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Pitipa Chongwatpol, Elizabeth Rendina-Ruedy, Barbara J Stoecker, Stephen L Clarke, Edralin A Lucas, Brenda J Smith Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA Abstract: Compromised zinc status and chronic inflammation are independent factors that can contribute to bone loss. However, zinc's role in regulating lymphoid and myeloid cell populations, combined with the interplay between the immune and skeletal systems raises the question as to the extent to which a low-grade inflammatory challenge in the context of marginal zinc deficiency would exacerbate bone loss. To address this question, young adult C57BL/6 male mice (n=32) were used in a 2×2 factorial design with dietary zinc (adequate or 35 ppm vs inadequate or −Zn =5 ppm) and lipopolysaccharide (LPS, 0 or 0.1 mg/kg body weight). Mice were fed their respective diets for 10 weeks. On the 6th week, mice had a slow release pellet implanted to induce a low-grade inflammation for the final 4 weeks of the study. −Zn induced a decrease in total white cell counts and peripheral lymphocytes, whereas LPS increased blood monocytes. LPS significantly reduced spine bone mineral density and trabecular bone volume and number of the vertebral body compared with both zinc adequate and inadequate without LPS groups. Likewise, the most pronounced effects on bone strength occurred with LPS, however, −Zn also had negative effects on the bone von Mises stresses. LPS induced an increase in TNF-α and this response was further increased with −Zn. Although the marginal zinc deficiency altered immune function, bone loss was not exacerbated with low-grade chronic inflammation in marginally zinc-deficient young adult mice. These findings demonstrate that in young adult animals an immune challenge modestly increases the inflammatory response and worsens bone biomechanics in the context of a marginal zinc deficiency, but not to the extent that more severe adverse outcomes are observed on bone structural parameters. Keywords: chronic inflammation, zinc deficiency, osteoporosis

Background: Maternal undernutrition during pregnancy is currently estimated at 23.5% in Africa, which is worrying given the negative impacts of malnutrition on maternal and fetal birth outcomes. The current study aimed at characterizing the associations of maternal dietary intake and nutritional status with fetal growth at 14-26 weeks gestation. It was hypothesized that maternal dietary intake was positively associated with maternal nutritional status and fetal growth both in early and late pregnancy., Methods: This was a cross-sectional survey of 870 pregnant women in mid-western Uganda conducted in August 2013. Data were collected on women's dietary intake (indicated by women's dietary diversity and the diet quality score) and nutritional status (indicated by hemoglobin level and mid-upper arm circumference) at 14-26 weeks gestation. Fetal growth was determined by symphysis-fundal height Z-scores processed using the INTERGROWTH-21st calculator. Associations between maternal dietary intake and nutritional status with fetal growth were determined using correlations and chi-square tests., Results: Overall, only 25% had adequate dietary diversity and the most utilized food groups were White tubers, roots and starchy vegetables; Pulses, nuts and seeds; Cereals and grains, Dark green leafy vegetables, and Fats and oils. A larger proportion of younger women (15-29 y) were classified as anemic (20.4% versus 4.4%) and underweight (23.7% versus 5.0%) compared to older women (30-43 y). Additionally, women aged 15 to 24 years had significantly lower mean SFH-for-gestation age Z-scores than women 36-43 years (F 4, 783 = 3.129; p = 0.014). Consumption of legumes nuts and seeds was associated with reduced risk of anemia while consumption of dairy products (mostly milk) was positively associated with better fetal growth. Surprisingly, low Hb level was positively associated with normal fetal growth (r P = -0.133; p = 0.016) after 20 weeks gestation, possibly indicating normal fetal growth paralleled with physiologically necessary hemodilution., Conclusions: Sub-optimal dietary patterns, characterized by limited dietary diversity and low protein intake, are likely to compromise maternal nutrition and fetal growth in limited resource settings. Improving pregnant women's access to cheaper but nutrient-dense protein sources such as pulses, nuts and dairy products (mostly milk) has potential to improve women's nutritional status and enhance fetal growth., (© 2024. The Author(s).)

Objective: This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda., Methods: A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms., Results: The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001)., Conclusion: Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs., Trial Registration: Clinicaltrials.gov, NCT05584969., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Komakech et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Women of reproductive age (WRA) in developing countries are often at risk of micronutrient deficiencies due to inadequate intakes and excessive losses., Objective: The purpose of this trial is to assess the effectiveness of United Nations International Multiple Micronutrient Antenatal Preparation-Multiple Micronutrient Supplements (UNIMMAP-MMS) versus iron-folic acid (IFA) among WRA in reducing anemia., Methods: Three parallel groups of WRA will participate in a community-based, individually randomized, double-blinded, placebo-controlled superiority trial. After consent, the sample of 375 mildly or moderately anemic women based on hemoglobin by Hemocue will be randomly assigned across two interventions and one control arm. Trial participants in intervention arms will receive UNIMMAP-MMS or IFA while those in the control arm will receive placebos twice a week for 17 weeks. The primary outcome will be a change in mean hemoglobin (Hb) concentrations. Outcome assessors and study participants will be blinded to the type of supplements and study arm., Discussion: The World Health Organization (WHO) added UNIMMAP-MMS to its essential medicine lists in 2021 but recommended rigorous study. Several factors in addition to inadequate intakes of iron and folic acid contribute to the high prevalence of anemia among WRA in the Somali region. The findings of this study will provide evidence on the effect of UNIMMAP-MMS and IFA on Hb concentrations and anemia prevalence among anemic WRA., Trial Registration: ClinicalTrials.gov NCT05682261. Registered on January 12, 2023., (© 2024. The Author(s).)

Background: The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region., Methods: Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents., Results: Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05]., Conclusions: The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention., (© 2023. The Author(s).)

Background: Evidence suggests that forced migration and refugee status may adversely impact mothers' breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda., Methods: This study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15-16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12., Results: Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers' fear of pain during breastfeeding and maternal mental health issues., Conclusion: Interventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations., (© 2023. The Author(s).)

Background: Complementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges., Objective: This study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda., Methods: A community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding., Results: At the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7)., Conclusion: Engaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969., (© 2023 The Author(s).)

