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

What lies behind the regressions findings (Ferritin)?

HH expense (BDT) Intake of iron (mg/d) S. ferritin (ng/ml) Iron Def. (%) Total Animal source “High” Iron Area “Low” iron Area “High” Iron area positively determined iron nutrition

S. ferritin (ng/ml) Iron Def. (%) Intake of animal iron(mg/d) HH using tubewell water (%) Rural Slum Slum is associated with lower iron nutrition in PSAC

S. ferritin (ng/ml) Iron Def. (%) Use of tubewell (%) HH expense <median (Rural) HH expense>=median (Urban) HH expense is negatively associated with iron nutrition in women

Serum ferritin (ng/ml) Total iron intake (mg/d) Animal iron intake (mg/d) Richest Poorest Richest quintile positively determines iron nutrition in women

HH expense(BDT) Iron intake (mg/d) Tubewell (%) S. ferritin (ng/ml) Moderately food insecure Food secure Food insecure households are associated with higher iron nutrition in Women HH food insecurity 47% “High” iron area 23% “Low” iron area

S. ferritin (ng/ml) Tubewell (%) Intake of iron (mg/d) Mothers knowledgeable about iron rich food Do not Mothers knowledge about health benefit of iron rich food is associated with higher iron nutrition in SAC

HH expense (BDT) Animal iron (mg/d) S. ferritin (ng/ml) Tubewell (%) Agricultural profession Non agricultural Agricultural professions are associated with higher iron nutrition in PSAC Agricultural profession 59%, Rural 20%, Urban

What lies behind regression findings (Hemoglobin)?

Intake of animal source iron (mg/7d) Anemic6.78 Non-anemic7.95 Animal source iron is positive determinant of hemoglobin

Anemia Vitamin A deficiency Preschool children 33% School children 17% NPNL women 19% Vitamin A deficiency is associated with increased Anemia

S. Zinc (mmol/l)Zinc Deficiency Anemic9.711% Non-anemic10.2 Zinc deficiency is associated with higher anemia in women

Iron intake (mg/d) Animal vitamin A (RE/d) Boy Girl Being girl children is negatively associated with hemoglobin

Intake of iron (mg/d) Intake of vitamin A (RE/d) Anemia (%) Urban Rural Urban residence is positively associated with higher hemoglobin in SAC

S. ferritin (ng/ml)Anemia (%) “High” iron area3917 “Low” iron area23 34 “High” iron area is positively associated with low anemia in PSAC

HH expense(BDT) Intake of animal iron (mg/7d) S. ferritin (ng/ml) Tubewell (%) Poorest Poorer Middle Richer Richest SES is not associated with hemoglobin in Women

Intake of animal iron (mg/7d) S. ferritin (ng/ml) Food Secure Moderate insecure Severe insecure4.553 HH food insecurity did not influence hemoglobin in women HH food insecurity 47% “High” iron area 23% “Low” iron area

What lies behind regression findings (Folate)?

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

Serum folate (nmol/l) National12.35 Rural12.58 Urban11.68 Slum11.40 Location of rural households almost positively associated with folate nutrition

Daily dietary folate (microgram) Serum folate (nmol/l) Refrigerator No refrigerator Non possession of refrigerator is negatively associated with folate nutrition

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

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

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

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

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

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 Salient Findings

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 Investigators