Association of Iron, Zinc, and Vitamin a Maternal Plasma Levels with Breast Milk Composition in Rural Southern Ethiopia.

Objectives: Nutritional status of mothers in Ethiopia is currently a major public health concern. There are three key factors of maternal nutrition that could have an impact on human milk composition: Dietary intake, nutrient store, and alterations in nutrient utilization. The aim of this study is to assess the association between maternal plasma status and breast milk content of iron, zinc and vitamin A. Methods: Community-based cross sectional data were collected from April to May 2012 from mothers living in the Boricha district of southern Ethiopia who were lactating and had infants between 6-12 months. Plasma levels and breast milk composition of iron, zinc, and retinol were assessed using HPLC, and AAS. Pearson’s correlations were performed to identify any associations betweenplasma levelsandbreast milk content of these micronutrients. Results: The prevalence of anemia (Hb< 120 g/L), zinc deficiency (plasma zinc < 0.7 mg/L), and vitamin A deficiency (plasma retinol ≤ 30 μg/dL) was 36%, 100% and 7.3%, respectively. Breast milk iron (0.24±0.1 mg/L) and breast milk zinc (0.08±0.06 mg/L) showed no relationship to plasma levels. The breast milk retinol (128.6±22.0 μg/L) showed a significant association with plasma retinollevels (r=0.22, p<0.05). Conclusions: Maternal micronutrient malnutrition is a serious problem in the Boricha district. Our results support other studies that demonstrate low vitamin A status reduces levels in milk. This can have detrimental effects on children whose complementary food intake may be of poor nutritional quality.

Performance of Ethiopia's Health System in Delivering Integrated Community-Based Case Management

Background. Analyzing complex health programs by their components and subcomponents serves design; documentation; evaluation; research; and gap identification and prioritization. In 2012; we developed a rapid methodology to characterize integrated community case management (iCCM) programs by assessing benchmarks for eight health system components in three program phases. Objective. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced; and to compare the benchmarks across the geographical region. Methods. Six national iCCM experts scored each of 70 benchmarks (no; partial; or yes) and then were facilitated to reach consensus. Results. Overall; iCCM benchmark achievement in Ethiopia was high (87.3); highest for pre-introduction (93.0); followed by introduction (87.9) and scale-up (78.1) phases. Achievement bysystem component was highest for coordination and policy (94.2) and lowest for costing and finance (70.3). Six regional countries' benchmark assessments; including two from Ethiopia 14 months apart; were highly correlated with program duration at scale (correlation coefficient: +0.88). Conclusion. Ethiopia has a mature; broad-based iCCM program. Despite limitations; the method described here rapidly; systematically; and validly characterized a complex program and highlighted areas for attention through government or partners