Ethiopian women have been reported to have low plasma 25-hydroxy-cholecalciferol (25(OH)D) concentrations despite an abundance of sunshine. Low dietary vitamin D intake, limited skin exposure to sun, and genetics are among factors suggested to affect vitamin D status in this population. In this study (Clinical Trial NCT02210884), we hypothesized that polymorphisms in the vitamin D binding protein (VDBP) gene (rs7041, rs4588) are associated with reduced plasma 25(OH)D concentrations in Ethiopian women. Lactating Ethiopian women (n = 110) were randomly assigned to weekly administration of vitamin D3 (15,000 IU) or a placebo. Plasma 25(OH)D was measured at baseline (within 2 weeks of delivery, before supplementation) and at 3, 6, and 12 months after delivery. Associations between VDBP polymorphism status for rs7041 and rs4588 and plasma 25(OH)D were determined by analysis of variance and multiple linear and logistic regressions. Multiple linear regression with maternal age as a covariate revealed that rs7041 is associated with reduced plasma 25(OH)D (P = .021) and more risk alleles at rs7041 and rs4588 are associated with reduced plasma 25(OH)D (P = .017). Logistic regression models for vitamin D insufficiency showed that additional risk alleles for rs7041 and rs4588 are associated with increased odds ratios (OR = 1.66; 95% CI, 1.10-2.62; P = .019) for plasma 25(OH)D below 40 nmol/L. Supplementation increased plasma 25(OH)D at 3 months in women with fewer risk alleles and across all genotypes at 6 and 12 months. VDBP polymorphisms may contribute to vitamin D insufficiency in Ethiopian lactating women. Furthermore, VDBP polymorphisms may blunt short-term responses to vitamin D supplementation and require longer periods of intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Evidence on the efficacy of women's empowerment to improve child growth and minimum dietary diversity (MDD) in the Eastern Africa (EA) region is limited. This cross-sectional study used recent Demographic and Health Survey data of mother-child dyads from seven countries in EA to examine the associations between women's empowerment measures, child growth and MDD. Length-for-age z-scores, weight-for-length z-scores and weight-for-age z-scores were used to categorize growth indicators of 6-23 months old children. Multivariable logistic regression was used to identify significant associations. Among all countries, 32%-59% of children experienced growth failure. Children meeting MDD were 18%-45%. Women having self-esteem were associated with lower odds of stunting (adjusted odds ratio [AOR] = 0.62 in Rwanda), wasting (AOR = 0.38 in Uganda), underweight (AORs = 0.60 and 0.57 in Tanzania and Uganda, respectively) and growth failure (AOR = 0.64 in Rwanda). Having health decision control in Burundi was associated with lower odds of stunting (AOR = 0.49) and child growth failure (AOR = 0.52) and higher odds of meeting MDD (AOR = 2.50). Having Legal empowerment among women increased the odds of stunting (AOR = 1.79 in Burundi), underweight (AOR = 1.77 in Uganda) and growth failure (AOR = 1.87 in Burundi). Economic empowerment showed mixed associations with child growth and MDD among some countries. Women's self-esteem and health decision control were associated with better child growth and MDD for some countries in EA. Nutrition-sensitive interventions aimed at improving child growth and MDD should consider local contexts when addressing women's empowerment., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The Home-grown School Feeding Program (HG-SFP) is a model designed to provide school meals to students using foods sourced from local markets. HG-SFP recently has been incorporated as one of the strategies of educational development in Ethiopia aiming to address hunger and food insecurity problems of school children. Yet, evaluation of the successes and challenges of the program has been limited evaluated. The purpose of the present study was to explore the successes and challenges of the SFP in Sidama Region, Southern Ethiopia. This exploratory qualitative study collected data from eight schools targeted for HG-SFP through key informant interviews and focus group discussions (FGDs). A total of sixteen FGDs and twenty-one in-depth interviews were conducted. Purposive sampling was used to include study participants based on their potential relevance in delivering in-depth information. The findings of the present study showed that HG-SFP was successful in improving class attendance and academic performance of school children. In addition, the program had a contribution in saving the parents' money and time as a result of the food provided. With regard to SFP challenges, lack of permanent clean water provision, delay in ration delivery, poor-quality food provision, inadequate amount of food allocated for the academic year, lack of necessary infrastructure for the program, and lack of training in sanitation and hygiene for cooks were among the major challenges identified. Therefore, program challenges need high-level attention in order to make the school feeding program more successful in Sidama Region, Ethiopia., (© The Author(s) 2022.)

In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting., (© The Author(s) 2022.)

Ethiopia recently scaled up the implementation of a school feeding program ( SFP) as a targeted intervention for protecting disadvantaged school children from hunger and food insecurity. However, the contribution of the program to advancing the nutritional status of children has not been adequately explored. We assessed the effect of SFP on the anthropometric and haemoglobin status of school children in Sidama Region, Southern Ethiopia. Our prospective cohort study compared the height-for-age z -score (HAZ), BMI-for-age z -score (BAZ) and haemoglobin concentration of SFP beneficiary ( n 240) and non-beneficiary ( n 240) children, 10-14 years of age. The children were recruited from 8 SFP implementing and 8 control schools using a multistage sampling procedure and were followed for an academic year. The SFP intervention and control schools were matched one-to-one based on agro ecological features and geographical proximity. Exposure, outcome and pertinent extraneous variables were collected through baseline and end-line surveys. Multilevel difference-in-differences (DID) analysis was used to measure the net effect on the outcomes of interest. In the multivariable DID model adjusted for potential confounders including maternal and paternal literacy, household monthly income, wealth index and household food insecurity, the SFP did not show significant effects on the haemoglobin concentration ( β = 0⋅251, 95 % confidence interval (CI): -0⋅238, 0⋅739), BAZ ( β = 0⋅121, 95 % CI: -0⋅163, 0⋅405) and HAZ ( β = -0⋅291, 95 % CI: -0⋅640, 0⋅588) of children., (© The Author(s) 2022.)

Aflatoxins are mycotoxins that can contaminate grains, legumes, and oil seeds. These toxic compounds are an especially serious problem in tropical and sub-tropical climates. The objective of this study was to raise awareness of aflatoxin exposure among primary school children in Shebedino woreda, southern Ethiopia, by measuring urinary aflatoxin M1 (AFM1). The study employed a cross-sectional design and systematic random sampling of children from eight schools in the district. The mean ± SD age of the children was 9.0 ± 1.8 years. Most (84.6%) households were food insecure with 17.9% severely food insecure. Urinary AFM1 was detected in more than 93% of the children. The median [IQR] concentration of AFM1/Creat was 480 [203, 1085] pg/mg. Based on a multiple regression analysis: DDS, consumption of haricot bean or milk, source of drinking water, maternal education, and household food insecurity access scale scores were significantly associated with urinary AFM1/Creat. In conclusion, a high prevalence of urinary AFM1 was observed in this study. However, the relation between AFM1 and dietary intake was analyzed based on self-reported dietary data; hence, all of the staple foods as well as animal feeds in the study area should be assessed for aflatoxin contamination.

