Nutrition for health

1. JIMMA UNIVERSITY
PUBLIC HEALTH FACULTY
DEPARTMENT OF HUMAN NUTRITION & DIETETICS
COURSE: NUTRITION IN LIFE CYCLE
TOPIC:COMMON PUBLIC MICRONUTRIENT
DEFICIENCY PROBLEMS IN ETHIOPIA
BY: H. NUTRION & DIETETICS STUDENTS (MSc)
1ST YEAR REGULAR, BATCH 2022/23
Desalegn M.
1
By Group 3
April 1, 2023

2.  Objectives of the presentation
 Introduction to Micronutrients
 Common micronutrient deficiency in Ethiopia
 Predisposing factors
 Etiology
 Clinical manifestation
 Prevention strategies
 Consequences of their deficiency
 Summary of the topic.
2
By Group 3
April 1, 2023

3. Learning Objectives
3
At the end of this session students will be able to:
 Know micronutrient deficiencies of public health
importance in Ethiopia
 Discuss Predisposing factors of these micronutrient
deficiency of public health importance
 Describe clinical manifestation of their deficiency
 Describe the disease burden contributed by micronutrient
deficiencies
 Explain the prevention and control measures of those
deficiency states
April 1, 2023
By Group 3

4. INTRODUCTION
• Micronutrient deficiency refers to the deficiency of
micronutrients that are essential for the vital function
including:
 growth,
 development,
 immunity,
 fertility and
 other lively processes.
By Group 3 4
April 1, 2023

5. Common Nutritional Problems of Public Heath
Importance in Ethiopia
Common:
 PEM
 Vitamin A deficiency (VAD)
 Iron deficiency anemia (IDA)
 Iodine deficiency disorders (IDD)
Others:
• Zinc deficiency
• Vitamin D deficiency (Rickets)
• Folic acid deficiency
Macro…
Micro…
By Group 3 5
April 1, 2023

6. Predisposing factors
 Lack of knowledge
 Poverty
 Famine and vulnerability: Being an orphan
 Infections: reciprocal relationship between
malnutrition and infection.
 Cultural factors: older children are given more food
 Gender bias
 Mal-distribution of food stuffs: Food Taboos
By Group 3 6
April 1, 2023

7. I. Vitamin A deficiency disease( VAD)
 Vitamin A is fat-soluble vitamin.
 Has diverse functions:
 vision,
 maintenance of body lining and skin,
 bone growth,
 anti oxidant activity and
 reproduction.
By Group 3 7
April 1, 2023

8. Etiology of VAD
 Inadequate intake of the vitamin A
 Infections like measles
By Group 3 8
April 1, 2023

9. Clinical manifestation of VADD
 Night blindness
 Corneal Xerosis(Dryness)
 Corneal Ulceration/ Keratomalacia
 Bitot’s spots: Conjuctival lesions
 Conjunctival Xerosis
 Corneal scar
 Diarrhea
 Susceptibility to respiratory infections
 Dry, rough skin
 Weight loss and Slow growth
 Weak tooth enamel By Group 3 9
April 1, 2023

10. Prevention of VAD
Breast feeding
Universal Supplementation
Disease targeted supplementation
Food Diversification
Food Fortification
Bio-fortification
Who is at the greatest risk?
 Children 6 to 59 months
 Women during pregnancy and lactation
By Group 3 10
April 1, 2023

11. II. Iron deficiency anemia (IDA)
By Group 3
 Dietary deficiencies account for the majority of the
cases of iron deficiency anemia.
 It is well known that there are two forms of dietary
iron: heme and nonheme.
 A diet containing ↑inhibitors and ↓enhancers will
lead to decreased availability of dietary iron which in
turn results in iron deficiency anemia.
In Ethiopia, 44% of children &
17% of women are anemic
(DHS,2011)
11
April 1, 2023

12. Factors enhancing and inhibiting absorption of non-
hem iron.
Enhancers
 Vitamin c
 Amino acids
 High altitude
 Hydrochloric acid
 Fermentation
 Alcohol
 Deficient stores
Inhibitors
Phytates
Tanins
Polyphenoles
Heavy metals
Fibers
Low altitude
Replete stores
Achlorhydria
April 1, 2023 By Group 3 12

13. Etiology of Iron Deficiency Anemia
Hookworm infection
Blood loss
Diet deficient in iron
Severe and chronic malaria
Chronic infections like tuberculosis
Taking foods that chelate/combine iron in the
intestine like phytates, milk, tannic acid, fiber,
phosvitin (in egg yolk), and antacid syrup.
Achlohydria
By Group 3 13
April 1, 2023

