Clinical vitamin-A deficiency and associated factors among pregnant and lactating women in Northwest Ethiopia: A community-based cross-sectional study

  • BMC Pregnancy and Childbirth, Volume 19, No. 1, Year 2019

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Study Justification:
– Vitamin A deficiency has adverse health consequences, such as blindness, growth retardation, and death.
– Ethiopia has implemented public health measures to address the problem, but little has been done to examine the deficiency among pregnant and lactating women.
– This study aims to assess the prevalence of Vitamin A deficiency and associated factors among pregnant and lactating women in Lay Armachiho district, northwest Ethiopia.
Study Highlights:
– 13.7% of the pregnant and lactating women had night blindness and 0.4% had Bitot’s Spot.
– Factors positively associated with Vitamin A deficiency include: mothers over 35 years of age, household monthly income less than USD 22.7, and poor hand washing practices after toilets.
– Factors negatively associated with Vitamin A deficiency include: mothers’ access to the media, formal education, over 18 years of age at first marriage, and no fasting.
Study Recommendations for Lay Reader:
– Community awareness about the risk of early marriage, poor hand hygiene practices after toilets, and fasting during pregnancy and lactating period is essential to reduce Vitamin A deficiency.
– Pregnant and lactating women with low incomes should be a focus for organizations working on maternal health to reduce their deficiency in Vitamin A.
Study Recommendations for Policy Maker:
– Increase community awareness programs about the risks of early marriage, poor hand hygiene practices after toilets, and fasting during pregnancy and lactating period.
– Allocate resources to target pregnant and lactating women with low incomes to reduce their deficiency in Vitamin A.
Key Role Players:
– Community health workers
– Health educators
– Maternal health organizations
– Local government officials
– Non-governmental organizations (NGOs)
Cost Items for Planning Recommendations:
– Community awareness programs
– Training for community health workers and health educators
– Educational materials and media campaigns
– Monitoring and evaluation activities
– Support for low-income pregnant and lactating women to access Vitamin A-rich foods

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a community-based cross-sectional design and a large sample size, which enhances the generalizability of the findings. The study also used appropriate statistical analysis to identify factors associated with Vitamin A deficiency. However, the study relied on self-reported data, which may introduce recall bias. To improve the evidence, future studies could consider using objective measures to confirm Vitamin A deficiency and implement a longitudinal design to establish causality.

Background: Vitamin A deficiency is known for its adverse health consequences, such as blindness, growth retardation and death. To curb the problem, Ethiopia has implemented various public health measures although little has been done to examine the deficiency among pregnant and lactating women. As a result, this study assessed the prevalence of Vitamin A deficiency and associated factors among pregnant and lactating women in Lay Armachiho district, northwest Ethiopia. Methods: A community-based cross-sectional study was conducted on pregnant and lactating women in Lay Arimachiho district, northwest Ethiopia, using the multistage systematic sampling technique to select participants. The binary logistic regression model was fitted to test the effect of exposure variables, and the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were computed to identify the significance and the strength of the associations of variables with Vitamin A deficiency. Results: The study revealed that 13.7% of the pregnant and lactating women had night blindness and 0.4% had also Bitot's Spot. Over 35 years of age of mothers (AOR = 2.74; 95%CI: 1.15,7.43), less than USD 22.7 household monthly income (AOR = 8.9; 95%CI: 4.54,21.73), and poor hand washing practices after toilets (AOR = 8.87; 95% CI: 4.43,18.68) were positively associated with VAD, while mothers' access to the media (AOR = 0.20; 95%CI:0.07, 0.59), formal education (AOR = 0.09; 95% CI: 0.03, 0.41), over 18 years of age at first marriage (AOR = 0.19; 95%CI: 0.08,0.36), and no fasting (AOR = 0.14; 95%CI: 0.04,0.46) were negatively associated. Conclusions: Maternal Vitamin A deficiency was the major public health problem in Lay Armachiho district. Over 35 years of age of mothers, less than USD 22.7 household monthly income and poor hand washing practices after toilets were high risks for VAD, while mothers' access to the media, formal education, over 18 years at first marriage, and no fasting were low risks. Therefore, community awareness about the risk of early marriage, poor hand hygiene practices after toilets, and fasting during pregnancy and lactating period were essential. Organizations working on maternal health need to focus on mothers with low incomes in order to reduce their deficiency in Vitamin A.