Alcohol abuse among women is a public health importance that may impair prenatal and postnatal growth. Tella is among the most common homemade alcoholic beverages in rural Ethiopia, but little is known about the magnitude of tella intake during pregnancy and lactation or its effects on child growth. The present study investigated associations between maternal tella intake and the growth of their children. A cross-sectional mixed-methods study was conducted with mothers ( n 228) and their 12-36-month-old children and with key informants ( n 12). Tella intake during most recent pregnancy and lactation was estimated retrospectively by glasses per drinking event and frequency of events. Nearly 80 % of mothers had consumed some amount of tella during their most recent pregnancy and lactation. Furthermore, 72 % of children had tasted or drunk tella at some time during their life. Stunting was 42 % and was significantly associated with maternal tella consumption at least every other day during pregnancy (adjusted odds ratio (AOR) 4⋅97, 95 % confidence interval (CI) 2⋅20, 11⋅25), male sex (AOR 2⋅31, 95 % CI 1⋅27, 4⋅19), two or more under-5-year-old children in the household (AOR 3⋅52, 95 % CI 1⋅49, 8⋅33) and family size >5 (AOR 1⋅84, 95 % CI 1⋅01, 3⋅36). Underweight was 24⋅6 % and was associated with the child drinking tella with their mother (AOR 4⋅23, 95 % CI 1⋅99, 8⋅97), being male (AOR 3⋅73, 95 % CI 1⋅73, 7⋅94), having ≥3 diarrhoeal episodes in the last 3 months (AOR 11⋅83, 95 % CI 4⋅22, 33⋅14) and being in the older age group (AOR 2⋅98, 95 % CI 1⋅09, 8⋅13). The associations between tella intake and child growth suggest the need to mitigate the effects of tella on child anthropometry., (© The Author(s) 2022.)

The SLC39A12 gene encodes the zinc transporter protein ZIP12, which is expressed across many tissues and is highly abundant in the vertebrate nervous system. As a zinc transporter, ZIP12 functions to transport zinc across cellular membranes, including cellular zinc influx across the plasma membrane. Genome-wide association and exome sequencing studies have shown that brain susceptibility-weighted magnetic resonance imaging (MRI) intensity is associated with ZIP12 polymorphisms and rare mutations. ZIP12 is required for neural tube closure and embryonic development in Xenopus tropicalis. Frog embryos depleted of ZIP12 by antisense morpholinos develop an anterior neural tube defect and lack viability. ZIP12 is also necessary for neurite outgrowth and mitochondrial function in mouse neural cells. ZIP12 mRNA is increased in brain regions of schizophrenic patients. Outside of the nervous system, hypoxia induces ZIP12 expression in multiple mammalian species, including humans, which leads to endothelial and smooth muscle thickening in the lung and contributes towards pulmonary hypertension. Other studies have associated ZIP12 with other diseases such as cancer. Given that ZIP12 is highly expressed in the brain and that susceptibility-weighted MRI is associated with brain metal content, ZIP12 may affect neurological diseases and psychiatric illnesses such as Parkinson's disease, Alzheimer's disease, and schizophrenia. Furthermore, the induction of ZIP12 and resultant zinc uptake under pathophysiological conditions may be a critical component of disease pathology, such as in pulmonary hypertension. Drug compounds that bind metals like zinc may be able to treat diseases associated with impaired zinc homeostasis and altered ZIP12 function., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Undernutrition is a major global health problem. Various types of animal milk are used for feeding children at early ages; however, associations of camel milk (CaM) and bovine milk (BM) with the nutritional status of children have not been explored. A comparative community-based cross-sectional study was conducted among pre-schoolers in rural pastoral districts of Somali, Ethiopia. Children were selected from households with lactating camels or cows. Anthropometric measurements followed standard procedures for height-for-age, weight-for-age and weight-for-height scores. Independent sample t -tests identified significant differences in anthropometric indices based on the type of milk consumed. Multivariable logistic regression was used to examine associations between milk consumption and other predictors of growth failures. The prevalence of stunting was 24⋅1 % [95 % confidence interval (CI) 20⋅5, 28⋅3] of pre-schoolers, 34⋅8 % (95 % CI 29⋅9, 39⋅6) were wasted and 34⋅7 % (95 % CI 30⋅1, 39⋅9) were underweight. Higher proportions of BM-fed children were severely stunted, wasted and underweight compared with CaM consumers. Using logistic regression models, children who consumed BM [adjusted odds ratio (AOR): 2⋅10; 95 % CI 1⋅22, 3⋅61] and who were anaemic (AOR: 4⋅22; 95 % CI 2⋅23, 7⋅98) were more likely to be stunted than their counterparts, while girls were less likely to be stunted than boys (AOR: 0⋅57; 95 % CI 0⋅34, 0⋅94). Similarly, children who consumed BM (AOR: 1⋅97; 95 % CI 1⋅20, 3⋅24), who were anaemic (AOR: 2⋅27; 95 % CI 1⋅38, 3⋅72) and who drank unsafe water (AOR: 1⋅91; 95 % CI 1⋅19, 3⋅07) were more likely to be underweight than their counterparts. In conclusion, CaM consumption was associated with lower prevalence of stunting and underweight than BM. Promoting CaM in pastoralist areas may help to curb the high level of undernutrition., (© The Author(s) 2021.)

Objective: We hypothesise that exposure to aflatoxins and fumonisins, measured in serum, alters protein synthesis, reducing serum protein and insulin-like growth factor 1 (IGF-1), increasing inflammation and infection, leading to child's linear growth failure., Design: Children 6-35 months, stratified by baseline stunting, were subsampled from an intervention trial on quality protein maize consumption and evaluated at two time-points., Setting: Blood samples and anthropometric data were collected in the pre-harvest (August-September 2015) and post-harvest (February 2016) seasons in rural Ethiopia., Participants: 102 children (50 stunted and 52 non-stunted)., Results: Proportions of children exposed to aflatoxin G1, aflatoxin G2 and aflatoxin M1 were higher in the pre-harvest (8, 33 and 7, respectively) compared to post-harvest season (4, 28 and 4, respectively). The proportion of children exposed to any aflatoxin was higher in the pre-harvest than post-harvest season (51 % v. 41 %). Fumonisin exposure ranged from 0 % to 11 %. In joint statistical tests, aflatoxin exposure was associated with serum biomarkers of inflammation (C-reactive protein, α-1-glycoprotein) and protein status (transthyretin, lysine, tryptophan), IGF-1 and linear growth (all P < 0·01). However, exposure to specific aflatoxins was not significantly associated with any biomarkers or outcomes (all P > 0·05)., Conclusions: Aflatoxin exposure among rural Ethiopian children was high, with large variation between seasons and individual aflatoxins. Fumonisin exposure was low. There was no clear association between aflatoxin exposure and protein status, inflammation or linear growth. A larger study may be needed to examine the potential biological interactions, and the assessment of aflatoxins in food is needed to determine sources of high exposure.

