethiopia.

Objectives: · To find achievements and gaps in the existing policy, program and practices in reference to Infant and Young Child Feeding in Ethiopia. · To build a consensus among all partners on the way forward to improve the existing IYCF practice. Methods: National publications, guidelines and reports were collected and assessed based on the 15 indicators modified by International Baby Food Action Network (IBFAN) to identify the current situations in the country in reference to the infant and young child feeding policy, program and practices. Participants from government and non-government reviewed and compiled the report. There was an elaborate discussion on each indicator before consensus was reached. The document was also validated by participants from different organizations on February 13, 2013. Results: In this assessment gaps were identified and recommendations were also forwarded. The main gaps include the absence of National Code of Marketing of Breast milk Substitutes and Baby Friendly Hospital Initiative, Idequate maternity leave conditions , lack of knowledge and experience by mothers about optimal complementary feeding practiceand the risk of bottle feeding. Conclusions: Key recommendations are the need of Implementation of the Baby Friendly Hospital Initiative and the International Code of Marketing of Breast milk Substitutes and capacitating of ealth workers in giving IYCF support skills for mothers. There is the needto review labour regulations s. This calls for the attention of policy makers and partners to promote optimal breastfeeding for the well being of infants and children in the country.

Sensory Acceptability Trial for a Chickpea-based Ready-to-use Supplementary Food.

Objectives: To assess sensory acceptability of WFP developed, chickpea based and locally produced RUSF products for treatment of moderately malnourished (MAM) children aged from 6 to 59 months and assess the readiness of their caregivers to administer such food Methods: Mother to child pair of 129 numbers from 5 Woredas participated in a two phased acceptability and preference tests to first select two of the most preferred products out of 4 (Chickpea only; Chickpea+Soy; Chickpea+Maize+Soy; and Chickpea+Maize) and then went on assessing the sensory acceptability of the two selected RUSF products with a cohort type study design. Results: Out of the four products, chickpea only was selected to pass to the second phase evaluation of acceptability test and chickpea+soya joins it with random selection owing to the statistical similarity of the rest of the three products. Similarly, Chickpea only was better accepted product out of the two during the 6 days acceptability assessment of the study excelling in 8 of the 9 study variables/quality parameters. Both products has a mean value of more than 4 in most of the study parameter indicating that they were well accepted by the study participants. Conclusions: Chickpea only and chickpea+soya were well accepted and the study concluded that follow on effectiveness study should be carried out to assess the nutritional adequacy of the RUSF products so that it can be put in nutrition programs for MAM treatment.

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.

Implementation of Micronutrient Supplementations in Community-Based Nutrition Program in Ethiopia after Integrated Refresher Training (IRT).

Objectives: Community-Based Nutrition (CBN) is important component of National Nutrition Program, designed to build upon the Health Extension Program packages to improve nutritional status of under-five children, pregnant and lactating women. Therefore, this study was conducted to assess CBN program implementation after IRT. Methods: The study was conducted from October to November, 2012 in four agrarian regions. Institutional based cross-sectional study with both qualitative and quantitative data collection approach at 56 kebeles were used. Results: Some of the Health Extension Workers (HEWs) were not delivering GMP in a quality way as they were trained on IRT. For HEWs it was difficult to follow the procedure of GMP service properly. The gap in skill was higher in the new CBN woredas. Task shifting from VCHWs to HDAs didn't occur in most kebeles of Amhara region. In most regions it was observed that supportive supervision and review meetings are offered but it is not regular and consistent. It was observed that some new programs contradict with CBN service like new community health management information system. Based on the information gathered, all health post of study areas were conducting Community Health Day services for micronutrient supplementations in every three months regularly except very few. Conclusions: Factors which affect the implementation of CBN are: lack of training for both HEWs and HDAs, work load for HEWs. Training should be given as it helps to improve competencies/refresh the already trained and trainees those who didn't get it. Strengthening the CBN service can be achieved by increasing the manpower.

Effective Modalities to Improve Pregnant Women’s Compliance to Daily Prenatal Iron Supplementation.

Objectives: Prenatal Iron Supplementation (PIS) has a paramount contribution for reducing maternal mortality. The coverage and compliance in Ethiopia is 17.3% and 0.4% respectively. The aim of this study was to determine the coverage of and adherence to prenatal PIS and to identify factors affecting utilization of the service. Methods: The formative research was conducted in eight selected woredas, namely Alamata, Enderta, Menze Mama, Menze Gera, Ada Berga, Meta Robi, Sankura and Meskan. The study applied descriptive cross-sectional design with quantitative and qualitative elements targeted at determining the coverage and adherence of PIS and identifying factors affecting utilization of PIS. Results: Among women who gave birth in the preceding year, 40.1% took iron tablets during the pregnancy. The coverage exceeded 50% in Sankura, Enderta and Alamata Woredas; whereas, only one-in-three and one-in-ten women were supplemented in Menze Gera and Menze Mama woredas respectively. However, only 3.6% of them took the supplement for the recommended 90 or more days. Conclusions: The coverage among women who gave birth in the preceding year and among women who were pregnant at the time of the survey was 40.1% and 38.5%, respectively. Lack of adequate stock and poor logistic system, lack of training for front line health workers on ANC, lack of BCC and job aid materials, fear of side effect, fear of taking medication during pregnancy, lack of awareness on the benefits of the supplement have contributed for the low coverage and adherence to PIS.