14. Clinical manifestations of IDA
 Dizziness
 Fatigue
 Dyspnea on exertion
 Coldness and parasthesia of the hands and feet
 Angular stomatitis in 10-15%
 Capricious appetite
 Pallor
 Pica
 Lusterless, thin and brittle finger nails
 murmur, splenomegaly, dependent edema, and lastly
congestive heart failure.
By Group 3 14
April 1, 2023

15. How to diagnose?
 Clinical signs and symptoms
 Biochemical Method
 Dietary
Treatment protocol for nutritional anemia
Age group Dose Duration of Treatment
<2 years 25 mg iron + 100 -
400μg folic acid daily
3 months
2-12 years 60 mg iron +400μg
folic acid daily
3 months
Adolescent and adult
including pregnant
mother
120 mg of iron +
800μg folic acid
Daily
3 months
By Group 3 15
April 1, 2023

16. Who is at the risk of IDA?
 Children 6-24 months
Menstruating women
Vegetarians
 Special risk infants: LBW, premature, and/or from
anemic mothers.
Women of reproductive age, especially pregnant
women.
Adolescents (especially females)
People living with HIV/AIDS / PLWHA
By Group 3 16
April 1, 2023

17. Consequences of Anemia in pregnant Women:
 Premature birth
 IUGR
 LBW
 Increased risk of maternal mortality
 Reduced ability to survive bleeding during and after
birth
 Decreased productivity due to fatigue and tachypnea
By Group 3 17
April 1, 2023

18. Prevention of IDA:
• Supplementation
• Dietary Diversification
• Bio-fortification
• Food Fortification
• Deworming
• Provision of ITN
• Breast feeding
• Starting complementary feeding at 6 months of age
By Group 3 18
April 1, 2023

19. III. IODINE DEFICIENCY DISORDERS
IDD remains a significant public health problem in
many countries.
Globally, 30 % of the world’s population is affected
by IDD and more than 150 million people are
affected in Africa alone
In Ethiopia, one out of every 1000 is a cretin
(severely mentally retarded dwarf), and about 50,000
peri-natal deaths are occurring annually due to IDD.
38% of <5 children have goiter and
35% of their biological mothers have
goiter
By Group 3 19
April 1, 2023

20. Etiology and risk factors of IDD
Living in the mountainous areas where plant foods
have inadequate in iodine
Taking cassava tuber as a food without detoxifying it
and other chelating substances
Not taking sea foods
Eating large amounts of raw food that can cause
goiter (goiterogens), such as spinach, lettuce, beets,
kale are also at risk of developing iodine deficiency.
By Group 3 20
April 1, 2023

21. Clinical manifestations of IDD:
Young and Adult
 Fatigue and weakness
 Weight gain
 Constipation
 Depression
 Swelling of thyroid
gland in the neck
 Cretinism
 Goiter
 Thinning hair
 Feeling colder than usual
infants
o Frequent choking
o Enlarged tongue
o Constipation
o Poor muscle tone
o Sleeping more often
By Group 3 21
April 1, 2023

22. Prevention of IDD
 Universal salt iodization
 Supplementation of iodine capsule
 Dietary Diversification
 Eating iodine rich food such as:
 seafood,
 fish(tuna, cod)
 Dairy products (milk, yoghurt, cheese & eggs)
 Boiling/cooking (eg. Cassava)
By Group 3 22
April 1, 2023

23. Diagnosis
Three components to diagnosing IDD:
1. Determination of thyroid size/goiter
2. Determination of urine iodine excretion
3. Determination of blood T4 +TSH levels
Usually the diagnosis must depend upon clinical
assessment only using WHO criteria
By Group 3 23
April 1, 2023

24. Consequences of IDD
Retarded physical and mental development
Juvenile hypothyroidism
Abortion
Still birth
Congenital anomalies
Increased infant mortality
Impaired mental function
General IQ decrease of 10 Points (Mild iodine
deficiency)
By Group 3 24
April 1, 2023

25. IV. Zinc deficiency
Functions:
Functions as antioxidant.
Promotes normal growth and development.
Immunity (decreases the severity of diarrhea in
children)
Promotes normal fetal growth.
Helps synthesize DNA and RNA.
Promotes cell division, cell repair, cell growth.
Maintains normal level of vitamin A in blood.
By Group 3 25
April 1, 2023

