Browsing by Author "Samson Gebremedhin"

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    Epidemiology and Effect on Birthweight of Prenatal Zinc and Vitamin A Deficiencies in Rural Sidama Southern Ethiopia.
    (Addis Abeba Universty, 2012-06) Samson Gebremedhin; Fikre Enquselassie
    Background: In the developing world pregnant women face diverse nutritional deficiencies with potentially grave consequences. The most prevalent deficiencies are assumed to be Protein Energy Malnutrition (PEM), Iron Deficiency Anemia (IDA), Vitamin A (VA) Deficiency (D), Iodine Deficiency Disorders (IDD) and Zinc Deficiency (ZD). Nevertheless, currently limited information is available about the prevalence of prenatal zinc and vitamin A deficiencies in Ethiopia. Previous studies which attempted to identify the correlates of the deficiencies and their effects on birthweight ended up in equivocal conclusions. Objective: To assess the prevalence, correlates and effect on birthweight of prenatal ZD and VAD in rural Sidama, Southern Ethiopia. Methods: The study included a community based cross-sectional baseline study to assess the prevalence and correlates of the deficiencies and a prospective cohort study to evaluate the effects of the deficiencies on birthweight. The baseline study was conducted in January 2011 among 700 randomly selected pregnant women. Data on potential correlates of the deficiencies were gathered using a structured questionnaire. Serum zinc, retinol, ferritin, hemoglobin and C - Reactive Protein (CRP) concentrations were determined from venous blood following standard procedures. In the cohort study 575 pregnant women who were in their second or third trimester during the baseline survey were successfully followed until delivery and birthweight was measured within 72 hours of birth. Data were analyzed using linear, logistic and log-binomial regression models. The dissertation also incorporated a meta-analysis of Randomized Control Trials (RCTs) so as to assess the effect of prenatal zinc supplementation on birthweight. Relevant studies were identified through web-based search. Effect Size (ES) was measured based on standardized mean difference and pooled using a variant of random effect model. Results: About 53.0%, 37.9% and 17.4% of the subjects had ZD, VAD and Iron Deficiency (ID). Taking the three deficiencies into consideration, 32.9% of the subjects had two or more concomitant deficiencies and 5.1% had three of the deficiencies. Elevated CRP and gestational age were significant negative correlates of zinc status. ZD was substantially higher among pregnant women from food in secured households and amongst those who had low Dietary Diversity Score (DDS) in the preceding day of the survey. Illiterates and women devoid of self income had 1.71 (95% CI: 1.09-2.60) and 1.74 (95% CI: 1.11-2.74) times increased risk of ZD. The risk was also 1.65 (95% CI: 1.02-2.67) times higher among women from maize staple diet category compared to Enset. Women aged 25-34 and 35-49 years were 1.57 (95% CI: 1.04-2.34) and 2.18 (95% CI: 1.25-3.63) times more likely to be deficient than those aged 15-24 years. Grand multiparas were 1.74 (95% CI: 1.09-3.23) times at risk than nulliparas. Frequency of coffee intake was negatively associated to zinc status. Positive association was noted between serum zinc and hemoglobin concentrations. Elevated CRP was associated with 22.5% reduction in serum retinol concentration. Women at their third trimester had 2.59 (95% CI: 1.23-5.48) times increased risk of VAD compared to those at the first trimester. The risk of VAD was significantly higher among illiterates and women without their own income. Women aged 35-49 years had 2.23 (95% CI: 1.31-3.81) times higher risk compared to those aged 15-24 years. Women with low DDS were 1.94 (95% CI: 1.17-3.19) times more likely to be deficient than their counterparts with high DDS. Compared to nulliparas, multiparas had 2.25 (95% CI: 1.20-4.22) times increased risk of VAD. VAD and ZD were associated to each other with adjusted OR of 1.80 (95% CI: 1.28-2.53). The mean birthweight among babies born to women who were at their second or third trimester at the time of exposure assessment was 2896 g and 16.5% (95 % CI: 13.5-19.6%) had LBW. Prenatal ZD and VAD were not significantly associated to LBW with Adjusted Relative Risk (ARR) of 1.25 (95 CI: 0.86-1.82) and 1.27 (95% CI: 