Prevalence and associated factors of zinc deficiency among

Prevalence and associated factors of zinc deficiency among pregnant women attending antenatal care at Gambella Hospital, southwest of Ethiopia; Institution based cross sectional study, 2016 By : Ataguadil Mekonnen (Bsc, MPHN)

Introduction • Zinc is an essential trace mineral element vital for: – Physiological, biological, and metabolic functions. – 48% of the world’s population are at a high risk of ZD due to inadequate zinc intake (Brown KH et al. 2004). – 82% of all pregnant women are more likely to suffer from ZD worldwide (Caulfield L et al. 2004). – 31 % (4%-73%) across various regions of world’s po. • Highest Sub-Saharan Africa is 50% (37%-62%). • Asia (34 -73%), USA and Europe (4 -7%) is lowest. – Maternal ZD during and later pregnancy has: Devastating and irreversible consequences on mothers (Ramik U 2000). – 21. 1% of Ethiopian population was at risk of inadequate dietary zinc intake (INZi. NCG, 2004) 1

Objectives General objective • To assess prevalence and associated factors of zinc deficiency among pregnant women attending antenatal care at Gambella Hospital, 2016. Specific objectives • To determine the prevalence of zinc deficiency among pregnant women attending Antenatal care. • To identify factors associated with zinc deficiency among pregnant women attending Antenatal care. 2

Methods and Materials Study area and period: Gambella, January 01 -30, 2016. Study design: Institutional based cross-sectional Source population: All pregnant women Study population: Visited ANC and fulfill criteria. Inclusion criteria: Visiting ANC in the 1 st , 2 nd , 3 rd trimesters, Exclusion criteria: Critically ill and/or physical deformity. Sampling size determination: n=(za/2)2}x{(p (1 -p)}/d 2). n=268 Sampling procedure: A systematic random sampling Data collection procedures: Interviewer administered structured Data quality assurance • Translated in to local language. • Training was given. 3

Methods cont… • Pre-test of questionnaires was done. • Strict supervision was conducted during data. • Aseptic techniques and standard operating procedure. Data management process and analysis • EPI-Info v- 3. 5. 4 and Exported to SPSS v-20. 0 for cleaning and analysis. • Bivariate and Multivariable logistic regression analysis • Statistically significant was obtained at odds ratio (OR) with 95% CI and p-value< 0. 05. • Zinc deficiency: serum zinc level of < 56 μg/dl during the 1 st trimesters' , or 50 μg/dl during the 2 nd or 3 rd trimesters' (IZi. NCG). 4

Results and Discussion Table 1: Background characteristics of the study participants attending antenatal care at Gambella Hospital, Southwest Ethiopia, April. Frequency 2016, (n=246). Percentage Background characteristics Age of years 15 -24 25 -34 35 -49 Religion Orthodox Protestant Muslim Catholic Ethnicity Agnua Amhara Oromo Nuer Others** Marital status Married (living with a partner) Others*** Residence Urban Rural Education status Illiterate Literate 73 127 46 29. 7 51. 6 18. 7 92 112 26 16 37. 4 45. 5 10. 6 6. 5 53 52 46 39 56 21. 5 21. 1 18. 7 15. 9 22. 8 235 11 95. 5 4. 5 165 81 67. 1 32. 9 56 190 22. 8 77. 2 5

Dark green leaf vegetable 26. 4% Milk and milk products 10. 6% Eggs 12. 2% Organ meat Food Groups Flesh meat and fish 12. 2% 51. 6% ther fruits and vegetables 70. 7% Vitamin A rich fruit and vegetables Legume , seed and nut Starchy staple 45. 15% 53. 3% 99. 4% Figure 1: Dietary diversity scores of the study participants attending antenatal care at Gambella Hospital, Southwest Ethiopia, April 2016, (n = 246) …. . DDS: 3. 87 (± 1. 012). 7

Result and… Prevalence of Zinc deficiency • The prevalence of ZD was 55. 3% [95% CI (50. 0, 61. 3)]. • This finding is relatively similar with studies in – Sidama reported 53% (G/medhin S et al. , 2011 ). – Gonder 57. 4% (Kumera G et al. , 2015). – India 55. 5% (Pathak P et al. , 2003). • But, this finding is much lower than studies done in – Sidama 72%, 74%, 76% (Abebe Y et al. 2009) – Nigeria 97. 2%, Cameroon 82%((Oguizu A et al. 2015) 8

Result and… • This variation could be explained by difference: – Cut-offs of serum zinc levels were used for defining. – Only pregnant women in the 3 rd were included. – Sample size difference and urban-rural. • Relatively higher than reports from other studies: – Sudan 38% (Bushra M et al. 2010). – Bangladesh 14. 7% , Iran 29% (Shamin A et al. 2013). • High prevalence of ZD in the present study might be: ─ Poor pre- and during pregnancy nutritional status. ─ Prone to seasonality bias. 9

Table 3: Bivariate and multivariable analysis of factors associated with ZD among pregnant women attending antenatal care at Gambella Hospital, Southwest Ethiopia, April 2016 Zinc status ZD++(n=136) Predicator variables Frequency Nutrition Education 44(47. 3) Yes No 92(60. 1) Birth interval < 24 70(75. 3) month ≥ 24 month 38(48. 1) Trimester First 36(64. 3) Second 35(38. 5) Third 65(65. 7) Animal sources 63(44. 7) Yes No 73(69. 5) Normal(n=110) Frequency (%) 49(52. 7) COR (95%CI) 1 R AOR (95%CI) 1 R 61(39. 9) 23(24. 7) 1. 68(0. 99, 2. 83)* 3. 28( 1. 72 -6. 26)* 41(51. 9) 20(35. 7) 56(61. 5) 34(34. 3) 78(55. 3) 1 R 1 R 1. 06(0. 56, 2. 11)* 3. 06(1. 69, 5. 53)* 1 R 2. 40(1. 01, 5. 74)** 2. 604(1. 08, 6. 273) * 1 R 1 R 0. 84(0. 31 -2. 22) 3. 76(1. 49, 9. 49)** 1 R 32(30. 5) 2. 82(1. 66, 4. 81)* Adequate 62(53. 0) Inadequate 74(57. 4) 55(47. 0) 55(42. 6) 1 R 1. 91(0. 72, 1. 96)* No 77(46. 1) 90(53. 9) 1 R DDS Anemia 3. 05(1. 31, 7. 07)** 1 R 3. 59(1. 45, 8. 96)** 9 1 R

Recommendations To policy makers and programmers – Should motivate and attract NGO working with micronutrient deficiencies. To Hospital and Regional health Bureau – Encourage effective methods of family planning implementation – Improving dietary diversity, modified feeding practice – Nutrition education center need to be established to provide nutrition education. – Provide iron or iron-folate supplementation – Treatment of the underlying cause’s anemia. – Promoting and practice the consumption of zinc rich foods. v. Further research should be done on this area using different designs. 11

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