Ahmed 5 introduction to key indicators

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Ahmed 5 introduction to key indicators

  1. 1. Nutritional Anemia in Bangladesh: Problems and Solutions Dr Tahmeed Ahmed Director Centre for Nutrition & Food Security ICDDR,B Professor, Public Health Nutrition James P. Grant School of Public Health, BRAC University
  2. 2. AnemiaA condition in which the Hbconcentration in the blood is belowa defined level, resulting in areduced oxygen-carrying capacityof red blood cells
  3. 3. Definition of Anemia at Sea Level Stoltzfus & Dreyfuss; INACG/UNICEF/WHO 1998
  4. 4. Consequences of Anemia• Poor immune function and increased morbidity from infection• Fatigue and lower physical work capacity• Poor physical growth• Impaired learning and school achievement Brabin BJ 2001 Grantham-McGregor S 2001
  5. 5. Consequences of Anemia in Pregnancy • Increased risk of complications during delivery, including prolonged labor, preterm delivery, LBW and maternal and neonatal deaths • Infants of mothers with iron deficiency anemia are more likely to have low iron stores and to become anemic Brabin BJ 2001 Grantham-McGregor S 2001
  6. 6. Anemia causes huge economic loss• Results in productivity loss• Economic cost of anemia in Bangladesh is estimated to be 7.9% of GDP Christian P 2005 UN/SCN 2004
  7. 7. What are the causes of anemia?• Iron deficiency – dietary deficiency, loss of iron• Hookworm• Vitamin deficiencies, eg vitamin B12, folic acid• Malaria• Hemoglobinopathies, eg thalassemia• Chronic infections, such as TB, HIV
  8. 8. Iron Deficiency Anemia• Iron deficiency is the most important cause of anemia• 60% of all anemia is due to iron deficiency Stoltzfus R 1998, Black RE 2008
  9. 9. Review of Anemia Control Program• Review of literature, survey reports• Meta analyses• Communication with stake holders from public, private and research sectors• 22 interviews - NNP, DGFP, IPHN, IEDCR, CMSD, NIPORT, EDCL, UNICEF, MI, BRAC, ICDDR,B• Informal round table discussion at ICDDR,B
  10. 10. Prevalence of Anemia in BangladeshAge Year Settings Sample Size %Infants 20041 Rural 1227 U-5 92(6-11 mo) 20032 Urban 93 83.9 20032 CHT 51 90 20013 Rural 1148 U-5 74.1 19994 Urban 183 92.3 NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004
  11. 11. Prevalence of Anemia in BangladeshAge Year Settings Sample Size %Infants 20041 Rural 1227 U-5 92(6-11 mo) 20032 Urban 93 83.9 20032 CHT 51 90 20013 Rural 1148 U-5 74.1 19994 Urban 183 92.3 •Demand for iron is high •Complementary feeding is inappropriate •No program for anemia control in infants NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004
  12. 12. Complementary Foods Provide little Micronutrients to Bangladeshi Infants Breast milk contributes to 75% of total energy intake Small amounts of CF offered Vitamin B6 50% of RNI Vitamin A 48% of RNI Zinc 45% of RNI Iron 9% of RNI Increase in CF will not substantially increase MN intake Kimmons J, 2006
  13. 13. Pre-school Children and Adolescent Girls Age Year Settings Sample Size % Pre-school 20041 Rural 1227 68 (6-59 mo) 20032 Urban 861 55.7 20013 Rural 1148 48.3 Adolescent 20041 Rural 661 39.7 (13-19 yr) 20032 Urban 1341 23.4 20013 Rural 237 30 NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023
  14. 14. Anemia Prevalence Trends in Bangladesh Infant Pre school Adolescent NPNL women Pregnant Women Lactating Women 100 92 90 80 74.1 67.9 70 60 48.3 46 50 46.7 46 40 39.7Pncert 30 35 33 38.8 20 30 10 0 2001 2003 2004 NSP 2004, Anemia prevalence survey UNICEF/BBS 2003, NSP 2002, WHO global database on anemia
  15. 15. Strategies for Anemia Prevention and Control • Micronutrient supplementation • Dietary improvement • Parasitic disease control • Food fortification • Family planning and safe motherhood National Strategy for Anemia Prevention and Control in Bangladesh, MOHFW 2007
  16. 16. Existing Programs on Iron Supplementation Age group Department Infants, children No national program Adolescents DGFP PLW DGFP, DGHS, NGOs NPW DGFP
  17. 17. Dose of Iron-folic Acid TabletsTarget group DosesAdolescent girls 2 tablets/weekNewly wed women 2 tablets/weekPregnant women 2 tablets daily up to delivery (NGOs 1 tab daily)Lactating mother 1 tablet daily for 90-120 d
  18. 18. Iron-folic Acid Tablets
  19. 19. Dispensing IFA TabletsDGFP Given in a polythene bag Spoilage ?DGHS Wrapped in paper Spoilage ?BRAC Now giving tablets in Tk 14 for 100 tab vs blister pack Tk 12 for 100 open tabs
  20. 20. Iron Coverage among Pregnant Women HFSNA 2009
  21. 21. IFA Tablet Coverage during Pregnancy in BINP AreasIndicator Survey Area BINP (%) Comparison (%) All (%)IFA intake Regular 25.4 16 19.5 Irregular 9.9 9.5 9.6 None 64.7 74.5 70.9Total (n) 2193 3785 5979 NNP Baseline Survey 2004
  22. 22. Reasons for Not Taking IFA Tablets RegularlyReasons N=1741 pregnant women, %Side effects (diarrhea, etc) 25.5Forget to take 19.5Did not consider necessary 16.3Lack of supply 12.0Do not receive enough tablets 6.1Economic constrains 4.5Objection of family members 1.9Lost tablets 0.2Others 7.8 NNP Baseline Survey 2004
  23. 23. Multiple Micronutrient Powder 1 RDA of •Iron •Folic acid •Vitamin A •Vitamin C •Zinc
  24. 24. No colorNo taste of its own No odor
  25. 25. Children with the following conditions are excluded: •Any acute illness •Severe cough •Breathlessness •Severe visible wasting
  26. 26. What can we do to control anemia?
  27. 27. Comprehensive Nutrition Actions Required• Increase exclusive breastfeeding rates• Improve complementary feeding practices by using various foods rich in iron• Consider home-based fortification of CF using multiple micronutrient powder• Coordination of efforts of different agencies and the private sector in control of anemia
  28. 28. • Promote factors that will increase coverage of IFA supplementation among adolescent girls, pregnant & lactating women – Effective counseling – Sustained supply – Appropriate packaging – Mass media coverage – Trained workforce

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