26. Etiology of Zinc deficiency
 Conditions that decrease absorption of zinc, like
phytates and dietary fibers
 Diet poor in zinc content
 Conditions that increase the excretion of zinc
 Alcoholism
 Extensive burn
 Chronic renal disease
By Group 3 26
April 1, 2023

27. Clinical manifestation of zinc deficiency
Moderate deficiency
• Impaired taste and smell
• Delayed sexual maturation
and impotence
• Growth retardation
• Glossitis
• Stomatitis
• Low sperm count and
hypogonadism
• Delayed wound healing
Severe deficiency
• Delayed bone maturation
• Enlarged spleen or liver
• Decreased size of testicles
• Testicular function less
than normal
• Decreased growth
(dwarfism)
• Impaired taste
acuity(hypoguesia)
By Group 3 27
April 1, 2023

28. DIAGNOSIS
• It is not practical to do the static and functional
biochemical tests in our setup but the diagnosis
could be made based up on
clinical manifestations and
dietary history.
By Group 3 28
April 1, 2023

29. Prevention of Zn deficiency
 Zinc supplementation
 Reducing alcohol intake
 Counseling on the importance of increased
consumption of zinc rich foods such as:
 Meat
 Fish
 Cereals
 Legumes
 Diary products
 seeds
High amount
Moderate amount of Zn
By Group 3 29
April 1, 2023

30. V. Vitamin D Deficiency
• Rickets also contributes to increased morbidity,
disability and mortality.
• The incidence of rickets is particularly high in slum
children who live in crowded houses almost devoid
of sunlight.
• Vitamin D deficiency is the most common cause of
rickets in Ethiopia.
• The deficiency of calcium may increase the
requirement for vitamin D, and therefore calcium
deficiency may aggravate a borderline vitamin D
status.
By Group 3 30
April 1, 2023

31. Etiology of rickets and osteomalacia
Luck of exposure to sunlight
Inadequate intake of foods rich in vitamin D such as
Milk and milk products
Fat mal-absorption
Inadequate intake of calcium
Lactose intolerance
Being vegan (predisposing?)
Renal and kidney disease
By Group 3 31
April 1, 2023

32. Clinical manifestation
Rickets
malformations of joints
or bones,
late tooth development,
weak muscles,
listlessness,
double malleolus
Bowed legs and
knocked knees,
delayed Fontanels
closure,
craniotabes
Osteomalacia
Pain in:
 ribs,
 lower spine,
 pelvis and
 legs,
Muscle weakness and
spasm,
 brittle, easily broken
bones.
By Group 3 32
April 1, 2023

33. Diagnosis
i. Clinical: signs and symptoms
ii. Biochemical: serum reduced vitamin D
iii. Biophysical: Bone X-ray
iv. Dietary Method
By Group 3 33
April 1, 2023

34. Prevention of rickets and osteomalacia
 Spending some time in sunlight
 Eating diet that includes vitamin D and Ca
 Vitamin D supplementation
 Calcium supplementation
By Group 3 34
April 1, 2023

35. VI. FOLATE DEFICIENCY
It is one of the major causes of nutritional anemia
especially among pregnant women in the developing
countries
Folic acid prevents Neural tube defects (NTD)
Elderly,
Taking birth control pills,
long-term usage of antibiotic,
alcoholics.
Are at greatest
risk for a folate
deficiency
By Group 3 35
April 1, 2023

36. Clinical manifestation
Irritability
Neural tube defects if deficient during pregnancy
Weakness
Lack of energy
Sleeping difficulties
Paleness
Sore red tongue
Mild mental symptoms, such as forgetfulness and
confusion
Diarrhea
By Group 3 36
April 1, 2023

37. Prevention and Treatment
Supplementation of folic acid
Folate rich food like:
 Dark green leafy vegetables (brocolli)
 Beans
 peanuts
By Group 3 37
April 1, 2023

38. SUMMARY
IDA, IDD, And VAD are the three more common
micronutrient deficiency of public health importance
in Ethiopia considering their health and economic
burden of their consequences.
The other less common micronutrient deficiency of
public health importance in Ethiopia are Zn
deficiency, Vitamin D deficiency and Folic acid
deficiency.
By Group 3 38
April 1, 2023

39. Reference
Micronutrient Deficiency For the Ethiopian Health
Center Team
By Group 3 39
April 1, 2023

40. THANK YOU!!
April 1, 2023 By Group 3 40