x

LIBERIA NATIONAL MICRONUTRIENT SURVEY 2011

Summary of Key Findings

28 September 2011x

Mamba Point Hotel

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

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

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

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

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

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

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

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

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

%

Correction Procedure

Reference Incubation Early convalescence Late convalescence0

10

20

30

40

50

60

70

Median ferritin concentration

WomenChildren

μg/L

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

Key Findings: Anemia

Pregnant Non-pregnant Children0

10

20

30

40

50

60

70

37.8 33.2

59.1

Anemia

Anemia

%

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

%

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

%

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

%

Key Findings: Iron Deficiency Anemia

Pregnant Non-pregnant Children0

5

10

15

20

25

9.411.3

21.2

Iron Deficiency Anemia

IDA

%

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

%

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

Thank You