Nutritional anemia in bangladesh problems and solutions
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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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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

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


Definition of anemia at sea level

Definition of Anemia at Sea Level

Stoltzfus & Dreyfuss; INACG/UNICEF/WHO 1998


Consequences of anemia

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


Consequences of anemia in pregnancy

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


Anemia causes huge economic loss

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


What are the causes of anemia

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


Iron deficiency anemia

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


Nutritional anemia in bangladesh problems and solutions

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


Nutritional anemia in bangladesh problems and solutions

Prevalence of Anemia in Bangladesh

NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023 , NSP 20004


Nutritional anemia in bangladesh problems and solutions

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


Nutritional anemia in bangladesh problems and solutions

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


Nutritional anemia in bangladesh problems and solutions

Pre-school Children and Adolescent Girls

NSP 20041 , Anemia prevalence survey UNICEF/BBS 20032, NSP 20023


Anemia prevalence trends in bangladesh

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


Strategies for anemia prevention and control

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


Existing programs on iron supplementation

Existing Programs on Iron Supplementation


Dose of iron folic acid tablets

Dose of Iron-folic Acid Tablets


Iron folic acid tablets

Iron-folic Acid Tablets


Nutritional anemia in bangladesh problems and solutions

Dispensing IFA Tablets


Iron coverage among pregnant women

Iron Coverage among Pregnant Women

HFSNA 2009


Ifa tablet coverage during pregnancy in binp areas

IFA Tablet Coverage during Pregnancy in BINP Areas

NNP Baseline Survey 2004


Reasons for not taking ifa tablets regularly

Reasons for Not Taking IFA Tablets Regularly

NNP Baseline Survey 2004


Multiple micronutrient powder

Multiple Micronutrient Powder

  • 1 RDA of

  • Iron

  • Folic acid

  • Vitamin A

  • Vitamin C

  • Zinc


Nutritional anemia in bangladesh problems and solutions

No color

No taste of its own

No odor


Nutritional anemia in bangladesh problems and solutions

  • Children with the following conditions are excluded:

    • Any acute illness

    • Severe cough

    • Breathlessness

    • Severe visible wasting


What can we do to control anemia

What can we do to control anemia?


Comprehensive nutrition actions required

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


Nutritional anemia in bangladesh problems and solutions

  • 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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