Abstract

Multiple micronutrient deficiencies are widespread in Ethiopia. However, the distribution of Se and Zn deficiency risks has previously shown evidence of spatially dependent variability, warranting the need to explore this aspect for wider micronutrients. Here, blood serum concentrations for Ca, Mg, Co, Cu and Mo were measured (n 3102) on samples from the Ethiopian National Micronutrient Survey. Geostatistical modelling was used to test spatial variation of these micronutrients for women of reproductive age, who represent the largest demographic group surveyed (n 1290). Median serum concentrations were 8·6 mg dl-1 for Ca, 1·9 mg dl-1 for Mg, 0·4 µg l-1 for Co, 98·8 µg dl-1 for Cu and 0·2 µg dl-1 for Mo. The prevalence of Ca, Mg and Co deficiency was 41·6 %, 29·2 % and 15·9 %, respectively; Cu and Mo deficiency prevalence was 7·6 % and 0·3 %, respectively. A higher prevalence of Ca, Cu and Mo deficiency was observed in north western, Co deficiency in central and Mg deficiency in north eastern parts of Ethiopia. Serum Ca, Mg and Mo concentrations show spatial dependencies up to 140-500 km; however, there was no evidence of spatial correlations for serum Co and Cu concentrations. These new data indicate the scale of multiple mineral micronutrient deficiency in Ethiopia and the geographical differences in the prevalence of deficiencies suggesting the need to consider targeted responses during the planning of nutrition intervention programmes.

Highlights

  • Multiple micronutrient deficiencies remain widespread globally with particular attention on Fe, folate, vitamin A, iodine and Zn through the analysis of biomarkers for population-level surveillance[1]

  • A study analysing serum concentration of Mg, Zn, Se, Ca, Fe, Co and Mo shows the presence of high prevalence of Se (62 %) and Zn (47 %) deficiency among school age children (SAC) from Northwest Ethiopia

  • The median serum concentrations of micronutrients differed between the regions, with the highest serum Ca and Mg concentrations observed in Dire Dawa followed by Amhara

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Summary

Introduction

Multiple micronutrient deficiencies remain widespread globally with particular attention on Fe, folate, vitamin A, iodine and Zn through the analysis of biomarkers for population-level surveillance[1]. High dietary Ca concentration in the luminal environment reduces the rate of Mg absorption[9], while Zn and Cu compete for absorption in the intestine[10] Such available evidence of nutrient–nutrient interactions suggests that data on multiple micronutrient status of populations are important to understand the magnitude of the nutritional problem and the context of the nutritional problem including presence of antagonistic or synergistic interactions to effectively design interventions. The aim of this study was to determine the prevalence of multiple micronutrient deficiencies in Ethiopia and explore potential spatial dependencies of this variation based on each of the serum biomarkers. Multi-elemental analyses of serum samples were reported, both for Se[11] and for Zn which included adjustments for inflammation[6] These two studies provided strong additional evidence that Se and Zn deficiencies are widespread in Ethiopia, consistent with previous cross-sectional studies[14]. Serum Zn concentration data reported previously[6] were used to quantify Cu:Zn ratios, as a potential indicator for infection[16,17]

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