Consumption of Micronutrient rich Animal Source Foods and Cognitive Performance in Primary School Children in Hawassa Town, Southern Ethiopia.

Objectives: To assess consumption of animal source foods (ASF) and cognitive performance in Ethiopian primary school children. Methods: A cross-sectional study was conducted in Hawassa town, Southern Ethiopia among primary school children (n=116) aged 7-9 and enrolled in five schools. Participants were selected by two stage random sampling. Child dietary diversity was assessed using 8 food groups recommended by Food and Nutrition Technical Assistance (FANTA). Child anthropometric status and family socioeconomic characteristics were also measured. The Raven’s Colored Progressive Matrices (CPM board version) and selected tests from the Kaufman Assessment Battery for Children (KABC-II) were used to assess cognitive performance. KABC-II scores were standardized for age before analysis. Results: Thirteen (13%) of the children were stunted, 5% were wasted and 13% were underweight. Mean (SD) weight-for- age (WAZ), height-for-age (HAZ) and BMI-for-age Z-scores were -0.9 (0.9), -0.7 (1.1) and -0.6 (0.8), respectively. All participants consumed foods made from grains, roots and tubers. However, only 15% of children consumed ASF, which included meat, poultry, fish or eggs. The Mean diet diversity score was 3.8 (1.1). Wealth significantly predicted child diet diversity (P= 0.006, R2=0.12). Consumption of ASF predicted Sequential Scale (P= 0.05, Adj. R2=0.14) and Triangles (P= 0.022, R2=0.14) cognitive test scores. Height-for-age (P= 0.001), and maternal education (P= 0.002) accounted for 27% of variance in Pattern Reasoning test scores. Maternal education also predicted sequential scale (P=0.002) and triangles (P=0.0004) scores. Conclusions: Consumption of ASF was low in this group of school children and along with maternal education predicted performance on cognitive tests.

A Randomized Controlled Zinc Supplementation Trial to Evaluate Biomarkers of Zinc Status of Adult Women in Rural Sidama, Southern Ethiopia.

Objectives: Effects of 20 mg Zn or placebo for 23 d on zinc transporter and metallothionein (MT) mRNA abundance, plasma zinc and zinc-related biomarkers were evaluated in apparently healthy women. Methods: Participants (n=48) were randomly selected from village lists of non-pregnant, nonlactating women with body mass index (BMI) ranging from18.5 to 24.9 residing in rural southern Ethiopia. Demographic and household dietary diversity data were collected. Women were randomized to placebo or zinc supplementation groups. Morning fasting blood, urine and fecal samples were collected at baseline and after 23 d. RNA was extracted from peripheral blood mononuclear cells, reverse-transcribed, and used for gene expression analyses. The mRNA abundance of zinc transporters (ZnT1/ZIP3/ZIP4/ZIP8) and MT1 was determined by qPCR. Plasma zinc was measured by inductively coupled plasma mass spectrometry and plasma, urine and fecal biomarkers by ELISA. Results: Mean ± SD age of participants was 33±5. Household dietary diversity score was 4.5 with no meat, fish, or egg consumption in the last 24h. ZIP4 (P=0.036) and ZIP8 (P=0.038) mRNA abundance decreased following zinc supplementation. Mean plasma zinc at baseline was 680±105 for zinc and 741±92 μg/L for placebo groups. At endpoint plasma zinc for placebo (717±103 μg/L) did not change significantly from baseline but in the zinc-supplemented group, plasma zinc at 735±80 μg/L was higher than baseline (P< 0.01). Plasma bone-specific alkaline phosphatase increased after zinc supplementation (P=0.015), while other potential biomarkers were not significantly affected. Conclusions: The results show that ZIP4 and ZIP8 transporters respond to zinc supplementation in zinc deficient women.

Vitamin D Insufficiency in a Sunshine-Sufficient Area: Southern Ethiopia.

Objectives: This study assessed vitamin D status by measuring plasma 25(OH)D concentrations in rural women in southern Ethiopia living in the Rift Valley at 7°3´ N latitude. Methods: Nonpregnant women (n = 202) living in three adjacent rural communities volunteered to participate in this cross-sectional study. Demographic, socioeconomic, health, and food frequency data were acquired by questionnaire. Anthropometric measurements and a fasting venipuncture blood sample were obtained by qualified professionals. Body mass index (BMI) was calculated. ELISA kits from ImmunoDiagnostic Systems were used to determine concentrations of 25(OH)D with external quality control standards from UTAK Laboratories. Results: The self-reported mean±SD age was 30.8±7.8 years. The mean number of pregnancies was 4.7±2.7, household size was 6.0±2.6, and BMI was 20.0±2.2. None of the participants reported ever consuming vitamin D–rich foods, fortified foods, or dietary supplements. Only 15.8% of the participants had 25(OH) D levels above 50 nmol/L, and 14.8% were below 30 nmol/L, which represents risk of deficiency relative to bone health. Conclusions: Vitamin D insufficiency is a serious problem in the study population, and living near the Equator does not assure adequate vitamin D status. (Supported by Hawassa University and Oklahoma Agricultural Experiment Station).

High Variability of Urinary Iodine Concentrations (UIC) and Iodine in Salt from Rural Households in Sidama Zone, Southern Ethiopia.

