1. x LIBERIA NATIONAL MICRONUTRIENT SURVEY Summary of Key Findings 28 September 2011 x Mamba Point Hotel

2. Background
Micronutrients play a critical role in child survival and human health
Iron deficiency reduces adults’ physical activity and stunts mental development
Vitamin A deficiency responsible for increased morbidity and mortality; blindness
Iodine deficiency creates pregnancy complications and development in utero
1. 53% of children with VAD; 62% or pregnant women, 87% of children with anemia

3. Background
Government of Liberia endorsed World Fit for Children and MDG nutrition goals
Nutrition and micronutrients emphasized in Essential Package of Health Services (EPHS)
Most recent available data for micronutrient status in Liberia from 1999
MOHSW and partners needed updated information for policy and programming

4. General Objectives
Determine national and urban/rural prevalence of micronutrient deficiencies in women years and children 6-35 months
Assess coverage of ongoing interventions that aim to prevent micronutrient deficiencies
Gather information on underlying determinants of micronutrient deficiencies in Libera
-Vitamin A supplementation, iron for pregnant women, etc.

5. Specific Objectives
Estimate vitamin A, iron, and iodine deficiency for women of reproductive age; iron supplementation coverage
Estimate vitamin A and iron deficiency for children 6-35 months; vitamin A supplementation and deworming coverage
Estimate proportion of households consuming adequately iodized salt

6. Methodology
LNMS used a two-stage cluster design, stratified by urban and rural areas; 57 clusters in each
2008 census frame was used to select PSUs at first stage
Households sampled within communities by systematic random sampling; 15 in each
Minimum sample size calculated using prevalence estimates from LMIS 2009 and 1999 survey – 1,710 households total

7. Methodology
Training held in Monrovia 7-12 March 2011; three days of pre-testing followed in urban/rural
Fieldwork conducted between 7 April-18 June
Teams administered paper questionnaire, measured Hb and malaria on site; took venous blood samples from women/children, urine samples from women, salt samples from HH
Biological samples transported via cold chain from field to NDS at JFK Hospital

8. Sample Analyses
Blood samples (Germany): ELISA method used to measure ferritin, transferrin receptor (sTfR), retinol binding protein (RBP), and inflammation proteins (APPs)
Urine samples (Tanzania): ammonium persulfate digestion method to measure iodine concentration
Salt samples (Tanzania): simple titration to measure iodine ppm

9. Correction Procedure
Ferritin and RBP concentrations affected by infection; even if not presenting clinical signs
This creates problem when using standard cut-off points defined by WHO to classify micronutrient deficiencies, esp. for children
In LNMS, identified four stages of infection response using APPs, then adjusted ferritin and RBP measurements to “healthy” subgroup

10. Correction Procedure

11. Correction Procedure

12. Correction Procedure

13. Key Findings: Anemia

14. Key Findings: Anemia

15. Key Findings: Iron Deficiency

16. Key Findings: Iron Deficiency

17. Key Findings: Iron Deficiency Anemia

18. Key Findings: Vitamin A Deficiency

19. Way Forward & Next Steps
Technical working group to carry out causal analysis to identify key determinants (e.g., age, geography, education) in October
Final comprehensive report, including programming recommendations based on results of causal analysis by mid-November
Based on findings in final report, develop and cost a micronutrient implementation plan for Liberia by end of November

20. Thank You