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.

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.