0.86-1.87), respectively. The occurrences of ZD and VAD, neither in the second nor third trimester, were associated to LBW. The deficiencies did not show synergetic interaction in causing LBW with SI of 1.04 (95% CI: 0.17- 6.28). Significant determinants of LBW were maternal illiteracy, maternal thinness and stunting, primiparity, female sex of the baby and elevated CRP during pregnancy. Among 17 RCTs included in the meta-analysis, 3 reported positive association between zinc supplementation and birthweight, 1 had marginally negative association where as 13 found no association. Based on DerSimonian and Laird’s random effect model, the pooled ES was 0.071 (95% CI: 0.162 to -0.019) and it remained insignificant after stratification was made based on the dose of supplementation (optimal or high dose), design of the studies (community or health institution-based), and development status of the study country (developed or developing). Conclusion: ZD and VAD are of public health concern in the area. Key correlates of ZD were household food insecurity, low DDS, dependency on maize as a staple diet and low level of consumption of animal source foods. Illiterates and women devoid of self income had increased risk of ZD. Grand multiparity, old age pregnancy and frequent consumption of coffee were negative correlates. Pertaining to VAD, advanced gestational age elevated CRP were negatively associated with serum retinol level. Advanced maternal age, inferior socio-economic status, dependence on poorly diversified and plant based diet, ZD and history of too close and too many births were pertinent correlates of VAD. Prenatal ZD and VAD occurring neither in the second nor third trimester were not associated to LBW. Further, the deficiencies did not show synergetic interaction in causing LBW. Based on the meta-analysis, prenatal zinc supplementation did not show positive effect on birthweight. Recommendation: Zinc and VA deficiencies should be combated through food-based approach as it is a sustainable strategy to prevent multiple micronutrient deficiencies. Approaches that focus on dietary diversification like backyard gardening and poultry production should be promoted. The existing efforts to improve women’s awareness about optimal nutrition prior and during pregnancy should be strengthened through building the capacity of health extension workers and voluntary community health promoters. Strong intersectoral collaboration must be established between the health and agriculture sectors so as to address the root causes of malnutrition. Use of household based phytate reduction techniques, utilization of zinc containing fertilizers should be considered as potential strategies to combat ZD. Expansion of family planning coverage, livelihood promotion and socio-economic empowerment of women shall have affirmative influence.
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    Hypertension Among Adults in Addis Ababa, Ethiopia: Prevalence and Dietary Risk Factors
    (Addis Ababa University, 2024-06) Mulugeta Mekonene; Kaleab Baye; Samson Gebremedhin
    The global burden of hypertension is rising rapidly, especially in low- and middle-income countries (LMICs) like Ethiopia, where it has emerged as the leading non-communicable disease (NCD) in recent years. Overweight and obesity are also increasingly recognized as major modifiable risk factors for hypertension and cardiovascular disease (CVD). Hence, early detection of CVD risk is crucial for prevention and treatment. The Framingham risk score (FRS) is a simplified tool to predict 10-year CVD risk but has not been validated in sub-Saharan Africa. Fruits and vegetables (FV) may help lower CVD risk, though the optimal intake levels remain uncertain. In addition to other lifestyle habits, dietary patterns as a whole likely impact hypertension and obesity. The Dietary Approaches to Stop Hypertension (DASH) diet is proven to reduce blood pressure in Western populations, nonetheless, its applicability to Ethiopia is unknown. Therefore, this dissertation investigated the epidemiology of hypertension among adults, predicted the 10-year CVD risk of hypertensive patients and its association with FV intake, and lastly assessed DASH-style diet adherence and its relation to hypertension and adiposity among adults in Addis Ababa. A community-based cross-sectional study was conducted from May to June 2021 among randomly