Objective: Ethiopia recently scaled up the implementation of a school feeding programme (SFP). Yet, evidence on the impact of such programmes on academic outcomes remains inconclusive. We evaluated the effect of the SFP on class absenteeism and academic performance of primary school students (grade 5-8) in Sidama zone, Southern Ethiopia., Design: This prospective cohort study enrolled SFP-beneficiary (n 240) and non-beneficiary (n 240) children 10-14 years of age from sixteen public schools and followed them for an academic year. School absenteeism was measured as the number of days children were absent from school in the year. Academic performance was defined based on the average academic score of the students for ten subjects they attended in the year. Data were analysed using multivariable mixed effects negative binomial and linear regression models., Setting: Food insecure districts in Sidama zone, Southern Ethiopia., Participants: SFP-beneficiary and non-beneficiary children 10-14 years of age., Results: The mean (sd) number of days children were absent from school was 4·0 (sd 1·5) and 9·3 (sd 6·0), among SFP beneficiaries and non-beneficiaries, respectively. Students not covered by the SFP were two times more likely to miss classes (adjusted rate ratio = 2·30; 95 % CI 2·03, 2·61). Pertaining to academic performance, a significant but small 2·40 (95 % CI 0·69, 4·12) percentage point mean difference was observed in favour of SFP beneficiaries. Likewise, the risk of school dropout was six times higher among non-beneficiaries (adjusted rate ratio = 6·04; 95 % CI 1·61, 22·68)., Conclusions: SFP promotes multiple academic outcomes among socio-economically disadvantaged children.

Few studies have investigated fathers' roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers' involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6-23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers' involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers' involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite widespread suboptimal breastfeeding practices and maternal experiences of intimate partner violence (IPV), the association of IPV and breastfeeding practices remains unclear. This study investigated the associations between maternal experience of physical, sexual, emotional violence, and controlling behaviors with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia., Methods: Data included mother-infant dyads from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879). Intimate partner violence (physical, sexual, and emotional) was measured using the Revised Conflict Tactics Scale. Breastfeeding practices were early initiation of breastfeeding (within 1 h of birth), exclusive breastfeeding (in previous 24 h), and continued breastfeeding. Associations between experience of physical, sexual, or emotional violence or controlling behaviors and breastfeeding practices, as well as associations between the frequency of IPV and breastfeeding practices were assessed., Results: Many Malawian (77.6%) and Zambian (67.7%) and just over half (53.6%) of Tanzanian mothers, initiated breastfeeding within 1 h of birth. Exclusive breastfeeding was 70.6% in Zambia and 60.1% in Malawi, while 55.0% of Tanzanian mothers breastfed exclusively. Continued breastfeeding to at least 1 year was high in Malawi 92.2%, Tanzania 93.4%, and Zambia 95.0%. Most mothers reported experiences of IPV in Tanzania 79.1%, Zambia 78.9%, and Malawi 73.9%. Mothers who experienced sexual IPV were significantly more likely to delay breastfeeding (Malawi [AOR 1.55 (1.14, 2.10)]; Tanzania [AOR 1.30 (1.04, 1.62)]; and Zambia [AOR 1.28 (1.06, 1.54)]). Sexual IPV in Malawi and Zambia was associated with greater odds of not exclusively breastfeeding (Malawi [AOR 1.90 (1.05, 3.45)]; Zambia [AOR 1.75 (1.15, 2.67)]). Tanzanian mothers who experienced IPV often or sometimes were two times more likely not to breastfeed at one-year post-delivery [AOR 2.23 (1.09,4.57)]., Conclusions: In the three countries investigated maternal experience of IPV was associated with suboptimal breastfeeding practices. Policies and programs targeting improved breastfeeding practices should consider screening during antenatal and postnatal care for experience of violence and support initiatives to reduce IPV.

Background: Iodine is a trace element required for the synthesis of thyroid hormones. The multiple effects of iodine deficiency on human health are called iodine deficiency disorders (IDDs). IDDs have been common nutritional problems in Ethiopia. In 2012, Ethiopia launched a national salt iodization program to address IDDs. The objective of this study was to assess the effects of this program after 5 years by measuring urinary iodine concentration (UIC) and prevalence of goiter in school age children as well as household salt iodine concentration (SIC)., Methods: A school-based cross-sectional design was employed. After ethical approval, 408 children from eight randomly selected primary schools provided urine samples. UIC was analyzed by inductively coupled plasma mass spectrophotometry (ICP-MS). A 10 g salt sample was collected from each household of a sampled child. SIC was analyzed with a digital electronic iodine checker (WYD, UNICEF) and goiter was assessed by palpation., Results: The mean (±SD) age of the children was 9 ± 2 years. The prevalence of goiter was 4.2% and no child had grade 2 goiter. The median (IQR) UIC was 518 (327, 704) μg/L and UIC ranged from 3.1 to 2530 μg/L. Of the salt samples, 15.6% were not adequately iodized (< 15 ppm), 39.3% were adequately iodized (≥15 to ≤40 ppm), and 45.1% were > 40 ppm. SIC ranged from 4.2 to 195 ppm. Of the mothers, 92% said iodized salt prevents goiter and 8% mentioned prevents mental retardation., Conclusions: In 2017 iodine deficiency was no longer a public health problem in the study area. However, the high variability in UIC and SIC and excessive iodine intake are of great concern. It is vital to ensure that salt is homogenously iodized at the production site before being distributed to consumers.

