GRADUATE AND POSTDOCTORAL STUDIES FINAL ORAL EXAMINATION

Transcription

1 GRADUATE AND POSTDOCTORAL STUDIES MCGILL UNIVERSITY FINAL ORAL EXAMINATION FOR THE DEGREE OF DOCTOR OF PHILOSOPHY OF KARIM BOUGMA SCHOOL OF DIETETICS AND HUMAN NUTRITION EFFECTS OF IODIZED SALT ON CHILD MENTAL AND PHYSICAL DEVELOPMENT IN AMHARA REGION, ETHIOPIA November 18 th, :45 am Macdonald Stewart Building, Room MS2-022 McGill University, Macdonald Campus COMMITTEE: Dr. J. Whalen (Pro-Dean) (Department of Natural Resource Sciences) Dr. T. Johns (Chair) (School of Dietetics and Human Nutrition) Dr. G. Marquis (Supervisor) (School of Dietetics and Human Nutrition) Dr. K. Koski (Internal Examiner) (School of Dietetics and Human Nutrition) Dr. F. Aboud (External Member) (Department of Psychology) Dr. G. Hickey (External Member) (Department of Natural Resource Sciences) Dr. Josephine Nalbantoglu, Dean of Graduate and Postdoctoral Studies Members of the Faculty and Graduate Students are invited to attend

2 ABSTRACT Almost 40% of children under five years of age in low- and middleincome countries do not reach their full developmental potential, and iodine deficiency is among the main risk factors. Universal salt iodization is the recommended strategy to tackle iodine deficiency disorders, but its effectiveness in improving development of young children has not been assessed. We evaluated the effects of iodized salt on the mental and physical development of children under 30 months of age in Ethiopia. A community-based cluster randomized effectiveness trial was conducted in 60 districts randomly selected out of 75 in the Amhara region of Ethiopia. Thirty districts were randomly allocated to the intervention arm and the remaining thirty to the control arm. In each district, one village was randomly selected. As iodized salt was gradually produced in the nearby Afar region, it was brought early into the markets of the 30 intervention villages before it became widely available and so entered in the 30 control villages through market forces four to six months later. The primary outcome was the mental development (cognitive, language, and fine motor) scores of infants on the Bayley Scales and the anthropometric standardized scores. Other outcomes included psychosocial stimulation and maternal depressive symptoms. Analysis was intention-to-treat using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT We recruited exhaustively and assessed 1835 infants 5 11 mo at baseline between October 2011 and April 2012 in 60 villages. The same children (85% of the baseline sample) were re-assessed between March and October 2013 when they were 20 to 29 mo of age. At this point all villages had iodized salt. At endline, urinary iodine concentration was significantly higher in intervention compared to control children (median vs µg/l, respectively), presumably due to their longer exposure to higher quality iodized salt. The intervention group had significantly higher scores than controls on three of the four Bayley subscales: cognitive (53.27 vs 52.54; d = 0.13, 95% CI 0.03,0.23), receptive language (20.71 vs 20.18, d = 0.13, 95% CI 0.03,0.24), fine motor (35.45 vs

3 34.94, d = 0.15, 95% CI 0.04,0.25) as well as on the standardized Bayley composite score ( vs ; d = 0.13, 95% CI 0.02,0.23). Intervention mothers also had significantly fewer depressive symptoms (16.12 vs 17.74; d = 0.16, 95% CI 0.06, 0.27). Regarding physical growth, there was no significant effect of the intervention, but significant interactions were found indicating modifier effects of early access to iodized salt. Children from families with more assets and better water and sanitation facilities in the intervention group had better nutritional status on height-forage z-score and MUAC-for-age z-score. These findings are discussed in terms of critical issues in this field such the timing of iodine exposure and the format of iodine delivery, namely iodized oil capsules vs iodized salt. Implications for policy from the current findings are (a) the need to support children s iodine status and mental development, (b) the importance of monitoring the salt quality but prioritizing access for the majority of the population over iodization quality, and (c) enacting and maintaining the mandatory legislation to sustain universal iodization.

4 CURRICULUM VITAE UNIVERSITY EDUCATION Ph.D. candidate (Human Nutrition). McGill University, QC, Canada. Sept 2010 Present M.Sc. in International Nutrition. University of Montreal, QC, Canada Jan Dec 2008 B.Sc. in Human Nutrition and Food Technology. University of Ouagadougou, Burkina Faso in collaboration with Wageningen Agricultural University, Netherlands Oct 1995 Sept 1999 EMPLOYMENT Sept 2016 Present: Technical Advisor. Adolescent Girls Weekly Iron Folic Acid Supplementation and Nutrition Counselling Programme, Micronutrient Initiative, Ottawa, Canada. April 2015 Jan 2016: Technical Advisor on Dietary Diversity Studies (Food Security Programme in Mali). European Agency for Health and Development, Montreal/Bamako. Jan March 2015: Technical Advisor. Home Fortification Programme in Bangladesh, Global Alliance for Improved Nutrition. Dec 2013 Feb 2014: Consultant. SMART/SENS Survey in Chad, United Nations High Commissioner for Refugees. Oct 2009 July 2010: Consultant. SMART Surveys in Bangladesh. Action Against Hunger. June Sept 2009: Consultant. Evaluation of the Universal Salt Iodization Programme in Haiti. Micronutrient Initiative Oct 2008 May 2009: Volunteer. Immigrant students homework support. Frontier College. Montreal, Canada June 2001 July 2003: Field Supervisor. Household Food Security Research Project in Burkina Faso. Cornell University. Oct 1999 June 2006: Teacher in Biological Sciences. Sainte Colette High School, Burkina Faso.

