Dietary patterns in relation with nutritional outcomes and associated factors among adolescents: implications for context-specific dietary intervention for the Agrarian Community, Northwest Ethiopia.

Introduction: Dietary pattern analysis allows us to characterize the dietary intakes of individuals rather than nutrient intake data and strongly predicts disease risks. The relationship between food intake and adolescents' nutritional health is not well understood yet. Therefore, this study aimed to generate evidence for context-specific dietary intervention for adolescents. Objective: This study aimed to determine dietary patterns and their relationship with nutritional outcomes and identify the contributing factors among adolescents in the Agrarian Community of Northwest Ethiopia. Methods: A cross-sectional survey was conducted among 622 randomly selected adolescents. Dietary data were collected over a 1-week recall period using the Food Frequency Questionnaire (FFQ). After testing the basic assumptions, an exploratory factor analysis was conducted to determine the dietary patterns. Anthropometric data on weight and height were collected to determine the nutritional status using WHO Anthroplus 2010 software. A chi-square test was conducted to evaluate the effect of different dietary patterns on nutritional outcomes. A multivariable binary logistic regression model was used to identify factors affecting the dietary patterns of adolescents. Result: Three types of dietary patterns, namely, traditional, mixed, and animal-source foods with traditional alcoholic beverage consumption were identified. These dietary patterns explain 58.64% of the variance in adolescent diet in the study setting. The burden of stunting was 15.12% vs. 11.21, 19.40% vs. 6.94, and 8.36% vs.17.97% among adolescents with lower traditional, mixed, and higher animal sources with alcoholic dietary pattern consumption habits, respectively (value of p <0.05). Adolescents who resided in low-land agroecology (AOR = 2.44; 95% CL: 1.24, 4.81) and had access to animal-source foods (AOR = 1.64; 95% CI: 1.04, 2.60) were associated with lower consumption of traditional dietary patterns. Similarly, adolescents who resided in low-land (AOR = 1.80; 95% CI: 1.18, 2.74) had formal education (AOR = 2.38; 95% CI: 1.35, 4.19) and had poor nutrition knowledge (AOR = 2.83; 95% CL: 1.55, 5.19) were associated with lower consumption of mixed dietary patterns. Moreover, adolescents residing in the high-land (AOR = 2.50; 95% CI: 1.37, 4.56) and being female (AOR =1.87; 95% CI: 1.27, 2.74) were significant factors associated with lower consumption of animal-sourced foods with traditional alcoholic beverage consumption patterns. Conclusion: Multidimensional modifiable factors were explored that could be targeted for public health interventions for the identified dietary patterns. Integrated and multifaceted dietary intervention approaches are needed to promote healthy diets and discourage the consumption of unhealthy diets to reduce undernutrition in the study area and similar settings.

Nutritional composition of some wild edible plants consumed in Southwest Ethiopia.

Wild Edible Plants (WEPs), namely Chaw (Solanum nigrum L.), Shutamodoroy (Vigna membranacea A. Rich), Entut (Dioscorea praehensilis Benth.), Gagut (Trilepisium madagascariense D.C.), and Tikawoch (Cleome gynandra L.), are naturally grown WEPs and are consumed by the Meinit cultural community in the Bench Maji zone of southwest Ethiopia. However, their nutritional and anti-nutritional compositions of these WEPs have not been documented. In this regard, the proximate, mineral and anti-nutrient contents of the edible portions of these WEPs were analyzed using standard food analysis methods. The nutritional analysis revealed that the WEPs contain valuable nutrients in the following ranges: protein (4.0-21.7%), fat (0.7-6.1%), fiber (8.9-22.3%), carbohydrates (38.1-83%) and energy (275-371.1 kcal/100 g). These WEPs were also rich in macro and micro minerals such as calcium (3.7-594.8 mg/100 g), potassium (440.6-1487.8 mg/100 g), sodium (174.9-277.4 mg/100 g), magnesium (68.2-588.1 mg/100 g), iron (0.8-38.5 mg/100 g), zinc (2.4-5.9 mg/100 g) and copper (0.1-0.5 mg/100 g). The phytate, condensed tannin, and oxalate content of WEPs varied from 8.6 to 307.3 mg/100 g, 5.8-329.0 mg/100 g, and 43.7-443.9 mg/100 g, respectively. The result indicated that these WEPs are rich sources of nutrients that could help combat nutrient deficiencies, particularly in rural communities. The results of this study can be used as baseline information for the nutraceuticals industry and community-based nutrition practitioners.

