x LIBERIA NATIONAL MICRONUTRIENT SURVEY 2011 Summary of Key Findings 28 September 2011 x Mamba Point Hotel

Background Micronutrients play a critical role in child survival and human health Iron deficiency reduces adults’ physical activity and stunts mental development Vitamin A deficiency responsible for increased morbidity and mortality; blindness Iodine deficiency creates pregnancy complications and development in utero 1. 53% of children with VAD; 62% or pregnant women, 87% of children with anemia

Background Government of Liberia endorsed World Fit for Children and MDG nutrition goals Nutrition and micronutrients emphasized in Essential Package of Health Services (EPHS) Most recent available data for micronutrient status in Liberia from 1999 MOHSW and partners needed updated information for policy and programming

General Objectives Determine national and urban/rural prevalence of micronutrient deficiencies in women 15-49 years and children 6-35 months Assess coverage of ongoing interventions that aim to prevent micronutrient deficiencies Gather information on underlying determinants of micronutrient deficiencies in Libera -Vitamin A supplementation, iron for pregnant women, etc.

Specific Objectives Estimate vitamin A, iron, and iodine deficiency for women of reproductive age; iron supplementation coverage Estimate vitamin A and iron deficiency for children 6-35 months; vitamin A supplementation and deworming coverage Estimate proportion of households consuming adequately iodized salt

Methodology LNMS used a two-stage cluster design, stratified by urban and rural areas; 57 clusters in each 2008 census frame was used to select PSUs at first stage Households sampled within communities by systematic random sampling; 15 in each Minimum sample size calculated using prevalence estimates from LMIS 2009 and 1999 survey – 1,710 households total

Methodology Training held in Monrovia 7-12 March 2011; three days of pre-testing followed in urban/rural Fieldwork conducted between 7 April-18 June Teams administered paper questionnaire, measured Hb and malaria on site; took venous blood samples from women/children, urine samples from women, salt samples from HH Biological samples transported via cold chain from field to NDS at JFK Hospital

Sample Analyses Blood samples (Germany): ELISA method used to measure ferritin, transferrin receptor (sTfR), retinol binding protein (RBP), and inflammation proteins (APPs) Urine samples (Tanzania): ammonium persulfate digestion method to measure iodine concentration Salt samples (Tanzania): simple titration to measure iodine ppm

Correction Procedure Ferritin and RBP concentrations affected by infection; even if not presenting clinical signs This creates problem when using standard cut-off points defined by WHO to classify micronutrient deficiencies, esp. for children In LNMS, identified four stages of infection response using APPs, then adjusted ferritin and RBP measurements to “healthy” subgroup

Correction Procedure

Correction Procedure

Correction Procedure

Key Findings: Anemia

Key Findings: Anemia

Key Findings: Iron Deficiency

Key Findings: Iron Deficiency

Key Findings: Iron Deficiency Anemia

Key Findings: Vitamin A Deficiency

Way Forward & Next Steps Technical working group to carry out causal analysis to identify key determinants (e.g., age, geography, education) in October Final comprehensive report, including programming recommendations based on results of causal analysis by mid-November Based on findings in final report, develop and cost a micronutrient implementation plan for Liberia by end of November

Thank You