selected adults aged 18-64 years (n=600). A face-to-face interview using an adapted STEPwise was conducted. The participants completed standardized blood pressure, blood glucose, lipid profile, and anthropometric measurements including body fat percentage (BF%). FV consumption, salt intake, and stress levels were also measured with 24-hour dietary recall, INTERSALT equation, and Cohen’s Perceived Stress Scale, respectively. The 10-year CVD risk was calculated among a subset of the original samples using the FRS as well as a country-specific Globorisk score from 191 patients diagnosed with hypertension. Dietary pattern was assessed using a DASH diet score based on eight food groups constructed from a validated food frequency questionnaire. Multilevel mixed-effects logistic regression, multiple linear regression, and multivariate logistic regression models were fitted to determine factors associated with different outcomes of interests related to hypertension. The sample consisted of a total of 600 adults (mean age: 31.2 ± 11.4 years, 51.7% women). The overall age-standardized prevalence of hypertension was 22.1% and 47.8% according to the JNC7 and the 2017 AHA guidelines, respectively. The age groups of 40-54 years (AOR= 8.97; 95% CI: 2.35,34.23), and 55-64 years (AOR=19.28; 95% CI: 3.96,93.83) as compared to the 18-24 age group, male sex (AOR=2.90; 95% CI: 1.22,6.87), obesity (AOR=1.92; 95% CI: 1.02,3.59), abdominal obesity (AOR=4.26; 95% CI: 1.42,12.81), and very poor sleep quality (AOR=3.35; 95% CI: 1.15,9.78) were independent predictors of hypertension. In the prevalence of predicted 10-year CVD risk study, a total of 42.4%, 27.7%, and 29.8% of hypertensive patients were at low, moderate, and high CVD risks, respectively. There was a substantial agreement between the FRS and Globorisk models (weighted kappa 0.77). After adjusting for covariates, increasing FV intake from 120-450g/day was significantly related to 11.1-15.2% lower CVD risk in a dose-response manner. Additionally, the highest tertile of total fruit, but not total vegetable was associated with decreased CVD risk. The average DASH score was 22.5 (95% CI: 22.2-22.8), higher in women 23.7 (95% CI: 23.3-24.2) than men 21.2 (95% CI: 20.7-21.5). After controlling for confounders, individuals in the highest DASH-style diet adherence had 72% lower odds of hypertension than those in the lowest level. Furthermore, the risk of adiposity assessed using BF%, waist circumference, and waist-to-hip ratio were reduced by 15%, 62%, and 82%, respectively, in participants with higher DASH adherence compared to lower. The study concluded that hypertension is fairly high among adults and independently associated with the older age group, male sex, obesity, abdominal obesity, and poor sleep quality. There is a high prevalence of CVD risk among hypertensive patients and inversely associated with high FV consumption. The adherence to a DASH-style diet is moderate; however, high adherence is associated with a reduced risk of hypertension and adiposity among adults in Addis Ababa. Therefore, the study suggests a need to develop an integrated NCD prevention and control approach. Specifically, healthy dietary patterns should be adopted and tailored to public health policies and clinical practice to halt the NCD burden
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    School Feeding Program in Addis Ababa, Ethiopia: Safety and Nutritional Quality of Meals and Programmatic Challenges
    (Addis Ababa University, 2024-11) Yihalem Tamiru; Samson Gebremedhin; Afework Mulugeta; Abebe Ayelign
    The implementation of SFPs faces significant challenges, including limited institutional capacity, resource constraints, and inadequate food safety measures. Existing literature highlights a lack of data in these areas, emphasizing the need for comprehensive research to enhance program effectiveness and protect student well-being. In Ethiopia's SFP, issues persist regarding food provision, infrastructure, and administrative concerns related to food quality and hygiene. Previous studies in Addis Ababa which evaluated dietary quality and food safety knowledge among food handlers; however, they were not comprehensive. Therefore, this research aims to fill critical gaps by assessing the dietary quality of school meals, microbiological safety, food safety knowledge among food handlers, and the perceived benefits and