Making a Case for Calcium Supplementation for Prevention of Pregnancy Hypertension in Ethiopia.

Objectives: Calcium supplementation significantly reduces the risk of pre-eclampsia, a major cause of maternal death and pre-term birth. The World Health Organization recommends preventive elemental calcium supplementation for all pregnant women living in areas with low calcium intake. Currently, no intake data is available in Ethiopia to inform the policy decision to include calcium supplementation in the existing antenatal care program. We used data from the 2011 Ethiopian National Food Consumption Survey (ENFCS) to identify regions with low dietary calcium intake and to determine factors associated with calcium intake. Methods: Nationally and regionally representative ENFCS data from 7549 women of 15-45 y, weighted for relative population sizes,) were analyzed. ANOVA was used to determine which regions were consuming low calcium levels (defined as <900 mg). Univariate general linear model was used to identify determinants of calcium intake. Results: All regions were found to consume below 900 mg of calcium per day, with women in the Afar region consuming the highest levels (416.87±1.002 mg; p<0.05). Women with a higher educational status, socio-economic status, and those living in rural areas were associated with higher calcium consumption (p<0.05). The mean intake of women below the age of 30 y (276.06 ±1.00 mg) was significantly higher than women between 30-40 y (251.77±1.00 mg) and above 40y (262.42±1.002 mg) (p<0.05). Conclusions: Calcium supplementation is recommended for antenatal care in all regions of Ethiopia. Improving women's education and socioeconomic status may help to increase the calcium intake of women.

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 Prevalence of Iron Deficiency Anemia (IDA) and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: In Ethiopia, there are no data which reflect the current prevalence of iron deficiency (ID) or iron deficiency anemia (IDA) at national or regional levels. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional prevalence of ID and IDA among children 6-59 months old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The prevalence of ID will be determined by measuring serum ferritin (SF) and soluble transferrin receptor (sTfR) from venous blood samples using an automated electrochemiluminescence immunoassay (ELISA) and immuno-turbidimetry technique. Iron deficiency will be defined by SF<12.0 μg/L and sTfR>6.0 mg/L for children 6-59 months of age and SF<15.0 μg/L and sTfR>5.33 mg/L for non-pregnant women. Acute phase proteins alpha-1-acidglycoprotein (AGP) and C-reactive protein (CRP) will be measured to account for the effects of inflammation. The prevalence of anemia will be determined from hemoglobin levels in venous blood samples using a Hemocue® photometer. Anemia will be defined as hemoglobin <11.0 and <12.0 g/dL for children 6-59 months of age and non-pregnant women, respectively. IDA will be defined as either: 1) low serum ferritin levels and low hemoglobin (anemia) or 2) elevated sTfR (iron deficiency) and low hemoglobin (anemia). Results: The national and regional prevalence of iron deficiency and IDA will be presented with and without inflammation among children 6-59 months and non-pregnant women 15-49 years of age in Ethiopia. Conclusions: This survey will provide national and regional data for anemia control and fortification programs in Ethiopia.

The Prevalence of Vitamin A Deficiency (VAD) and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: There are no data which provide information on the current prevalence of VAD at the national and regional levels in Ethiopia. The 2014 Ethiopia National Micronutrient Survey (ENMS) will provide these estimates among children 6-59 months old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates of vitamin A deficiency. The retinol concentration of venous blood serum will be determined by HPLC. Mild VAD will be defined as a serum retinol concentration <0.70 μmol/L and severe VAD as <0.35 μmol/L. Acute phase proteins alpha-1-acidglycoprotein (AGP) and C-reactive protein (CRP) will be measured by immunoassay technique to account for the effects of inflammation when interpreting VAD. Results: The national and regional prevalence of vitamin A deficiency will be presented among children 6-59 months and non-pregnant women 15-49 years of age with and without inflammation in Ethiopia. Conclusions: This survey will provide national and regional data for vitamin A supplementation and fortification programs in Ethiopia.

Prevalence of Anemia and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: According to Ethiopia Demographic and Health Survey 2011, the prevalence of anemia among children age 6-59 months and women of reproductive age is 44.2% and 16.6% respectively. The 2014 Ethiopia National Micronutrient Survey will provide national and regional estimates of the prevalence of anemia among children 6-59 months’ old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates of anemia. The prevalence of anemia will be determined from hemoglobin levels in venous blood samples using a Hemocue® photometer. Anemia will be defined by a hemoglobin <11.0 and <12.0 g/dL for children 6-59 months of age and non-pregnant women, respectively. Hemoglobin values will be adjusted for altitude and smoking status. Results: The national and regional prevalence of anemia will be presented for children 6-59 months old and non-pregnant women 15-49 years of age. Conclusions: This survey will provide national and regional data for anemia control and fortification programs in Ethiopia.

Sensory Acceptability Trial for a Chickpea-based Ready-to-use Supplementary Food.

Objectives: To assess sensory acceptability of WFP developed, chickpea based and locally produced RUSF products for treatment of moderately malnourished (MAM) children aged from 6 to 59 months and assess the readiness of their caregivers to administer such food Methods: Mother to child pair of 129 numbers from 5 Woredas participated in a two phased acceptability and preference tests to first select two of the most preferred products out of 4 (Chickpea only; Chickpea+Soy; Chickpea+Maize+Soy; and Chickpea+Maize) and then went on assessing the sensory acceptability of the two selected RUSF products with a cohort type study design. Results: Out of the four products, chickpea only was selected to pass to the second phase evaluation of acceptability test and chickpea+soya joins it with random selection owing to the statistical similarity of the rest of the three products. Similarly, Chickpea only was better accepted product out of the two during the 6 days acceptability assessment of the study excelling in 8 of the 9 study variables/quality parameters. Both products has a mean value of more than 4 in most of the study parameter indicating that they were well accepted by the study participants. Conclusions: Chickpea only and chickpea+soya were well accepted and the study concluded that follow on effectiveness study should be carried out to assess the nutritional adequacy of the RUSF products so that it can be put in nutrition programs for MAM treatment.

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.