The role of changing diet and altitude on goitre prevalence in five regional states in Ethiopia

Objective: Iodine Deficiency Disorders (IDD) as one of the leading nutritional problems has been increasing through time due to iodine deficiency; aggravating factors and IDD knowledge in many parts of Ethiopia. The effect of changing diet and altitude on goitre prevalence is assessed. Methodology: Randomly selected five regional states (Amhara; Oromiya; Tigray; SNNP and Benshangul-Gumuz) were used to conduct cross-sectional study on IDD. In each region cluster sampling method was applied to select study subjects. Low land and adjacent high land were independently sampled to investigate the role of altitude on goiter prevalence. Totally 6960 children and the same number of biological mothers of the children were included in the clinical examination for goiter and household interview. Urine samples were collected from children for urinary iodine examination/analysis (UIE). Besides; in all clusters qualitative data were collected on IDD knowledge and cassava introduction; cultivation and consumption. Results: Cassava consumption and living in high altitude were found to be risk factors for IDD. In the two regions (SNNP and Benshangul-Gumuz) among three where cassava is cultivated; those who consume cassava frequently were significantly (p0.001) affected by goitre than those consuming rarely or not. In the last thirty years cassava consumption has been increasing with the concomitant increase in goitre rate and other associated health problems. Acute cyanide intoxication in children from cassava meal was reported. In Amhara region; goitre rate was significantly (p0.05) higher in high altitudes than in low both for children and mothers. This was due to significantly (p0.01) low level of iodine intake in high lands than in low as indicated by UIE. Due to stigma; parents do not send goitrous children to schools and goitrous girls are not wanted for marriage. Conclusion: Besides low level of iodine intake; cassava consumption and living in high altitude were responsible for the observed variation and severity in goitre rates. IDD affects several dimensions of human life including school enrolment and marriage. Addressing IDD in-terms of salt iodization and training communities on cassava processing techniques to remove cyanide; awareness creation on IDD and soil conservation are highly recommended

Determinants of CD4 counts among HIV-negative Ethiopians: role of body mass index, gender, cigarette smoking, khat (Catha Edulis) chewing, and possibly altitude?

To study the determinants of CD4% and CD4 counts among HIV-negative Ethiopians, and to identify factors susceptible to explain the low CD4 counts observed among Ethiopian subjects. Cohort studies among factory workers in Akaki and Wonji, Ethiopia. Clinical and laboratory examinations, including determination of HIV serological status and T-cell subsets, were performed during follow-up visits every six months. In addition, micronutrients (retinol, carotenoids, tocopherol, transferrin receptor, and selenium) plasma concentrations were determined in a subset of 38 HIV-positive and 121 HIV-negative participants. HIV-negative participants with at least one CD4 count measurement were 157 females in Akaki, 203 males in Akaki, and 712 males in Wonji. CD4 counts were independently and positively associated with body mass index (through an increase in lymphocyte counts), female gender (through an increase in CD4%), cigarette smoking (through an increase in CD4%), khat chewing (through an increase in both lymphocyte counts and CD4%), and Akaki study site (through a large increase in lymphocyte counts compensating a decrease in CD4%). Intestinal parasitic infections were not associated with CD4% or CD4 counts. Retinol, carotenoids, and alpha-tocopherol plasma concentrations decreased with HIV infection and advancing immunosuppression, but were not associated with CD4 counts among HIV-negative subjects. Low body mass index among Ethiopians may have contributed to their overall low CD4 counts. Other factors remain to be elucidated.

A compositional study of Moringa stenopetala leaves.

OBJECTIVE: To investigate nutrient composition in moringa leaves and compare with those of kale (Brassica carinata) and Swiss chard (Beta vulgaris). DESIGN: Laboratory based study, nutrient composition of fresh and cooked leaves of M. stenopetala were analyzed. SETTING: Gama-Gofa, south-western Ethiopia. RESULTS: Raw M. stenopetala leaves contain 9% dry matter as crude protein, about 3-fold lower than in kale and swiss chard. M. stenopetala leaves contain higher percentage of carbohydrate, crude fiber and calcium compared to both raw and cooked kale and swiss chard. Vitamins are present at nutritionally significant levels averaging 28 mg/100g of vitamin C and 160 microg/100g of beta-carotene. Minerals such as potassium, iron, zinc, phosphorus and calcium also exist in significant concentrations with the average values of 3.08 mg/100g iron and 792.8 mg/100g calcium. CONCLUSION: Although the nutrient composition of M. stenopetala leaves in most cases is lower compared to kale and swiss chard they can be a good source of nutrients in dry season potentially when other vegetables are scarce. However, the presence of small amount of cyanogenic glucosides in M. stenopetala leaves may have a health risk in areas of high incidence of endemic goitre as an exacerbating factor if consumed more for a long period of time.

