Transcript
Nutritional Anemia in Bangladesh: Problems and Solutions
Dr Tahmeed Ahmed
Director Centre for Nutrition & Food Security ICDDR,B
Professor, Public Health NutritionJames P. Grant School of Public Health, BRAC University
Anemia
A condition in which the Hb
concentration in the blood is below
a defined level, resulting in a
reduced oxygen-carrying capacity
of red blood cells
Definition of Anemia at Sea Level
Stoltzfus & Dreyfuss; INACG/UNICEF/WHO 1998
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 2001Grantham-McGregor S 2001
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 2001Grantham-McGregor S 2001
Christian P 2005UN/SCN 2004
Anemia causes huge economic loss
• Results in productivity loss
• Economic cost of anemia in Bangladesh is
estimated to be 7.9% of GDP
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
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
• 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
Review of Anemia Control Program
Age Year Settings Sample Size %
Infants
(6-11 mo)
20041
20032
20032
20013
19994
Rural
Urban
CHT
Rural
Urban
1227 U-5
93
51
1148 U-5
183
92
83.9
90
74.1
92.3
NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004
Prevalence of Anemia in Bangladesh
Age Year Settings Sample Size %
Infants
(6-11 mo)
20041
20032
20032
20013
19994
Rural
Urban
CHT
Rural
Urban
1227 U-5
93
51
1148 U-5
183
92
83.9
90
74.1
92.3
NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004
Prevalence of Anemia in Bangladesh
•Demand for iron is high•Complementary feeding is inappropriate•No program for anemia control in infants
Complementary Foods Provide little Micronutrients to Bangladeshi Infants
Kimmons J, 2006
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
Age Year Settings Sample Size %
Pre-school
(6-59 mo)
20041
20032
20013
Rural
Urban
Rural
1227
861
1148
68
55.7
48.3
Adolescent
(13-19 yr)
20041
20032
20013
Rural
Urban
Rural
661
1341
237
39.7
23.4
30
NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023
Pre-school Children and Adolescent Girls
0
10
20
30
40
50
60
70
80
90
100
Perc
en
t
Infant Pre school
Adolescent NPNL women
Pregnant Women Lactating Women
200420032001
74.1
92
67.9
48.3
39.7
30
46
33 38.8
46.735
46
NSP 2004, Anemia prevalence survey UNICEF/BBS 2003, NSP 2002, WHO global database on anemia
Anemia Prevalence Trends in Bangladesh
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
Existing Programs on Iron Supplementation
Age group Department
Infants, children No national program
Adolescents DGFP
PLW DGFP, DGHS, NGOs
NPW DGFP
Dose of Iron-folic Acid Tablets
Target group Doses
Adolescent girls 2 tablets/week
Newly wed women 2 tablets/week
Pregnant women 2 tablets daily up to delivery(NGOs 1 tab daily)
Lactating mother 1 tablet daily for 90-120 d
Iron-folic Acid Tablets
DGFP Given in a polythene bag Spoilage ?
DGHS Wrapped in paper Spoilage ?
BRAC Now giving tablets in blister pack
Tk 14 for 100 tab vs
Tk 12 for 100 open tabs
Dispensing IFA Tablets
Iron Coverage among Pregnant Women
HFSNA 2009
IFA Tablet Coverage during Pregnancy in BINP Areas
NNP Baseline Survey 2004
Indicator Survey Area
BINP (%) Comparison (%) All (%)
IFA intake Regular Irregular None
25.49.9
64.7
169.5
74.5
19.59.6
70.9
Total (n) 2193 3785 5979
Reasons for Not Taking IFA Tablets Regularly
Reasons N=1741 pregnant women, %
Side effects (diarrhea, etc)Forget to takeDid not consider necessaryLack of supplyDo not receive enough tabletsEconomic constrainsObjection of family membersLost tabletsOthers
25.519.516.312.06.14.51.90.27.8
NNP Baseline Survey 2004
Multiple Micronutrient Powder
1 RDA of•Iron•Folic acid•Vitamin A•Vitamin C•Zinc
No colorNo taste of its own
No odor
Children with the following conditions are excluded:
•Any acute illness
•Severe cough
•Breathlessness
•Severe visible wasting
What can we do to control anemia?
• 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
Comprehensive Nutrition Actions Required
• 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
top related