results of the national micronutrient survey in malawi
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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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overview of presentation
Overview of presentation
  • Background and objectives
  • Methods
  • Demographics
  • Anthropometry
  • Morbidity
  • Food consumption
  • Iodine
  • Vitamin A
  • Anemia and iron deficiency
  • Summary findings
purpose of national survey
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
survey objectives
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
  • Nationally and regionally representative
    • Northern
    • Central
    • Southern
  • Stratified sampling: 30 clusters per region = 90 clusters
  • Randomly selected clusters
  • Included 26 of the 27 districts
household and school based survey
Household and school based survey
  • 18 households per cluster
  • 540 households per region
  • 1,620 households nationally
  • 90 schools (1 per cluster)
target groups
Target Groups
  • Preschool children (6-36 months)
  • School children (6-12 years)
  • Women of childbearing age (15-45 years)
  • Men (20-55 years)
total sample by target group
Total sample by target group

Preschool children 548

School children 701

Women of childbearing age

Non-pregnant 475

Pregnant 57

Men 161

vitamin a and iodine indicators
Vitamin A and Iodine Indicators
  • Vitamin A
    • Serum retinol
  • Iodine
    • Test household salt
    • Salt titration
    • Urinary iodine
anemia and iron deficiency indicators
Anemia and Iron Deficiency Indicators
  • Hemoglobin (Hb)
  • Zinc protoporphyrin (ZP)
  • Transferrin receptor (TfR)
parasitic infection indicators
Parasitic infection indicators
  • Malaria
  • Urinary schistosomiasis
  • Intestinal parasites
    • Hookworm
    • Roundworm
    • Schistosoma mansoni
general household questionnaire
General Household Questionnaire
  • Demographics & socioeconomic status
  • Knowledge of anemia, vitamin A and iodized salt
  • Breastfeeding history
  • Supplementation
  • Health history
  • Consumption of centrally processed foods
fortification rapid assessment tool frat
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
biological sample collection procedures
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)
other collection procedures
Other Collection Procedures
  • Height and weight measurements on preschool children and women
  • Household salt samples for iodine content
sequence of events
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


  • Analysis of data and lab specimens – Nov 2001 – Nov 2002
  • Final report & dissemination meeting – May 2003
  • 5 year action plan – May 2003


Age and Sex

Residence – urban and rural

Formal Education

Socioeconomic status index

education of respondents
Education of respondents

Percentage of women and men

socioeconomic status ses index
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.
index of socioeconomic status
Index of socioeconomic status

Percentage of households

national height for age z score haz distribution curve
National Height-for-age Z-score (HAZ)Distribution Curve



National data is weighted to account for survey design.

stunting by region
Stunting by region

Height-for-age Z-score prevalence %

national weight for height z score whz distribution curve
National Weight-for-height Z-score (WHZ) Distribution Curve


National data is weighted to account for survey design.

prevalence of malaria parasitemia by target group
Prevalence of malaria parasitemia by target group

National data is weighted to account for survey design.

prevalence of intestinal parasites and urinary schistosomiasis among school children 6 12 y
Prevalence of intestinal parasites and urinary schistosomiasis among school children (6-12 y)
food consumption results


Breastfeeding results

Fortification Rapid Assessment Tool (FRAT) - 24 hour dietary recall results

breastfeeding for preschool children 12 months
Breastfeedingfor preschool children >12 months


  • Age when child given anything other than breastmilk
    • Less than six months 53.1%
    • Greater or equal to 6 months 46.9%


  • Age when stopped breastfeeding
    • Less than 12 months 4.3%
    • Greater or equal to 12 months 95.7%
fortification rapid assessment tool frat methods
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
  • 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%)
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
rapid test kit results
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
household salt titration results n 510
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
national prevalence of vitamin a deficiency by target group
National prevalence of vitamin A deficiency by target group

Note: Cut-offs for VAD were <20mcg/dL for all subjects

vitamin a supplementation intake preschool children n 540
Vitamin A Supplementation IntakePreschool children (n=540)
  • 64.4% ever received supplement in last 6 months
  • 85.4% one dose in the last 12months
months since last vitamin a supplement by age group
Months since last vitamin A supplement by age group*

*Among children who received a vitamin A supplement at least once

national vitamin a supplementation results women of childbearing age n 427
National Vitamin A supplementation resultsWomen of childbearing age (n=427)
  • 34.9% received a supplement within 2 months of their last delivery
  • Women with higher education were more likely to report having received a vitamin A supplement
use of iron supplements
Use of iron supplements
  • Pregnant women
    • 46.3% were taking iron supplements
  • Non-pregnant women
    • 7.0% were taking iron supplements
  • Frequency of taking iron supplements
      • 90.2% daily
      • 2.8% regularly
      • 1.5% weekly