Childhood undernutrition and the potential of amaranth for reducing anaemia in southern Ethiopia
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The overall objective of this thesis was to investigate the efficacy of consuming bread containing processed amaranth on the treatment of anaemia and IDA among children 2-5 years of age in southern Ethiopia. Also, it sought to establish the prevalence of iron deficiency anaemia and associated risk factors, focusing on iron-rich food consumption among children aged 2-5 years in southern Ethiopia, and to assess the prevalence of co-morbid anaemia and stunting (CAS), and factors associated with CAS among children aged 2-5 years, in southern Ethiopia. Methods: The nutritional situations of 340 randomly selected children aged 2-5 years were assessed to establish baseline data. Mothers were interviewed using a structured questionnaire to obtain child and household information. Anthropometric measurements and blood samples for haemoglobin were taken from 331 children. From children with anaemia 107/331, serum ferritin and C-reactive protein (CRP) were analysed to asses IDA. A cluster randomized controlled trial was then conducted, including 100/107 anaemic children (N=100), to determine the efficacy of bread containing processed amaranth compared to maize bread, followed for 6 months. Children in the amaranth arm (N=50) received 150 g bread daily containing 70% amaranth and 30% chickpea. Amaranth grain processing included soaking, germinating, and fermenting, to decrease phytate concentration. Children in the maize arm (N=50) received 150 g bread daily, containing processed maize, roasted and fermented to give a similar colour and structure to amaranth bread. Dietary practice and morbidity patterns were monitored on a monthly basis while haemoglobin, ferritin, and CRP were measured at baseline and at the end of the interventions. Results: Baseline results indicated that 107/331 (32.3 %) children were anaemic, and of those children, 27/107 (25%) had IDA, and 23/107 (20%) of children with anaemia also had elevated CRP, a sign of inflammation. Furthermore, from the baseline, 125/331 (37.8%) of the children were stunted and 59/331 (17.8%) had comorbid anaemia and stunting. Only 50/331 (15%) of children consumed iron-rich foods in the preceding 24 hours. The last follow-up measurement of the trial showed that anaemia prevalence was significantly lower in the amaranth group (32%) compared to the maize group (56%) adjusted risk ratios (aRR: 0.3; 95%CI: 0.1-0.7). The haemoglobin concentration estimate was significantly higher in the amaranth group compared with the maize group adjusted beta coefficient (aβ: 8.9g/L; 95%CI: 3.5-14.3). The risk of iron deficiency anaemia was lower in the amaranth group (aRR: 0.4; 95%CI: 0.2-0.8) in the intention to treat analysis, but this was not significant in the complete case analysis. There was no difference between the groups with regard to iron deficiency (aRR: 0.8; 95%CI: 0.5-1.1). Conclusion: Anaemia, IDA, and stunting are public health concerns among children in the study area. Household food insecurity and iron supplementation of mothers during pregnancy were factors associated with these problems in the area. Consumption of bread containing processed amaranth had favourable effects on haemoglobin concentration in anaemic children. Processed amaranth grain products may therefore have a potential to improve nutritional status in children. Further research and awareness-raising are needed.Formålet med avhandlingen var å sammenlikne prosessert amarantbrød mot det mer vanlige maisbrødet og å se om det var endring i anemi, inkludert jernmangelanemi blant anemiske barn i alderen 2-5 år i sør-Etiopia. Også forekomst av jernmangelanemi og komorbid anemi og vekstretardasjon, samt risikofaktorer ble studert. Forekomst av en rekke helse og ernærings-tilstander ble først undersøkt. Blant dem ble hundre anemiske barn randomisert til å få amarant- eller mais brød hver dag i seks måneder. Arbeidet bygger på forskning fra kandidaten som har evaluert ernæringsinnholdet i prosessert amarant. Studien viste at amarantbrødet hadde gunstig effekt på hemoglobinkonsentrasjonen blant anemiske barn. Studien viste også at anemi, inkludert jernmangelanemi, vekstretardasjon og samtidig anemi- og vekstretardasjon er store folkehelseproblem blant barn i området. Barna fikk nesten ikke jernholdig mat og mikrostoff- beriking og tillegg var nesten ukjent.
Has partsPaper I: Orsango AZ, Habtu W, Lejisa T, Loha E, Lindtjørn B, Engebretsen IMS. 2021. Iron deficiency anaemia among children aged 2-5 years in southern Ethiopia: a community based cross-sectional study. PeerJ 9:e11649. The article is available at: https://hdl.handle.net/11250/2838833
Paper II: Orsango AZ, Loha E, Lindtjørn B, Engebretsen IMS. Co-morbid anaemia and stunting among children 2-5 years old in southern Ethiopia: a community-based crosssectional study. BMJ Paediatrics Open 2021;5:e001039. The article is available at: https://hdl.handle.net/11250/2975798
Paper III: Orsango AZ, Loha E, Lindtjørn B, Engebretsen IMS. Efficacy of processed amaranth-containing bread compared to maize bread on haemoglobin, anaemia and iron deficiency anaemia prevalence among two-to-five year-old anaemic children in Southern Ethiopia: A cluster randomized controlled trial. PLOS ONE. 2020;15(9):e0239192. The article is available at: https://hdl.handle.net/11250/2994664