challenges of the SFP in Addis Ababa. A cross-sectional study was conducted involving 293 adolescents from 20 schools. The dietary intake was evaluated via a multiple-pass 24-hour recall method against the RDA. Dietary diversity was measured using a 12-food groups score and analyzed with STATA software. Microbial contamination in RTE and drinking water was assessed collecting samples from 18 primary school kitchens in March and April 2024. This included microbiological analysis for 37 cooked food samples and 18 drinking water samples following ISO and NMKL guidelines. The KAP regarding food safety was evaluated employing structured face-to-face interviews (knowledge with a 29-question questionnaire (70% cutoff), attitudes with a 22-question scale, and practices with a 22-question instrument (scores of 16 or more indicating good practices)). Data were analyzed using descriptive statistics, pairwise correlations, and multiple linear regressions. Additionally, a qualitative phenomenological study was carried out in May 2023 on 98 participants (48 mothers of the students, 20 students, 20 school principals, and 10 experts gathered through key informant interviews and focus group discussions). The qualitative data was transcribed, translated, and thematically analyzed using ATLAS-TI software. The study highlighted significant nutrient inadequacies of meals provided to adolescents in schools. While school meals contributed a sufficient amount of carbohydrates (74.4%) of the RDA, they fell short in other essential nutrients: energy (34.1%), protein (42.5%), calcium (9.3%), zinc (14.6%), iron (52.9%), vitamin A (14.0%), thiamine (16.7%), vitamin B12 (12.8%), and niacin (3.8%). Moreover, this study assesses the 24-hour DDS of public primary school adolescents. Key findings reveal that 88.1% achieved adequate dietary diversity (DDS of 5 or higher), with 34.7% scoring 5, 38.5% scoring 6, 13.1% scoring 7, and 2.8% scoring 8. Despite a diverse diet, significant nutrient inadequacies persisted in both the school meals and overall 24-hour dietary intakes. The microbiological analysis of RTE meal samples indicated an overall acceptable level of quality and safety. However, several concerns were identified. Yeasts and molds exceeded reference standards in 78.4% of the RTE cooked meal samples (>102 cfu/ml), while E. coli surpassed the acceptable limit in 10.8% of samples (>102 cfu/ml), and S. aureus counts exceeded limits in 5.4% of samples (103 -104). Cooked rice showed the highest microbiological counts, particularly for E. coli and S. aureus. Approximately, 14.4% of the food samples were deemed unsatisfactory, exhibiting contamination from E. coli, S. aureus, and yeasts and molds. Regarding drinking water quality, 23.4% of samples were found to be non-potable, raising concerns about the total APC, TC, and FC. Notably, 72% of drinking water samples exceeded the APC criteria (>100 cfu/ml), 16% surpassed the TC standard (>1 cfu/ml), and 5.5% exceeded the FC threshold. The study revealed high levels of knowledge (85.8%), positive attitudes (79.6%), and satisfactory practices 72.3% among food handlers. Key factors influencing these outcomes included education, years of service, and marital status. Education was found to significantly enhance knowledge (p = 0.004) and practices (p < 0.001). While years of service positively influenced knowledge (p < 0.001), it had a negative impact on practices (p = 0.019). Marital status also played a role, with significant associations observed in attitudes (p = 0.046) and practices (p = 0.043). Logistic regression analysis highlighted the importance of specific facilities: having a separate storage area for raw and RTE foods reduced unsatisfactory food safety practices by 55% (AOR = 0.45), while a water facility in the kitchen decreased poor hygiene practices by 46% (AOR = 0.54). Additionally, a hand-washing facility lowered the odds of poor practices by 35% (AOR = 0.65). Notably, food handlers with higher attitude scores had an 81% lower likelihood of exhibiting poor food safety and hygiene practices (AOR = 0.19). Moreover, a qualitative study shed light on the benefits and challenges of the SFP, showcasing positive impacts on attendance, academic performance, reduced dropout rates, financial relief, improved behavior, and a safer learning environment. However, challenges such as underpaid kitchen workers, operational