Folate deficiency in women of reproductive age in nine administrative regions of Ethiopia: an emerging public health problem

Abstract

Objective: To investigate the country-wide extent of folate deficiency and risk factors in Ethiopian women. Design: Cross-sectional study. Methods: Multistage cluster sampling and systematic sampling were used to select 970 women aged 15 to 49 years from nine accessible regions of Ethiopia. Demographic and health information was collected via questionnaire. Biological samples were collected by medical technologists. Outcome measures: demographic and health variables, food frequency, haemoglobin status, ferritin status and folate status. Results: Mean ± SD plasma folate was 5.57 ± 3.84 ng/mL. Forty-six per cent of women had severe folate deficiency (= 4 ng/mL) and 21.2% had marginal folate deficiency (> 4–6.6 ng/mL) with unequal prevalence across the country. Severe folate deficiency was higher in women who were unmarried (p = 0.002), had parity of 4–6 (p = 0.001), used oral contraceptives (p = 0.01), had no illnesses (p = 0.001), had intestinal parasites (0.001), followed lower plant food diets (0.001), followed lower animal product diets (0.001), had no anaemia (0.001) and had no iron deficiency (0.001). In logistic regression analysis, only low plant food diets (p = 0.001) and iron deficiency (p < 0.001) retained their significance with regard to folate deficiency. The odds for developing folate deficiency was 0.9 times less likely among those with higher plant food intake (AOR-0.9;95%CI – 0.72–1.2) and 0.2 times less likely among those with adequate iron (AOR-0.2;95%CI – 0.17–0.34). Conclusions: Folate deficiency is widespread in Ethiopian women, emphasising the need for sustainable folate intake through dietary diversification and appropriate public health measures.

Keywords: folate deficiency; Ethiopia; women; iron deficiency