Dietary Sources of Iron in Uganda

Dietary Sources of Iron in Uganda Data from the 2009/2010 Uganda National Panel Survey Jack Fiedler, Leanne Dougherty, Celeste Sununtnasuk

Uganda National Panel Survey 2009/10 UNPS A national survey representative at the regional level Modules: Household, Agriculture, Community Sample size: 2,898 households The 2010/11 survey of the same households has just been released. Another survey is currently being done

Uganda National Panel Survey 2009/10 UNPS Household food consumption 61 food items Source: purchases, own productions, gifts Household crop production 57 crops, including 49 food crops Livestock and small animal ownership, fishing

What information does the UNPS contain that could be useful in fighting anemia? The consumption module can be used to estimate: 1. Dietary diversity 2. Identify the sources of iron-rich foods being consumed 3. Iron intake levels a. The prevalence of inadequate iron intake (usual daily intake and EAR) b. The magnitude of the iron intake gap

UNPS Consumption Module 4. Coverage of food fortification vehicles 5. Commercial fortification impact simulations

UNPS Agricultural Module 1. The sources of iron-rich foods being produced 2. What happens to the food that is produced (eaten, sold, stored, etc.) 3. Animal ownership and raising: potential food sources of high bioavailable (heme) iron

61 Items UNPS: Consumption Module

Dietary Diversity and Nutrition Household Food and Diet Diversity Number of unique food groups consumed over a given reference period Highly predictive of micronutrient intake adequacy of women Highly correlated with hemoglobin concentrations in women and children U5 (and children s anthropometric measures, caloric and protein adequacy and birth weight)

Common Food Groups Cereals Roots and Tubers Legumes Eggs Meat and Poultry Fish Fruits Vegetables Nuts Milk Fat and Oils Sugar and Sweets

HarvestPlus Food Composition Table (FCT) Nutrient content per 100g of edible food for more than 700 food descriptions

Top 20 Food Sources for Iron Intake in Uganda, Nationwide Rank Food Item % Cumulative % 1 Sweet Potatoes 14.7 14.7 2 Matooke 12.5 27.2 3 Beans, dry 9.3 36.5 4 Cassava 8.4 44.9 5 Cassava Flour 7.8 52.7 6 Dodo (Amaranth) 5.2 57.9 7 Maize Flour 5.1 63.0 8 Sorghum 4.7 67.7 9 Vegetables, other 4.4 72.1 10 Bread 2.4 74.5 Rank Food Item % Cumulative % 11 Millet 2.3 76.7 12 Tomatoes 2.2 78.9 13 Beans, fresh 2.0 80.9 14 Beef 2.0 82.9 15 Mango 1.8 84.7 16 Fish, smoked 1.6 86.3 17 Nuts 1.2 87.5 18 Eggs 1.2 88.7 19 Irish Potatoes 1.1 89.8 20 Sesame 1.1 90.9 95% are plant sourced

Top 10 Food Sources for Iron Intake by Region Kampala % Central % Eastern % Northern % Western % Matooke 14.3 Matooke 22.0 Sweet Pot. 19.5 Cassava 12.5 Matooke 22.6 Bread 13.2 Sweet Pot. 16.6 Cassava Fl. 11.5 Cassava Fl. 12.4 Sweet Pot. 15.9 Beans (d) 10.4 Beans (d) 11.3 Matooke 7.1 Sorghum 12.1 Beans (d) 11.6 Sweet Pot. 7.9 Cassava 8.0 Maize Fl. 6.7 Veg (other) 10.5 Dodo 8.3 Maize Fl. 6.2 Maize Fl. 6.8 Beans (d) 6.5 Sweet Pot. 9.7 Cassava 6.5 Beef 4.5 Tomatoes 3.3 Dodo 6.2 Beans (d) 8.9 Cassava Fl. 6.2 Cassava 3.8 Bread 3.2 Sorghum 5.7 Dodo 4.1 Maize Fl. 4.5 Eggs 3.8 Dodo 3.0 Cassava 5.5 Sesame 3.8 Millet 3.8 Tomatoes 3.8 Beef 2.6 Veg (other) 4.2 Maize Fl. 2.9 Beans (f) 3.2 Veg (other) 3.5 Beans (f) 2.4 Millet 2.6 Mango 2.5 Irish Pot. 2.0

Estimating iron consumption Combining the UNPS food list data with food composition tables allows estimating the apparent household intake of iron With an assumption about how the food is distributed within the household distribution, these estimates can provide a proxy measure of individual iron intakes

Average Daily Iron Intakes and Inadequacies (mg/day) Mean SE 95% CI # Inadequate % Inadequate A2Z-GAIN-WFP- Makerere Survey Kampala 11.5 0.58 10.3 12.6 1,148 87.6 89 Central 10.7 0.54 9.6 11.7 3,820 87.2 Eastern 14.2 0.54 13.1 15.2 3,485 76.1 Northern 13.6 0.64 12.4 14.9 3,430 77.9 71 Western 13.4 0.43 12.6 14.2 3,249 80.0 65 NATIONAL 12.8 0.27 12.3 13.4 15,175 81.0

