Prevalence of Anemia and Associated Factors among Secondary School Adolescent Girls in Jimma Town, Oromia Regional State, Southwest Ethiopia.

BACKGROUND: Anemia defined as a low blood hemoglobin concentration is public health importance. The adolescence age group is the most neglected in public health and nutrition research as priorities are usually given to pregnant women, lactating mothers, and their children less than 2 years. Current Ethiopian Food and Nutrition policy included adolescent girls in the most at-risk group for nutritional demands; however, only a few published studies have assessed a deficiency of anemia and associated factors to tackle the intergenerational cycle of malnutrition. OBJECTIVE: To assess the prevalence of anemia and associated factors among high school adolescent girls in Jimma town. METHODS: Data were collected from 528 secondary school adolescent girls by a school-based cross-sectional study design in Jimma town from 1/1/2019 to 1/2/2019, southwest Ethiopia. A multistage sampling technique was used to select the study participants. A portable battery-operated HemoCue Hb 301+ analyzer was used to measure the hemoglobin level, and then reading was classified as normal Hb ≥ 12 g\dl and anemic if the hemoglobin value <12 g/dl based on the WHO 2011 recommended cutoff points after adjustments to altitude was made. Bivariate analysis at p value ≤0.25 was considered as a candidate for multivariable logistic regression. Multivariable logistic regression was done to control for confounders and to identify factors independently associated with anemia. Level of statistical significance was declared at p < 0.05. RESULTS: A total of 528 adolescent girls were included in the study yielding a response rate of 95.8%. The prevalence of anemia was found to be 26.7%, 95% CI (22.7, 30.50). In multivariate logistic regression analysis, those living separately from their family (AOR = 4.430, 95% CI (2.20, 8.90)), low dietary diversity score (AOR = 3.57, 95% CI (1.88, 6.75)), menstrual bleeding more than 5 days (AOR = 2.25, 95% CI (1.17, 4.33)), and low economic status (AOR = 2.16, 95% CI (1.17, 4.33)) were positively associated factors with anemia and only having at least a secondary school in mother's educational status AOR = 0.43, 95% CI (0.18, 0.97) was negatively associated with anemia in the study area. CONCLUSION: Prevalence of anemia among school adolescent girls was moderate public health importance according to the World Health Organization prevalence estimation of anemia. The living condition of the adolescent girls, dietary diversity score, duration of menses, and low economic status were positive predictor variables, whereas mothers who are being secondary school and above was a protective factor for anemia. Therefore, iron-rich and diversified food consumption should be given attention.

A health facility based case-control study on determinants of low birth weight in Dassie town, Northeast Ethiopia: the role of nutritional factors.

BACKGROUND: Low birth weight remains a major public health problem affecting developing countries. Evidence shows that low birth weight has long lasting negative health consequences through its contribution to stunting, mental impairment and non-communicable chronic diseases in later life. Thus, it is worth investigating the role of nutritional factors as determinants of low birth weight to suggest nutritional interventions to curb its negative health outcomes. This study aimed to investigate the determinants of low birth weight with main focus on the role of nutritional factors in Ethiopia. METHODS: A facility-based case-control study was conducted from 3 February to 29 April, 2017. The data were collected using structured, pretested interviewer-administered questionnaire in all public health facilities of Dessie Town. Anthropometric measurements were made following standard procedures for both mothers and their newborns. Consecutive live births of < 2500 g and two succeeding normal weight babies were selected as cases and controls, respectively. Data were entered in to Epi-data software version 3.1, and exported to SPSS version 21, and analyzed using frequency, mean and percentage. Factors with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model to determine significant determinants of LBW. Statistical significance was considered at p < 0.05. Results were reported with odds ratio and 95% CI. RESULTS: Mean ± SD of birth weight (g) was 2138 ± 207 for cases and 3145 ± 415 for controls. After adjusting for potential confounders using multivariable logistic regression analysis, the absence of iron and folate supplementation, receiving no nutritional counseling and consuming no additional meal, maternal undernutrition, maternal anemia and inadequate dietary diversity during the current pregnancy were found to be significant determinants of low birth weight in our study. CONCLUSION: Lack of nutritional counseling, absence of additional meal intake and iron and folate supplementation during pregnancy, and maternal undernutrition, maternal anemia and inadequate maternal dietary diversity were significant determinants of low birth weight. The importance of nutritional counseling, improving iron and folate supplementation during pregnancy, and nutritional status of pregnant women need to be strengthened to reduce the incidence of LBW in Ethiopia. In addition, behavioral change communications targeting pregnant women to improve women dietary diversity and their extra meal intake practice need to be enhanced in Ethiopia.

