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Results of the National Micronutrient Survey in Malawi

Results of the National Micronutrient Survey in Malawi. 18 June 2003. Overview of presentation. Background and objectives Methods Demographics Anthropometry Morbidity Food consumption Iodine Vitamin A Anemia and iron deficiency Summary findings. BACKGROUND AND OBJECTIVES.

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Results of the National Micronutrient Survey in Malawi

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  1. Results of the National Micronutrient Survey in Malawi 18 June 2003

  2. Overview of presentation • Background and objectives • Methods • Demographics • Anthropometry • Morbidity • Food consumption • Iodine • Vitamin A • Anemia and iron deficiency • Summary findings

  3. BACKGROUND AND OBJECTIVES

  4. Purpose of National Survey • Data for Advocacy • Existing data was clinical and localized • Government of Malawi in process of creating sector investment programs and poverty reduction strategies • Need national data to make micronutrient interventions a national priority • Baseline for monitoring • Need information to support for future MN interventions, especially for fortification • Support future communication efforts • Capacity building

  5. Survey Objectives • To determine the prevalence of vitamin A deficiency as a public health problem in target groups • To determine the prevalence and nature of anemia with respect to iron deficiency, parasites and infections as a public health problem in target groups • To determine the magnitude of iodine deficiency among primary school aged children as a proxy for the total population • Validate the identified food vehicles for fortification and estimate levels of consumption

  6. METHODS

  7. Sampling • Nationally and regionally representative • Northern • Central • Southern • Stratified sampling: 30 clusters per region = 90 clusters • Randomly selected clusters • Included 26 of the 27 districts

  8. Household and school based survey • 18 households per cluster • 540 households per region • 1,620 households nationally • 90 schools (1 per cluster)

  9. Target Groups • Preschool children (6-36 months) • School children (6-12 years) • Women of childbearing age (15-45 years) • Men (20-55 years)

  10. Total sample by target group Preschool children 548 School children 701 Women of childbearing age Non-pregnant 475 Pregnant 57 Men 161

  11. Vitamin A and Iodine Indicators • Vitamin A • Serum retinol • Iodine • Test household salt • Salt titration • Urinary iodine

  12. Anemia and Iron Deficiency Indicators • Hemoglobin (Hb) • Zinc protoporphyrin (ZP) • Transferrin receptor (TfR)

  13. Parasitic infection indicators • Malaria • Urinary schistosomiasis • Intestinal parasites • Hookworm • Roundworm • Schistosoma mansoni

  14. General Household Questionnaire • Demographics & socioeconomic status • Knowledge of anemia, vitamin A and iodized salt • Breastfeeding history • Supplementation • Health history • Consumption of centrally processed foods

  15. Fortification Rapid Assessment Tool (FRAT) • National sample only • Targeted 24 hour dietary recall • Centrally processed staple foods • Sugar • Oil • Maize flour • Complementary food • Quantity consumed to set levels of fortification

  16. Biological Sample Collection Procedures • Malaria thick smears • Microtainers to collect capillary blood samples • Hemoglobin with HemoCue • Whole blood for biochemical analysis • Dried blood spots • Spun down blood for serum • Stool samples for intestinal parasites (school children only) • Urine sample for iodine and urinary schistosomiasis (school children only)

  17. Other Collection Procedures • Height and weight measurements on preschool children and women • Household salt samples for iodine content

  18. Sequence of events July 2001 • Community mobilization • Enumeration of households • Development, translation & pre-testing of questionnaires Sept/Oct 2001 • Training and field testing for survey • Fieldwork: 6 teams for 3-4 weeks • Data entry Forever • Analysis of data and lab specimens – Nov 2001 – Nov 2002 • Final report & dissemination meeting – May 2003 • 5 year action plan – May 2003

  19. DEMOGRAPHICS Age and Sex Residence – urban and rural Formal Education Socioeconomic status index

  20. Age distribution of preschool children (n=527)

  21. Age distribution of school children (n=699)

  22. Age distribution of women (n=524) and men (n=156)

  23. Residence of respondents Percentage

  24. Education of respondents Percentage of women and men

  25. Socioeconomic status (SES) Index • Composite index composed from household data on: • cooking fuel • water source • sanitary facilities • material of roof and floor • number of rooms • ownership of various assets • Sufficient information was available for 90% of the sample.

  26. Index of socioeconomic status Percentage of households

  27. ANTHROPOMETRY

  28. National Height-for-age Z-score (HAZ)Distribution Curve Reference % National data is weighted to account for survey design.

  29. Stunting by region Height-for-age Z-score prevalence %

  30. National Weight-for-height Z-score (WHZ) Distribution Curve Reference National data is weighted to account for survey design.

  31. Weight-for-height <-2 Z-scoreby region %

  32. Weight-for-age Z-score (WAZ) by Age %

  33. Summary of anthropometry results for preschool children Percentage of children 6-36 months

  34. Body Mass Index for non-pregnant women of childbearing age Body Mass Index

  35. MORBIDITY

  36. Prevalence of malaria parasitemia by target group National data is weighted to account for survey design.

  37. Mosquito bednet knowledge and use by SES

  38. Prevalence of intestinal parasites and urinary schistosomiasis among school children (6-12 y)

  39. FOOD CONSUMPTIONRESULTS Breastfeeding results Fortification Rapid Assessment Tool (FRAT) - 24 hour dietary recall results

  40. Breastfeedingfor preschool children >12 months EXCLUSIVE BREASTFEEDING • Age when child given anything other than breastmilk • Less than six months 53.1% • Greater or equal to 6 months 46.9% DURATION OF BREASTFEEDING • Age when stopped breastfeeding • Less than 12 months 4.3% • Greater or equal to 12 months 95.7%

  41. Fortification Rapid Assessment Tool (FRAT) Methods • Validated FRAT through cooking exercise with group of women to determine standards • Portion sizes • Average quantities for household utensils • Standard recipes

  42. Consumption of centrally processed staple foods

  43. SUGAR • 61.2% usually have sugar in the house • Average consumption varied by group: 45 grams for preschool children, 68 grams for women and 54 grams for men • Sugar is consumed in all seasons by children (47.8%), women (41.7%), and men (35.4%)

  44. Sugar Consumption

  45. COOKING OIL • Half (50.3%) the women interviewed usually cook with oil • Similar average amount consumed by children (3.7 g), women (3.8g) and men (4.3g) • In the past 7 days, children (52.4%), women (56.1%) and men (61.5%) ate food with oil • Oil was consumed in all seasons by 41.7% of children, 41.5% of women and 35.4% of men

  46. IODINE RESULTS

  47. Rapid Test Kit Results • Qualitative results – color change • 1461 households surveyed • 86.1% salt available • 91.7% some iodine • least likely to have salt available for testing • lower SES households • households in southern region

  48. Household Salt Titration Results (n=510) • 77.6% of salt samples contained some iodine (>0 ppm) • 47.1% contained 15 ppm • International standard • 36.7% contained 25 ppm • Southern African standard

  49. VITAMIN A RESULTS

  50. National prevalence of vitamin A deficiency by target group Note: Cut-offs for VAD were <20mcg/dL for all subjects

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