Phytochemical profile and antioxidant capacity of some wild edible plants consumed in Southwest Ethiopia.

Wild edible plants (WEPs) such as Solanum nigrum L., Vigna membranacea A. Rich., Dioscorea praehensilis Benth., Trilepisium madagascariense DC., and Cleome gynandra L. are widely used for various forms of culinary and folk medicine in Southwest Ethiopia. However, the phytochemical content of these plants is not explored. Thus, this study aimed to determine the total phenols, flavonoids, antioxidants, vitamin C, and ß-carotene in edible parts of the plants. Edible parts were oven-dried and extracted with methanol. Total phenolic content (TPC) and total flavonoid content (TFC) were determined using Folin Ciocalteu and Aluminium chloride colorimetric methods, respectively. In vitro, antioxidant activities were evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) tests. ß-carotene and vitamin C content were assessed using spectrophotometric and titration, respectively. TPC ranged from 0.25 ± 0.06 mg GAE/g in D. praehensilis tuber to 35.73 ± 2.52 mg GAE/g in S. nigrum leaf, while TFC varied from 0.85 ± 0.03 to 11.25 ± 0.01 mg CE/g in D. praehensilis tuber and C. gynandra leaf. In the DPPH assay, the antioxidant value ranged from 50.09% in D. praehensilis tuber to 87.63% in S. nigrum leaf; while in the FRAP assay, the value ranged from 49.16 ± 2.13 in D. praehensilis tuber to 188.12 ± 1.13 mM Fe2+/100 g in S. nigrum leaf. Similarly, ß-carotene content was recorded between 11.81 ± 0.00 mg/100g in D. praehensilis tuber to 34.49 ± 0.95 mg/100g in V. membranacea leaf. The concentration of vitamin C ranged from 10.00 ± 0.61 in D. praehensilis tuber to 45 ± 1.80 mg/100g in V. membranacea leaf. The results showed strong positive correlations between FRAP and TPC (r = 0.94), and FRAP and vitamin C (r = 0.93). S. nigrum and C. gynandra contain abundant levels of TPC and TFC. V.membranacea leaf contains a good source of vitamin C and ß-carotene. These WEPs contribute a natural supply of dietary antioxidants that prevent oxidative stress.

Aflatoxin contamination in red pepper from producers in Addis Ababa.

This study was conducted to determine the occurrence and levels of aflatoxins in powder red pepper. Thirty powder red pepper samples commercially available in Addis Ababa market were collected and the level of aflatoxins (AFB1, AFB2, AFG1, and AFG2) was determined. Aflatoxins were detected in almost all of the samples at concentrations ranging from 0.4 to 52.3 µg/kg. AFB1 was detected in all of the red pepper samples, with levels ranging from 1.8 to 33.3 µg/kg. Out of all the AFB1 positive samples, 25 (83%) contained AFB1 above the EU limit of 5 µg/kg, while 29 (97%) of the samples exceeded the maximum limit of 10 µg/kg for total aflatoxins. Further, all the red pepper samples were contaminated by AFG1 with levels ranging from 0.7 to 52.3 µg/kg. Overall, the majority of the red pepper collected in Addis Ababa market was contaminated by aflatoxins above the EU limit.

Exploring barriers to diversified dietary feeding habits among adolescents in the agrarian community, North West Ethiopia.

