Skip to main content
Top
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Prevalence and associated factors of zinc deficiency among pregnant women and children in Ethiopia: a systematic review and meta-analysis

Authors: Kidanemaryam Berhe, Freweini Gebrearegay, Hadush Gebremariam

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Pregnant women and children are the most vulnerable groups to zinc deficiency. Despite the presence of few primary studies, studies that could provide strong evidence that would help policymakers to develop appropriate interventional strategies in addressing zinc deficiency among pregnant women and children are limited in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to estimate the national pooled prevalence and associated factors of zinc deficiency among pregnant women and children.

Methods

We searched Pub Med, Scopus, CINAHL, Google Scholar, and Google for studies reported on zinc deficiency and associated factors among pregnant women and children. Search terms were ‘zinc deficiency’, ‘zinc status’, ‘associated factors’, ‘children’, ‘pregnant women’, and ‘Ethiopia’ using the boolean operators ‘OR’ or ‘AND’. Searches were using English language. A preferred reporting item for systematic reviews and meta-analysis (PRISMA) checklist was used. Two authors independently reviewed the studies. The effect sizes of the meta-analysis were the prevalence of zinc deficiency and adjusted odds ratio (AOR) of the associated factors. Finally, the Comprehensive Meta-Analysis (CMA) version 3.3.07 was used for statistical analysis by applying the random-effects model and publication bias was assessed using funnel plots and Egger’s test.

Results

Thirteen studies (7 among pregnant women having total participants of 2371 pregnant women and 6 among children with total participants of 5154 children) were included in this systematic review and meta-analysis. Using the random-effects model, the pooled prevalence of zinc deficiency was 59.9% (95%CI: 51.9, 67.7%) and 38.4% (95%CI: 28.6, 49.4) among pregnant women and children, respectively. The associated factors for zinc deficiency among pregnant women were coffee intake (adjusted odds ratio (AOR) =1.76), low intake of animal source foods (AOR = 2.57), and inadequate diet diversity (AOR = 2.12).

