Nutrition-specific and nutrition-sensitive factors associated with mid-upper arm circumference as a measure of nutritional status in pregnant Ethiopian women: Implications for programming in the first 1000 days.

Shibani Ghosh,Kidane Ayele,Krista Zillmer,Yitbarek Kidane,Eileen Kennedy,Leslie Wentworth,Tefera Belachew,Jeffrey K Griffiths,Meghan Kershaw,Ashish Pokharel,Kathryn Spielman

doi:10.1371/journal.pone.0214358

Shibani Ghosh, Kidane Ayele + Show 9 more

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https://doi.org/10.1371/journal.pone.0214358

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Journal: PloS one	Publication Date: Mar 26, 2019
Citations: 22	License type: CC BY 4.0

Affiliation: Tufts University, Jimma University

Abstract

Poor nutritional status in pregnancy expressed as low mid-upper arm circumference (MUAC) is associated with low birth weight. The study aims were to assess the nutritional status of pregnant Ethiopian women using MUAC and examine association with nutrition-specific and nutrition-sensitive factors, using baseline data of a prospective longitudinal observational birth cohort study conducted in three rural districts in the Oromia region of Ethiopia. Recruitment into the cohort was rolling over a period of nine months, and the data used for this analysis were collected while the women were between 12–32 weeks of gestation. Detailed household socio-demographics, agricultural production, women’s health, morbidity and diets, with weights, heights and MUAC, and anemia prevalence (HemoCue) were collected. The prevalence of low MUAC (< 23 cm) was 41%. Controlling for location and clustering, wealth quintile (OR = 0.88, CI = 0.82 to 0.96, p<0.01) was associated with decreased risk of low MUAC, while trimester (OR = 1.31, CI = 1.16 to 1.48, p<0.001) was associated with increased risk of low MUAC. The only significant factor amenable to nutrition-specific interventions was altitude-adjusted anemia, which was associated with increased risk of low MUAC (OR = 1.28, CI = 1.09 to 1.49, p<0.01). Significant factors amenable to nutrition-sensitive factors and associated with higher odds of low MUAC were household food insecurity (OR = 1.04, CI = 1.02 to 1.06, p<0.001), distance to the clinic in minutes (OR = 1.01, CI = 1.0 to 1.01, p<0.0001) and season of recruitment (lean versus non lean) (OR = 1.30, CI = 1.10 to 1.54, p<0.01). Literacy (OR = 0.85, CI = 0.74 to 0.98, p<0.05) and numeracy (OR = 0.75, CI = 0.62 to 0.91, p<0.01) were also significantly associated with lower odds of low MUAC. Poor nutritional status in pregnancy expressed as percent with low MUAC was high in Ethiopian women. It was associated with several nutrition-specific and -sensitive factors indicating the importance of multisectoral actions in improving outcomes within the first 1000 days.

Highlights

Poor nutritional status in pregnancy as expressed as mid-upper arm circumference (MUAC) has been significantly associated with low birth weight in infants in both Asia and Africa [1,2,3,4]
While literature points to the association of low MUAC with adverse birth outcomes, little is known about the factors that affect the MUAC in pregnancy
In this study we examined factors that are targets of nutrition-specific interventions and nutrition-sensitive interventions that could potentially explain the risk/odds of a low MUAC as a pregnant woman in a select population in Ethiopia

Summary

Introduction

Poor nutritional status in pregnancy as expressed as mid-upper arm circumference (MUAC) has been significantly associated with low birth weight in infants in both Asia and Africa [1,2,3,4]. This is important since low birth weight is directly associated with higher rates of morbidity, mortality, stunting and poor cognitive development. In Ethiopia, stunting in infants and young children under 24 months of age has been found to be associated with wealth, birth weight, maternal height and maternal BMI [10]. WASH (water, hygiene and sanitation) practices and access, and anemia are significant contributors to maternal and child morbidity in Ethiopia [11,12,13]

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