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Epidemiology

Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher

Abstract

Background/Objectives:

In 2009, the Ministry of Health of Kyrgyzstan launched a national Infant and Young Child Nutrition (IYCN) program which included point-of-use fortification of foods with micronutrient powders (MNP) containing iron, vitamin A, and other micronutrients. Caretakers of children aged 6–23 months were given 30 sachets of MNP every 2 months. Micronutrient surveys were conducted in 2009 and 2013. The objective of the study was to compare the prevalence of anemia and deficiencies of iron and vitamin A among children aged 6–29 months prior to the MNP program (2009) with those after full implementation (2013).

Subjects/Methods:

Cross-sectional national surveys were conducted in 2009 (n = 666) and 2013 (n = 2150). Capillary blood samples were collected to measure hemoglobin, iron (ferritin and soluble transferrin receptor [sTfR]) and vitamin A (retinol binding protein [RBP]) status, and inflammation status (C-reactive protein [CRP] and α-1-acid glycoprotein [AGP]). Ferritin, sTfR, and RBP were adjusted for inflammation; hemoglobin was adjusted for altitude.

Results:

The prevalence of anemia was non-significantly lower in 2013 compared to 2009 (32.7% vs. 39.0%, p = 0.076). Prevalence of inflammation-adjusted iron deficiency (54.8% vs. 74.2%, p<0.001) and iron deficiency anemia (IDA, 25.5% vs. 35.1%, p = 0.003) were lower and the prevalence of inflammation-adjusted vitamin A deficiency was higher (4.3% vs. 2.0%, p = 0.013) in 2013 compared to 2009.

Conclusions:

Four years after the initiation of a national Infant and Young Child Nutrition program including the introduction of point-of-use fortification with MNP, the prevalence of iron deficiency and IDA is lower, but the prevalence of vitamin A deficiency is higher.

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Notes

  1. Oblast is the first administrative level below the national level in the Kyrgyz Republic. There are seven oblasts in the country and each oblast comprises multiple districts.

  2. Among a subsample of the 2009 survey participants, the CDC Nutrition Laboratory compared RBP and plasma retinol; RBP concentration <0.71 µmol/L was determined to be the optimal threshold for defining vitamin A deficiency (personal communication, Rosemary Schleicher).

References

  1. World Health Organization. WHO guideline: Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years. Geneva: WHO. 2016. http://www.who.int/nutrition/publications/micronutrients/guidelines/mmpowders-infant6to23mons-children2to12yrs/en/ Accessed 7 August 2018.

  2. Soofi S, Cousens S, Iqbal SP, Akhund T, Khan J, Ahmed I, et al. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial. Lancet. 2013;382:29–40.

    Article  CAS  Google Scholar 

  3. Salam RA, MacPhail C, Das JK, Bhutta ZA. Effectiveness of micronutrient powders (MNP) in women and children. BMC Public Health. 2013;13(Suppl 3):S22.

    Article  Google Scholar 

  4. United Nations Children’s Fund. Improving child nutrition: the achievable imperative for global progress. New York: UNICEF 2013. https://www.unicef.org/publications/index_68661.html. Accessed 7 August 2018.

  5. National Statistical Committee of the Kyrgyz Republic (NSC), Ministry of Health [Kyrgyz Republic], and ICF International. 2013. Kyrgyz Republic Demographic and Health Survey 2012. Bishkek, Kyrgyz Republic, and Calverton, MD, USA: NSC, MOH, and ICF International.

  6. Serdula MK, Lundeen E, Nichols EK, Imanalieva C, Minbaev M, Mamyrbaeva T, et al. Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic. Eur J Clin Nutr. 2013;67:703–7.

    Article  CAS  Google Scholar 

  7. Namaste SM, Aaron GJ, Varadhan R, Peerson JM, Suchdev PS. Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106(Suppl 1):333S–47.

    PubMed  PubMed Central  Google Scholar 

  8. Ip H, Hyder S, Haseen F, Rahman M, Zlotkin S. Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control. Eur J Clin Nutr. 2009;63:165–72.

    Article  CAS  Google Scholar 

  9. Erhardt JG, Estes JE, Pfeiffer CM, Biesalski HK, Craft NE. Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr. 2004;134:3127–32.

    Article  CAS  Google Scholar 

  10. Sullivan KM, Mei Z, Grummer-Strawn L, Parvanta I. Haemoglobin adjustments to define anaemia. Trop Med Int Health. 2008;13:1267–71.

    Article  CAS  Google Scholar 

  11. Gorstein JL, Dary O, Pongtorn, Shell-Duncan B, Quick T, Wasanwisut E. Feasibility of using retinol-binding protein from capillary blood specimens to estimate serum retinol concentrations and the prevalence of vitamin A deficiency in low-resource settings. Public Health Nutr. 2008;11:513–20.

    Article  Google Scholar 

  12. Thurnham DI, McCabe GP, Northrop-Clewes CA, Nestel P. Effects of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet. 2003;362:2052–8.

    Article  CAS  Google Scholar 

  13. Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA, McCabe GP. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr. 2010;92:546–55.

    Article  CAS  Google Scholar 

  14. Suchdev PS, Namaste SM, Aaron GJ, Raiten DJ, Brown KH, Flores-Ayala R. Overview of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. Adv Nutr. 2016;7:349–56.

    Article  CAS  Google Scholar 

  15. Larson LM, Namaste SM, Williams AM, Engle-Stone R, Addo OY, Suchdev PS, et al. Adjusting retinol-binding protein concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106:390S–401.

    PubMed  PubMed Central  Google Scholar 

  16. Rohner F, Namaste SM, Larson LM, Addo OY, Mei Z, Suchdev PS, et al. Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106:372S–82.

    PubMed  PubMed Central  Google Scholar 

  17. Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106:359S–71.

    PubMed  PubMed Central  Google Scholar 

  18. World Food Programme. Food Security Assessment in the Kyrgyzstan Republic: Food Security Analysis, Integrated Household Survey 2006, 2007 and 1st Quarter of 2008. Rome: World Food Programme. 2008. https://documents.wfp.org/stellent/groups/public/documents/ena/wfp196789.pdf?iframe. Accessed 12 August 2018.

  19. Brinkman HJ, de Pee S, Sanogo I, Subran L, Bloem MW. High food prices and the global financial crisis have reduced access to nutritious food and worsened nutritional status and health. J Nutr. 2010;140:153S–61.

    Article  CAS  Google Scholar 

  20. Jefferds ME, Irizarry L, Timmer A, Tripp K. UNICEF-CDC global assessment of home fortification interventions 2011: current status, new directions, and implications for policy and programmatic guidance. Food Nutr Bull. 2013;34:434–43.

    Article  Google Scholar 

  21. United Nations Children’s Fund. Annual Results Report 2015: Nutrition. New York: UNICEF. 2016. https://www.unicef.org/publicpartnerships/files/2015ARR_Nutrition.pdf. Accessed 7 August 2018.

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Acknowledgements

Both surveys were administered under a cooperative agreement between the United Nations Children’s Fund (UNICEF) and the U.S. Centers for Disease Control and Prevention. The surveys were carried out with support from the Central and Eastern Europe/Commonwealth of Independent States UNICEF regional office and the Swiss Red Cross. Collaborating partners in the Kyrgyz Republic included the Ministry of Health, the National Statistical Committee, and the UNICEF country office.

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Correspondence to Elizabeth A. Lundeen.

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Lundeen, E.A., Lind, J.N., Clarke, K.E.N. et al. Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher. Eur J Clin Nutr 73, 416–423 (2019). https://doi.org/10.1038/s41430-018-0368-7

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