Archive for May, 2016

Scale up of nutrition and health programs in Ethiopia and their overlap with reductions in child stunting

Wirth JP, Matji J, Woodruff BA, Chamois S, Getahun Z, White JM, Rohner F

May 2016 – Maternal & Child Nutrition

In Ethiopia, the national stunting prevalence and number of stunted children have decreased consistently since 2000. We compare regional differences and temporal patterns in stunting with large-scale program coverage to identify where and when programs may have led to reductions in stunting. Data from three national demographic and health surveys and population statistics illustrate, at the regional level, where andwhen the prevalence and number of stunted children changed since 2000.Reports from large-scale nutrition and health programs were used to identify ecologic associations between geographic program coverage and reductions in stunting. From 2000 to 2005, the decline in the national stunting prevalence was mainly a result of reductions in Oromiya, SNNP and Tigray. Few nutrition programs had high coverage during this time, and economic growth may have contributed to stunting reduction by increasing household wealth and investments in sanitation. From 2005 to 2011, declines in stunting prevalence in Amhara, SNNP, Somali and Oromiya were largely responsible for national reductions. Numerous programs were implemented at scale and could have plausibly improved stunting. While ecologic relationships suggest that economic growth and large-scale programs may have contributed to the reduction in stunting in Ethiopia, stunting did not decrease in all regions despite increased program coverage expansion of the health system.

Assessment of the WHO Stunting Framework using Ethiopia as a case study

Wirth JP, Rohner F Petry N Onyango AW, Matji J, Bailes A, de Onis M, Woodruff BA

May 2016 – Maternal & Child Nutrition

Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the ‘WHO framework’) that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhoea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts.

Determinants of stunting reduction in Ethiopia 2000 – 2011

Woodruff BA, Wirth JP, Bailes A, Matji J, Timmer A, Rohner F

May 2016 – Maternal & Child Nutrition

The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0–59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height-for-age z-scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6months, 6–23 months, and 24–59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children<6months of age, only mother’s height was both a significant predictor of HAZ and showed a progressive, albeit non-significant, increase from 2000 to 2011. In children 6–23 months of age, only mother’s use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24–59 months of age a consistent and progressive change is seen in child’s diarrhea, fever, mother’s education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child’s age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5 years of age include markers of child health, mother’s nutritional status, mother’s educational level, and environmental hygiene.

Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak – Findings of a Cross-Sectional Study

Wirth JP, Rohner F, Woodruff BA, Chiwile F, Yankson H, Koroma AS, Russel F, Sesay F, Dominguez E, Petry N, Shahab-Ferdows S, de Onis M, Hodges MH

May 2016 – PLOS ONE

To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, a nationally representative cross-sectional survey was conducted in rural and urban areas of Sierra Leone. Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence of anemia (76.3%), malaria (52.6%), and acute and chronic inflammation (72.6%) was high. However, the prevalence of vitamin A deficiency (17.4%) was moderate, and the prevalence of iron deficiency (5.2%) and iron-deficiency anemia (3.8%) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8%, 35.1%, and 23.6% were affected by anemia, malaria, or inflammation, respectively. The prevalence of iron deficiency (8.3%), iron-deficiency anemia (6.1%), vitamin A deficiency (2.1%) and vitamin B12 deficiency (0.5%) were low, while folate deficiency was high (79.2%). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone, and other causes of anemia, such as hemoglobinopathies, should also be explored.

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