Introduction: Adolescence is a critical and neglected age group of the population in any form of nutritional intervention. A comprehensive study that assesses barriers that influence their diversified feeding habit is not well investigated in qualitative approaches. Therefore, this study was conducted to fill this gap by providing evidence on exploring barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia. Objective: The aim of the study was to explore barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia. Methods: A phenomenological qualitative study design was conducted among adolescents in the age group of 10-19 years, and adults in the age range of 25 to 64 years (representatives of farmers, agricultural, health, and education sectors). We conducted 24 in-depth interviews (12- adolescents, 4-health, 2- agricultural extension, 3-education, and 3-farmer representative) among purposively selected community groups. In-depth interview guides and observation checklist were utilized for data collection. The audio-recorded qualitative data were transcribed word by word into English. Finally, the translated data were exported to ATLAS ti version 7.1 software for thematic analysis based on inductive content analysis. All coded quotations, including memos written throughout the coding process, were then analyzed to identify themes inductively. Results: Dietary habit of adolescents in the study area was predominantly plant-based cereals with low protein, vitamins, and mineral contents. Adolescents have limited consumption of fruits, vegetables, and animal source foods. Adolescents with these feeding habits had suboptimal intake of micronutrients and proteins, which are crucial for their rapid growth stage. Individual-level barriers, family-level influence, dietary tradition of community, agricultural practice (poor agroforestry practice of the community, and poor agricultural practice to produce year-round diverse food items), and week multi-sectorial collaboration for nutritional intervention all influenced adolescent dietary habits. Conclusion: Multiple layers of barriers influenced the diverse dietary habits of adolescents in the study setting. These multiple and interconnected influences ranged from individual level to multi-sectorial collaboration. Nutritional interventions should be implemented at the individual, family, agricultural, and multi-sectorial levels to improve adolescents' diverse dietary habits.

Validation of a HACCP community-based infants' complementary food safety assurance method in cash crop producing communities in Gedeo zone, Southern Ethiopia.

A method based on a hazard analysis critical control point (HACCP)-based standard operating procedure (SOP) has been developed and implemented in community-based (CB) production of complementary foods (CFs) in agrarian regions in rural Ethiopia. The objective of this study was to validate the method in another setup, more specifically in cash crop (coffee and khat) producing communities in Southern Ethiopia. A quasi-experimental study was employed for the method validation. Two villages in the Gedeo zone, Southern Ethiopia were selected and a total of 40 mother-child pairs, 20 in each village, were involved in the study. Sociodemographic data, knowledge, and complementary feeding practices were collected using pretested questionnaires. The training was given to each mother for 1 h about community-based CFs production and implementation of the method. Then, 30 CF samples were collected and the level of aflatoxins (AFB1, AFB2, AFG1, and AFG2) was determined using a validated method. The majority (77.5%) of the mothers understand the importance of complementary feeding and give it to their infants beyond 6 months. Nearly two-thirds (62.5%) of the mothers had knowledge about the health impacts of aflatoxins, but the remaining 37.5% lacked awareness about the health risks of aflatoxins. Mothers were very well-motivated for the training and they promised to implement the knowledge and skill gained from the training for improving the nutritional status of their children. Overall, 23.3% of the CFs were contaminated by aflatoxins. AFB1 and AFG1 were detected in 6.7 and 16.7% of the CF samples, respectively. In cash crop-producing communities around the country, the HACCP-based SOP is easily validated in CB CFs production. Therefore, a scaleup of the method at the national level and beyond is recommended.

Household, dietary and healthcare factors predicting childhood stunting in Ethiopia.

Stunting, decidedly prevalent in Ethiopia, is a reduction of linear growth associated with a series of adverse consequences. However, little is known about its determinants and factors associated in Ethiopia and elsewhere. Therefore, this study aimed to determine major undelying factors associated with risk of stunting among under-five children in Ethiopia. We used the 2016 Ethiopian Demographic and Heath Survey (EDHS) data and analysed a total of 11,023 children aged 0-59 months' data. Bivariate and multivariate logistic regression were fitted to identify key predictors and factors associated with stunting. Results show that, household and demographic factors such as maternal education (AOR: 0.67, 95% CI: 0.51, 0.89), wealth index (AOR: 0.65 (0.54, 0.78), sex of child (AOR: 0.78 (0.72, 0.85), possession of refrigerator (AOR: 0.57 (0.36, 0.89), possession of television and others like twin birth, house main floor material, types of cooking fuel were significantly association with stunting. Among dietary factors, early initiation of breast feeding; feeding powdered or fresh milk (AOR: 0.63 (0.52, 0.76); formula feeding (AOR: 0.41 (0.21, 0.81); consumption of organ meat(s) (AOR: 0.52 (0.32, 0.85) and beta-carotene rich fruits and vegetables were significantly associated lower odds of stunting. Antenatal care (ANC) follow-up, deworming during pregnancy (AOR : 0.11 (0.02, 0.74), institutional delivery (AOR : 0.64 (0.58, 0.71) and birth size (AOR: 5.1 (1.64, 15.88) were among the health care factors associated with stunting of under-five children. In conclusion, stunting is modulated by several household, dietary and healthcare factors, both at household and community-level. Likewise; improving household income, women empowerment, dietary diversity among mothers and children and improving maternal health care system are critical to mitigate under-five stunting more rapidly.

