Disparities in micronutrient intake among children 6-23 months in Ethiopia: a multi-level analysis based on national survey data 10.55131/jphd/2022/200106
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Abstract
Both micronutrient deficiency and undernutrition among children are priority areas of public health concern in Ethiopia. The main objective of this study was to examine the factors associated with disparities in micronutrients intake among children 6-23 months. Data were drawn from the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total of 3076 children aged 6-23 months were used for the present analysis. The outcome variable was multiple micronutrient intake, which was constructed based on the linear combination of six sets of variables (4 supplements and 2 food-based intakes). Mixed-effect Poisson regression model was used to assess the determinants of multiple micronutrient intakes. The regression results show that micronutrient intakes were lower among children of non-first birth order by 58% (IRR=0.492, 95% CI:0.441-0.550); higher for children who got antenatal care (ANC) service during pregnancy (RR=1.121 95%CI:1.027-1.224) and postnatal care service in the first two months after birth (RR=1.255, 95% CI:1.138-1.383). Other predictors included mother’s age (RR=1.246, 95%CI: 1.118-1.389), parity (RR=1.538, 95% CI:1.316-1.798), maternal education (RR=1.204, 95%CI:1.089-1.331, maternal work status, household wealth, and access to the radio. The results also showed a regional disparity in micronutrient intake. Given the huge adverse impacts of poor micronutrient intake, fortification (supply side) is suggested as one of the ways to enable households to get easy access to these essential micronutrients. In conjunction with this, improving knowledge and attitude mothers through continuous behavioral change communication approaches could make a significant impact on the uptake of micronutrient supplements.
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References
WHO. Appropriate complementary feeding [Internet]. 2019. Available from: https://www.who.int/elena/ titles/complementary_feeding/en/.
Black RE, Allen LH, Bhutta Z et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371:243-260.
Black RE, Cesar G Victora, Susan P Walker, Zulfi qar A, Bhutta PC et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382:427–51.
WHO. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. 2016.
Girma B, Berhane Y. Children who were vaccinated, breast fed and from low parity mothers live longer: a community based case-control study in Jimma, Ethiopia. BMC Public Health. 2011;11(197).
WHO. Undernutrition [Internet]. 2018 [cited 2019 November 11] Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition.
WHO. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health [Internet]. 2008. Available from: http://www. who.int/social_determinants/thecommission/finalreport/en.
WHO. The Global Strategy for Women’s, Children’s and Adolescents’ Health, (2016–2030): Survive, Thrive and Transform [Internet]. 2016. Available from: http://globalstrategy.everywomaneverychild.org.
WHO and UNICEF. Progress on Sanitation and Drinking Water: 2014 Update. Geneva, Switzerland: World Health Organization. 2014.
Mulholland EK, Smith L, Carneiro I, Becher H, Lehmann D. Equity and child-survival strategies. Bull World Heal Organ. 2008;86:399–407.
UN. The Millennium Development Goals Report 2011. New York, USA; 2011.
Zere, E., Moeti, M., Kirigia, J. et al. Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007;7(78). doi: https:// doi.org/10.1186/1471-2458-7-78
Sheehy T. , Carey, E., Sharma S . et al. Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets. Nutr J 2019;18(46). doi: https://doi.org/10.1186/s12937-019-0471-1
FAO. Gender and Nutrition (Fact sheet) [Internet]. 2010. Available from: http://www.fao.org/docrep/012/al184e/al184e00.pdf.
CSA & ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia & Calverton, MD: Central Statistical Agency & ICF International. 2016.
CSA and ICF International. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia: Central Statistical Agency. 2016.
African Union Commission, NEPAD Planning and Coordinating Agency, UN Economic Commission for Africa & UWFP. The Cost of Hunger in Africa: Social and Economic Impact of Child Undernutrition in Egypt, Ethiopia, Swaziland and Uganda. Addis Ababa, Ethiopia. 2014.
World Bank. The World Bank in Ethiopia [Internet]. 2019 [cited 2021]. Available from: https://www. worldbank.org/en/country/ethiopia/overview#2.
Federal Democratic Republic of Ethiopia/FDRE. Country Profile of Federal Democratic Republic of Ethiopia, IMF Country Report No. 13/308. 2013.