issues, reduced reading time, increasing food costs, limited market access, inadequate infrastructure, and growing the intention of dependency were also identified. This study emphasiz the necessity of enhancing nutritional adequacy, ensuring microbiological safety, sustaining food safety knowledge, and addressing program challenges to optimize the SFP in Addis Ababa. The study underscores the critical need to address nutrient inadequacies among school adolescents by prioritizing menu planning that incorporates nutrient-dense foods and implementing cost-effective strategies utilizing locally sourced options. Implementing nutrition education programs and collaborating with stakeholders on tailored initiatives such as community gardens, partnerships with local farmers, and enhancing the availability of free nutritious meals—are essential for promoting student well-being. While the microbiological quality of meals served through the Addis Ababa SFP generally meets established standards, some food samples exceeded permissible limits, indicating hygiene challenges that must be addressed through stringent hygiene practices. Also, food handlers in the program exhibited high knowledge and positive attitudes towards food safety, yet significant gaps in actual practices highlight the need for targeted educational interventions that consider local and cultural influences. Future researches should focus on objective measurements to better understand food safety practices and their implications for public health. Overall, although the SFP seems to contribute to a safer learning environment and improved educational outcomes, these conclusions may rely more on perception than on measurable evidence. However, urgent action is needed to address critical issues such as underpaid kitchen staff, operational inefficiencies, rising food costs, and inadequate infrastructure. To ensure the program's long-term sustainability, it is essential to implement strategies for reducing workloads, enhancing kitchen infrastructure, adhering to government guidelines, and promoting self-reliance among schools.
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    Unhealthy Weight Control Practice and Related Factors among Postpartum Women in Addis Abeba, Ethiopia
    (2021-06) Hana Assefa; Samson Gebremedhin
    Background: Women in the postpartum period are more concerned about their weight status and frequently practice unhealthy weight control methods. However, little is known about the practice of unhealthy weight control among postpartum women in Ethiopia. Objectives: To investigate the prevalence of unhealthy weight control practices and related facors with postpartum weight status and body image dissatisfaction among postpartum women in Addis Ababa, Ethiopia. Methods: A health facility-based cross-sectional study was conducted among 640 postpartum women from 6 months to 9 months postpartum period from randomly selected public health centers and private maternal and child medical centers. Unhealthy weight control practices were assessed by using the 12 item self-reporting tool with the reference period of 30 days. Body image dissatisfaction was measured by using 8 items Evan & Dolan Body Shape Questionnaire. Bivariable and multivariable logistic models were fitted to identify predictors of unhealthy weight control practice while controlling for possible confounders. The results are presented using adjusted odds ratio (aOR) with the respective 95% confidence interval (CI). Results: The prevalence of unhealthy weight control practice among postpartum women in the past 30 days was 38.3% (95%CI: 34.4-42.2). Factors that were associated with unhealthy weight control practices were Perceived overweight (aOR = 7.68; 95%CI: 2.01-29.38), being overweight (aOR=6.48; 95%CI:1.86-22.53), having only one child (aOR = 2.98; 95%CI: 1.63-5.45), being a single mother (aOR=5.94; 95%CI: 2.13-16.55 and having body image dissatisfaction (aOR=1.16; 95%CI: 1.11-1.21). Further reported peer (aOR = 2.96; 95%CI: 1.56-5.62), husband/dating partner (aOR = 2.63; 95%CI: 1.44-4.82) and social media (aOR = 4.79; 95%CI: 2.22-10.33) influences were associated practice of unhealthy weight control practices. Conclusion: Unhealthy weight control practice are commonly among post-partum women in Addis Ababa. To address the problem, programmatic and severe provision related attentions should be given attention.