Conclusion

Overall, zinc deficiency among pregnant women and children is a significant public health concern in Ethiopia. Promoting dietary modification to enhance the bioavailability of zinc, improving diet diversity, and consuming animal source foods would help in alleviating and/or minimizing the problem among the target groups. Zinc supplementation could also be considered for pregnant women and children.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization. The world health report, health systems: improving performance; 2000, pp. 1–10. World Health Organization. The world health report, health systems: improving performance; 2000, pp. 1–10.
2.
go back to reference Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Rev. 2010;32(1):243–55.CrossRef Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Rev. 2010;32(1):243–55.CrossRef
3.
go back to reference Welch RM, Graham RD. Breeding for micronutrients in staple food crops from a human nutrition perspective. J Exp Bot. 2004;55(396):353–64.PubMedCrossRef Welch RM, Graham RD. Breeding for micronutrients in staple food crops from a human nutrition perspective. J Exp Bot. 2004;55(396):353–64.PubMedCrossRef
4.
go back to reference World Health Organization. (ACC/SCN), United Nations-Administrative Committee on Coordination/Sub-Committee on Nutrition 3rd Report on the World Nutrition Situation; 1997, pp. 1–142. World Health Organization. (ACC/SCN), United Nations-Administrative Committee on Coordination/Sub-Committee on Nutrition 3rd Report on the World Nutrition Situation; 1997, pp. 1–142.
5.
go back to reference Ryan W, Kenneth H. Estimating the global prevalence of zinc deficiency : results based on zinc availability in national food supplies and the prevalence of stunting. PLoS One. 2012;7(11):e50568.CrossRef Ryan W, Kenneth H. Estimating the global prevalence of zinc deficiency : results based on zinc availability in national food supplies and the prevalence of stunting. PLoS One. 2012;7(11):e50568.CrossRef
6.
go back to reference Robert E, Cesar G, Susan P, Zulfi A, Parul C, de Onis M, et al. Maternal and child nutrition 1 maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;6736(13):1–25. Robert E, Cesar G, Susan P, Zulfi A, Parul C, de Onis M, et al. Maternal and child nutrition 1 maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;6736(13):1–25.
7.
go back to reference Fischer Walker CL, Ezzati M, Black RE. Global and regional child mortality and burden of disease attributable to zinc deficiency. Eur J Clin Nutr. 2008;63(5):591–7.PubMedCrossRef Fischer Walker CL, Ezzati M, Black RE. Global and regional child mortality and burden of disease attributable to zinc deficiency. Eur J Clin Nutr. 2008;63(5):591–7.PubMedCrossRef
8.
go back to reference Reena B, Tina S. What is the extent of vitamin and mineral deficiencies? Food Nutr Bull. 2007;28(1):174–81. Reena B, Tina S. What is the extent of vitamin and mineral deficiencies? Food Nutr Bull. 2007;28(1):174–81.
9.
go back to reference Caulfield LE, Zavaleta N, Shankar AH, Merialdi M. Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival. Am J Clin Nutr. 1998;68:499S–508S.PubMedCrossRef Caulfield LE, Zavaleta N, Shankar AH, Merialdi M. Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival. Am J Clin Nutr. 1998;68:499S–508S.PubMedCrossRef
10.
go back to reference Bruno B, Ian D, Lena D, Olivier F. Conclusions of the joint WHO/UNICEF/IAEA/IZiNCG interagency meeting on zinc status indicators. Food Nutr Bull. 2007;28(3):480–4. Bruno B, Ian D, Lena D, Olivier F. Conclusions of the joint WHO/UNICEF/IAEA/IZiNCG interagency meeting on zinc status indicators. Food Nutr Bull. 2007;28(3):480–4.
13.
go back to reference Federal Democratic Republic of Ethiopia, Food and Nutrition Policy; 2018, pp 1–40. Federal Democratic Republic of Ethiopia, Food and Nutrition Policy; 2018, pp 1–40.
14.
go back to reference Moher D, Liberati A, Tetzlaff JAD. The PRISMA (2009) checklist. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):1–2.CrossRef Moher D, Liberati A, Tetzlaff JAD. The PRISMA (2009) checklist. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):1–2.CrossRef
21.
go back to reference Federica D, Zerihun A, Federica R, Aldo M, Cristiana A, Bernard N. High frequency of symptomatic zinc deficiency in infants in northern Ethiopia. Dermatol Res Pract Hindawi. 2014:1–4. Federica D, Zerihun A, Federica R, Aldo M, Cristiana A, Bernard N. High frequency of symptomatic zinc deficiency in infants in northern Ethiopia. Dermatol Res Pract Hindawi. 2014:1–4.
22.
go back to reference Mamo N, Tsegaye T, Desta H. Household Food insecurity, low dietary diversity, and early marriage were predictors for Undernutrition among pregnant women residing in Gambella, Ethiopia. Adv Public Health Hindawi. 2018:1–10. Mamo N, Tsegaye T, Desta H. Household Food insecurity, low dietary diversity, and early marriage were predictors for Undernutrition among pregnant women residing in Gambella, Ethiopia. Adv Public Health Hindawi. 2018:1–10.
23.
