Additional Analyses from National Micronutrient Survey 2011-12 (Iron, Anemia &

Folate)

Sabuktagin RahmanSenior Program Manager, Monitoring

Learning & ResearchGAIN, Bangladesh

What lies behind the regressions findings (Ferritin)?

HH expense

(BDT)

Intake of iron (mg/d) S. ferritin (ng/ml)

Iron Def. (%)

Total Animal source

“High” Iron Area

6904 3.1 0.65 39 8.5

“Low” iron Area

8518 4.1 0.93 21 18.6

“High” Iron area positively determined iron nutrition

S. ferritin (ng/ml)

Iron Def. (%)

Intake of animal iron(mg/d)

HH using tubewell water

(%)

Rural 31 9.4 0.74 77

Slum 21 27.2 0.73 31

Slum is associated with lower iron nutrition in PSAC

S. ferritin (ng/ml)

Iron Def. (%) Use of tubewell (%)

HH expense <median 71 5.1 79 (Rural)

HH expense>=median 63 8.5 62 (Urban)

HH expense is negatively associated with iron nutrition in women

Serum ferritin (ng/ml)

Total iron intake (mg/d)

Animal iron intake (mg/d)

Richest 67 8.8 1.79

Poorest 68 6.5 0.79

Richest quintile positively determines iron nutrition in women

HH expense(BDT)

Iron intake (mg/d)

Tubewell (%)

S. ferritin (ng/ml)

Moderately food insecure

7697 6.8 74 74

Food secure 11396 7.8 72 61

Food insecure households are associated with higher iron nutrition in Women

HH food insecurity

47% “High” iron area

23% “Low” iron area

S. ferritin (ng/ml)

Tubewell (%)

Intake of iron (mg/d)

Mothers knowledgeable about iron rich food

49.4 77 6.97

Do not 40.8 74 5.12

Mothers knowledge about health benefit of iron rich food is associated with higher iron nutrition in SAC

HH expense

(BDT)

Animal iron (mg/d)

S. ferritin (ng/ml)

Tubewell (%)

Agricultural profession

7877 0.64 35 77

Non agricultural 11052 0.95 27 70

Agricultural professions are associated with higher iron nutrition in PSAC

Agricultural profession

59%, Rural

20%, Urban

What lies behind regression findings (Hemoglobin)?

Intake of animal source iron (mg/7d)

Anemic 6.78

Non-anemic 7.95

Animal source iron is positive determinant of hemoglobin

Anemia

Vitamin A deficiency Preschool children 33%

School children 17%

NPNL women 19%

Vitamin A deficiency is associated with increased Anemia

S. Zinc (mmol/l) Zinc Deficiency

Anemic 9.7 11%

Non-anemic 10.2

Zinc deficiency is associated with higher anemia in women

Iron intake (mg/d) Animal vitamin A (RE/d)

Boy 6.40 137

Girl 5.88 87

Being girl children is negatively associated with hemoglobin

Intake of iron (mg/d)

Intake of vitamin A (RE/d)

Anemia (%)

Urban 6.80 770 11.8

Rural 5.95 563 21.7

Urban residence is positively associated with higher hemoglobin in SAC

S. ferritin (ng/ml) Anemia (%)

“High” iron area 39 17

“Low” iron area 23 34

“High” iron area is positively associated with low anemia in PSAC

HH expense(BDT)

Intake of animal iron (mg/7d)

S. ferritin (ng/ml)

Tubewell (%)

Poorest 5541 5.59 54.6 70

Poorer 7405 6.77 56.8 77

Middle 8866 8.32 41.7 80

Richer 10097 8.43 49.9 68

Richest 15063 12.57 49.4 67

SES is not associated with hemoglobin in Women

Intake of animal iron (mg/7d)

S. ferritin (ng/ml)

Food Secure 9.7 45

Moderate insecure 5.6 66

Severe insecure 4.5 53

HH food insecurity did not influence hemoglobin in women

HH food insecurity

47% “High” iron area

23% “Low” iron area

What lies behind regression findings (Folate)?

Plant source folate is positively and animal source folate intake is negatively associated with folate nutrition

Plant folate 92%

Animal

folate 8%

Serum folate (nmol/l)

National 12.35

Rural 12.58

Urban 11.68

Slum 11.40

Location of rural households almost positively associated with folate nutrition

Daily dietary folate (microgram)

Serum folate (nmol/l)

Refrigerator 198 15.3

No refrigerator 153 11.9

Non possession of refrigerator is negatively associated with folate nutrition

Serum ferritin & retinol was positively associated with serum folate

Intake of Dietary Iron and Dietary folate

are positively correlated;

R=57%, p<0.001 Intake of Dietary Vitamin A and

Dietary folate are positively correlated;

R=32%, p<0.001

RDA(%) Intake (%) Animal source

intake(%)

0102030405060708090

100100

47.2

9.7

100

55.7

10

IronVitamin A

GAP in Vitamin A

It is the GAP in Dietary Intake in Preschool children…………………………..

GAP in Iron

Iron Vitamin A Folate0

10

20

30

40

50

60

70

80

90

100100 100 100

41.1

55

40

5.7 4.2 3.1

RDA(%)Intake (%)Animal source intake(%)

GAP GAPGAP

It is the GAP in Dietary Intake in Women…………….

Hemoglobin

Vitamin AIron

FolateZinc

Micronutrient Framework to determine Hemoglobin

Hemoglobin

Salient Findings

Prevalence of Iron Deficiency is less than widely held assumption

Prevalence of anemia appears less but still remains as major nutrition concern

Mothers awareness may improve iron nutrition in children

Slum population requires special attention to mitigate iron malnutrition

High level of iron in water needs due appraisal in the perspective of iron/anemia control strategy

Girl children need attention to improve micronutrient intake

Animal source iron is important to improve hemoglobin status

One in ten women suffer from folate deficiency

Anemia control strategy should underpin - strategy to improve iron, vitamin A, folate and zinc

A clear need is evident to reduce very wide GAP in dietary micronutrient intake

Salient Findings

IPHNProf. Ekhlasur RahmanDr. Mustafizur RahmanUNICEFDr. Ireen Akhter Chowdhuryicddr,bDr. Tahmeed AhmedDr. Sabuktagin RahmanDr. Nurul AlamDr. Ahmed Shafiqur RahmanDr. A. M. Shamsir AhmedGAINDr. Sabuktagin Rahman

Investigators