- 1. Biochemical and Clinical indices to assessnutritional status
and response to nutritionalinterventions : VAD and IDDByDr Zeba
Mahmud, Director, Micronutrient InitiativeTraining on Assessment of
Nutritional Status 18-22 December 2011Date : 20 December
2011,Venue: ICDDRBThe Training is organized by the National
National Food Policy Capacity Strengthening Programme (NFPCSP) .
The NFPCSP is jointly implemented by the Food Planning and
Monitoring Unit (FPMU), Ministry of Food and DisasterManagement and
Food and Agriculture Organization of the United Nations (FAO) with
the financial support of the EU andUSAID.
www.micronutrient.org
2. www.micronutrient.orgA world free from hidden hunger2 3. THE
HIDDEN HUNGERBangladesh is not in a complex nutritional
emergency.Most of the malnutrition in our country is hidden
andoccurs on a much larger scale than can be imagined. Itis not
only due to lack of food as such; it has more todo with a diet
which is insufficiently varied, leading todeficiency of certain
micronutrients.www.micronutrient.org 4. www.micronutrient.orgThe
need for vitamins and minerals Health BargainPrevent deathsDecrease
burden of diseaseAlleviate suffering Social Development Bargain
Educational performanceFamily and parenting impactsEconomic
Development BargainInvestments in human capitalImprovements in
productivity4 5. www.micronutrient.orgMicronutrient deficiencies
:decreased cognition and productionbillions of dollars loss. 5%
depression in GNP annually : 5 6. Needed in minute quantities but
its deficiencies cancause permanent damages.Victims of
micronutrient malnutrition can suffer fromintellectual
impairment,growth stunting,susceptibility to infections,mental
retardation,.www.micronutrient.org 7. Needed in minute quantities
but its deficiencies cancause permanent damages.Victims of
micronutrient malnutrition can suffer frompoor health,low working
capacity,blindness,behavioral changes,learning disabilitiesand even
death.www.micronutrient.org 8. www.micronutrient.org Situation
Analysis Benefits of Vitamin A and iodine Assessment 8 9. Country
Overview www.micronutrient.org Health, Population, Nutrition
Development Sector Program(HPNDSP) : endorsed for 2011-16
Development Project Proposal (2011 - 16) for Control ofIodine
Deficiency Disorder (CIDD) under BSCIC, MOI isunder process
Operation plan for National Nutrition Service approved on17 October
2011 Age for VAS to be from 6 months instead of 9 months Revolving
fund being utilized to procure KIO39 10.
Analysiswww.micronutrient.orgPopulation of >148 million
(estimated )child population ( 0 59 months) of 22 millionChild
Survival: Under five mortality : 61/1000 live births (190,000)
Clinical / sub clinical VAD: 22% (estimated) 2 wk diarrhea
prevalence: 10%BDHS 2007, NSP 2004, BSCIC, UNICEF 200610 11.
Analysiswww.micronutrient.orgChild Development: Anemia prevalence
rates ( 6-59 months): 68% IDD rates ( % with UIE below 100 ug/L):
34%Womens health: Anemia prevalence rates PLW: 49% NPNL: 46% VAD
NPNL: 33%BDHS 2007, NSP 2004, BSCIC, UNICEF 200611 12.
www.micronutrient.orgCoverage of Key interventionsChild Survival
VAS: 88% ZnS and LO ORS: 20% diarrhoea affected childrenChild
Development HH level coverage of iodized salt: 84%Womens Health IFA
coverage among P&LW: 55%BDHS 2007, USI Survey 2006, GOB 200412
13. www.micronutrient.orgOutline Situation Analysis Benefits of
Vitamin A and Iodine Assessment13 14. Technical brief on
qualitative universal salt iodizationwww.micronutrient.org 15.
www.micronutrient.orgWhat is iodineA mineral needed for normal
growth anddevelopment of the body.Produces thyroid hormone
necessary fornormal development and function of the brain
andnervous system.maintains the metabolic rate and
energymetabolism.Found in the mines of Chile and underground
inJapan 15 16. Deficiencywww.micronutrient.orgeffect the child even
before they are born andchange their adult lives.IDD of the women
during pregnancy can effectboth foetus and infant.Women have
abortions and stillbirths.Children are born with low birth weights
andpermanent physical and mental birth defects.School children may
have lower intelligence andMore learning disabilities.It
significantly reduces mental capacity and workpotential.16 17.
www.micronutrient.orgIodine Deficiency DisordersGoiters most
obvious signs of IDDCretinism most serious form of IDD17 18.
www.micronutrient.orgRequirement : Children (preschool) 90 ug
Children 6 10 years120 ug Males & Females 11+ years150 ug
Pregnant and lactating women 175 -200 ug 18 19.
www.micronutrient.orgIodine deficiency disorder (IDD) 56 m people
are iodine deficient 23 m have goitre (4 m visible) 5 lakhs have
cretinism 250,000 people are mentally impaired 41,000 still births
occur yearly; 33,000 infants die in the first year of life 15,000
women give birth to mentally impaired children annually. 19 20.
www.micronutrient.orgWhy does Bangladesh have iodine
deficiencygeography is the primary factor.oceans and seas that is
the water are the primary sources.absorbed into the
atmospherereleased in the soil through rainHeavy rainfall and
floods wash away large amounts of iodineleaving behind iodine
deficient soil.Bangladesh is a delta for three major rivers.The
flood cycle of rivers, compounded by monsoon rains,routinely
leaches iodine from the soil 20 21. www.micronutrient.org But why
iodize salt?Salt is a superior food for iodizationLeast
expensiveThe process requires minimal capital investment and
imposeslow operating expense.Every day every person everywhere in
the world eats salt.Humans consume salt in a predictable range. 21
22. www.micronutrient.orgIDD Elimination in Bangladesh Salt
production50,000 salt farmers 70,000 acres salt production area
Process of drying up of seawater by solar heat. 750 salt ghonas
(clusters of salt beds) in the coastalzones (i) the Chittagong Coxs
Bazaar area, and (ii) theSathkhira area. monitored by 15 salt
centers of BSCIC. 22 23. www.micronutrient.orgIDD Elimination in
Bangladesh Salt processingAnnual requirement / production 850,000
MT 295 salt factories in 8 zones set up in the 1990sZone wise
factory Chandpur Chittagong 3925 CoxS Bazar48 Dhaka94 Jhalokati
Khulna 2317 15Narayanganj 31 Patiya23 24. IDD Elimination in
Bangladesh Status of SIP20 Large factories producing >50
tons/day96 medium factories producing 20 49 tons/day91 Small
factories producing 30% Severe40 41. www.micronutrient.orgTo
eliminate Vitamin A deficiency and its consequences Determine
Existence Severity and Extent Of Vitamin A deficiency in the
population41 42. www.micronutrient.orgClinical symptoms like night
blindness , bitot s spot, xerosis, keratomalacia,
xeropthalmiaDietary intakeTissue concentration (liver and
serum)< 15 ug/dl severe15 25 ug/dl moderate25 40 ug/dl
marginal> 40 ug/ dl adequate42 43. www.micronutrient.orgThank
you 43