Professional Documents
Culture Documents
Dr Tahmeed Ahmed
Director, Centre for Nutrition & Food Security, ICDDR,B
Professor, Public Health Nutrition, James P. Grant School of Public Health, BRAC University
Outline of Presentation
Calcium deficiency and anemia burden in Asia and Middle East
Evidence of impact on maternal and neonatal morbidity and mortality Program constraints Research agenda
Rasmussen K 2001
Black RE 2008
Causes Of Anemia
Iron deficiency Hookworm Vitamin A deficiency Malaria infection Chronic infections: TB, HIV Vitamins B12, folic acid Hemoglobinopathies: Thalassemia
Children 05-59 mo < 110 5-11 yrs <115 12-13 yrs <120 Women NPW Preg Men <120 <110 <120
Moderate
20-39.9
1.0-9.9
Mild
5-19.9
0.1-0.9
WHO 1997 WHO 1992
100 90 80 70 60 50 40 30 20 10 0
92
74.1 67.9
Percent
48.3
46.7 35 33 30
46
46 39.7 38.8
2001
2003
2004
NSP (HKI) 2004, Anemia prevalence survey unicef/BBS 2003, NSP (HKI) 2002, WHO global database on anemia
The overall goal is to reduce 1/4th of anemia among high risk groups by 2015
20
40
60
80
National Strategy for Anemia Prevention and Control in Bangladesh, MOHFW 2007
The overall goal is to reduce 1/4th of anemia among high risk groups by 2015
32
42
48
64
87
100
National Strategy for Anemia Prevention and Control in Bangladesh, MOHFW 2007 ; NSP 2006
National Strategy for Anemia Prevention and Control in Bangladesh, MOHFW 2007
Adolescents
PLW NPW
Other
Adolescent girl
Newly wed 02 tablets/week (Only NNP) women Pregnant women 01 tablet daily up to delivery
DGFP FWV,FW 21000 Well trained (18 months A training for FWV) NNP CNP 23246 Short training and refreshers training BRAC SS 7000 2 weeks basic training
*No training manual is particularly intended for anemia or IFA supplementation
Procurement
Availability
DGFP
DGHS
NNP
Central procurement 8000 IFA tablets/ union per month From EDCL through civil surgeon 65-70 million IFA tablets purchased yearly Self procurement funded by GOB, CIDA etc Self procurement
Enough, no stock-out
Available
BRAC
Available
NNP
BRAC
Posters
No IEC materials Posters & flip charts Posters & flip charts Agriculture and social marketing sectors are also using some IEC material
HH level FWA does all BCC Advised by doctors during routine visit Use by CNPs
SS done all BCC No co-ordination with health sector
46
38.6
15.4
Pregnant women (n= 937) NSP April 2004
Proportion anemic
80
60 40
52.5
49.3
43.8
20
Supplem entation
Why Fortification
The Copenhagen Consensus 2004 concluded that the returns of investing in micronutrient programs are second only to those of fighting HIV/AIDS The benefit-to-cost ratio of iron interventions was estimated to be as high as 200:1
Behrmann JR, Alderman H, Hoddinott J. Hunger and malnutrition. Copenhagen Consensus Challenge Paper, 2004
100.00
10
Favours treatment
Favours control
Ahmed T 2008
10
Favours treatment
Ahmed T 2008
01 According to age (< 2 years of age) 65 107.60(11.00) Giovannini, 2006 254 104.40(12.70) Menon, 2007 319 Subtotal (95% CI) Test for heterogeneity: Chi = 2.93, df = 1 (P = 0.09), I = 65.8% Test for overall effect: Z = 2.86 (P = 0.004) 02 According to age (> 2 years of age) 109 Sharieff, 2005 109 Subtotal (95% CI) Test for heterogeneity: not applicable Test for overall effect: Z = 0.00 (P = 1.00)
60 161 221
99.70(10.30) 100.50(13.90)
128.00(10.00)
108 108
128.00(9.00)
34.99 34.99
428 Total (95% CI) Test for heterogeneity: Chi = 12.45, df = 2 (P = 0.002), I = 83.9% Test for overall effect: Z = 1.75 (P = 0.08)
329
100.00
-10
-5 Favours placebo
5 Favours sprinkles
10
Ahmed T (unpublished)
Somewhat liked
n= 140
10%
Hyder Z 2004
Acceptability of Sprinkles for Children 12-24 Months: Major Health Benefits Perceived
General improvement of childs health 100%
29% 28%
28%
Hyder Z 2004
Acceptability of Sprinkles for Children 12-24 Months: Mixing With Weaning Food
Did not change normal food Smell Colour Taste
n= 140
Hyder Z 2004
National policy & strategy present Anemia prevention control but need to more effective should be included in other relevant guidelines
NNP is passing through a major Proper planning and costock out. There is no system of ordination among different back up when there is an acute stake holders is necessary shortage
Characteri Uncoated and wrapped in Blister pack is a solution stics of Iron paper, chances of disintegration tablet in humid climate
Improve co-ordination
Lesson could be learned from SUZY project for using TV and other media
Breast feeding, Infection control, Food security Supplementation Fortification Deworming Breast feeding
Adapted from National Strategy for Anemia Prevention and Control in Bangladesh, MOHFW 2007
Pirgacha
Trishal
Pirgacha
Trishal
26.2 6.7
29.6 8.8