5 AWARDS Graduate Student Research Award, American Society for Nutrition, Experimental Biology, Boston, MA, USA (April 2015) Micronutrient Global Conference, Presenter travel award (June 2014) Graduate Research Enhancement and Travel Award (March 2014) Graduate Research Enhancement and Travel Award (Feb 2014) Graduate Students Excellence Award in Dietetics & Human Nutrition (Sept 2013 Aug 2014) PROFESSIONAL SERVICES Peer review for Nutrients journal (2016) MPH thesis supervision (April 2013 April 2015) Prevalence and associated factors of malnutrition in children under five years old in East Gojjam zone, Amhara Region, Ethiopia Submitted by Agernesh Alem To University of Debremarkos and Gamby College of Medical Sciences, Ethiopia PUBLICATIONS Aboud FE, Bougma K, Lemma T, Marquis GS. Evaluation of the effects of iodized salt on the mental development of preschool-aged children: a cluster randomized trial in northern Ethiopia. Matern Child Nutr doi: /mcn [Epub ahead of print] Gashu D, Stoecker BJ, Bougma K, Adish A, Haki GD, Marquis GS. Stunting, selenium deficiency and anemia are associated with poor cognitive performance in preschool children from rural Ethiopia. Nutr J Apr 12; 15:38. doi: /s z Gashu D, Stoecker BJ, Adish A, Haki GD, Bougma K, Aboud FE, Marquis GS. Association of serum selenium with thyroxin in severely

6 iodine-deficient young children from the Amhara region of Ethiopia. Eur J Clin Nutr, [Epub 16 Mar; 1-6]. doi: /ejcn Gashu D, Stoecker BJ, Adish A, Haki GD, Bougma K, Marquis GS. Ethiopian pre-school children consuming a predominantly unrefined plant-based diet have low prevalence of iron-deficiency anaemia. Public Health Nutr, 2016:19(10): Bougma K, Aboud FE, Harding KB, Marquis GS. Iodine and Mental Development of Children 5 Years Old and Under: A Systematic Review and Meta-Analysis. Nutrients. 2013; 5(4): PRESENTATIONS Bougma K, Marquis G, Aboud F, Frongillo E, Lemma T, Samuel A. Iodized Salt Improves Child's Iodine Status, Mental Development, and Physical Growth in a Cluster Randomized Trial in Ethiopia. FASEB J April :28.6 Bougma K, Mohammed H, Marquis GS, Aboud FE, Lemma T, Singla D, Frongillo EA, Samuel A. Iodine and other nutritional predictors of infant and young child development: Results from a Cluster Randomized Trial in Amhara, Ethiopia. Oral presentation, Micronutrient Global Conference, Addis Ababa, Ethiopia, 2-6 June Aboud FE, Marquis GS, Bougma K, Lemma T, Mohammed H, Samuel A. Iodine and other nutritional predictors of preschool-aged children's development in Amhara, Ethiopia. Oral presentation, Micronutrient Global Conference, Addis Ababa, Ethiopia, 2-6 June Bougma K, Marquis GS, Aboud FE, Frongillo EA, Lemma T, Samuel A. Iodized Salt Benefits Infant Mental Development: Preliminary Results from a Cluster Randomized Trial in Ethiopia. Oral presentation, Experimental Biology, San Diego, CA, USA, April 26-30, Bougma K, Marquis GS, Aboud FE, Lemma T, Samuel A. Iodized Salt Benefits Children School Readiness: Preliminary Results from a Cluster Randomized Trial in Ethiopia. Poster presentation, Experimental Biology, San Diego, CA, USA, April 26-30, Bougma K, Marquis GS, Aboud FE, Frongillo EA, Singla D, Harding KB, Lemma T, Samuel A, Zerfu D. Iodine Deficiency and Child Development

7 in Ethiopia. Poster presentation, Experimental Biology, Boston, MA, USA, April 20-24, Aboud F, Marquis GS, Bougma K, Harding KB, Abuye C, Lemma T, Zerfu D. Iodine Deficiency and Infant & Child Cognitive Development: A Review of the Evidence and some Baseline Findings. Poster presentation, XIII World Congress on Public Health, Addis Ababa (Ethiopia), April 2012 Harding KB, Neufeld LM, Briscoe C, Bougma K, Aboud F. Iodine supplementation and infant and child cognitive and motor development: a review of the evidence. Poster presentation, Global Health Conference, Montreal (Canada), November Bougma K, Somé IT, Massé P, Delisle H. To Improve Populations Vitamin A Status and Reduce Poverty: Challenges of the Red Palm Oil Project In Burkina Faso. Poster presentation. Micronutrient Forum, Istanbul (Turkey), April Bougma K, Delisle H. Mobilizing Communities to Reduce Vitamin A Deficiency: The Red Palm Oil Project Experience in Burkina Faso. Oral presentation, A2Z satellite workshop, Micronutrient Forum, Istanbul (Turkey), April Bougma K, Bayili A, Tankoano FA, Zagré NM. [Study of breastfeeding and complementary feeding practices in a rural area in Burkina Faso]. Oral presentation. National forum of scientific research and technological innovation Proceedings. 4th ed., Ouagadougou (Burkina Faso), 3-8 April 2000.