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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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Fig. 1

Notes

  1. 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. 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).

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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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