x liberia national micronutrient survey 2011 summary of key findings 28 september 2011 x mamba point...
DESCRIPTION
Background Micronutrients play a critical role in child survival and human health Iron deficiency reduces adults’ physical activity and stunts mental development Vitamin A deficiency responsible for increased morbidity and mortality; blindness Iodine deficiency creates pregnancy complications and development in utero 1. 53% of children with VAD; 62% or pregnant women, 87% of children with anemiaTRANSCRIPT
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x
LIBERIA NATIONAL MICRONUTRIENT SURVEY 2011
Summary of Key Findings
28 September 2011x
Mamba Point Hotel
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Background
• Micronutrients play a critical role in child survival and human health
• Iron deficiency reduces adults’ physical activity and stunts mental development
• Vitamin A deficiency responsible for increased morbidity and mortality; blindness
• Iodine deficiency creates pregnancy complications and development in utero
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Background
• Government of Liberia endorsed World Fit for Children and MDG nutrition goals
• Nutrition and micronutrients emphasized in Essential Package of Health Services (EPHS)
• Most recent available data for micronutrient status in Liberia from 1999
• MOHSW and partners needed updated information for policy and programming
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General Objectives
1. Determine national and urban/rural prevalence of micronutrient deficiencies in women 15-49 years and children 6-35 months
2. Assess coverage of ongoing interventions that aim to prevent micronutrient deficiencies
3. Gather information on underlying determinants of micronutrient deficiencies in Libera
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Specific Objectives
• Estimate vitamin A, iron, and iodine deficiency for women of reproductive age; iron supplementation coverage
• Estimate vitamin A and iron deficiency for children 6-35 months; vitamin A supplementation and deworming coverage
• Estimate proportion of households consuming adequately iodized salt
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Methodology
• LNMS used a two-stage cluster design, stratified by urban and rural areas; 57 clusters in each
• 2008 census frame was used to select PSUs at first stage
• Households sampled within communities by systematic random sampling; 15 in each
• Minimum sample size calculated using prevalence estimates from LMIS 2009 and 1999 survey – 1,710 households total
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Methodology
• Training held in Monrovia 7-12 March 2011; three days of pre-testing followed in urban/rural
• Fieldwork conducted between 7 April-18 June• Teams administered paper questionnaire,
measured Hb and malaria on site; took venous blood samples from women/children, urine samples from women, salt samples from HH
• Biological samples transported via cold chain from field to NDS at JFK Hospital
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Sample Analyses
• Blood samples (Germany): ELISA method used to measure ferritin, transferrin receptor (sTfR), retinol binding protein (RBP), and inflammation proteins (APPs)
• Urine samples (Tanzania): ammonium persulfate digestion method to measure iodine concentration
• Salt samples (Tanzania): simple titration to measure iodine ppm
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Correction Procedure
• Ferritin and RBP concentrations affected by infection; even if not presenting clinical signs
• This creates problem when using standard cut-off points defined by WHO to classify micronutrient deficiencies, esp. for children
• In LNMS, identified four stages of infection response using APPs, then adjusted ferritin and RBP measurements to “healthy” subgroup
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Correction Procedure
Reference Incubation Early convalescence Late convalescence0
10
20
30
40
50
60
70
80
90
80.1
10.7 5.4 3.8
44.1
2.7
23.529.7
Subclinical infection status
WomenChildren
%
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Correction Procedure
Reference Incubation Early convalescence Late convalescence0
10
20
30
40
50
60
70
Median ferritin concentration
WomenChildren
μg/L
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Correction Procedure
Reference Incubation Early convalescence Late convalescence0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Median RBP concentration
WomenChildren
μmol
/L
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Key Findings: Anemia
Pregnant Non-pregnant Children0
10
20
30
40
50
60
70
37.8 33.2
59.1
Anemia
Anemia
%
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Key Findings: Anemia
15-19 20-24 25-29 30-34 35-39 40-44 45-490
5
10
15
20
25
30
35
40
45
Anemia among non-pregnant women
Anemia
Age in years
%
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Key Findings: Iron Deficiency
Pregnant Non-pregnant Children0
5
10
15
20
25
30
35
19.3 19.6
29.8
Iron deficiency
Iron deficiency
%
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Key Findings: Iron Deficiency
15-19 20-24 25-29 30-34 35-39 40-44 45-490
5
10
15
20
25
30
35
Iron deficiency among all women
Iron deficiency
Age in years
%
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Key Findings: Iron Deficiency Anemia
Pregnant Non-pregnant Children0
5
10
15
20
25
9.411.3
21.2
Iron Deficiency Anemia
IDA
%
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Key Findings: Vitamin A Deficiency
Pregnant Non-pregnant Children0
2
4
6
8
10
12
14
2.6 2.2
13.2
Vitamin A Deficiency
VAD
%
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Way Forward & Next Steps
• Technical working group to carry out causal analysis to identify key determinants (e.g., age, geography, education) in October
• Final comprehensive report, including programming recommendations based on results of causal analysis by mid-November
• Based on findings in final report, develop and cost a micronutrient implementation plan for Liberia by end of November
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Thank You