1. Additional Analyses from National Micronutrient Survey 2011-12 (Iron, Anemia & Folate) Sabuktagin Rahman Senior Program Manager, Monitoring Learning & Research GAIN, Bangladesh

2. What lies behind the regressions findings (Ferritin)?

3. HH expense (BDT) Intake of iron (mg/d) S. ferritin (ng/ml) Iron Def. (%) Total Animal source “High” Iron Area 69043.10.65398.5 “Low” iron Area 85184.10.932118.6 “High” Iron area positively determined iron nutrition

4. S. ferritin (ng/ml) Iron Def. (%) Intake of animal iron(mg/d) HH using tubewell water (%) Rural319.40.7477 Slum2127.20.7331 Slum is associated with lower iron nutrition in PSAC

5. S. ferritin (ng/ml) Iron Def. (%) Use of tubewell (%) HH expense <median715.179 (Rural) HH expense>=median638.562 (Urban) HH expense is negatively associated with iron nutrition in women

6. Serum ferritin (ng/ml) Total iron intake (mg/d) Animal iron intake (mg/d) Richest678.81.79 Poorest686.50.79 Richest quintile positively determines iron nutrition in women

7. HH expense(BDT) Iron intake (mg/d) Tubewell (%) S. ferritin (ng/ml) Moderately food insecure 76976.874 Food secure113967.87261 Food insecure households are associated with higher iron nutrition in Women HH food insecurity 47% “High” iron area 23% “Low” iron area

8. S. ferritin (ng/ml) Tubewell (%) Intake of iron (mg/d) Mothers knowledgeable about iron rich food 49.4776.97 Do not40.8745.12 Mothers knowledge about health benefit of iron rich food is associated with higher iron nutrition in SAC

9. HH expense (BDT) Animal iron (mg/d) S. ferritin (ng/ml) Tubewell (%) Agricultural profession 78770.643577 Non agricultural110520.952770 Agricultural professions are associated with higher iron nutrition in PSAC Agricultural profession 59%, Rural 20%, Urban

10. What lies behind regression findings (Hemoglobin)?

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

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

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

14. Iron intake (mg/d) Animal vitamin A (RE/d) Boy6.40137 Girl5.8887 Being girl children is negatively associated with hemoglobin

15. Intake of iron (mg/d) Intake of vitamin A (RE/d) Anemia (%) Urban6.8077011.8 Rural5.9556321.7 Urban residence is positively associated with higher hemoglobin in SAC

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

17. HH expense(BDT) Intake of animal iron (mg/7d) S. ferritin (ng/ml) Tubewell (%) Poorest55415.5954.670 Poorer74056.7756.877 Middle88668.3241.780 Richer100978.4349.968 Richest1506312.5749.467 SES is not associated with hemoglobin in Women

18. Intake of animal iron (mg/7d) S. ferritin (ng/ml) Food Secure9.7 45 Moderate insecure5.6 66 Severe insecure4.553 HH food insecurity did not influence hemoglobin in women HH food insecurity 47% “High” iron area 23% “Low” iron area

19. What lies behind regression findings (Folate)?

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

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

22. Daily dietary folate (microgram) Serum folate (nmol/l) Refrigerator19815.3 No refrigerator15311.9 Non possession of refrigerator is negatively associated with folate nutrition

23. 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

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

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

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

27. 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

28. 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

29. 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