Success and Challenges in maternal anemia programming in Asia

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1 Success and Challenges in maternal anemia programming in Asia Emorn Wasantwisut, PhD Pattanee Winichagoon, PhD Institute of Nutrition, Mahidol University Thailand Presented at the Maternal nutrition session, USAID workshop, September 5 th, 2007

2 Other micronutrients, eg., Vitamin A, C Vitamin B12, folate Parasitic infestation: Hook worms Other worms Malaria ANEMIA Iron deficiency Other factors: chronic blood loss HIV/AIDS Genetically inherited traits, e.g., sickle cell Hemoglobinopathy, Multiple causes of anemia

3 Total population Anemia Iron deficiency anemia Iron deficiency Anemia & Iron deficiency/anemia

4 Tissue iron deficiency Work performance Child development & cognition Severe anemia Child mortality Maternal mortality Perinatal mortality Other factors Conceptual l model of iron deficiency, anemia & functional outcomes Source: Stoltzfus, 2001

5 SUCCESS FEATURES Situation analysis: prevalence survey, formative research target, causes, existing programs Awareness and partnership-commitment from policy to community Multisectoral interventions: -Nutrition (supplements, fortification, diet) -Infection controls -ANC/safe motherhood -Child health -Family Planning/Reproductive health --- Monitoring & Evaluation

6 Indonesia Source: Anemia prevention and control: what works, 2003

7 Indonesia experiences High commitment from the government Raise awareness/program promotion community/religious leaders Iron-folic acid supplementation -program guidelines and protocols available -Increased supply/availability: health system incl. distribution by community health workers & private sales -clear message to mitigate side effects -improved packaging and taste Monitoring system for anemia and IFA supplement used

8 Prevalence of anemia in children years old, pregnant & lactating women, National Nutrition Surveys, Thailand yr. pregnant lactate 0 3rd NNS, th NNS, th NNS, 2003

9 Success of maternal anemia program in Thailand Policy in place and clear service protocol Intervention effectively implemented Supply and inventory of iron + FA/MTV tablets IFA tablets provided free, cost for anemia test for poor women covered by welfare system Effective delivery system Identifying pregnant women Nutr education coupled to ANC Monitoring of anemia Effective referral system: linking front line to secondary/tertiary care

10 Contributing factors addressed in Thailand anemia/primary health care program Health services and sanitation addressed via Primary health cares Village Health Volunteers Ratio 1 VHV per HH Maternal nutrition identify and encourage pregnant women to attend ANC regularly Clean water/sanitation: family/community Wearing shoes Latrine: availability and use

11 Thailand -- more General nutrition of children and women addressed in national nutrition program community-based growth monitoring program surveillance for anemia and goitre UIE (later) Breast feeding and complementary feeding school nutrition: national school lunch and school milk programs / nutrition/health education Food-based dietary guidelines: specific guidelines for pregnant women (recommended foods and portion/amount)

12 Challenges in anemia programming

13 Challenges POLICY -Linking data to policy decision -Maternal nutrition as a priority PROGRAM -Pre-pregnancy for prevention target -Strengthen pregnancy program: #supplements, compliance, effective counseling - Interphase of Iron interventions: supplements, fortification, diet modification -Strengthen partnership and commitment -Sustainability

14 CHALLENGES KNOWLEDGE GAPS Anemia of multiple causes Micronutrient interaction Delivery of iron in infection-prevalent areas Efficacy/Effectiveness of interventions and scale-up

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