Additional Analyses from National Micronutrient Survey 2011-12 (Iron, Anemia & Folate)

1. Additional Analyses from National Micronutrient Survey 2011-12 (Iron, Anemia & Folate) Sabuktagin Rahman Senior Program Manager, Monitoring Learning & Research GAIN, Bangladesh

2. What lies behind the regressions findings (Ferritin)?

3. “High” Iron area positively determined iron nutrition

4. Slum is associated with lower iron nutrition in PSAC

5. HH expense is negatively associated with iron nutrition in women

6. Richest quintile positively determines iron nutrition in women

7. Food insecure households are associated with higher iron nutrition in Women 47% “High” iron area HH food insecurity 23% “Low” iron area

8. Mothers knowledge about health benefit of iron rich food is associated with higher iron nutrition in SAC

9. Agricultural professions are associated with higher iron nutrition in PSAC 59%, Rural Agricultural profession 20%, Urban

10. What lies behind regression findings (Hemoglobin)?

11. Animal source iron is positive determinant of hemoglobin

12. Vitamin A deficiency is associated with increased Anemia

13. Zinc deficiency is associated with higher anemia in women

14. Being girl children is negatively associated with hemoglobin

15. Urban residence is positively associated with higher hemoglobin in SAC

16. “High” iron area is positively associated with low anemia in PSAC

17. SES is not associated with hemoglobin in Women

18. HH food insecurity did not influence hemoglobin in women 47% “High” iron area HH food insecurity 23% “Low” iron area

19. What lies behind regression findings (Folate)?

20. Plant source folate is positively and animal source folate intake is negatively associated with folate nutrition Plant folate 92% Animal folate 8%

21. Location of rural households almost positively associated with folate nutrition

22. Non possession of refrigerator is negatively associated with folate nutrition

23. Serum ferritin & retinol was positively associated with serum folate Intake of Dietary Iron and Dietary folateare positively correlated; R=57%, p<0.001 Intake of Dietary Vitamin A and Dietary folateare positively correlated; R=32%, p<0.001

24. It is the GAP in Dietary Intake in Preschool children………………………….. GAP in Vitamin A GAP in Iron

25. It is the GAP in Dietary Intake in Women……………. GAP GAP GAP

26. Micronutrient Framework to determine Hemoglobin Vitamin A Iron Hemoglobin Hemoglobin Folate Zinc

27. Salient Findings Prevalence of Iron Deficiency is less than widely held assumption Prevalence of anemia appears less but still remains as major nutrition concern Mothers awareness may improve iron nutrition in children Slum population requires special attention to mitigate iron malnutrition High level of iron in water needs due appraisal in the perspective of iron/anemia control strategy

28. Salient Findings • Girl children need attention to improve micronutrient intake • Animal source iron is important to improve hemoglobin status • One in ten women suffer from folate deficiency • Anemia control strategy should underpin - strategy to improve iron, vitamin A, folate and zinc • A clear need is evident to reduce very wide GAP in dietary micronutrient intake

29. Investigators IPHN Prof. Ekhlasur Rahman Dr. Mustafizur Rahman UNICEF Dr. Ireen Akhter Chowdhury icddr,b Dr. Tahmeed Ahmed Dr. Sabuktagin Rahman Dr. Nurul Alam Dr. Ahmed Shafiqur Rahman Dr. A. M. Shamsir Ahmed GAIN Dr. Sabuktagin Rahman