This community based cross-sectional study was conducted in Lay Armachiho district from February to March 2017. The district is situated in North Gondar administrative zone, the Amhara National Regional State, 210 km from Bahir Dar, capital of the region. According to the 2016/17 Central Stastical Agency estimation, the total population of the district was 140,417; pregnant and lactating mothers accounted for 3.36 and 3.09% of the population, respectively. Cereals, grains, roots and tubers are the commonest food products of the district. All pregnant and lactating women who lived in Lay Armachiho district were the source population, while all pregnant and lactating mothers in slected kebeles of the district were the study population. Lactating woman was defined as a breastfeeding mother who had less than one year old children. The sample size was determined using the single population proportion formula considering a 95% level of confidence, 4% margin of error and a prevalence of maternal night blindness in Tahitay Koraro district, Tigray Region of 17.3% [9]. A 10% adjustment for non-response rate and 2 design effect yielded a sample of 754. Sample size for the second objective (determinants of VAD) was also calculated by assuming a 22% proportion of night blindness among pregnant and lactating mothers aged over 35 years, and less than ETB 500 household monthly income (24%) [9], 80% power, 95% level of confidence, 10% non-response rate and 2 design effect yielded 317 and 517, lower than the sample (754) for the first objective. Thus, 754 was taken as the final sample. The multi-stage systematic sampling technique was used to select eligible participants; 6 of the 31 kebeles (lowest administration units) were selected by the lottery method. Then, 392 and 362 pregnant and lactating women were proportionally allocated to the selected kebeles. Finaly, the systematic sampling technique was employed to select eligible participants, and pregnancy was confirmed by mothers’ own reports. Vitamin A deficiency was clinically confirmed by night blindness and Bitot’s Spot, while history of night blindness (dafint) was elicited by asking mothers in their local language for a word that stood for night blindness. Information on whether a woman faced any difficulty in identifying objects in dim light, especially at sun set, was collected [22]. On the other hand, mothers with opaque whitish/cheezy appearance deposits on sclera of their eye/s were deemed as having Bitot’s Spot [22, 23]. Consequently, if participants had at least one of the clinical signs (night blindness or Bitot’s Spot), the woman was defined as Vitamin-A deficient. A standardized tool was used to measure the dietary diversity of the participants. The tool comprised 14 food groups, and food items consumed by participants in the previous 24-h were labeled as “food groups”. The final figures participants scored of the maximum of 14 based on their consumption of diversified food were categorized as “low”, “medium” and “high” if they reported to have consumed ≤3, 4–5 and ≥ 6 food groups, respectively [24]. Furthermore, a seven-day quasi-food frequency questionnaire was used to estimate mothers’ dietary intake for vitamin-A rich food. Participants were requested to report the number of days they ate the listed vitamin-A rich food groups one week before the data collection. In this study, pregnant or lactating mothers were also considered as fasting when they didn’t consume any thing for a minimum of nine hours (morning to 3:00 PM) except weekends, and couldn’t take any animal products at any time (day and night) for at least one month before the actual data collection. A structured interviewer administered questionnaire was developed by reviewing literatures [8, 9, 24], and the questionnaire was first developed in English and translated into Amharic and back to English to maintain consistency. Six deploma level and two BSc degree graduate nurses were recruited to collect data and supervise the process, respectively. A two-day training was given to both groups on how to identify the clinical features of VAD (night blindness and/or Bitot’s Spot), interview techniques and data collection procedures. The questionnaire was modified based on the pre-test administered at Musie Bamb kebele on 38 mothers. Data were entered and analysed using Epi Info version 7 and SPSS version 20, respectively after cleaning to check accuracy, consistency and the identification of missed values. Descriptive statistics, such as frequency distributions, percentages, means, and standard deviations were used to summarize variables. A binary logistic regression model was fitted to test the effect of exposure variables on VAD. First, bivariable analysis was carried out to examine the effect of each independent variable on the outcome variable. Variables with p-values of < 0.2 in the bivariable analysis were fitted into the multivariable analysis. In the final model, independent variables with p-values of < 0.05 were considered as having statistically significant association with VAD. The strength of associations was determined using the adjusted odds ratio with 95%CI.

Based on the information provided, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources on maternal health, including vitamin A deficiency prevention and management. These apps can be easily accessible to pregnant and lactating women, providing them with educational materials, reminders for prenatal and postnatal care, and access to healthcare professionals.

2. Community Health Workers: Train and deploy community health workers to educate pregnant and lactating women about the importance of vitamin A in their diet and provide guidance on proper nutrition. These workers can also conduct regular home visits to monitor the health of mothers and provide support and referrals to healthcare facilities when needed.

3. Telemedicine: Establish telemedicine services that allow pregnant and lactating women in remote areas to consult with healthcare professionals through video calls or phone calls. This can help address the lack of access to healthcare facilities and provide timely advice and guidance on maternal health, including vitamin A deficiency prevention.

4. Health Education Campaigns: Conduct targeted health education campaigns in the community to raise awareness about the risks of vitamin A deficiency during pregnancy and lactation. These campaigns can include workshops, seminars, and community events that provide information on proper nutrition, supplementation, and the importance of regular check-ups.

5. Collaboration with Media Outlets: Partner with local media outlets, such as radio stations and television channels, to disseminate information on maternal health, including the prevention and management of vitamin A deficiency. This can help reach a wider audience and ensure that accurate and reliable information is available to pregnant and lactating women.

