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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