nutrition

1. DEPARTMENT OF PUBLIC HEALTH
AFOMIA T. (BSC, MPH/NUTRITION)

2. MICRONUTRIENT DEFICIENCIES OF PUBLIC
HEALTH IMPORTANCE IN ETHIOPIA
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3. INTRODUCTION
• The health and vitality of human beings depends on diets that
include adequate amounts of vitamins and minerals to promote
effective physiological processes including:
– Reproduction
– Immune response
– Brain and other neural function
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4. INTRODUCTION CONT…
• Very minute quantities of vitamins and minerals are needed for
health and these are measured in micrograms or milligrams, thus
supporting their description as micronutrients.
• Their deficiency increase the overall risk of mortality and
associated with a variety of adverse health effects, including:
– Poor intellectual development and cognition
– Decreased immunity
– Impaired work capacity.
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5. INTRODUCTION…
• The adverse effects of micronutrient deficiencies are most severe
for:
– Children
– pregnant women
– fetus
• Approximately 30% of the world’s population is unable to use
their full mental and physical potential as a result of
micronutrient malnutrition.
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6. INTRODUCTION…
• According to the World Bank estimates the problem of
micronutrient malnutrition cost national economies to 5%
their gross domestic product (GDP) through death and
disability, but that the solution would cost as little as 0.3% of
the GDP.
• Also the economic payoffs of micronutrient intervention
programs are high.
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7. INTRODUCTION CONT…
• Among micronutrients, three have obtained worldwide attention
due to their high public health significance.
• Vitamin A, Iodine and Iron deficiencies
– Lead to grave health, social and economic consequences but
there are cost effective strategies to overcome these
deficiencies.
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8. VITAMIN A DEFICIENCY (VAD)
Introduction
• Vitamin A deficiency has long been known to cause blindness
• But more importantly, its deficiency is closely associated with:
– Increased mortality and morbidity among young children
– Increased risk of maternal death.
• Vitamin A is an essential micronutrient for proper functioning of
the immune system.
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9. RATIONALE FOR ACTION
• In our country, 17% of child deaths are attributable to vitamin A deficiency.
• Improving children’s vitamin A status increases their chance of survival:
• Deaths from measles can be reduced by 50%
• Deaths from diarrhea can be reduced by 40%
• Over all mortality can be reduced by 25%
• Improving vitamin A status reduces the severity of childhood illnesses =>
• Less strain on clinic outpatient services and hospital admissions
• Contributes to the well-being of children and families
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10. RATIONALE cont…
Improving vitamin A status also:
– Prevents night blindness, xeropthalmia, corneal
destruction, and blindness
– May reduce birth defects
– May prevent epithelial and perhaps other types of cancer
– Prevents Anemia
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11. Cont..
Improving vitamin A status is very cost-effective:
– Just a few cents per capsule
– Reduces health costs by decreasing hospital and clinic
visits
– Easily integrated into existing public health /immunization
programs
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12. Causes of Vitamin A Deficiency
Vitamin A deficiency (VAD) occurs :
• When vitamin A intake or liver stores fail to meet daily metabolic
requirements
• The most common cause is a persistently low intake of vitamin
A-rich foods;
• When there is a problem with absorption, conversion or
utilization of vitamin A; or
• If a diet is lacking oils or fats, vitamin A is not well absorbed and
utilized.
• When children suffer from repeated infections or diseases
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13. Population at Risk
• Infants
• Under five children
• Pregnant women
• Lactating women.
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14. STRATEGIES TO CONTROL
• The main strategies which have been adopted globally to
control and eliminate vitamin A deficiency are:
1. Promote and support exclusive breastfeeding up to 6
months of age
2. Universal supplementation
3. Dietary diversification and modification
4. Food fortification
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15. 1. Promote and Support Exclusive
Breastfeeding up to 6 Months of Age
• In their first 6 months of life, breast milk protects infants against
infectious diseases that can deplete vitamin A stores and
interfere with vitamin A absorption.
• In areas where vitamin A deficiency is common, post-partum
women should be given a single high-dose (200,000 IU) vitamin A
capsule as soon after delivery as possible, but no later than 6-8
weeks postpartum.
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16. 2. Supplementation of Vitamin A
Capsules
Supplementation for prevention
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Vitamin A should not be given in less than one-
month intervals.