Exposure to unsafe level of aflatoxin in early life may lead to growth faltering. However, the extent of contamination of breast milk and complementary foods is poorly examined. We determined aflatoxin M 1 (AFM 1 ) and B 1 (AFB 1 ) contamination of human breast milk and cereal-based cooked complementary foods, respectively, among households having children 6-23 months of age in Sidama zone, southern Ethiopia. Data were collected through two cross-sectional surveys implemented in the wet (n = 180) and dry (n = 180) seasons. Eligible households (n = 360) were recruited from three agroecological zones (lowland, midland and highland, each with sample size of 120) using a multistage sampling technique. AFB 1 and AFM 1 levels were determined using enzyme-linked immunosorbent assay. Mann-Whitney U and Kruskal-Wallis tests were performed to compare aflatoxin levels between seasons and across the agroecological zones. Among 360 breast milk samples tested, 64.4% had detectable AFM 1 and 5.3% exceeded the 0.025 parts per billion (ppb) limit set by the European Union for infant milk. The median AFM 1 in the lowlands was significantly higher than in the other agroecological settings (P < 0.001). By season, AFM 1 was higher in breast milk samples collected in the dry season (P = 0.041). AFB 1 was detected in 96.4% of the food samples tested, and 95.0% had concentration exceeding the permissible European Union limit of 0.1 ppb. The median AFB 1 was significantly higher in the lowland (P = 0.002), but there was no difference between the seasons (P = 0.386). The study indicated that, in southern Ethiopia, foods intended for infants are heavily contaminated with AFB 1 . Contamination of breast milk is also a significant health concern., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

In Ethiopia and many other low-income countries, little is known about the exposure of lactating women to aflatoxin, which is a major health concern to the mother and her nursing infant. We determined the aflatoxin B 1 contamination of family foods (AFB 1 ) and urinary aflatoxin M 1 (AFM 1 ) of lactating women in Sidama, southern Ethiopia, and compared the levels across agroecological settings (lowland, midland, highland) and two seasons. We conducted two surveys ( n  = 360) that represented the dry and wet seasons of the locality. AFM 1 and AFB 1 were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was made using Mann-Whitney U test and Kruskal-Wallis test. The median (interquartile range) AFB 1 was 0.94 (0.63-1.58) ppb. AFB 1 was detected in 95.6% of the food samples, and 13.6% exceeded the 2.0 ppb threshold. We observed an increasing trend for aflatoxin exposure from highland to lowland ( p  < .001), but there was no difference between seasons ( p  = .743). The median (interquartile range) urinary AFM 1 was 214 (undetectable to 2,582) ppt, and AFM 1 was detectable in 53.3% of the samples. Urinary AFM 1  showed significant difference among agroecological zones ( p  < .001) but not between seasons ( p  = .275). A significant but weak correlation was observed between AFB 1 and urinary AFM 1 ( r s  = 0.177, p  = .001). We concluded that lactating women in Sidama, especially those in the lowland area, have unsafe exposure to aflatoxin., Competing Interests: The authors declare no conflicts of interest. The sponsor had no role in the design, execution, interpretation, or writing of the study., (© 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar., Objectives: This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6-23 mo in the Vakinankaratra region of Madagascar., Methods: Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z -scores using the 2006 WHO growth standards. A z -score less than -2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach., Results: Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers' workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding., Conclusions: Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected for measuring hemoglobin, iron biomarkers, zinc, selenium, and inflammation markers. The median (IQR) hemoglobin (Hb) was 132 (123, 139) g/L. Of the women, 19% were anemic and 7% had iron deficiency anemia; 31% were iron deficient and 2% had iron overload. Also, 8% had functional iron deficit, 6% had acute inflammation, 13% had chronic inflammation, and 16% had tissue iron deficiency. The majority (78%) of the women had low plasma zinc out of which more than 16% were anemic. Hb was positively associated with plasma iron and plasma zinc and negatively associated with transferrin receptor (TfR) and α-1-acid glycoprotein (AGP). Plasma iron, AGP, TfR, hepcidin and plasma zinc were significant predictors of maternal anemia. Additionally MUAC and level of education were associated positively with maternal hemoglobin. This study showed that maternal anemia was associated with multiple factors including nutritional deficiencies, inflammation and limited education., Competing Interests: The authors have declared that no competing interests exist.

Brain zinc dysregulation is linked to many neurological disorders. However, the mechanisms regulating brain zinc homeostasis are poorly understood. We performed secondary analyses of brain MRI GWAS and exome sequencing data from adults in the UK Biobank. Coding ZIP12 polymorphisms in zinc transporter ZIP12 (SLC39A12) were associated with altered brain susceptibility weighted MRI (swMRI). Conditional and joint association analyses revealed independent GWAS signals in linkage disequilibrium with 2 missense ZIP12 polymorphisms, rs10764176 and rs72778328, with reduced zinc transport activity. ZIP12 rare coding variants predicted to be deleterious were associated with similar impacts on brain swMRI. In Neuro-2a cells, ZIP12 deficiency by short hairpin RNA (shRNA) depletion or CRISPR/Cas9 genome editing resulted in impaired mitochondrial function, increased superoxide presence, and detectable protein carbonylation. Inhibition of Complexes I and IV of the electron transport chain reduced neurite outgrowth in ZIP12 deficient cells. Transcriptional coactivator PGC-1α, mitochondrial superoxide dismutase (SOD2), and chemical antioxidants α-tocopherol, MitoTEMPO, and MitoQ restored neurite extension impaired by ZIP12 deficiency. Mutant forms of α-synuclein and tau linked to familial Parkinson's disease and frontotemporal dementia, respectively, reduced neurite outgrowth in cells deficient in ZIP12. Zinc and ZIP12 may confer resilience against neurological diseases or premature aging of the brain., (© 2020 Federation of American Societies for Experimental Biology.)

The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children's Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6-23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (β = 0.13, p < 0.01) and Tanzania (β = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (β = 0.07, p < 0.01) and Tanzania (β = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.

