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Dietary intake, nutritional status of lactating women and their 6-23-months-old children in Genta Afeshum District, Rural Ethiopia : adaptation and validation of calculator for inadequate micronutrient intake (CIMI)
(2020) Desalegn, Beruk; Frank, Jan
Religious fasting is one of the categories of dietary or food taboos, which may affect the dietary intake and nutritional status of individuals. In Ethiopia, about half of the population are followers of Ethiopian Orthodox Tewahedo religion, and approximately 250 days per annum are fasting days. In these fasting days, lactating and pregnant women and children are exempted from fasting. However, lactating and pregnant women fast and are not also happy to prepare non-fasting foods for their children during the fasting days due to fear of contamination of family food. Early identification of micronutrient deficiencies in Ethiopia are flouted, as most often the quantitative dietary data are not available. As a result, the hidden hunger might have not been addressed properly, where it remains high and persistent. Therefore, easy to use, less costly and applicable assessment tool which can estimate the quantitative dietary intake of an individual or a community is urgently needed to achieve the national and international goals set for eradicating malnutrition. The Calculator for Inadequate Micronutrient Intake (CIM) is a simple, easy-to-use, informative, web-based application of quantitative dietary assessment method, which was first developed in Indonesia for Indonesian population. It estimates energy and nutrient intake correctly, and identifies nutrient inadequacy according to FAO/WHO recommended nutrient intake (RNI) regarding age, sex and physiological stage. Thus, the present study was conducted with the aim of assessing and comparing the nutritional status and dietary intake of lactating women and their 6-23-months-old children in fasting and non-fasting periods, and to adapt and validate the CIMI program for Ethiopian population. This study was conducted in rural Genta Afeshum district, in Tigray, Ethiopia, where almost all people in the woreda are followers of Ethiopian Orthodox Christianity. A longitudinal study was conducted using575 and 522 lactating women and their 6-23-months-old children in the lent fasting and non-fasting. In the present study it was found out that the prevalence of underweight (BMI < 18.5 kg/m2) in fasting lactating women was high (50.6%) which is associated with maternal age, maternal illness within four weeks preceding the fasting survey, fasting status during their pregnancy and lactation period of their children included in this study. Additional predictor variables for maternal underweight were grandfathers‘ as household decision maker, use of non-improved water source, household aid experience and the absence of chicken in the household. The average number of meals, diet diversity, and animal source foods consumption scores were significantly higher in non-fasting compared to fasting periods, regardless of the fasting status (p < 0.001, p < 0.05 and p < 0.001, respectively). Whereas, 31.6–33.7%, 11.7–15.7% and 4.4–4.8% of the 6-23-months-old children in the study population were stunted, underweight and wasted, respectively. In the fasting period, the weight-for-length (WLZ) and length-for-age (LAZ) values for the 6-23-months-old children of non-fasting mothers were significantly higher (p < 0.05) than the children of the fasting mothers‘ group. Similarly, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly lower in fasting compared to non-fasting period. The proportion of the 6-23-months-old children who met the minimum acceptable diet (MAD) was small (2.3-6.7%) in the study population; however, this proportion was significantly (p < 0.001) higher in the non-fasting than fasting period in the children of fasting mothers. Age of the child, maternal fasting status during pregnancy and lactation periods, maternal education and occupation were associated with child underweight. Likewise, age of the child, colostrum intake status, maternal fasting status during pregnancy and lactation period and toilet presence in the household were associated with child stunting. But, maternal fasting status during lactation period and maternal education predicted wasting in the children precisely. The average energy, protein and almost all micronutrients intakes of children and women were lower in fasting compared to non-fasting period. At the same time, the prevalence of inadequate intakes of energy, protein and most micronutrients were higher in both the children and lactating women during fasting than non-fasting period. The result of this study revealed that the correlation coefficients for the average dietary nutrient intake calculated by CIMI and the reference software NutriSurvey (NS) were between 0.741-0.956 for the children and between 0.779-0.920 for the lactating women groups. As a conclusion, the dietary pattern and nutritional status of lactating women and their breastfed children are affected during the fasting period. Therefore, the existing multi-sectoral nutrition intervention strategies in Ethiopia should include religious institutions in a sustainable manner. CIMI adapted for the rural Ethiopian setting estimates the average nutrient intake accurately; and identifies inadequate micronutrient intake of individuals enabling enumerators to provide feedback and suggest improvements. Thus, CIMI can be used in Ethiopia, as a simple dietary assessment tool by nutrition and related researchers, policy makers, implementers and evaluators.