World Bank. GDP per capita, PPP (constant 2017 international) [Internet]. 2019. Available from: https://data.worldbank.org/indicator/NY.GDP.PCAP.PP.KD 2017.
FDRE-Ethiopia. National Nutrition Programme June 2013-June 2015 [Internet]. 2013. Available from: http://www.usaid.gov/sites/default/files/documents/1867/National Nutrition Programme.pdf.
CSA and ICF International. Central Statistical Agency [Ethiopia] and Macro International. Ethiopian Demographic Health Survey, 2016. Calvrton,USA. 2016.
FMOH. National Strategy for Infant and Young Child Feeding - Ethiopia. 2004.
Rutstein SO, Rojas G. Guide to DHS statistics. Demographic and health surveys methodology [Internet]. 2006. Available from: https://dhsprogram. com/pubs/pdf/DHSG1/Guide_to_DHS _Statistics_29 Oct 2012_DHSG1.pdf.
Bell, Andrew, Kelvyn J. Explaining fixed effects: Random effects modeling of time-series cross-sectional and panel data. Polit Sci Res Methods. 2015;3(1):133-153.
StataCorp. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.
Hocking R. Methods and Applications of Linear Models. In: Willey, New York. 1966.
Hosmer DW, Hosmer T, Le Cessie S. A comparison of goodness-of-fit tests for the logistic regression model. Stat Med. 1997;16(9):965–80.
Hawkins SS, Stern AD, Baum CF, Gillman M. Evaluating the impact of the baby-friendly hospital initiative on breast-feeding rates: a multi-state analysis. Public Heal Nutr. 2015;18(2):189–97.
Gregory J, Lowe S. National Diet and Nutrition Survey: Young People Aged 4–18 Years. London, The Stationary Office. 2000.
Bereket E, Zewdie B, Dessalegn T, Garumma T. Complementary feeding practices and associated factors in Damot Weydie District, Welayta zone, South Ethiopia. BMC Public Health. 2018;18:419.
Chapagain R. Factors affecting complementary feeding practices of Nepali mothers for 6 months to 24 months children. J Nepal Heal Res Counc. 2013;11(24):205–7.
Archana P, Yamini P, Neetu B, Jitesh B, Kingsley EA, Michael J. Determinants of inappropriate complementary feeding practices in young children in India: secondary data analysis of demographic and health survey 2006–2007. Matern Child Nutr. 2012;8(1):28–44.
Ogbo FA, Page A, Idoko J, Claudio F, Agho K. Trends in complementary feeding indicators in Nigeria, 2003-2013. BMJ Open 2015;5(e008467). doi:10. 1136/bmjopen-2015-008467
Senarath U, Dibley MJ, Godakandage SS, Jayawickrama H, Wickramasinghe A, Agho K. Determinants of infant and young child feeding practices in Sri Lanka: secondary data analysis of demographic and health survey. Food Nutr Bull. 2010;31(2):352–65.
Upul S, Kingsley EA, Dur-e-Samin A, Sanjeeva SP et al. Comparisons of complementary feeding indicators and associated factors in children aged 6–23 months across five South Asian countries. Matern Child Nutr. 2012;8(11):89–106.
Vishnu K, Kay S, Yun Z. Determinants of complementary feeding practices among Nepalese children aged 6–23 months: Findings from demographic and health survey 2011. BMC Pediatr. 2013;13(131).
Ersino, G., Henry, CJ., & Zello GA. Suboptimal feeding practices and high levels of undernutrition among infants and young children in the rural communities of Halaba and Zeway, Ethiopia. Food Nutr Bull. 2016;37(3):409-424.
Muzi Na, Larissa J, Sameera AT, Saifuddin A. Association between women’s empowerment and infant and child feeding practices in sub-Saharan Africa: an analysis of Demographic and Health Surveys. Public Health Nutr 2015;18(17):3155–3165. doi: 10.1017/S1368980015002621
WHO. MDGs to SDGs. Geneva: World Health Organization. [Internet]. 2015 Available from: http://www.who.int/gho/publications/mdgs-sdgs/en/.
Thrasher JF, Huang LL, Perez-Hernandez R, Niederdeppe J, Arillo-Santillan E, Alday J . Evaluation of a social marketing campaign to support Mexico City’s comprehensive smoke-free law. Am J Public Heal. 2011;101:328–35.