Non- Agricultural Households Agricultural Households Non- Livestock Households Livestock Households Agricultural Households w/ Livestock Average Daily Iron Intakes and Inadequacies by Type of HH # People Mean II 95% CI # Inadequate % Inadequate 3,093 10.3 9.4 11.1 2,756 89.1 15,641 13.3 12.7 13.9 12,450 79.6 4,846 11.7 10.9 12.4 4,095 84.5 13,888 13.2 12.6 13.8 11,083 79.8 13,393 13.3 12.7 13.9 10,647 79.5 NATIONAL 18,734 12.8 12.3 13.4 15,175 81.0

Percent of Ugandans in Households Purchasing Iron Food Fortification Vehicles Region Maize Flour Wheat Flour Kampala 62% 61% Central 45% 26% Eastern 27% 20% Northern 19% 12% Western 39% 8% Uganda 34% 20%

Coverage and Additional Iron Intake with Alternative Fortification Vehicles Percent of Households Covered Iron (mg) Mean Iron (mg) Median Portfolio 1: Maize 34% 5.50 3.30 2: Wheat 20% 1.60 1.00 10: Maize + Wheat 43% 2.10 0.00 Estimated Average Requirements of iron: Non-pregnant woman 19-30y: 8.1; Children 1-3: 3.0 A modest contribution, but with the increase in anemia vulnerability, a potentially important one.

UNPS agricultural module Food crops Animal ownership Livestock, poultry, fish Animal products Biofortified crops? (Could model adoption and production of orange flesh sweet potato-with minor modifications)

UNPS: Agriculture Module 57 Crops

Production of Top Iron-Source Crops Percent of households producing some of the crop, first or second season Sweet Potatoes Matooke Beans Cassava Dodo Maize Sorghum Kampala 3.7% 4.1% 4.5% 4.1% 0.8% 5.7% 0.0% Central 45.2% 51.6% 55.2% 50.9% 0.9% 58.1% 1.4% Eastern 50.1% 28.7% 46.9% 67.5% 1.0% 71.2% 25.9% Northern 44.4% 7.9% 55.9% 66.2% 0.4% 61.5% 51.5% Western 52.6% 65.9% 83.4% 44.3% 0.2% 52.3% 15.0% NATIONAL 44.3% 35.1% 55.4% 53.1% 0.6% 56.3% 21.8%

Farmer iron-production profiles Under-development: Estimates of the total iron availability in the food crops produced by individual farming households Method: Combine information from the Uganda food composition table with the quantity of each food crop produced by season

Households that owned or raised livestock in the previous 12 months

Livestock, Poultry, Fish Households owning or raising livestock, small animals, or that fish Cattle Goats Pigs Sheep Chicken Fish Kampala 2.9% 3.3% 2.0% 0.0% 4.1% 0.0% Central 26.3% 28.7% 27.3% 4.4% 38.2% 3.0% Eastern 43.0% 48.0% 16.7% 7.2% 69.0% 4.1% Northern 38.9% 54.9% 10.1% 14.5% 63.5% 3.0% Western 23.0% 44.9% 17.2% 8.9% 48.0% 0.9% NATIONAL 30.5% 40.8% 16.5% 8.1% 50.6% 2.6% (Livestock & fish: last 12m; chickens: last 3m; others: last 6m)

Production of Animal Products Percent of households producing in past 12 months Meat Eggs Milk Ghee Kampala 0.0% 1.2% 1.6% 0.4% Central 0.3% 5.6% 12.5% 1.3% Eastern 0.4% 9.8% 18.4% 0.6% Northern 0.8% 2.5% 11.0% 0.7% Western 1.4% 5.9% 13.8% 1.3% NATIONAL 0.7% 5.5% 12.9% 0.9%

Nutrition Programs are Generally Managed as Stand-alone, Independent Interventions Biofortified Food Programs Food Fortification Programs Point-of-Use Fortification (MNP) Programs Insecticide Treated Bednets Deworming Nutrition Status Iron Supplementation Programs 26

An Integrated Nutrition Policy Requires an Understanding of the Programs Interactions and Their Harmonization as a Portfolio Biofortified Food Programs Food Fortification Programs Point-of-Use Fortification (MNP) Programs Insecticide Treated Bednets Deworming Nutrition Status Iron Supplementation Programs 27

UNPS and Anemia Strategies Anemia rates in Uganda: 49% of children under 5 years 23% of women 15-49 years The UNPS can help identify: Prevalence of inadequate iron intake across regions and populations Consumption patterns of iron-rich foods Production patterns of iron-rich foods Potential iron fortification vehicles

Going Forward Could UBOS, MAAIF and MOH regularly produce a UNPS report on agriculture and food security issues? Could a working group of UBOS, MAAIF, MOH, Makerere strengthen the UNPS as a tool for addressing food and nutrition issues?

Thank You Questions or Comments?