Optimal cut-off for obesity and markers of metabolic syndrome for Ethiopian adults.

BACKGROUND: Metabolic syndrome (MetS) is defined as the presence of central obesity plus any two of the following markers: high triglycerides (> 150 mg/dl), low high density lipoprotein (HDL) cholesterol < 40 mg/dl in men and < 50 mg/dl in women, hypertension (blood pressure > 130/85 mmHg or use of antihypertensive medication), high fasting blood glucose (> 100 mg/dl or use of treatment for diabetes mellitus). Since recently, metabolic syndrome and obesity have become emerging problems of both low and middle income countries, although they have been the leading cause of morbidity and mortality in high income countries for the past decades. It has been indicated that the international anthropometric cut-off for detecting obesity is not appropriate for Ethiopians. This study developed optimal cut off values for anthropometric indicators of obesity and markers of metabolic syndrome for Ethiopian adults to enhance preventive interventions. METHODS: A total of 704 employees of Jimma University were randomly selected using their payroll as a sampling frame. Data on socio-demographic, anthropometry, clinical and blood samples were collected from February to April 2015. Receiver Operating Characteristic Curve analyses were used to determine optimal anthropometric cut-off values for obesity and markers of the metabolic syndrome. WHO indicators of obesity based on body fat percent (> 25% for males and > 35% for females) were used as binary classifiers for developing anthropometric cut-offs. Optimal cut-off values were presented using sensitivity, specificity and area under the curve. RESULTS: The optimal cut-off for obesity using body mass index was 22.2 k/m2 for males and 24.5 kg/m2 for females. Similarly, the optimal waist circumference cut-off for obesity was 83.7 cm for males and 78.0 cm for females. The cut-off values for detecting obesity using waist to hip ratio and waist to height ratio were: WHR (0.88) and WHtR (0.49) for males, while they were 0.82 and 0.50 for females, respectively. Anthropometric cut-off values for markers of metabolic syndrome were lower compared to the international values. For females, the optimal BMI cut-offs for metabolic syndrome markers ranged from 24.8 kg/m2 (triglycerides) to 26.8 kg/m2 (fasting blood sugar). For WC the optimal cut-off ranged from of 82.1 cm (triglyceride) to 96.0 cm(HDL); while for WHtR the optimal values varied from 0.47(HDL) to 0.56(fasting blood sugar). Likewise, the optimal cut-offs of WHR for markers of metabolic syndrome ranged from 0.78(fasting blood sugar) to 0.89(HDL and blood pressure). For males, the optimal BMI cut-offs for metabolic syndrome markers ranged from 21.0 kg/m2 (HDL) to 23.5 kg/m2 (blood pressure). For WC, the optimal cut-off ranged from 85.3 cm (triglyceride) to 96.0 cm(fasting blood sugar); while for WHtR the optimal values varied from 0.47(BP, FBS and HDL) to 0.53(Triglyceride). Similarly, the optimal cut-offs of WHR form markers of metabolic syndrome ranged from 0.86(blood pressure) to 0.95(fasting blood sugar). CONCLUSION: The optimal anthropometric cut-offs for obesity and markers of metabolic syndrome in Ethiopian adults are lower than the international values. The findings imply that the international cut-off for WC, WHtR, WHR and BMI underestimate obesity and metabolic syndrome markers among Ethiopian adults, which should be considered in developing intervention strategies. It is recommended to use the new cut-offs for public health interventions to curb the increasing magnitude of obesity and associated metabolic syndrome and diet related non-communicable diseases in Ethiopia.

Serum Vitamin D Level Associates With Handgrip Muscle Strength Among Ethiopian Schoolchildren: A Cross-Sectional Study.