Familial tendency and dietary association of goitre in Gamo-Gofa, Ethiopia.

OBJECTIVE: To assess the familial tendency and dietary association of goitre. DESIGN: Cross-sectional study with descriptive and analytical components. SETTING: Goma-Gofa, south Ethiopia. SUBJECTS: Five hundred and ninety seven elementary school children aged 6-18 years and their biological parents. RESULTS: Prevalence of goitre was found to be 51.7% of which 21.7% was visible goitre. The mean urinary iodine extraction levels indicated adequate dietary intake of iodine by the study group. A significant association (p < 0.001) was established for familial tendency of goitre between parents and their children. Consumption of halleko (Moringa stenopetala), a leafy vegetable common in the study area, of more than two times per day was significantly (p < 0.005) associated with causation of goitre. CONCLUSION: These results strongly suggest that goitre prevalence in Gamo-Gofa, Ethiopia is due to familial tendency as well as dietary factors.

PIP: This cross-sectional study assessed the familial tendency and dietary factors associated with causation of goiter in Gamo-Gofa, Ethiopia. Data were gathered through clinical examination and collection of other information such as family history of goiter, and diet frequency. A total of 597 schoolchildren aged 6-18 years were included in the sample. Results revealed that goiter prevalence accounted for 51.7%, of which 21.7% was visible goiter. The mean urinary iodine extraction levels indicated adequate dietary intake of iodine by the study group. Furthermore, a significant association was established for familial tendency of goiter between parents and their children. Consumption of halleko (Moringa stenopetala), a leafy vegetable common in the area, more than twice a day was significantly associated with the causation of goiter. These results indicate that the causation of goiter in Gamo-Gofa is multifaceted and associated with familial tendency and the consumption of halleko.

Health effects of cassava consumption in south Ethiopia.

Health problems associated with cassava consumption was studied in three villages (Kodowono, Lotte and Woidewashe) of Gamo-Gofa, South Ethiopia. Total goitre rate (% TGR) increased with increasing rate of cassava consumption while, urinary iodine excretion (UIE) was found to be in the normal value range for the three villages. In both males and females incidence of goitre after the introduction of cassava to Kodowono village was significantly higher than before introduction of cassava (p < 0.001). This may indicate that the high rate of goitre is attributed to the frequency of cassava consumption. Of 450 individuals interviewed for health problems associated with cassava meal consumption, 50% reported that they were suffering from epigastric burning pain and dizziness while 38.7% reported abdominal distention and vomiting. Vomiting was relatively higher in the age group 20 years and below than it was in those above 20 years of age. These problems may be attributed to cassava consumption because, cassava contains cyanide which results in intoxication when poorly processed cassava meal is taken. Goitre prevalence and health problems attributed to cassava consumption therefore, necessitate an intervention programme to control iodine deficiency disorders (IDD), develop appropriate processing techniques to eliminate cassava toxicity and educate villagers on how to prepare safer meals from cassava.

The effect of varying doses of oral iodized oil in the prophylaxis of endemic goitre in elementary schools children.

The effect of oral iodine supplementation on total goitre rate (%TGR) and urinary iodine excretion among school children 4 to 16 years of age was studied. In the first group (n = 57) 200mg oral iodized oil reduced %TGR from 31.6% to 17.5% and 33.3% to 24.6% in males and females respectively, while in the second group (n = 53), 400mg iodine reduced the %TGR from 34.0% to 20.8% in males and 35.9% to 24.5% in females after 13 months of intervention. This gave a relative indication that the 200mg is as effective as the 400mg in goitre reduction. In subsequent tests, the maximum urinary iodine excretion was obtained from the groups which received two doses of iodized oil 24 hours after the intervention. A significant (p = 0.003) greater increase in urinary iodine excretion was noted at 24 hours among both male and female children administered 400mg than among those who received 200mg. Measurements after 24 hours showed no significant difference between urinary iodine excretion of the two dose groups. These results suggest that: (i) 200mg is likely equally effective as 400mg for iodine deficiency disorders control and prevention among children and (ii) iodine could be administered annually rather than biannually.