title: Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State.
abstract: BACKGROUND
  The present study describes the distribution of selected micronutrients and anaemia among school-aged children living in Libo Kemkem and Fogera (Amhara State, Ethiopia), assessing differences by socio-demographic characteristics, health status and dietary habits.
  
  
  METHODS
  A cross-sectional survey was carried out during May-December 2009. Socio-demographic characteristics, health status and dietary habits were collected. Biomarkers were determined for 764 children. Bivariate and multivariable statistical methods were employed to assess micronutrient deficiencies (MD), anaemia, and their association with different factors.
  
  
  RESULTS
  More than two thirds of the school-aged children (79.5%) had at least one MD and 40.5% had two or more coexisting micronutrient deficiencies. The most prevalent deficiencies were of zinc (12.5%), folate (13.9%), vit A (29.3%) and vit D (49%). Anaemia occurred in 30.9% of the children. Children living in rural areas were more likely to have vit D insufficiency [OR: 5.9 (3.7-9.5)] but less likely to have folate deficiency [OR: 0.2 (0.1-0.4)] and anaemia [OR: 0.58 (0.35-0.97)]. Splenomegaly was positively associated with folate deficiency and anaemia [OR: 2.77 (1.19-6.48) and 4.91 (2.47-9.75)]. Meat and fish consumption were inversely correlated with zinc and ferritin deficiencies [OR: 0.2 (0.1-0.8) and 0.2 (0.1-0.9)], while oil consumption showed a negative association with anaemia and deficiencies of folate and vitamin A [0.58 (0.3-0.9), OR: 0.5 (0.3-0.9) and 0.6 (0.4-0.9)]. Serum ferritin levels were inversely correlated to the presence of anaemia (p<0.005).
  
  
  CONCLUSIONS
  There is a high prevalence of vitamin A deficiency and vitamin D insufficiency and a moderate prevalence of zinc and folate deficiencies in school-aged children in this area. The inverse association of anaemia and serum ferritin levels may be due to the presence of infectious diseases in the area. To effectively tackle malnutrition, strategies should target not only isolated micronutrient supplementation but also diet diversification.
authors.affiliation: National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain.
authors.forename: Zaida
authors.initials: Z
authors.lastname: Herrador
authors.affiliation: National Centre of Epidemiology, ISCIII, Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain; Network Biomedical Research Centers, Epidemiology and Public Health (CIBERESP in Spanish), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Sordo
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Endalamaw
authors.initials: E
authors.lastname: Gadisa
authors.affiliation: University Hospital La Paz, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Buño
authors.affiliation: University Hospital La Paz, Madrid, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Gómez-Rioja
authors.affiliation: University Hospital La Paz, Madrid, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Iturzaeta
authors.affiliation: Orense University Hospital, Orense, Spain.
authors.forename: Lisset Fernandez
authors.initials: LF
authors.lastname: de Armas
authors.affiliation: National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Benito
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: National Centre of Microbiology, ISCIII, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Moreno
authors.affiliation: National Centre of Microbiology, ISCIII, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cañavate
authors.affiliation: National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain.
authors.forename: Estefania
authors.initials: E
authors.lastname: Custodio
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D005494:Folic Acid Deficiency / Q000453:epidemiology; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000172:deficiency*; D014802:Vitamin A Deficiency / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000453:epidemiology; D015032:Zinc / Q000172:deficiency
chemical_list: D018977:Micronutrients; D015032:Zinc