Epidmiology and Effct on Birtweight of Prenatal Zinc and Vitamin a Deficiencies in Rural Sidama Southern Ethiopia
No Thumbnail Available
Date
2012-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba Universty
Abstract
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.
xii
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 insecured 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.
xiii
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.
Key Words:
Prenatal zinc deficiency, prenatal vitamin A deficiency, low birthweight.
Description
Keywords
Prenatal zinc deficiency, prenatal vitamin A deficiency, low birthweight.