The Nutritional Status of Vulnerable Populations in Ethiopia.

Objectives: According to the Ethiopia Demographic and Health Survey 2011, the prevalence of stunting, wasting, and underweight among children 6-59 months old was 44%, 12% and 29% respectively. The proportion of non-pregnant women with a Body Mass Index (BMI) below 18.5 kg/m2, indicating chronic energy deficiency was 27%. This survey will measure anthropometric status among children 6-59 months of age, school age children 5-14 years of age, non-pregnant women 15-45 years old, and men 15-54 years old at national and regional levels. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates of nutritional status. Anthropometry measurements will be conducted for all target groups using standard methods. Anthropometric indicators of length/heightfor- age, weight-for-height, and weight-for-age will be determined for children 6-59 months. Thinness, normal, overweight and obesity will be assessed according to BMI among other target groups. Results: The national and regional prevalence of stunting, wasting, and underweight among children 6-59 months of age will be presented. The national and regional proportions of thinness, overweight and obesity among all target groups will also be presented. Conclusions: This survey will provide national and regional data to guide nutrition programs in Ethiopia.

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.

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.

The Proportion of Households with Adequately Iodized Salt in Ethiopia.

Objectives: According to the Ethiopia Demographic and Health Survey 2011, the proportion of households using iodized salt (>15 parts per million [PPM]) was 15.4%. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional proportions of households using adequately iodized (>15 ppm) salt in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates. Samples of salt (20 gram) usually consumed will be collected from approximately 4,000households for qualitative testing using the rapid test kit. Salt samples will be sent to the Ethiopian Health and Nutrition Institute Laboratory where iodometric titration will be conducted. Results: The national and regional proportions of households with adequately iodized (>15 ppm) salt will be presented. Conclusions: This survey will provide national and regional data for monitoring and evaluating the progress of the Universal Salt Iodization (USI) program in Ethiopia.

The Prevalence of Iodine Deficiency (IDD) among Vulnerable Populations in Ethiopia.

Objectives: IDD is a common cause of preventable mental retardation and brain damage in the world. In Ethiopia, there are no data which reflect the current status of IDD at the national or regional levels. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional prevalence of IDD among children 5-14 years of age 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 iodine deficiency. Urine samples will be collected from children aged 5-14 years of age and from all non-pregnant womenof reproductive age. Approximately 10 ml of urine will be stored at -20ºC until analyzed for urinary iodine excretion by the Sandell-Kolthoff reaction. WHO/UNICEF/ICCIDD urinary iodine criteria (among school-age children and non-pregnant women of reproductive age) will be used to interpret the findings. Results: The national and regional iodine status will be presented based on median urinary iodine levels for children 5-14 years old and non-pregnant women 15-49 years of age in Ethiopia. Conclusions: This survey will provide national and regional datafor monitoring the progress toward the elimination of IDD 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.

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.

Examining Means of Reaching School and Non School Attending Adolescent Girls for Iron Supplementation in Tigray Region, Northern Ethiopia.

Objectives: To examine means of reaching school and non-school attending adolescent girls for iron supplementation in Tigray region. Methods: The study employed cross-sectional survey consisting of both quantitative and qualitative approaches. Stratified multi-stage systematic random sampling technique was used to collect data from 828 adolescent girls in nine districts. Data was cleaned, coded and analyzed using SPSS version 20 for windows. Results: A significant proportion of adolescent girls (30%) were non-school attending. Symptoms of anemia; paleness and fatigue are known by 18% and 42% of the subjects respectively. Eating iron rich foods (87.6%) and taking iron supplements (36.7%) were mentioned as the preferred methods of preventing anemia. Radio (84%) is selected as the best media. Schools (39%) and health facilities (69%) were the preferred public facilities for provision of supplements. According to key informants low community awareness, perception of iron tablet as contraceptive, cultural influences and lack of knowledge were some of the potential barriers. Conclusions: Nutrition information communication through radio and health development army and use of school and health facilities to distribute iron supplements were recommended.

Early Childhood Stunting, Household Food Security, Micronutrient Rich Foods Consumption Southern Ethiopia.

Objectives: This study aims to assess micronutrient rich food consumption, household food security status and its association with stunting. Methods: Community based cross-sectional design was employed to obtain data from 584 participants from three rural communitie. A two stage stratified sampling procedure was employed. Results: Only 14.4% of the mother fed their children optimally. The prevalence of stunting was higher for the Infant aged 6 to 8 months (43.04%) compared to other. Only 21.2% of household were food secure. Eighty six percent of the children had diets below the minimum dietary diversity group The prevalence of Vitamin A and iron rich food consumptions were very low. The majority (93.1%) of mothers in this study reported that children consumed complementary foods made from grains, roots, and tubers. Consumption of fruits and vegetables was also minimal (37.9%). Moreover, only 6.3% of children consumed vitamin-A rich fruits and vegetables. In this study, only 1.9 % of the children consumed meat, fish, poultry. Children who had never consumed Vitamin A rich sweet potato were 16 times more likely to be stunted than those who consumed (P<0.05). Conclusions: The feeding practices of most mothers were not according to the recommendation of WHO standard and consumption of micronutrient rich foods were very minimal. There is a need for promotion of optimal feeding and micronutrient rich food consumption for improving nutritional status.

Effects of Governance Structures in Ethiopia on Implementation of Nutrition Interventions.

Objectives: 1. Assess factors that enhance or constrain implementation of nutrition interventions at national and sub national levels. 2. Analyze how direct nutrition interventions and multi sector approaches are implemented at national, regional, zonal and woreda levels. 3. Identify models of effective governance for nutrition interventions. Methods: Key informants were interviewed using a structured questionnaire. National level interviews from the agricultural, health, education, finance, economic development, social protection sectors and UN agencies, civil society and donors were included. Parallel interviews were conducted in four regions - Amhara, Oromia, SNNPR and Tigray - and 16 woredas for a total of 312 interviews at the subnational level. Results: While there was general awareness of the Government's activities as part of the SUN movement, key individuals at the national level were, in general, not able to identify specific actions that had been launched as a result of the 2013 National Nutrition Programme. Linkages between policy and program initiatives between national and sub national levels varied. The vertical and horizontal collaborations were most active where a specific, coordinating body or mechanism had been established. Several models of effective implementation are identified and most often originate outside the health sector. Conclusions: Two dominant models of implementing a multi pronged strategy to alleviate malnutrition exist in Ethiopia. The appropriateness of these models and factors associated with each are discussed.