Iodine and other Nutritional Predictors of Infant and Young Child Development: Results from a Cluster Randomized Trial in Amhara, Ethiopia.

Objectives: The objective was to examine nutritional, health, and social predictors of early child mental development in the Amhara region of Ethiopia Methods: Using a cluster randomized design, iodized salt was forced early into the markets of 30 villages (intervention group) before it became available in the 30 control villages following national salt iodization legislation. A total of 1880 infants 6 to 10 mo old in the 60 villages were administered Bayley Scales of Infant and Toddler Development (BSID-III) at baseline and when they were 20-29 mo of age (86% of sample) Results: The two groups had similar socioeconomic, nutrition, and mental development scores at baseline. These variables were significant predictors of endline cognitive and language development scores: length-for-age z-score (p<0.001), weight-for-age z-score (p<0.001), psychosocial stimulation (p<0.001), water/sanitation (p<0.001), mother's education (p<0.01), family assets (p<0.001), recent deworming (p<0.05), and maternal depression (p<0.05). The intervention group had significantly higher mental development scores, and a multiple regression analysis revealed that the intervention effect was positively partially mediated by length-for-age z-score (std β= 0.16 to 0.21, p<0.01) and water/sanitation score (std β= 0.09 to 0.10, p<0.01). Conclusions: In conclusion, iodized salt improved children's mental development both directly and indirectly by its effect on growth. The indirect effect through water/sanitation may be because water and sanitation improve health.

Iodine and Other Nutritional Predictors of Preschool-Aged Children's Development in Amhara, Ethiopia.

Objectives: The study examined nutritional and other predictors of mental development of preschool-aged children in northern Ethiopia. The current analysis of older children from the iodized salt project (see Infant study) included the effects of iodized salt, along with other determinants. Methods: Using a cluster randomized design, 1550 children in 60 villages in Amhara, Ethiopia were given tests of School Readiness and Wechsler verbal and nonverbal reasoning, twice at 54- 60 months and again at 69-78 months. Between these assessments, iodized salt was distributed early in the markets of 30 randomly assigned villages (intervention group) before it became available in 30 control villages. Results: The two groups were largely comparable at baseline. In addition to the effects of iodized salt on School Readiness (p=0.01) and nonverbal reasoning (p<0.10) seen at the endline, the following predictors were positively and significantly associated with cognitive outcomes: heightfor- age z-score (HAZ; p<0.0001), weight-for-age z-score (p<0.0001), family assets (p<0.0001), recent deworming (p=0.01), improved water/sanitation (p<0.01), and mother's education (p<0.05). Although over two-thirds had palpable goiter, hemoglobin status was good (M=134 g/L). Children overall performed relatively better on the School Readiness test (M=6.66 Intervention and 6.25 Control) than nonverbal reasoning (M= 4.15 Intervention and 3.95 Control)(theoretic ranges 0-19). A multiple regression, following the Baron and Kenny mediation analysis, on School Readiness scores revealed that the intervention effect was partially mediated by HAZ (std β= 0.37 , p<0.0001). Conclusions: In conclusion, iodized salt improved children's School Readiness skills and nonverbal reasoning, both directly, and indirectly by way of its effect on growth.

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.

Poor Pregnancy and Birth Outcomes are Associated with the Indicators of Inadequate Dietary Intakes of Micronutrients in Rural Women of the Amhara Region of Ethiopia.

Objectives: High prevalence of poor pregnancy (miscarriage) and birth (stillbirth) outcomes has been reported among poor women in Ethiopia. This study evaluated the underlining associated factors. Methods: The study used a cross-sectional design to interview 5192 mothers of children under 5 years of age, who were living in 60 villages, across 60 sub-districts in 6 zones of the Amhara Region of Ethiopia. Socio-demographic, obstetric, and birth information were collected using standardised questionnaires and household salts were tested with rapid test kits. The study protocol received ethical approval from McGill University, Ethiopian Health and Nutrition Research Institute, and the Ethiopian National Research Ethics Review Committee. Results: Households were mainly individual dwellings (83.4%) with agricultural land (90.9%) and rearing livestock (94.1%). Majority of household heads and mothers were illiterate (63.7% and 81.2%, respectively). Sanitation (61.0% scored ≤ 1 out of 3), assets (84.1% scored ≤5 out of 10) and use of iodised salt (6.4%) were very poor and goiter presence in the family was high (41.7%). Prevalence of miscarriage was 95.4 per 1000 pregnancies and stillbirth was 22.7 per 1000 live births. The use of non-iodised salt was associated with miscarriage (r=0.06; p<0.05). Self-reported anaemia, vomiting, and urinary tract infection during pregnancy were common (37.2%, 26.08%, and 19.47% respectively) and were associated with prevalence of miscarriage and stillbirth(r=0.04 to 0.06; p<0.05). Conclusions: Poor pregnancy and birth outcomes occur frequently in rural Ethiopia and are associated with indicators of inadequate dietary intakes of micronutrients.