Background: Child undernutrition is a major public health problem in Ethiopia. Stunting is highest in food-insecure areas and insufficient evidence may impair the design of suitable interventions., Objectives: This study aimed to identify key factors contributing to undernutrition among 6- to 23-mo-old children., Methods: A community-based cross-sectional study in food-insecure areas of Amhara and Oromia regions in April-June, 2018, enrolled 464 mother-child dyads. Bivariate and multivariate logistic regression analyses were conducted., Results: The prevalence of stunting (43.1%), wasting (12.3%), and underweight (27.3%) were high. Factors significantly associated with both stunting and underweight were child age of 12-23 mo (vs 6-11 mo), female, more siblings, lack of zinc supplement for diarrhea, inadequate diet diversity, and lack of iodized salt in complementary food. Conclusions: Our findings support the need to emphasize appropriate child feeding practices and iodized salt utilization. Improvement of primary health care services related to micronutrient supplementation and family spacing also are important to address child undernutrition in the study area., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Child undernutrition is widespread in low- and middle-income countries (LMIC) and is associated with health and economic losses. Undernutrition is estimated to contribute to 3.1 million deaths per year in children less than 5 years of age. A complex causal and contextual factors contributing to child undernutrition have been assessed, but maternal depression, which could contribute to child undernutrition by interfering with the mother's child caring practice and ability, has been received little attention. The objective of this study was to assess the association between maternal postpartum depression symptoms and infant (5-10 months of age) stunting in northern Ethiopia. A community-based cross-sectional study was conducted among mother-infant pairs (n = 232) between March and April 2018. Through interviewer-administrated questionnaire, information on sociodemographic variables were collected, and maternal depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS≥13). Infants' length and weight were measured and converted to length and weight for age Z scores using the WHO growth standards. Breastfeeding was a norm, but the adequacy of complementary feeding practice was sub-optimal. Only 25% of the infants met the minimum meal frequency (MMF), less than 10% met the minimum dietary diversity (MMD; 9%) or minimum acceptable diet (7%). Maternal depression was prevalent (22.8%) and was significantly associated with inappropriate complementary feeding and stunting (P < .05). Improving complementary feeding practices is central to preventing stunting in this and other settings. However, such efforts should integrate interventions that address maternal depression to improve child feeding and caring practices to effectively prevent stunting., (© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

Background: Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting., Methods: The most recent Malawi Demographic Health Survey (2015-2016) was used and data for 2294 children aged 0-23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women's empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of < 0.05 were considered significant in the final model., Results: Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13-23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight., Conclusions: Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.

Iodine deficiency is one of the major causes of brain damage in childhood. However, iodine supplementation during early pregnancy and lactation can prevent the ill effects of iodine deficiency. This study evaluated maternal and infant thyroid function and infant visual information processing (VIP) in the context of maternal iodine supplementation. A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were enrolled within the first 10 days after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 μg iodine) daily for 26 weeks or iodized salt weekly for 26 weeks. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. At baseline, neither mothers nor infants in the two groups were significantly different in any of the biomarkers or anthropometric measurements. Maternal TSH and goiter prevalence significantly decreased following iodine supplementation. The percentage of infants who preferentially remembered the familiar face was 26% in the capsule and 51% in the I-salt groups. Infant sex, length for age Z score, BMIC, maternal education and household food security were strong predictors of novelty quotient. In conclusion supplementation daily for six months with an iodine capsule or the use of appropriately iodized salt for an equivalent time was sufficient to reduce goiter and TSH in lactating women. Higher BMIC and LAZ as well as better household food security, maternal education, and male sex predicted higher novelty quotient scores in the VIP paradigm., Competing Interests: The authors have declared that no competing interests exist.

Selenium is an important nutrient for humans and livestock. Soil selenium concentration in the world is highly variable; deficiency and toxicity occur in populations living short distance apart. Knowledge of Se concentrations in humans and the environments, especially because the range for toxicity and deficiency is narrow, is important for effective intervention. Dietary data and serum samples were collected from children (n = 555) 69-78 months old from rural villages of the Amhara Region, Ethiopia. In addition, information on the socio-demography of households was collected. Serum Se was analyzed by inductively coupled plasma mass spectrometer. Almost all (90.3%) of participants reported eating grain, roots, or tubers 24 h preceding the survey followed by legumes, nuts, and seeds (64.6%). Consumption of animal source foods was very low (4.6%). Compared to children from the western part of the region, children from eastern Amhara had higher dietary diversity score (2.1 ± 0.9 vs 1.8 ± 0.7; p < 0.001).The median serum Se concentration was 70.6 μg/l (IQR 48.2, 96.6). Selenium inadequacy (serum Se < 70 μg/l) was detected in 49.1% of children. However, the distribution had an important geographical pattern across administrative zones. Children from the western part of the Amhara Region were highly deficient (up to 91.1% prevalence), while there was little or no Se deficiency in children from the eastern part of the region. Serum Se level exhibited an important spatial variation in the Amhara Region, Ethiopia. Further studies investigating contributing factors for the variation such as soil characteristics and Se concentration in staple crops are needed.

Selenium (Se) is an integral component of iodothyronine deiodinase, glutathione peroxidase and thioredoxin reductase enzymes and thus is important for normal thyroid function. This study investigated the influence of Se inadequacy on thyroid response of iodine-replete young children. Serum thyroxine (T 4 ), triiodothyronine (T 3 ), thyroglobulin (Tg), thyroid stimulating hormone (TSH), and Se were analyzed in 54-60 mo old children (n = 628) from the Amhara region of Ethiopia before salt iodization was commenced; analyses were repeated (n = 555) 15 mo after iodized salt became available. Iodized salt coverage increased from 12.2% to 91.6% of households. Median urinary iodine concentration (UIC) among children increased from 9 μg/l to 167 μg/l (p < 0.001). In addition, all thyroid indices except T 3 showed significant improvement (p < 0.05). Nearly, half of the study children (49.1%) had Se inadequacy (serum Se < 70 μg/l). Serum Se was significantly correlated with T 3 (r = 0.38, p < 0.001), T 4 (r = 0.15, p < 0.001), TSH (r=-0.205, p < 0.001) and Tg (r= -0.11, p < 0.01) concentrations 15 mo after iodine repletion; baseline serum Se and T 4 (r= -0.22, p < 0.01) were inversely correlated. Despite adequate iodine status, children with low serum Se had lower serum T 4 (p = 0.003) and T 3 (p < 0.001) but higher TSH concentration (p = 0.003). In the partial least square regression model, Se was among the latent variables significantly explaining T 4 and T 3 . Results of the present study suggest that Se inadequacy negatively affects the thyroid metabolism of iodine-replete children and may present a substantial public health concern thus emphasize the need to consider correction of Se status for normal thyroid function as well as for benefits from its diverse biological roles., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Background: Maternal iodine deficiency (ID) during pregnancy has been recognized as a major cause of abortion, stillbirth, congenital abnormalities, perinatal mortality and irreversible mental retardation. In Ethiopia limited information is available regarding the epidemiology of maternal ID. The purpose of the present study was to assess the prevalence of iodine deficiency and associated factors among pregnant women in Ada district, Oromia region, Ethiopia., Method: A community based, cross-sectional study was conducted in rural areas of Ada district, October to November, 2014. Data were collected from 356 pregnant women selected by multistage cluster sampling technique. Presence of goiter was examined by palpation and urinary iodine concentration was measured using inductively-coupled-plasma mass spectrometry. Salt iodine concentration was determined using a digital electronic iodine checker. Statistical analysis was done primarily using binary logistic regression. The outputs of the analysis are presented using adjusted odds ratio (AOR) with the respective 95% confidence intervals (CI)., Results: The median urinary iodine concentration (UIC) was 85.7 (interquartile range (IQR): 45.7-136) μg/L. Based on UIC, 77.6% (95% CI: 73.0-82.0%) of the study subjects had insufficient iodine intake (UIC < 150 μg/L). The goiter rate was 20.2% (95% CI: 16.0-24.0%). The median iodine concentration of the household salt samples was 12.2 (IQR: 6.9-23.8) ppm. Of the households, only 39.3% (95% CI: 34.0-44.0%) consumed adequately iodized salt (≥15 ppm). Prevalence of goiter was significantly higher among pregnant women aged 30-44 years (AOR = 2.32 (95% CI: 1.05-5.14)) than among younger women and among illiterate women (AOR = 2.71 (95% CI: 1.54-4.79)). Compared to nulliparous, women with parity of 1, 2 and 3 or more had 2.28 (95% CI: 1.01-5.16), 2.81 (95% CI: 1.17-6.74) and 4.41 (95% CI: 1.58-12.26) times higher risk of goiter., Conclusion: Iodine deficiency was a public health problem in the study area. This indicates the need for further strengthening of the existing salt iodization program in order to avail homogenously and adequately iodized salt. Also it is necessary to find ways to provide iodine supplements as needed until universal salt iodization (USI) is fully established.