go back to reference Girmay A, Tibebu M, Aregash S, Tsehai A, Solomon E, Aweke K. Dietary zinc intake and its determinants among Ethiopian children 6–35 months of age. BMC Nutrition. 2018;4(30):1–6. Girmay A, Tibebu M, Aregash S, Tsehai A, Solomon E, Aweke K. Dietary zinc intake and its determinants among Ethiopian children 6–35 months of age. BMC Nutrition. 2018;4(30):1–6.
24.
go back to reference Gebremedhin S, Enquselassie F, Umeta M. Independent and joint effects of prenatal zinc and vitamin a deficiencies on Birthweight in Rural Sidama, Southern Ethiopia: prospective cohort study. PLoS One. 2012;7(3):e50213.PubMedPubMedCentralCrossRef Gebremedhin S, Enquselassie F, Umeta M. Independent and joint effects of prenatal zinc and vitamin a deficiencies on Birthweight in Rural Sidama, Southern Ethiopia: prospective cohort study. PLoS One. 2012;7(3):e50213.PubMedPubMedCentralCrossRef
25.
go back to reference Amare B, Tafess K, Moges F, Moges B, Yabutani T, et al. Levels of serum zinc, copper and copper/zinc ratio in patients with diarrhea and HIV infection in Ethiopia. Vitam Trace Elem. 2011;1(1):1–5. Amare B, Tafess K, Moges F, Moges B, Yabutani T, et al. Levels of serum zinc, copper and copper/zinc ratio in patients with diarrhea and HIV infection in Ethiopia. Vitam Trace Elem. 2011;1(1):1–5.
26.
go back to reference Abera A, Bizuayehu K, Endalkachew N, Abayneh M, Melaku A. Serum zinc deficiency and associated factors among pre-ART and on-ART adults at Felege Hiwot referral hospital, Bahir Dar, Northwest Ethiopia. Int J Nutr Food Sci. 2014;3(4):311–7.CrossRef Abera A, Bizuayehu K, Endalkachew N, Abayneh M, Melaku A. Serum zinc deficiency and associated factors among pre-ART and on-ART adults at Felege Hiwot referral hospital, Bahir Dar, Northwest Ethiopia. Int J Nutr Food Sci. 2014;3(4):311–7.CrossRef
27.
go back to reference Rosalind S, Yewelsew A, Sally S, Robert H, Jamie E, Barbara J, et al. Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr. 2009;32(7):736–40. Rosalind S, Yewelsew A, Sally S, Robert H, Jamie E, Barbara J, et al. Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr. 2009;32(7):736–40.
28.
go back to reference Stoecker BJ, Abebe Y, Hubbs-Tait L, Kennedy TS, Gibson RS, Arbide I, et al. Zinc status and cognitive function of pregnant women in Southern Ethiopia. Eur J Clin Nutr. 2009;63(7):451–64.CrossRef Stoecker BJ, Abebe Y, Hubbs-Tait L, Kennedy TS, Gibson RS, Arbide I, et al. Zinc status and cognitive function of pregnant women in Southern Ethiopia. Eur J Clin Nutr. 2009;63(7):451–64.CrossRef
29.
go back to reference Gebremedhin S, Enquselassie F, Umeta M. Prevalence of prenatal zinc deficiency and its association with socio-demographic, dietary and healthcare-related factors in Rural Sidama, Southern Ethiopia: a cross-sectional study. BMC Public Health. 2011;11(898):1–10. Gebremedhin S, Enquselassie F, Umeta M. Prevalence of prenatal zinc deficiency and its association with socio-demographic, dietary and healthcare-related factors in Rural Sidama, Southern Ethiopia: a cross-sectional study. BMC Public Health. 2011;11(898):1–10.
30.
go back to reference Ragasaa K. Prevalence and associated risk factors of zinc deficiency among pregnant women in selected health centers in Addis Ababa, Ethiopia. Ekp. 2017;13(3):1576–80. Ragasaa K. Prevalence and associated risk factors of zinc deficiency among pregnant women in selected health centers in Addis Ababa, Ethiopia. Ekp. 2017;13(3):1576–80.
31.
go back to reference Afework K, Tomoki Y, Andargachew M, Belay T. Serum zinc, copper, selenium, calcium, and magnesium levels in pregnant and non-pregnant women in Gondar, Northwest Ethiopia. Biol Trace Elem Res. 2008;122(2):97–106.CrossRef Afework K, Tomoki Y, Andargachew M, Belay T. Serum zinc, copper, selenium, calcium, and magnesium levels in pregnant and non-pregnant women in Gondar, Northwest Ethiopia. Biol Trace Elem Res. 2008;122(2):97–106.CrossRef
32.
go back to reference Kumera G, Awoke T, Melese T, Eshetie S, Mekuria G, Mekonnen F, et al. Prevalence of zinc deficiency and its association with dietary, serum albumin and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Gondar, Northwest Ethiopia. BMC Nutrition. 2015;1(31):1–11. Kumera G, Awoke T, Melese T, Eshetie S, Mekuria G, Mekonnen F, et al. Prevalence of zinc deficiency and its association with dietary, serum albumin and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Gondar, Northwest Ethiopia. BMC Nutrition. 2015;1(31):1–11.
33.
go back to reference Amare B, Moges B, Fantahun B, Tafess K, Woldeyohannes D, Yismaw G, et al. Micronutrient levels and nutritional status of school children living in Northwest Ethiopia. Nutr J. 2012;11(1):1–8.CrossRef Amare B, Moges B, Fantahun B, Tafess K, Woldeyohannes D, Yismaw G, et al. Micronutrient levels and nutritional status of school children living in Northwest Ethiopia. Nutr J. 2012;11(1):1–8.CrossRef
34.
