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Nutritional Anemia in Bangladesh: Problems and Solutions

Nutritional Anemia in Bangladesh: Problems and Solutions. Dr Tahmeed Ahmed Director Centre for Nutrition & Food Security ICDDR,B Professor, Public Health Nutrition James P. Grant School of Public Health, BRAC University. Anemia. A condition in which the Hb

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Nutritional Anemia in Bangladesh: Problems and Solutions

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  1. Nutritional Anemia in Bangladesh: Problems and Solutions Dr Tahmeed Ahmed Director Centre for Nutrition & Food Security ICDDR,B Professor, Public Health Nutrition James P. Grant School of Public Health, BRAC University

  2. 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

  3. Definition of Anemia at Sea Level Stoltzfus & Dreyfuss; INACG/UNICEF/WHO 1998

  4. 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 2001 Grantham-McGregor S 2001

  5. 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 2001 Grantham-McGregor S 2001

  6. Anemia causes huge economic loss • Results in productivity loss • Economic cost of anemia in Bangladesh is estimated to be 7.9% of GDP Christian P 2005 UN/SCN 2004

  7. 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

  8. 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

  9. Review of Anemia Control Program • 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

  10. Prevalence of Anemia in Bangladesh NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004

  11. Prevalence of Anemia in Bangladesh • Demand for iron is high • Complementary feeding is inappropriate • No program for anemia control in infants NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004

  12. Complementary Foods Provide little Micronutrients to Bangladeshi Infants • 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 Kimmons J, 2006

  13. Pre-school Children and Adolescent Girls NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023

  14. Anemia Prevalence Trends in Bangladesh 92 74.1 67.9 48.3 46 46 46.7 39.7 35 33 38.8 30 2001 2003 2004 NSP 2004, Anemia prevalence survey UNICEF/BBS 2003, NSP 2002, WHO global database on anemia

  15. 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

  16. Existing Programs on Iron Supplementation

  17. Dose of Iron-folic Acid Tablets

  18. Iron-folic Acid Tablets

  19. Dispensing IFA Tablets

  20. Iron Coverage among Pregnant Women HFSNA 2009

  21. IFA Tablet Coverage during Pregnancy in BINP Areas NNP Baseline Survey 2004

  22. Reasons for Not Taking IFA Tablets Regularly NNP Baseline Survey 2004

  23. Multiple Micronutrient Powder • 1 RDA of • Iron • Folic acid • Vitamin A • Vitamin C • Zinc

  24. No color No taste of its own No odor

  25. Children with the following conditions are excluded: • Any acute illness • Severe cough • Breathlessness • Severe visible wasting

  26. What can we do to control anemia?

  27. Comprehensive Nutrition Actions Required • 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

  28. 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

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