Effects of fermentation and malt addition on the physicochemical properties of cereal based complementary foods in Ethiopia.

Complementary foods (CFs) in Ethiopia are characterised by bulkiness, and poor nutrient density as these foods are primarily made of starchy staples. Meanwhile, several modification techniques are available to improve the quality of the starch-based CFs. The objective of this study was to examine the effect of fermentation time and malt concentration on cereal-based CFs in Ethiopia, intending to improve the nutrient density and reduce dietary bulkiness. Oats, barley and teff flours, with added malt at different concentrations (0, 2 and 5%), were spontaneously fermented for 0, 24 and 48 h. The physical, chemical and sensory properties of the fermented CFs flour were evaluated. The protein, fat, fibre, energy, phytate, tannin, bulk density, water absorption capacity (WAC) and viscosity ranged between 8.12-16.82%, 1.63-4.55%, 1.58-5.96%, 359.33-380.26kcal/100g, 18.63-175.07mg/100g, 0.84-42.89mg/100g, 0.66-0.99 g/ml, 61.33-143.12%, 235cP-1016.33cP, respectively. For all the three kinds of cereal, fermentation for 24 h resulted in a better sensory quality regardless of the malt concentration. Crude fibre, crude fat, total carbohydrate, phytate, tannin, bulk density and viscosity of the three kinds of cereal were significantly reduced due to the interaction of fermentation and addition of malt. Conversely, crude protein and calorific value were significantly increased by the interaction. Addition of 2% malt and fermentation of the cereal flours for 24 h increased energy density and palatability, reduced dietary bulkiness and viscosity of CFs, which in turn will increase food intake by infants and young children.

Total aflatoxins in complementary foods produced at community levels using locally available ingredients in Ethiopia.

This study was conducted to determine the occurrence and levels of total aflatoxins in complementary foods (CFs) and their ingredients. A total of 126 samples collected from 20 Districts from Amhara, Tigray, Oromia, and Southern Nations Nationalities and Peoples (SNNP) regions were analysed for levels of total aflatoxins using enzyme linked immunosorbent assay (ELISA). Aflatoxins were detected in 62 out of 66 pre-milling samples with mean range of 0.3-9.9 µg/kg. Aflatoxins were also detected in 19 out of 20 post-production CFs and in all of the one-month stored CFs at households and grain banks, with a mean range of 0.5-8.0, 3.6-11.3, and 0.2-12.4 µg/kg, respectively. Overall, 3 out of 126 samples exceeded the maximum limit (10 µg/kg). Although most aflatoxin levels were below the maximum limit and thus considered to be safe for consumption, more effort should be implemented to reduce contamination, as these CFs are intended for consumption by young children.

Assessment of aflatoxin exposure among young children in Ethiopia using urinary biomarkers.

The direct measurement of biomarkers of exposure in biological fluids such as urine has become important for assessing aflatoxin exposure in humans as it is the only tool that integrates exposures from various routes. For this reason, a study was conducted to assess aflatoxin exposure among young children in Ethiopia using urinary biomarkers. A cross-sectional study was conducted in ten Woredas (Districts) from Amhara and Tigray regional states of Ethiopia including 200 children (aged 1-4 years). A total of 200 urine samples were collected from 200 children and assessed for the levels of aflatoxin B1 (AFB1), aflatoxin B2 (AFB2), aflatoxin G1 (AFG1), aflatoxin G2 (AFG2) and aflatoxin M1 (AFM1) using a validated LC-MS/MS method. Aflatoxins were detected in 34/200 (17%) of the urine samples whereby four out of five analysed aflatoxins were detected. AFM1 was detected in 14/200 (7%) of the urine samples in a range of 0.06-0.07 ng/mL. AFB2, AFG2 and AFG1 were detected in respectively 9/200 (4.5%), 6/200 (3%) and 5/200 (2.5%) of the urine samples whereas AFB1 was not detected in any of the samples. In this study, there was no association between the different malnutrition categories (stunted, wasting and underweight) and aflatoxin exposure. However, the biomarker analysis showed a clear exposure of young children to aflatoxins. Therefore, awareness to the public is important to prevent potential health consequences of aflatoxins.