1. TANZANIA HEALTH SUMMIT 11 th to 13 th November 2015 Risk Factors For Iron Deficiency Anemia In The First 1000days of life: The Case Of Kisarawe District-Tanzania Presenter: Angela E.Shija 13.Nov.2015

2. Presentation outline 1. Definition of key terms 2. Background 3. Objectives 4. Methods 5. Results 6. Discussion 7. Conclusion and recommendation

3. Definition of Key Terms Anemia: Is usually defined by a low haemoglobin (Hb) concentration Iron deficiency: A state in which there is insufficient iron to maintain normal physiological functions Iron deficiency anemia(IDA) :Is severe stage of iron deficiency in which hemoglobin fall below the above cut offs (Hb below 11g/dL)

4. Background First 1,000 days of life is a period from pregnancy to a child’s 2 nd birthday (rapid growth and high demand of nutrients ) It estimated 80% of iron reserve at birth is accumulated during 3 rd trimester(but 53% pregnant women are anemic with 4% took iron took iron supplement for 90days and 41% didn’t ) ( TDHS 2010) More than 75% of children below 2 yrs are anemic (TDHS 2010) Iron constitutes 70% of haemoglobin, which is essential for transportation of oxygen to brain and muscles; regulation of cell growth and differentiation. Iron constitute large portion of brain and 75% of brain development takes place during this period. Iron is Important for future mental and physical development,and deficiency have irreversible impact. Anemia lowers child’s ability to resist disease, physical stamina and weakens future learning ability

5. Objective and Methods Objective To identify risk factors associated with iron deficiency anemia among children aged 6 to 24 months in Kisarawe district. Methods A Cross sectional study design was used as a baseline study for a community based control trial for reducing micronutrient deficiency in children aged 6 to 24 months. The study site involved 4 villages from two wards,namely Kibuta and Msimbu ward. Data collection method involved Household survey(204); 8 Focus group discussions and market observation survey

6. Results Anemia Prevalence About 92.3% of children were anemic (Hb,11.0g/dl) Most of severe and moderate cases were found in children aged 6-9 month Most of mild anemia cases were found in children aged 16-18 month

7. Results cont. Risk factors for Iron deficiency anemia A. Direct factors a)Poor exclusive breast feeding due pre-lacteal feeding Warm water is given to the baby starting from day one before bathing (locally known as ‘upombe’),example if a baby is born yesterday before bathing you give her /her warm water so as to warm the stomach.’ (Discussant -Women FDG) Other babies are not satisfied by mother’s milk alone, that is why you can initiate porridge even in the first week or even after three days’ (Discussant -Women FDG )

8. Results cont.. b) Inadequate complementary feeding with poor Iron intake Poor diversification _Cassava and maize flour porridge is main meal from 1- 9 months and 10-12months stiff porridge and soup and above 12 family food Two meals per day below 9 month(porridge) and above that 3 meals Late introduction of iron rich food-at the age of one year Over dependence of plant based food for Iron (no single meat butcher observed) We are giving them cassava porridge with salt. The salt gives taste of the porridge to the baby. Where can you get sugar ?salt is easy to get and you can even ask from your neighbors,but sugar who can give you? (Women FDG ) Starting from nine months when the baby starting eating with the family members can take three meals, but on top of that can take breast milk( Women FDG )

9. Results cont.. c) Illness contribute to loose of iron and mal-absorption Half of the children(48%) were reported to receive deworming drug in the last 6 months 40% of children had malaria 2 weeks before survey I think diseases like worms infestation may cause anemia simply because of not following hygiene principle. Is possible for some one to give a fruit to the baby even without washing it, and fruit might be dirty, hence the child may get worms (Male FDG ).

10. Results cont.. B. Indirect factors a)Poor dietary intake among lactating women b)Food and nutrition insecurity at household level c) Nutrient looses during food preparation d) Poor household income which affect purchasing power Some they give porridge because even getting food for herself is a problem. If a mother does not get enough food, the breast milk will be full of water that’s why she is deciding to initiate porridge early because the milk will not satisfy the baby…(Male FDG ). The vegetables we are eating such as spinach and beans,during cooking some of us we are throwing away the soup in order to add coconut milk to make a soup, which is not supposed to be. And when your boiling spinach your only supposes to use ten to fifteen minutes but some people they boil for a longtime which increases nutrients looses, hence what you eat at the end has no nutrients.(Women FDG ).

11. Results cont.. e) Social -cultural norms and believes Social cultural norms and belief affect optimal feeding Pressure from parents /mother in-law affect feeding decision Indigenous knowledge determines feeding practices At the clinic we given health education first before other service. They taught us that what you eat will goes straight to breast milk and the baby is getting it though her mother. But when we come back home, is when we realize the baby is thirsty, hungry and when you feed him/her you don’t see any problem (Women FGD.) When you go to the hospital when your asked if you give porridge to your baby, you refuse because is not allowed,since they say children will suffer from stomach pain,but when we give them they don’t, and if they suffer from stomach pain is just like other diseases (Women FDG).

12. Discussion Children aged 6-9 months are highly affected by moderate and severe anemia, imply they become anemic before 6mn Poor maternal nutrition and exclusive breast feeding are still challenges in addressing anemia in the first 6months. Poor intake and late introduction of iron rich food (mostly plants) which does not meet the demand for rapid growth are associated with high rate of anemia in children below 18 months. Ensuring food and nutrition security at the household and repeated health education are important intervention in anemia control

13. Conclusion The high prevalence of anemia (92.3% ) found is a public health concern. Risk factors contributing to the problem are multiple,hence multiple approaches and multidisciplinary actors are needed. Anaemia in the first 1,000 results to permanent effect on future growth, intellectual development and school performance. Addressing this problem is important for child health,survival and sustainable economic development both at household and nation at large.

14. Recommendation 1. Strengthening the health system in delivery, monitoring and evaluation of anemia control interventions. 2. Continues provision on of health education which addresses specific issues on cultural feeding practices 3. Integrating anemia screening in children 9-12 months in routine child clinics/immunization and micronutrient supplementation to highly affected communities. 4. Supporting agriculture diversification and food processing for improving food and nutrition security at household level through mult-sector collaboration.

15. Acknowledgement 1.Kisarawe Communities-Participation in the study 2.Kisarawe district -Providing permission for he study and technical support 3. NIMR Team – Technical Team 4.Grand Challenges Canada –Financial Support