Background: Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices., Methods: The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0-23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices., Results: The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6-8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity., Conclusions: Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6-23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.

Madagascar is among countries where the prevalence of stunting is dramatically high in under 5 years old children. This study investigated the determinants of child stunting based on the UNICEF framework on the causes of malnutrition. A cutoff at 24 months was used to separate the child population into two groups. By using the latest Demographic and Health Survey (2009), logistic regressions were performed to determine the variables associated with stunting. In 2009, 40.1% of the 1,863 children aged 0-23 months and 53.9% of the 2,911 children aged 24-59 months were stunted contributing to the 48.5% overall stunting prevalence in the sample. Girls were less likely to be stunted (adjusted odds ratio with confidence interval [AOR] = 0.69 [0.55-0.88] and 0.84 [0.72-0.97], p < 0.01) than boys; the risk of stunting increased with age. Regarding underlying predictors, increased maternal height was associated with lower odds of stunting in both age groups (AOR = 0.75 [0.68-0.83] and 0.69 [0.61-0.77], p < 0.001). Children living in households using iodized salt (>15 ppm) had lower risk of stunting in the younger group (AOR = 0.76 [0.61-0.94], p < 0.05). Children living in urban areas were less likely to be stunted in both age groups (AOR = 0.67 [0.51-0.88] and 0.73 [0.59-0.90] respectively, p < 0.01]. Region of residence was also a significant basic factor for stunting. This study contributes to the understanding of the determinants of child stunting in Madagascar. The results confirmed the need for specific interventions for each of the two age groups., (© 2016 John Wiley & Sons Ltd.)

Background: Anemia, which has many etiologies, is a moderate/severe public health problem in young children and women of reproductive age in many developing countries. The aim of this study was to investigate prevalence of iron deficiency, anemia, and iron deficiency anemia using multiple biomarkers and to evaluate their association with food insecurity and food consumption patterns in non-pregnant women from a rural area of southern Ethiopia., Methods: A cross-sectional study was conducted in 202 rural women of reproductive age in southern Ethiopia. Anthropometrics and socio-demographic data were collected. A venipuncture blood sample was analyzed for hemoglobin (Hb) and for biomarkers of iron status. Biomarkers were skewed and were log transformed before analysis. Mean, median, Pearson's correlations and ordinary least-squares regressions were calculated., Results: Median (IQR) Hb was 138 (127, 151) g/L. Based on an altitude-adjusted (1708 m) cutoff of 125 g/L for Hb, 21.3% were anemic. Plasma ferritin was <15 μg/L in 18.6% of the women. Only one woman had α-1-acid glycoprotein (AGP) >1.0 g/L; four women (2%) had > 5 mg/L of C-reactive protein (CRP). Of the 43 women who were anemic, 23.3% (10 women) had depleted iron stores based on plasma ferritin. Three of these had elevated soluble transferrin receptors (sTfR). Hemoglobin (Hb) concentration was negatively correlated with sTfR (r = -0.24, p = 0.001), and positively correlated with ferritin (r = 0.17, p = 0.018), plasma iron (r = 0.15, p = 0.046), transferrin saturation (TfS) (r = 0.15, p = 0.04) and body iron (r = 0.14, p = 0.05). Overall prevalence of iron deficiency anemia was only 5%., Conclusion: Iron deficiency anemia was not prevalent in the study population, despite the fact that anemia would be classified as a moderate public health problem.

Iodine deficiency during pregnancy and lactation could expose the infant to severe iodine deficiency disorders. A randomized supplementation trial among rural lactating women was conducted in Sidama zone, southern Ethiopia, to compare the methods of iodine delivery on breast milk iodine, and on maternal and infant urinary iodine concentrations. Women were randomly assigned either to receive 225 μg iodine as potassium iodide capsule daily for 6 months or 450 g of appropriately iodized salt (30-40 μg I as KIO 3 /g of salt) weekly for household consumption for 6 months. Breast milk iodine concentration (BMIC) and maternal and infant urinary iodine concentration (UIC) were measured at baseline and at 6 months. The women did not differ in BMIC and UIC, and infants did not differ in UIC in a time by treatment interaction. Median (IQR, interquartile range, IQR) BMIC at baseline was 154 [43, 252] μg/L and at 6 months was 105 [36, 198] μg/L, maternal UIC at baseline was 107 [71, 161] μg/L and at 6 months was 130 [80, 208] μg/L; infant UIC at baseline was 218 [108, 356] μg/L and at 6 months was 222 [117, 369] μg/L. Significant correlations among the three variables were obtained in both groups at both times. We conclude that for lactating women an adequate amount of appropriately iodized salt (30-40 μg I/g) had similar effects as a daily supplement of 225 μg I on BMIC and on maternal and infant UIC.