17. Supplementation Cont…
Supplementation of vitamin A capsules could take place during:
• National Immunization Days
• Mass supplementation campaigns (twice a year)
• Routine health service delivery including immunization sessions
• Maternal Child Health contacts
• Out-patient clinics for targeted diseases in children
• Child Health Days
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18. Supplementation Cont…
Therapeutic supplementation
• This is for children with severe acute
malnutrition, diarrhea, xerophthalmia and
measles.
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20. 3. Food Diversification for Vitamin A
• Populations should be encouraged to grow and
consume vitamin A rich foods throughout the
country at all times.
• This requires input from various entities Ministries
of Health, Agriculture, Education, Information and
Communication, the Regional states, donors and
NGOs.
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21. Food sources of Vitamin A
a. Animal Sources of Vitamin A
• breastmilk, egg yolks, organ meats (liver etc),
whole milk, and milk products, small fish with
liver intact, fish, butter.
• The best source of vitamin A for infants is
breastmilk.
• The mother’s secretion of vitamin A into
breastmilk is related to her own vitamin A
status.
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22. Food sources of Vitamin A....
b. Plant Sources of Vitamin A
• Plants contain beta-carotene that needs to be converted
into retinol by the body.
• The best plant sources of vitamin A are dark orange or
dark yellow fruits and vegetables such as papayas,
mangos, pumpkins, carrots, and yellow or orange sweet
potatoes and dark green vegetables such as spinach, kale
and Swiss chard.
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23. 4. Food Fortification with Vitamin A
• This involves adding one or more vitamins and minerals to
commonly consumed foods, especially those for children,
for the purpose of preventing or correcting a demonstrated
deficiency.
• Unfortunately, it is difficult to fortify foods in Ethiopia
because no staple food has been identified as widely
consumed in the entire country and the foods that are
relatively common are not processed in factories.
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24. IODINE DEFICIENCY DISORDERS (IDD)
• Iodine is an essential micronutrient for regulation of
physical growth and neural development.
• It is also an essential component of the thyroid
hormones, (thyroxin and tri -iodothyroxine) and
insufficient iodine level in the blood leads to poor
production of these hormones.
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25. 1.2. RATIONALE FOR ACTION
• Universal Salt Iodization (USI) can lead to an increase of the
average intelligence of the entire school age population by
as much as 13 points.
• Salt iodization will improve the physical and mental
development of millions more.
• The intellectual and cognitive development of whole
generations of Ethiopian children will be reduced by around
10% unless adequate iodine is provided.
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26. Causes of Iodine Deficiency
• Deforestation
• Erosion and
• Flooding of topsoil
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27. Population at Risk
• People of all ages and sexes are vulnerable but
this deficiency is more critical for the
fetus
young children
pregnant women and
lactating mothers.
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28. STRATEGIES
• The main strategies to control and eliminate
iodine deficiency are:
1. Universal iodization of salt for human and animal
consumption
2. Supplementation of iodine capsules to
populations in highly endemic areas.
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29. 1. Universal Iodization
• Iodized salt is both a preventive and corrective
measure for iodine deficiency.
– most effective
– low cost
– long-term solution
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30. 2. Supplementation of Iodine Capsules
• As a short-term strategy in highly endemic areas,
Lipiodol (iodized oil capsules), should be distributed on a
one-time basis to individuals.
• Dosages are:
– 1 capsule for pregnant women and children under 5
– 2 capsules for women of reproductive age and
children 5 to 14 years of age
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31. IRON DEFICIENCY ANEMIA (IDA)
• A deficiency of iron leads to anemia which is defined as a
low level of hemoglobin in the blood, as evidenced by
reduced quality and quantity of red blood cells.
• The daily requirement of iron for
– an adult male is 8-10 mg
– women, 10-18mg and
– pregnant and lactating women up to 20 mg.
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32. IDA CONT…
• Currently in Ethiopia, no systematic programs are
in place to address anemia because of a lack of
consensus regarding the severity and magnitude
of the problem.
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33. IDA CONT…
• In Ethiopia the studies conducted so far are very limited and
localized, making it difficult to estimate the exact prevalence of
IDA in the country.
• Nevertheless, a region specific study in Tigray showed that 16%
of women in the reproductive age group were anemic. In this
same study, anemia in children (6-60 months) was reported to be
42%.
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34. RATIONALE FOR ACTION
Control of anemia will:
• Decrease maternal mortality
• Decrease premature birth, intera-uterine growth retardation, and
low birth weight,
• Decrease infant mortality (due to low birth weight),
• Increase capacity to learn and
• Increase productivity in all individuals.
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35. Causes of Anemia
Its direct causes can be broadly categorized as:
– Poor, insufficient, or abnormal red blood cell production,
– Excessive red blood cell destruction, and
– Excessive red blood cell loss.
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36. Causes of Anemia cont...
Contributing causes include:
– Poor nutrition related to dietary intake; dietary quality;
– Infectious and parasitic diseases;
– Lack of access to health services; and poverty.
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37. Population at Risk
– Low birth weight infants
– Children aged 6-24 months
– Adolescent girls
– Pregnant and lactating women
– Children between 6 and 11 years of age
– People living with HIV and AIDS
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38. STRATEGIES
• The strategy for the reduction of iron deficiency anemia should
be multifaceted and sustainable.
The main strategies are:
1. Supplementation of iron and folic acid
2. Treatment of severe anemia
3. Dietary diversification – increased production and
consumption of locally available iron rich foods
4. Fortification of foods with iron
Additional strategies to reduce non-iron deficiency anemia are:
5. Control of malaria (prophylaxis and treatment),
helminthiasis, and schistosomiasis.
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39. 2. Treatment of Anemia
Anemia diagnosed:
• By clinical examination (extreme pallor of the palms of the
hands)
• By laboratory (hemoglobin/hematocrit tests)
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41. 3. Dietary Diversification
• Populations should be encouraged to produce and consume iron
rich foods throughout the country at all times.
• This requires input from various entities such as the Ministries of
Health, Agriculture, Education, Information and Communication,
the Regional states, donors and NGOs.
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42. 4. Food Fortification
• Fortification of staple foods with iron is the major way to increase
dietary intake of iron in countries where iron-rich foods are too
expensive for the poor to purchase.
• It is difficult to fortify foods in Ethiopia because no staple food has
been identified as widely consumed in the entire country and the
foods that are relatively common are not processed in factories.
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43. 5. Control of Direct Causes of Anemia
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44. CONT…
• In addition, it is important to encourage hygiene and
environmental sanitation to prevent women, children, or people
living with HIV & AIDS from getting parasites (worms).
• Control of schistosomiasis is also critical in endemic areas.
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45. Thank u!
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