Objectives: To assess salt iodine concentrations (SIC) and UIC after the national proclamation that all salt for human consumption should be iodized. Methods: Salt was collected from 193 rural households. SIC was analyzed with a portable digital electronic iodine checker (WYY, UNICEF) and re-analyzed using inductively-coupled-plasma mass spectrometry (ICP-MS); correlation was 0.69 (p<0.001). Mean SIC was 7.8 (8.0) ppm with the digital iodine checker and 9.8 (8.6) ppm by ICP-MS. Results: The recommended household SIC should be 15-40 ppm but in this survey varied from 0 to 163 ppm; only 21% of households had SIC >15 ppm. Urine samples were collected from 100 members of 40 randomly selected rural households.UIC was analyzed by ICP-MS. Based on UIC classification,18% were iodine deficient which included 2% severe, 5% moderate, and 11% mild. The adequate category included 32% of participants while 26% were more than adequate and 24% were classified as excessive UIC. The median (25, 75 percentile) UIC was 200 (118,296) with a range from 17 to 767 ug/L. Conclusions: Compared to previous UIC from the area, iodine deficiency is decreasing; however UICs now suggest some excessive iodine intakes. Salt may not be homogenously or appropriately iodized, and storage and handling may not be optimal. Hence a strong monitoring strategy from production to the household level for Ethiopia’s salt iodization program is of great importance. (Funded by Nestlé Foundation and Oklahoma State University).

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.

Vitamin A Status and Serum Carotenoid Levels of Adolescent School Girls from Northern Ethiopia.

Objectives: Determine the vitamin A status and serum carotenoid levels of adolescent school girls from Tigray, Northern Ethiopia. Methods: Serum samples separated from nonfasting venous blood were analyzed for retinol, α-carotene and β-carotene using reversed phase HPLC. The chromatographic separation was performed by isocratic elution with a mixture of methanol, dichloromethane and acetonitile (60:20:20 by volume) and at a flow rate of 0.8 mL/min. The concentrations of retinol and carotenoids were quantified at 325 and 450 nm, respectively. Results: Mean levels of serum retinol and α-carotene were 35.9µg/dL and 10.5µg/dL, respectively and the median value of β-carotene was 46.4µg/dL. About 3% of the school girls were vitamin A deficient and 26% had serum retinol values indicative of marginal vitamin A status. Clinical assessments revealed that 3.7% and 3.2% had Bitot’s spot and night blindness, respectively. About 27% of the girls mentioned the word “HIMA”, a local term for night blindness. Residence, age, hematocrit and β-carotene were the significant predictors of serum retinol concentrations (p < 0.0001). Conclusions: Our results demonstrated high levels of marginal vitamin A deficiency in adolescent girls. Because of cultural differences in food preparation, food consumption and food taboos in different parts of the country, our study is not generalizeable to all regions from Ethiopia and thus multicenter studies to substantiate our results and establish the vitamin A status of adolescents are recommended.

Zinc Deficiency was a Significant Public Health Problem in Adolescent School Girls from Northern Ethiopia.

Objectives: Determine the prevalence and factors contributing to zinc deficiency in adolescent school girls from Tigray, Northern Ethiopia. Methods: Cross-sectional study was conducted in 413 randomly selected adolescent school girls. Anthropometric data were collected following standard procedures. Z scores were calculated using the WHO Anthroplus software. Serum zinc was analyzed by ICPMS. To avoid zinc contamination, trace mineral free gloves and pipette tips and only plasticwares were used during analysis and reagent preparation, respectively. Quality control samples (Utak Laboratories, Inc., Valencia, CA) utilized in order to verify method performances were within recommended ranges. Results: Mean (sd) serum zinc concentration was 72.3 (14.3) µg/dL. About 49.2% of the adolescent girls were zinc deficient (< 70 µg/dL). Stunted (72.3±15.9 µg/dL) and non-stunted (72.3±13.9 µg/dL) girls had comparable serum zinc concentrations. Zinc deficiency was severe in 12 and 13 year old girls as were stunting and thinness. Area of residence (p = 0.0001), water source to households (p = 0.0007) and access to household toilet facilities (p=0.0110) were significantly associated with zinc status. Conclusions: Zinc deficiency was common in adolescent girls. The fact that zinc deficiency, stunting and thinness were prevalent at 12 and 13 years of age may reflect the higher growth rate and zinc requirements related to the growth spurt. Improving hygiene and sanitation of households and multicenter surveys to better understand zinc status in Ethiopian adolescent population are recommended.

Clinical Assessment of Goiter and Low Urinary Iodine Concentration Depict Presence of Severe Iodine Deficiency in Pregnant Ethiopian Women: A Cross-sectional Study in Rural Sidama, Southern Ethiopia.

Objectives: To determine iodine status and knowledge of iodine deficiency disorders (IDD) of pregnant women in rural Sidama, southern Ethiopia. Methods: A cross-sectional community-based study was conducted in three kebeles which were selected randomly from the eight kebeles in the study area using probability proportional to size methods. Data were collected in January, 2009, from 172 pregnant women. Main outcome measures were urinary iodine concentration (UIC), % of population with UIC < 20 µg/L, % of households using iodized salt, iodine content of salt and total goiter rate (TGR). Results: Median UIC was only 15 µg/L compared to the 150 µg/L minimum recommendation from WHO/UNICEF/ICCIDD for pregnant women. The UIC of 60% of the women was < 20 µg/L. More than 90% of households were not using iodized salt and median salt iodine content was almost zero compared to the recommended 15-40 mg/kg. TGR was 49% (95% CI: 42, 56) which is much higher than the 5% TGR cut-off signifying a problem of public health significance. In addition, > 90% of participants didn't know about IDD, about the cause of goiter or why iodized salt is important. Conclusions: Results indicated the presence of severe iodine deficiency in the study population; urgent intervention, through universal salt iodization, and iodine supplementation to high risk groups is required.