Diet Diversity is Negatively Associated with Stunting among Ethiopian Children 6-35 Months of Age.

Objectives: In 2011, the Ethiopian Demographic and Health Survey reported 44% of children under five years-of-age were stunted (i.e., height-for-age z-score (HAZ) below -2) and 11% were consuming minimum diet diversity (DD), a World Health Organization core indicator for infant and young child feeding. DD has been found to be negatively associated with stunting among children 6-23 months-of-age. Our objective was to determine the association between DD and stunting among Ethiopian children. Methods: We used nationally and regionally representative data from the 2011 Ethiopian National Food Consumption Survey, weighted for relative population sizes (N=6819 children 6-35 monthsof- age). A DD score was calculated for each child by categorizing individual foods consumed in quantities > 5 g in the past 24-hours into the United Nations Children's Fund seven food groups for DD. We used Chi-square to determine in which regions children were consuming minimum DD, defined as ≥4 food groups. We used logistic regression to determine the association between DD and stunting, including all potential socioeconomic, demographic and physiological confounders. Results: DD was negatively associated with stunting (OR= 0.965, p<0.0001). Nationally, 14.9% of children consumed adequate DD, with highest rates observed in the Addis Ababa (27.7%) and Harari (23.9%) region (p<0.0001). Conclusions: As with other populations, our Ethiopian findings suggest that increasing DD may be one method of reducing child stunting rates. Due to broad variations in regional dietary consumption in Ethiopia, future research will include more specific validation exercises of DD as a marker of dietary consumption in this population.

The Micronutrient Survey Manual: A Manual for Assessing Vitamin and Mineral Nutritional Status and Interventions Using Cross-sectional Surveys.

Objectives: An important component of public health nutrition programs is the periodic assessment of vitamin and mineral nutritional status and coverage of micronutrient interventions. Performing high quality cross-sectional surveys can be enhanced by the availability of guidance on steps in survey methods, sample size, sampling methods, data collection, analysis and interpretation, dissemination of results, and appropriate feedback to improve intervention programs. A manual to assist implementers is described. Methods: A previously published manual, "Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations", by the Centers for Disease Control and Prevention (CDC) and the Micronutrient Initiative (MI) served as the basis for this newer manual. New technical partners, WHO and UNICEF, have collaborated in the development of this up-to-date "Micronutrient Survey Manual". Results: In addition to updated resources for the assessment of anemia and iodine, iron, and vitamin A deficiencies, the manual has added information on folate and zinc deficiencies. Program indicators for assessing fortification of staple foods, point-of-use fortification with micronutrient powders, micronutrient supplementation, and dietary counselling are included. The manual contains detailed information on biologic sample collection and processing, sample size calculations, and analysis of survey data. Quality assurance throughout the survey process is emphasized. The issues of ethics, confidentiality, and informed consent are addressed. Conclusions: The "Micronutrient Survey Manual" can assist survey managers to improve the validity, efficiency, and standardization of cross-sectional surveys to better serve public health practice.

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.