Calculator for inadequate micronutrient intake for Ethiopia (CIMI-Ethiopia): Validation of the software for lactating mothers and their children under 2 years.

Early identification of inadequate intake of nutrients from a person's diet is usually crucial to prevent the development of micronutrient malnutrition. However, there is no single dietary assessment tool for Ethiopia that can assess the nutrient intake of a person from the type of food she or he consumed with a given amount. Therefore, the Calculator for Inadequate Micronutrient Intake (CIMI) application was adapted in consideration of food and nutrition contexts in Ethiopia and validated for its suitability to compute nutrient intake and identify nutrient intake inadequacy. For this, a 24-h recall quantitative dietary data of children aged 12-23 months (n = 781) and lactating mothers (n = 1086) were collected between February 15 and 30, 2017, from rural Genta Afeshum district, Tigray region, Ethiopia. An individual nutrient intake was estimated by calculating using CIMI-Ethiopia and also by NutriSurvey (NS) software for comparison. The average (mean and median) intake of energy and most nutrients and the prevalence of inadequacy calculated by the two software for the children aged 12-23 months and lactating mothers were comparable, except that of the vitamin A. The correlation coefficients for the intake results calculated by CIMI-Ethiopia and NS were between 0.85 and 0.97 for the children and between 0.5 and 0.96 for the lactating mothers' group. Most of the mean intake differences calculated by the two methods were within the acceptable limits, except for the vitamins A, D, and B12 in the Bland-Altman plots. CIMI-Ethiopia is very sensitive to identifying energy, protein, and selected micronutrients inadequacy included in this study, both for the lactating mothers (84.1%-100%) and 12-23-month-old children (77.6%-100%) group. Our results showed that CIMI-Ethiopia estimates the energy and nutrient intake, and can be also used as a screening tool to identify energy, protein, and selected micronutrients inadequacy from an individual woman's and child's diet in rural Tigray, Ethiopia.

Feeding Practices and Undernutrition in 6⁻23-Month-Old Children of Orthodox Christian Mothers in Rural Tigray, Ethiopia: Longitudinal Study.

Fasting period and fasting status affect the feeding practices and nutritional status of Ethiopian Orthodox mothers. Even if children are exempted from fasting, some mothers do not prepare their food from animal sources as it could contaminate utensils for cooking family foods. Therefore, the objective of this study was to assess feeding practices and undernutrition in 6⁻23-months old children whose mothers are Ethiopian Orthodox religion followers during lent fasting and non-fasting periods in rural Tigray, Northern Ethiopia, and to identify associated factors. A community-based longitudinal study was carried out in Ethiopian Orthodox lent fasting and non-fasting periods. Using a multi-stage systematic random sampling technique, 567 and 522 children aged 6⁻23 months old participated in the fasting and non-fasting assessments, respectively. Statistical analyses were done using logistic regression, an independent sample t-test, Wilcoxon signed-rank (WSRT) and McNemar's tests. The prevalences of stunting, underweight and wasting were 31.6⁻33.7%, 11.7⁻15.7% and 4.4⁻4.8%, respectively. The weight-for-height (WHZ) and height-for-age (HAZ) values for children of fasting mothers were significantly lower (p < 0.05) compared to those of non-fasting mothers. Likewise, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly higher in non-fasting than in fasting periods. A small proportion of children (2.3⁻6.7%) met the minimum acceptable diet (MAD) in the study population, but these measures were significantly increased (p < 0.001) in the children of non-fasting mothers. Mother's fasting during lactation period of the indexed child was amongst the independent factors common in child stunting, underweight and wasting. Nutritional status and feeding practices of 6⁻23-month-old children are affected by maternal fasting during the fasting period. Therefore, without involvement of religious institutions in the existing nutritional activities, reduction of undernutrition would not be successful and sustainable.

Ethiopian Orthodox Fasting and Lactating Mothers: Longitudinal Study on Dietary Pattern and Nutritional Status in Rural Tigray, Ethiopia.

About half of Ethiopians belong to the Orthodox Tewahedo religion. Annually, more than 200 days are dedicated to religious fasting, which includes abstaining from all types of food, animal source foods, and water. However, the association of fasting with undernutrition remains unknown in Ethiopia. Therefore, dietary pattern and nutritional status of lactating women during lent fasting and non-fasting periods were studied, and predictor variables for maternal underweight were identified. To achieve this, lactating mothers in lent fasting (N = 572) and non-fasting (N = 522) periods participated from rural Tigray, Northern Ethiopia. Average minimum diet diversity (MDD-W) was computed from two 24-h recalls, and nutritional status was assessed using body mass index (BMI). Binary logistic regression was used to identify potential predictors of maternal underweight. Wilcoxon signed-rank (WSRT) and McNemar's tests were used for comparison of the two periods. The prevalence of underweight in fasting mothers was 50.6%. In the multivariate logistic regression model, younger age, sickness in the last four weeks preceding the survey, fasting during pregnancy, lactation periods, grandfathers' as household decision makers, previous aid experience, non-improved water source, and not owning chicken were positively associated with maternal underweight. In WSRT, there was no significant (p > 0.05) difference on maternal body weight and BMI between periods. The average number of meals, diet diversity, and animal source foods (ASFs), consumption scores were significantly increased in non-fasting compared to fasting periods in both fasting and non-fasting mothers (p < 0.001, p < 0.05, and p < 0.001, respectively). Consumption of dark green leafy vegetables was higher in the fasting period (11%) than non-fasting (3.6%), in the study population. As a conclusion, Ethiopian Orthodox fasting negatively affected maternal nutritional status and dietary pattern in rural Tigray, Northern Ethiopia. To reduce maternal malnutrition in Ethiopia, existing multi-sectoral nutrition intervention strategies, should include religious institutions in a sustainable manner.