1. Biochemical and Clinical indices to assessnutritional status and response to nutritionalinterventions : VAD and IDDByDr Zeba Mahmud, Director, Micronutrient InitiativeTraining on Assessment of Nutritional Status 18-22 December 2011Date : 20 December 2011,Venue: ICDDRBThe Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and DisasterManagement and Food and Agriculture Organization of the United Nations (FAO) with the financial support of the EU andUSAID. www.micronutrient.org

2. www.micronutrient.orgA world free from hidden hunger2 3. THE HIDDEN HUNGERBangladesh is not in a complex nutritional emergency.Most of the malnutrition in our country is hidden andoccurs on a much larger scale than can be imagined. Itis not only due to lack of food as such; it has more todo with a diet which is insufficiently varied, leading todeficiency of certain micronutrients.www.micronutrient.org 4. www.micronutrient.orgThe need for vitamins and minerals Health BargainPrevent deathsDecrease burden of diseaseAlleviate suffering Social Development Bargain Educational performanceFamily and parenting impactsEconomic Development BargainInvestments in human capitalImprovements in productivity4 5. www.micronutrient.orgMicronutrient deficiencies :decreased cognition and productionbillions of dollars loss. 5% depression in GNP annually : 5 6. Needed in minute quantities but its deficiencies cancause permanent damages.Victims of micronutrient malnutrition can suffer fromintellectual impairment,growth stunting,susceptibility to infections,mental retardation,.www.micronutrient.org 7. Needed in minute quantities but its deficiencies cancause permanent damages.Victims of micronutrient malnutrition can suffer frompoor health,low working capacity,blindness,behavioral changes,learning disabilitiesand even death.www.micronutrient.org 8. www.micronutrient.org Situation Analysis Benefits of Vitamin A and iodine Assessment 8 9. Country Overview www.micronutrient.org Health, Population, Nutrition Development Sector Program(HPNDSP) : endorsed for 2011-16 Development Project Proposal (2011 - 16) for Control ofIodine Deficiency Disorder (CIDD) under BSCIC, MOI isunder process Operation plan for National Nutrition Service approved on17 October 2011 Age for VAS to be from 6 months instead of 9 months Revolving fund being utilized to procure KIO39 10. Analysiswww.micronutrient.orgPopulation of >148 million (estimated )child population ( 0 59 months) of 22 millionChild Survival: Under five mortality : 61/1000 live births (190,000) Clinical / sub clinical VAD: 22% (estimated) 2 wk diarrhea prevalence: 10%BDHS 2007, NSP 2004, BSCIC, UNICEF 200610 11. Analysiswww.micronutrient.orgChild Development: Anemia prevalence rates ( 6-59 months): 68% IDD rates ( % with UIE below 100 ug/L): 34%Womens health: Anemia prevalence rates PLW: 49% NPNL: 46% VAD NPNL: 33%BDHS 2007, NSP 2004, BSCIC, UNICEF 200611 12. www.micronutrient.orgCoverage of Key interventionsChild Survival VAS: 88% ZnS and LO ORS: 20% diarrhoea affected childrenChild Development HH level coverage of iodized salt: 84%Womens Health IFA coverage among P&LW: 55%BDHS 2007, USI Survey 2006, GOB 200412 13. www.micronutrient.orgOutline Situation Analysis Benefits of Vitamin A and Iodine Assessment13 14. Technical brief on qualitative universal salt iodizationwww.micronutrient.org 15. www.micronutrient.orgWhat is iodineA mineral needed for normal growth anddevelopment of the body.Produces thyroid hormone necessary fornormal development and function of the brain andnervous system.maintains the metabolic rate and energymetabolism.Found in the mines of Chile and underground inJapan 15 16. Deficiencywww.micronutrient.orgeffect the child even before they are born andchange their adult lives.IDD of the women during pregnancy can effectboth foetus and infant.Women have abortions and stillbirths.Children are born with low birth weights andpermanent physical and mental birth defects.School children may have lower intelligence andMore learning disabilities.It significantly reduces mental capacity and workpotential.16 17. www.micronutrient.orgIodine Deficiency DisordersGoiters most obvious signs of IDDCretinism most serious form of IDD17 18. www.micronutrient.orgRequirement : Children (preschool) 90 ug Children 6 10 years120 ug Males & Females 11+ years150 ug Pregnant and lactating women 175 -200 ug 18 19. www.micronutrient.orgIodine deficiency disorder (IDD) 56 m people are iodine deficient 23 m have goitre (4 m visible) 5 lakhs have cretinism 250,000 people are mentally impaired 41,000 still births occur yearly; 33,000 infants die in the first year of life 15,000 women give birth to mentally impaired children annually. 19 20. www.micronutrient.orgWhy does Bangladesh have iodine deficiencygeography is the primary factor.oceans and seas that is the water are the primary sources.absorbed into the atmospherereleased in the soil through rainHeavy rainfall and floods wash away large amounts of iodineleaving behind iodine deficient soil.Bangladesh is a delta for three major rivers.The flood cycle of rivers, compounded by monsoon rains,routinely leaches iodine from the soil 20 21. www.micronutrient.org But why iodize salt?Salt is a superior food for iodizationLeast expensiveThe process requires minimal capital investment and imposeslow operating expense.Every day every person everywhere in the world eats salt.Humans consume salt in a predictable range. 21 22. www.micronutrient.orgIDD Elimination in Bangladesh Salt production50,000 salt farmers 70,000 acres salt production area Process of drying up of seawater by solar heat. 750 salt ghonas (clusters of salt beds) in the coastalzones (i) the Chittagong Coxs Bazaar area, and (ii) theSathkhira area. monitored by 15 salt centers of BSCIC. 22 23. www.micronutrient.orgIDD Elimination in Bangladesh Salt processingAnnual requirement / production 850,000 MT 295 salt factories in 8 zones set up in the 1990sZone wise factory Chandpur Chittagong 3925 CoxS Bazar48 Dhaka94 Jhalokati Khulna 2317 15Narayanganj 31 Patiya23 24. IDD Elimination in Bangladesh Status of SIP20 Large factories producing >50 tons/day96 medium factories producing 20 49 tons/day91 Small factories producing 30% Severe40 41. www.micronutrient.orgTo eliminate Vitamin A deficiency and its consequences Determine Existence Severity and Extent Of Vitamin A deficiency in the population41 42. www.micronutrient.orgClinical symptoms like night blindness , bitot s spot, xerosis, keratomalacia, xeropthalmiaDietary intakeTissue concentration (liver and serum)< 15 ug/dl severe15 25 ug/dl moderate25 40 ug/dl marginal> 40 ug/ dl adequate42 43. www.micronutrient.orgThank you 43