Background/objectives: Selenium (Se) as part of glutathione peroxidase and iodothyronine deiodinase enzymes influences thyroid metabolism. This study investigated the association of serum Se levels with thyroid metabolism of severely iodine-deficient young children from the Amhara region of Ethiopia., Subjects/methods: In a cross-sectional study, Se, thyroid-stimulating hormone, total thyroxin, total triiodothyronine and thyroglobulin in serum of children (N=628) 54-60 months of age from the Amhara region, Ethiopia, were analyzed. In addition, iodine in urine and household salt was analyzed, and the presence of goiter was assessed., Results: The median serum Se concentration was 61.4 μg/l (10.7-290.9 μg/l). Selenium deficiency (serum Se <70 μg/l) was detected in 57.8% (N=349) of the children. The median urinary iodine concentration (UIC) was 9.8 μg/l. The majority (86.6%, N=449) of children had UIC below the recommended value (100 μg/l). In addition, 59.8% (N=310) of children were severely iodine deficient (UIC<20 μg/l). Only 12.7% of salt samples had iodine. Goiter was present in 44.6% (N=280) of the children. Selenium-deficient children had higher serum thyroxin (T4) than children with normal serum Se concentration (P<0.001)., Conclusions: Serum Se was negatively associated with T4 level in young children from the Amhara region of Ethiopia and may endanger the effectiveness of the salt iodization program.

Objective: Children from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households., Design: A cross-sectional study., Setting: Twenty six kebeles (the smallest administrative unit) from six zones of the Amhara region, Ethiopia., Subjects: Children aged 54-60 months (n 628)., Results: Grain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd 0·8). Most children (74·8 %, n 470) were in the lowest dietary diversity group (1-2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n 114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n 184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n 82) of children were anaemic, 9·1 % (n 57) were Fe deficient and 5·3 % (n 32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n 60) of children., Conclusions: Despite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

Background: Anthropometric characteristics and iron status affect cognitive performance in children. In addition, selenium can influence cognitive outcomes; protection of the brain from oxidative stress and its role in thyroid hormone metabolism are putative mechanisms., Methods: To investigate their association with cognitive performance, anthropometric indicators, iron biomarkers, and serum selenium of children (n = 541) of 54-60mo of age from rural Ethiopia were assessed. Cognitive assessment was conducted with the administration of two reasoning subtests of the Wechsler Preschool and Primary Scale of Intelligence and the school readiness test., Results: Stunting was found in 41.4 % of children, 28.7 % were underweight, and 6.3 % were wasted. The mean score of stunted children was lower than that of non-stunted children on non-verbal reasoning (7.0 ± 3.2vs7.9 ± 3.1; p = 0.01) and the school readiness tests (4.3 ± 2.2 vs 3.3 ± 2.1; p < 0.001). Compared to non-anemic children, anemic children had lower score for the verbal reasoning test (9.5 ± 1.7 vs 8.9 ± 2.2; p = 0.02). However, except for hemoglobin, none of the iron biomarkers had significant associations with the cognitive score of the study children (p > 0.05). Selenium deficient children had lower scores on all cognitive tests than normal children (p < 0.05)., Conclusion: The present study finding linking chronic undernutrition and micronutrient deficiency to cognitive deficits suggests the need for designing effective intervention programmes to control for protein energy malnutrition and micronutrient deficiency and address cognitive development in children.

Background: Inadequate nutrition during the first two years of life may lead to childhood morbidity and mortality, as well as inadequate brain development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer sufficient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. Therefore this study aimed to identify the factors associated with nutritional status of infants and young children (6-23 months) in Filtu town, Somali Region, Ethiopia., Methods: A cross-sectional community-based study was conducted. Simple random sampling was employed to select 214 infants for the study. Univariable and multivariable logistic regressions models were used in the statistical analysis. The strength of association was measured by odds ratios with 95% confidence intervals. Both the crude (COR) and adjusted odds ratios (AOR) are reported., Results: The prevalence of wasting, stunting and underweight among infants and young children were 17.5% (95% CI: 12.91-23.22), 22.9% (95% CI: 17.6-28.9) and 19.5% (95% CI: 14.58-25.3) respectively. The multivariable logistic regression model showed that breastfeeding was independently associated with reduced odds of wasting (AOR = 0.38(95% CI: 0.14-0.99)). Diarrhea in the past 15 days (AOR = 2.13 (95% CI: 1.55-4.69)) was also associated with increased odds for wasting. The independent predictors of reduced odds for stunting were dietary diversity score ≥ 4 (AOR = 0.45(95% CI: 0.21-0.95)) and introduction of complementary feeding at 6 months (AOR = 0.25 (95% CI: 0.09-0.66)). Bottle feeding was associated with increased odds of stunting (AOR = 3.83 (95% CI: 1.69-8.67)). Breastfeeding was associated with reduced odds of underweight (AOR = 0.24 (95% CI: 0.1-0.59)), while diarrheal disease in the past 15 days was associated with increased odds of underweight (AOR = 3.54 (95% CI: 1.17-7.72))., Conclusion: Under nutrition is a public health problem among infants and young children in Filtu town, Somali region Ethiopia. Breastfeeding was associated with lower odds of wasting and underweight while diarrheal disease was associated with higher odds of wasting and underweight. Low dietary diversity scores, inappropriate age of complementary feeding initiation and bottle feeding were identified to be significant predictors of stunting. Those factors should be considered for any intervention aimed to reduce under nutrition among infants and young children in Filitu town, Somali region, Ethiopia.

Zinc plays an integral role in numerous cellular processes including regulation of gene expression. This randomized placebo-controlled trial in adult women evaluated the effects of 20 mg Zn for 23 days. The mRNA abundance of zinc transporters (ZnT1/ZIP3/ZIP4/ZIP8) and metallothionein (MT1) from peripheral blood mononuclear cells was determined by real-time quantitative polymerase chain reaction. In paired samples (n = 6-9), the ZIP4 (P = 0.036) and ZIP8 (P = 0.038) mRNA abundance decreased following zinc supplementation. ZnT1, ZIP3, and MT1 mRNA abundance did not change significantly. The mean ± standard deviation plasma zinc concentration (by inductively coupled plasma mass spectrometry) at baseline was 680 ± 110 μg/L for the zinc group (n = 24) and 741 ± 92 μg/L for the placebo group (n = 23). At endpoint, plasma zinc in the zinc group increased to 735 ± 80 μg/L (P < 0.01) while in the placebo group (717 ± 100 μg/L) it did not change significantly from baseline. The change in mRNA abundance highlights the importance of further investigating ZIP4 and ZIP8 mRNA abundance as potential zinc status biomarkers.