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.

Practice-Based Implementation Research on the National Scale-Up of Micronutrient Powders in Bolivia.

Objectives: Bolivia is among few countries to have scaled-up Micronutrient Powders (MNPs) for children to the national level. Here we explore Bolivia’s experience as an early-adopter and in doing so, identify enabling conditions and stakeholders that led to scale-up, and barriers to increasing coverage and adherence. Methods: We reviewed a wide variety of documents spanning several years of program implementation (2006-2012) and communicated with those involved with the program. We defined scale-up as the process of increasing coverage to benefit more children and used a health system model to identify programmatic components. Results: Bolivia replaced iron syrup for children 6-23 months of age with MNPs in 2006. In 2012, MNP coverage reached 65% of Bolivia's approximately 536,000 children in this age group. Adherence rates in 2010 for children consuming all 60 sachets were 45% and 52% in urban and rural areas, respectively. Enabling political factors included integrating MNPs into the existing public health system. Politicians and policy makers helped accelerate scale-up by including MNPs within the national development plan and prioritizing effective coordination, including private sector engagement. Training of healthcare providers, support for supply chain management, communications, and program monitoring remain critical components of MNP scale-up. Behaviour change and demand creation strategies targeting the healthcare provider and caregiver were identified as key factors to sustain and increase coverage and adherence rates. Conclusions: Countries considering replacing iron syrup and transitioning to MNP implementation can benefit from Bolivia’s experience, particularly in creating an enabling environment whereby MNPs can be integrated within existing health and nutrition programs.