6. Income Generation Programs: Implement income generation programs that empower pregnant and lactating women to improve their economic status. This can help address the risk factor of low household income associated with vitamin A deficiency. By providing opportunities for women to earn a sustainable income, they can have better access to nutritious food and healthcare services.

7. Improved Sanitation Facilities: Focus on improving sanitation facilities, particularly access to clean water and proper handwashing practices after using toilets. This can help reduce the risk of infections and improve overall maternal health outcomes, including the prevention of vitamin A deficiency.

8. Policy and Advocacy: Advocate for policies and programs that prioritize maternal health and address the underlying factors contributing to vitamin A deficiency. This can include advocating for increased funding for maternal health services, improved healthcare infrastructure, and better access to nutritious food.

These innovations can help improve access to maternal health and address the specific challenges related to vitamin A deficiency identified in the study. It is important to tailor these innovations to the local context and ensure that they are sustainable and culturally appropriate.
AI Innovations Description
Based on the findings of the study, the following recommendations can be made to improve access to maternal health and address the issue of Vitamin A deficiency:

1. Increase community awareness: It is important to raise awareness among the community about the risks of Vitamin A deficiency during pregnancy and lactation. This can be done through health education campaigns, community meetings, and media platforms. Emphasize the importance of consuming a diverse diet that includes Vitamin A-rich foods.

2. Improve access to information: Mothers should have access to accurate and reliable information about maternal health, including the importance of Vitamin A during pregnancy and lactation. This can be achieved by providing educational materials, such as brochures and posters, in healthcare facilities and community centers. Additionally, utilizing media platforms, such as radio and television, can help reach a wider audience.

3. Promote hand hygiene practices: Poor hand washing practices after using the toilet were found to be positively associated with Vitamin A deficiency. Therefore, promoting proper hand hygiene practices, including hand washing with soap and water, is crucial. This can be done through educational campaigns that highlight the importance of hand hygiene in preventing infections and improving overall health.

4. Address socioeconomic factors: The study found that low household income was positively associated with Vitamin A deficiency. To address this, organizations working on maternal health should focus on providing support and resources to mothers with low incomes. This can include providing financial assistance, access to affordable nutritious food, and income-generating opportunities.

5. Address cultural practices: The study found that fasting during pregnancy and lactation was negatively associated with Vitamin A deficiency. It is important to address cultural practices that may restrict pregnant and lactating women from consuming certain foods. This can be done through community engagement and working with religious leaders to promote a balanced diet during these periods.

By implementing these recommendations, it is possible to improve access to maternal health and reduce the prevalence of Vitamin A deficiency among pregnant and lactating women in the Lay Armachiho district of Ethiopia.
AI Innovations Methodology
Based on the provided study, here are some potential recommendations to improve access to maternal health:

1. Increase awareness: Conduct community awareness campaigns to educate pregnant and lactating women about the importance of vitamin A in their diet and the risks associated with deficiency. This can be done through various channels such as media, community health workers, and local health clinics.

2. Improve nutrition: Implement programs that promote a diverse and balanced diet for pregnant and lactating women, including the consumption of vitamin A-rich foods. This can be achieved through nutrition education, food supplementation programs, and support for local agriculture to increase the availability of nutritious foods.

3. Enhance healthcare services: Strengthen the capacity of healthcare facilities to provide comprehensive maternal health services, including regular check-ups, prenatal and postnatal care, and screening for vitamin A deficiency. This can be done by training healthcare providers, improving infrastructure, and ensuring the availability of necessary resources and medications.

4. Empower women: Promote women’s empowerment and gender equality to address underlying factors that contribute to vitamin A deficiency, such as early marriage and low household income. This can be achieved through initiatives that promote education, economic opportunities, and women’s rights.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather information on the current prevalence of vitamin A deficiency among pregnant and lactating women, as well as their access to healthcare services and nutritional status. This can be done through surveys, interviews, and medical records review.

2. Intervention implementation: Implement the recommended interventions in a selected target population. This could involve implementing awareness campaigns, nutrition programs, and healthcare service improvements.

3. Monitoring and evaluation: Collect data on the implementation of the interventions, including the number of women reached, changes in knowledge and behavior, and improvements in healthcare service delivery. This can be done through surveys, interviews, and monitoring of healthcare facility records.

4. Data analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. This could involve comparing pre- and post-intervention data, conducting statistical analyses, and calculating indicators such as changes in prevalence of vitamin A deficiency and improvements in healthcare utilization.

5. Interpretation and dissemination: Interpret the findings of the analysis and communicate the results to relevant stakeholders, including policymakers, healthcare providers, and the community. This can be done through reports, presentations, and advocacy efforts to ensure that the recommendations are implemented and sustained.

By following this methodology, it would be possible to simulate the impact of the recommended interventions on improving access to maternal health and reducing the prevalence of vitamin A deficiency among pregnant and lactating women.

Statistics:
Citations: 4
Authors: 3
Identifiers:
DOI: 10.1186/s12884-019-2663-2
Research Areas:
Community Interventions, Disparities, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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