BACKGROUND: Despite varying serum levels of 25(OH)D among schoolchildren in Ethiopia, data are lacking whether this affects their muscle function as measured by handgrip strength of these children. Handgrip strength may be used as a proxy indicator of muscle strength and function. This study evaluated the association between serum levels of 25(OH)D and handgrip strength among schoolchildren in Ethiopia. METHODS: The study used a data set from a school-based cross-sectional study conducted on a total of 174 randomly selected schoolchildren from urban (N = 89) and rural (N = 85) settings of Adama Town and Adama Woreda, respectively. Handgrip strength, serum 25(OH)D levels, and anthropometry were measured for each child following standard procedures, while data on demographic characteristics of children and their parents were collected using a structured interviewer-administered questionnaire. A multivariable linear regression model was used to determine the association between serum vitamin D level and handgrip strength after adjusting for other predictors. RESULTS: The mean handgrip muscle strength of the students was 17.6 ± 6.9 kg. The average serum 25(OH)D for the group was 54.5 ± 15.8 nmol/L. On multivariable linear regression model, serum 25(OH)D level was significantly associated with handgrip strength (ß = 0.06, P = .008) of the children after controlling for potential confounders. Other variables, female gender (ß = -2.20, P = .004), age (ß = 1.97, P < .001), height (ß = .22, P < .001), weight (ß = 0.33, P < .001), and triceps skinfold thickness (ß = -0.19, P = .023), were identified to have significant association with handgrip strength of schoolchildren. CONCLUSION: Serum 25(OH)D levels had significant positive association with handgrip strength of Ethiopian schoolchildren. The results imply the need for incorporating school nutrition education on consumption of foods rich in important nutrients including vitamin D-rich foods in the school curricula and also enhancing behavioral change communication toward exposure to sunlight in the school to produce adequate vitamin D. Further longitudinal study involving a larger sample is recommended to confirm the findings.

Vitamin D Deficiency is Associated with Overweight and/or Obesity among Schoolchildren in Central Ethiopia: A Cross-Sectional Study.

Childhood and adolescent obesity is an international public health problem leading to an increased risk of adulthood obesity, mortality and morbidity. Its prevalence is increasing in low-income populations, and we hypothesized it may be associated with vitamin D deficiency. Low vitamin D status is a worldwide public health issue including in Ethiopia; however, no one has examined overweight/obesity in Ethiopian schoolchildren with regard to vitamin D status. The Analyses of a data set from a school-based cross-sectional study conducted in Adama Town (n = 89) and in rural Adama Woreda (n = 85) was carried out to determine vitamin D deficiency and its association with overweight and/or obesity. Data on a total of 174 schoolchildren aged 11-18 years was used for these analyses. The overall prevalence of overweight and/or obesity was 10.3%, with 8.5% overweight and 2.3% obese; the prevalence of underweight was 19%. In the multivariable logistic regression model, vitamin D deficiency, being in the higher age group, female sex and urban residence of students, their mothers' occupation of being employed and their households' high and middle socioeconomic status were significantly associated with overweight and/or obesity. We concluded that vitamin D deficiency is an independent predictor significantly associated with overweight and/or obesity among schoolchildren from rural and urban settings in Ethiopia. The results imply the need for behavior change communications on the importance of exposure to sunlight to produce adequate vitamin D to curb this emerging health problem of overweight/obesity following economic growth and globalization in Ethiopia. As this study only highlighted the association, prospective studies and randomized controlled trials are required to establish causality.

Vitamin D deficiency and its predictors in a country with thirteen months of sunshine: the case of school children in central Ethiopia.

Studies examining vitamin D status among children living in sunny climates indicated that children did not receive adequate vitamin D, however, this has not been looked at among children living in Ethiopia. In this study, we determined vitamin D deficiency and its predictors among school children aged 11-18 years, examining circulating 25-hydroxy vitamin D [25(OH)D]. The school-based cross-sectional study was conducted in schools in Adama Town (n = 89) and in rural Adama (n = 85) for a total sample of 174. Students were randomly selected using multi-stage stratified sampling method from both settings. Socioeconomic status of parents and demographic, anthropometric, sun exposure status and blood 25(OH)D levels were obtained. Vitamin D deficiency, defined as circulating levels of 25(OH)D <50 nmol/L, was found in 42% of the entire study participants. Prevalence of deficiency was significantly higher among students in urban setting compared to rural (61.8% vs 21.2%, respectively, p<0.001). After controlling for potential confounders using multivariable logistic regression model, duration of exposure to sunlight, amount of body part exposed to sunlight, place of residence, maternal education, body fatness, having TV/computer at home and socioeconomic status were significant predictors of vitamin D deficiency. The findings suggest that Vitamin D deficiency was prevalent in healthy school children living both in urban and rural areas of a country with abundant year round sunshine providing UVB, with the prevalence of deficiency being significantly higher among urban school children who were less exposed to sunlight. Behaviour change communication to enhance exposure to ultraviolet light is critical to prevent vitamin D deficiency in tropical country like Ethiopia. Further study is required to assess the deleterious effect of its deficiency on bone mineral homeostasis of growing children in Ethiopia during their most critical period of bone development.