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Meta-Analysis
. 2023 May 8;18(5):e0285281.
doi: 10.1371/journal.pone.0285281. eCollection 2023.

Folate deficiency among women of reproductive age in Ethiopia: A systematic review and meta-analysis

Berhe Gebremichael  1 , Hirbo Shore Roba  1   2 , Alemeshet Getachew  1 , Dejene Tesfaye  3 , Haftu Asmerom  4
Affiliations
Meta-Analysis

Folate deficiency among women of reproductive age in Ethiopia: A systematic review and meta-analysis

Berhe Gebremichael et al. PLoS One. .

Abstract

Background: Folate deficiency (FD) can cause adverse health outcomes of public health significance. Although FD is a significant micronutrient deficiency in Ethiopia, concrete evidence is limited. Therefore, this systematic review and meta-analysis was designed to estimate the pooled prevalence of FD among women of reproductive age (WRA).

Methods: A systematic literature search was performed using MEDLINE, Embase, CINAHL, Google Scholar, African Journals Online (AJOL), The Vitamin and Mineral Nutrition Information System (VMNIS) of the World Health Organization (WHO), Global Health Data Exchange (GHDx), and institutional repositories of major universities and research centers. Additionally, we scanned the reference lists of relevant articles. Two authors independently selected the studies, extracted the data, and the study risk of bias. Heterogeneity was assessed using the I2 statistic. We used a random-effects model to estimate the pooled mean serum/plasma folate and the pooled prevalence of FD. Begg's and Egger's tests were used to check publication bias.

Results: Ten studies-nine cross-sectional and one case-control-with a total of 5,623 WRA were included in the systematic review and meta-analysis. Four (WRA = 1,619) and eight (WRA = 5,196) cross-sectional studies were used to estimate the pooled mean serum/plasma folate and prevalence of FD, respectively. The pooled mean serum/plasma folate concentration estimate was 7.14 ng/ml (95% CI: 5.73, 8.54), and the pooled prevalence of FD was estimated to be 20.80% (95% CI: 11.29, 32.27). In addition the meta-regression analysis showed that the sampling technique was significantly associated with mean serum/plasma folate concentration.

Conclusions: FD is a significant public health issue among WRA in Ethiopia. Therefore, the public health strategies of the country should focus on promoting the consumption of folate-rich foods, strengthening the coverage of folic acid supplementation and its adherence, and swift translation of the mandatory folic acid fortification into action.

Systematic review registration: PROSPERO 2022-CRD42022306266.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram showing the selection process of studies for the systematic review and meta-analysis on folate deficiency among women of reproductive age in Ethiopia, 2022.
Fig 2
Fig 2. Forest plot of mean serum/plasma folate level among women of reproductive age in Ethiopia, 2022.
NOTE: Weights are from random-effects model.
Fig 3
Fig 3. Forest plot of the prevalence of folate deficiency among women of reproductive age in Ethiopia, 2022.
Fig 4
Fig 4. Forest plot of subgroup analysis for mean serum/plasma folate level by survey year among women of reproductive age in Ethiopia, 2022.
NOTE: Weights and between-subgroup heterogeneity test are from random-effects model.
Fig 5
Fig 5. Forest plot of subgroup analysis for mean serum/plasma folate level by sampling technique among women of reproductive age in Ethiopia, 2022.
NOTE: Weights and between-subgroup heterogeneity test are from random-effects model.
Fig 6
Fig 6. Forest plot of subgroup analysis for the prevalence of folate deficiency by population group among women of reproductive age in Ethiopia, 2022.
Fig 7
Fig 7. Forest plot of subgroup analysis for the prevalence of folate deficiency by mean age among women of reproductive age in Ethiopia, 2022.
See this image and copyright information in PMC

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