Calculator for inadequate micronutrient intake for Ethiopia (CIMI‐Ethiopia): Validation of the software for lactating mothers and their children under 2 years

Abstract

Early identification of inadequate intake of nutrients from a person's diet is usually crucial to prevent the development of micronutrient malnutrition. However, there is no single dietary assessment tool for Ethiopia that can assess the nutrient intake of a person from the type of food she or he consumed with a given amount. Therefore, the Calculator for Inadequate Micronutrient Intake (CIMI) application was adapted in consideration of food and nutrition contexts in Ethiopia and validated for its suitability to compute nutrient intake and identify nutrient intake inadequacy. For this, a 24-h recall quantitative dietary data of children aged 12-23 months (n = 781) and lactating mothers (n = 1086) were collected between February 15 and 30, 2017, from rural Genta Afeshum district, Tigray region, Ethiopia. An individual nutrient intake was estimated by calculating using CIMI-Ethiopia and also by NutriSurvey (NS) software for comparison. The average (mean and median) intake of energy and most nutrients and the prevalence of inadequacy calculated by the two software for the children aged 12-23 months and lactating mothers were comparable, except that of the vitamin A. The correlation coefficients for the intake results calculated by CIMI-Ethiopia and NS were between 0.85 and 0.97 for the children and between 0.5 and 0.96 for the lactating mothers' group. Most of the mean intake differences calculated by the two methods were within the acceptable limits, except for the vitamins A, D, and B12 in the Bland-Altman plots. CIMI-Ethiopia is very sensitive to identifying energy, protein, and selected micronutrients inadequacy included in this study, both for the lactating mothers (84.1%-100%) and 12-23-month-old children (77.6%-100%) group. Our results showed that CIMI-Ethiopia estimates the energy and nutrient intake, and can be also used as a screening tool to identify energy, protein, and selected micronutrients inadequacy from an individual woman's and child's diet in rural Tigray, Ethiopia.

Micronutrient inadequacy among lactating mothers in rural areas of North Mecha District, Amhara Region, Ethiopia

“…Vitamin A intake inadequacy was prevalent among 86.7% of lactating mothers, according to this study. This is comparable to studies conducted in Ethiopia ( 13 ), Niger ( 12 ), and Bangladesh ( 8 ). In contrast, this study finding is lower than studies conducted in Bahir Dar City, Ethiopia ( 14 ), Zambia ( 11 ), China ( 45 ), and California ( 10 ), and higher than reports from studies conducted in Nigeria ( 46 ), Indonesia ( 41 ), Thailand ( 44 ) and Iran ( 43 ).…”

“…When compared to all other micronutrients, nearly all mothers (98.4%) undoubtedly failed to meet the RDA for vitamin C. The finding corresponded to the Niger result ( 12 ); lower reports were obtained in Ethiopia ( 13 , 14 ), Zambia ( 11 ), Bangladesh ( 8 ), Thailand ( 44 ), China ( 45 ), Indonesia ( 41 ), Iran ( 43 ), and California ( 10 ). This could be explained by the variation in fruit and vegetable consumption, as the current study showed quite low fruit and vegetable consumption.…”

“…The study found that 18.1% of participants lacked adequate vitamin B6 (Pyridoxine); less than study results in Ethiopia ( 13 ), California ( 10 ), and higher percentages were found in Ethiopia ( 14 ), Zambia ( 11 ), Niger ( 12 ), Thailand ( 44 ), China ( 45 ), Indonesia ( 41 ) and Iran ( 43 ). Ethiopian cuisine traditionally includes whole grains and legumes, as well as fermented foods like injera ( 50 ).…”

“…In comparison to almost all the above study findings, the prevalence of niacin intake inadequacy is higher in rural lactating mothers. In Ethiopia, consumption of foods that are rich in niacin or tryptophan, a precursor to niacin synthesis, is modest ( 13 , 14 ). Furthermore, maize-based foods account for a substantial amount of dishes in the study area, and maize is low in niacin and tryptophan.…”

“…A study conducted among lactating mothers in the Genta Afeshum District of the Tigray Region, North Ethiopia, revealed that a significant proportion of the mothers were affected by micronutrient inadequacy. The inadequacies observed were as follows: vitamin A (79.5%), B1 (28.4%), B3 (58.8%), B6 (95.5%), B12 (99.9%), C (83.9%), calcium (99.9%), iron (24.6%), and zinc (58.3%) ( 13 ). Another study carried out among lactating mothers in Bahir Dar city of the Amhara Regional State, Northwest Ethiopia, also highlighted high levels of micronutrient inadequacy among mothers in the city.…”