go back to reference Roba K, O’Connor TP, Belachew T, O’Brien NM. Concurrent iron and zinc deficiencies in lactating mothers and their children 6–23 months of age in two agro-ecological zones of rural Ethiopia. Eur J Nutr. 2018;57(2):655–67.PubMedCrossRef Roba K, O’Connor TP, Belachew T, O’Brien NM. Concurrent iron and zinc deficiencies in lactating mothers and their children 6–23 months of age in two agro-ecological zones of rural Ethiopia. Eur J Nutr. 2018;57(2):655–67.PubMedCrossRef
35.
go back to reference Zaida H, Luis S, Endalamaw G, Antonio B, Ruben G, Jose M, et al. Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State. PLoS One. 2014;9(12):1–20. Zaida H, Luis S, Endalamaw G, Antonio B, Ruben G, Jose M, et al. Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State. PLoS One. 2014;9(12):1–20.
36.
go back to reference Belay A, Marquis G, Desse G. Effect of socio-demographic factors on zinc status of infants and preschool children in east Gojjam, Amhara region of Ethiopia. J Food Sci Eng. 2015;5:22–36. Belay A, Marquis G, Desse G. Effect of socio-demographic factors on zinc status of infants and preschool children in east Gojjam, Amhara region of Ethiopia. J Food Sci Eng. 2015;5:22–36.
37.
go back to reference Tessema M, De Groote H, Brouwer ID, Feskens EJM, Belachew T, Zerfu D, et al. Soil zinc is associated with serum zinc but not with linear growth of children in Ethiopia. Nutrients. 2019;11(2):1–14.CrossRef Tessema M, De Groote H, Brouwer ID, Feskens EJM, Belachew T, Zerfu D, et al. Soil zinc is associated with serum zinc but not with linear growth of children in Ethiopia. Nutrients. 2019;11(2):1–14.CrossRef
38.
go back to reference Christine H, Kenneth H. Contents International Zinc Nutrition Consultative Group (IZiNCG) technical document # 1 assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull. 2004;25(1(supplement)):1–114. Christine H, Kenneth H. Contents International Zinc Nutrition Consultative Group (IZiNCG) technical document # 1 assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull. 2004;25(1(supplement)):1–114.
39.
go back to reference Engle-stone R, Ndjebayi AO, Nankap M, Killilea DW, Brown KH. Stunting prevalence, plasma zinc concentrations, and dietary zinc intakes in a nationally representative sample suggest a high risk of zinc deficiency among women and young. J Nutr. 2014;144:1–10.CrossRef Engle-stone R, Ndjebayi AO, Nankap M, Killilea DW, Brown KH. Stunting prevalence, plasma zinc concentrations, and dietary zinc intakes in a nationally representative sample suggest a high risk of zinc deficiency among women and young. J Nutr. 2014;144:1–10.CrossRef
40.
go back to reference Maziya D, Akinyele I, Oguntona E, Nokoe S, Sanusi R, Harris E. Nigeria food consumption and nutrition survey. Int Inst Trop Agric. 2003:1–48. Maziya D, Akinyele I, Oguntona E, Nokoe S, Sanusi R, Harris E. Nigeria food consumption and nutrition survey. Int Inst Trop Agric. 2003:1–48.
42.
go back to reference Richard D, Semba M. Nutrition and health in developing countries. 2nd ed; 2008, pp 1–938. Richard D, Semba M. Nutrition and health in developing countries. 2nd ed; 2008, pp 1–938.
43.
go back to reference Seid A, Melkitu F, Tadesse A. Dietary diversity practice and associated factors among pregnant women in north east. BMC Res Notes. 2019;12:1–6.CrossRef Seid A, Melkitu F, Tadesse A. Dietary diversity practice and associated factors among pregnant women in north east. BMC Res Notes. 2019;12:1–6.CrossRef
45.
46.
go back to reference UNICEF. National Nutrition Survey report, Afghanistan; 2013, pp 1–115. https://reliefweb.int › report › national-nutrition-survey-Afghanistan. Accessed 15 Apr 2019. UNICEF. National Nutrition Survey report, Afghanistan; 2013, pp 1–115. https://​reliefweb.​int › report › national-nutrition-survey-Afghanistan. Accessed 15 Apr 2019.
47.
go back to reference Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey: Key Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. CSA and ICF; 2016, pp 1–59. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey: Key Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. CSA and ICF; 2016, pp 1–59.
48.
go back to reference Salgueiro J, Zubillaga MB, Lysionek AE, Caro RA, Weill R, Boccio R. The role of zinc in the growth and development of children. Elsevier. 2002;18:510–9. Salgueiro J, Zubillaga MB, Lysionek AE, Caro RA, Weill R, Boccio R. The role of zinc in the growth and development of children. Elsevier. 2002;18:510–9.
49.
go back to reference Nriagu J. Zinc deficiency in human health: introduction, etiology of zinc deficiency and epidemiological aspects of zinc deficiency. Elsevier; 2007, pp 1–8. Nriagu J. Zinc deficiency in human health: introduction, etiology of zinc deficiency and epidemiological aspects of zinc deficiency. Elsevier; 2007, pp 1–8.
Metadata
Title
Prevalence and associated factors of zinc deficiency among pregnant women and children in Ethiopia: a systematic review and meta-analysis
Authors
Kidanemaryam Berhe
Freweini Gebrearegay
Hadush Gebremariam
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7979-3

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue