Subclinical Vitamin A Deficiency and Associated Factors Among Pregnant Women in Eastern Ethiopia

Kedir Teji Roba ^1,2 Gemechu Asefa ¹ Meseret Belete Fite ³ Abdu Oumer ^1* Dureti Abdurahman ¹ Aboma Motuma ¹ Abebayehu N. Yilma ^4,5 Gretchen Thompson ⁶ Alexandra Brewis ⁷ Asher Y. Rosinger ^2,8

• ¹ School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
• ² Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania, United States
• ³ College of Medical and Health Sciences, Wollega University, Nekemte, Oromia Region, Ethiopia
• ⁴ Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, United States
• ⁵ Institutes for Energy and the Environment, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States
• ⁶ FHI 360, Washington, California, United States
• ⁷ School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States
• ⁸ Department of Anthropology, College of the Liberal Arts, The Pennsylvania State University, University Park, Pennsylvania, United States

Introduction: Vitamin A is essential for maternal and child health and plays a key role in reducing maternal and child mortality rates. A need exists for more evidence on the prevalence and associated factors of Vitamin A deficiency (VAD) among pregnant women in rural, underserved areas, such as eastern Ethiopia, where many risk factors for VAD may be concentrated. Methods: A community-based cross-sectional study was conducted with 397 randomly selected pregnant women at the Haramaya University Demographic Health Surveillance sites. Data were collected through structured questionnaires, anthropometric measurements, blood serum samples, and other relevant household and individual-level information. Vitamin A deficiency (VAD) was defined as serum retinol levels < 0.7 µmol/L, while marginal deficiency was defined as 0.70-1.05 µmol/L. Bivariable and multivariable logistic regression analyses were used to identify factors associated with VAD.Results: Approximately 48.1% (43.1%-53.1%) of pregnant women in eastern Ethiopia had subclinical vitamin A deficiency (VAD), with a mean serum retinol concentration of 0.82 (±0.02) µmol/L. Only 122 (30.7%) and 159 (40.1%) of the participants reported having adequately diversified diets and adequate food variety scores, respectively. The use of khat (a stimulant) (adjusted odds ratio [AOR] = 1.67; 95% CI: 1.08-2.57) and a lack of awareness regarding vitamin A-rich foods (AOR = 1.67; 95% CI: 1.04-2.68) were found to be positively associated with VAD. Khat chewing was responsible for approximately 40.1% of VAD cases. Additionally, greater educational attainment of the husband (AOR = 0.47; 95% CI: 0.25-0.90) was significantly protective against subclinical VAD.Almost half of the pregnant women in this eastern Ethiopian sample were found to have subclinical VAD, highlighting the need for nutritional education during antenatal care and community nutrition awareness campaigns by various stakeholders. Context-specific, targeted behavioral change communications are essential to improve dietary practices and healthcare utilization.