The Kenya National Micronutrient Survey 2011

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Ministry of HealthThe Kenya NationalMicronutrient Survey2011

The Kenya National Micronutrient Survey 2011PartnersKenya Medical Research Institute (KEMRI)Kenya National Bureau of Statistics (KNBS)Ministry of Health (MoH) – Nutrition and Dietetics Unit (NDU)National Public Health Laboratory Services (NPHLS)United Nations Children’s Fund (UNICEF)Micronutrient Initiative (MI)Global Alliance for Improved Nutrition (GAIN)World Food Programme (WFP)Centre for Disease Control (CDC)World Health Organisation (WHO)Ministry of Health

The Kenya National Micronutrient Survey 2011Acknowledgementsthe Ministry of Health, KEMRI and KNBS as well as local administration in the various Counties.Our sincere gratitude goes to partners, including UNICEF, MI, GAIN, WFP, CDC, WHO and Save thelate Usha Mudava of CDC who was instrumental in setting up the laboratories and ensuring SOPs wereundertook analyses of blood specimens for Haemoglobinopathies as well as Division of Vaccines andImmunization who provided invaluable support through supply of some of the Nitrogen tanks used inWe appreciate the role played by the former Provincial Directors of Public Health and Sanitation as wellChiefs and Assistant Chiefs for ensuring security and mobilization of communities, provision of motorUnit (formerly Division of Nutrition), MoH and those of Kenya National Bureau of Statistics. Othersuccess of this survey are also appreciated.Most importantly, we wish to recognise and thank the many women, men and children who willinglyparticipated in this study without whom there would be no results to report about. We also give specialthanks to all those who participated in the data analysis and report writing processes not forgetting theA special thanks to the external peer reviewer, Dr James A Berkeley, Centre for Tropical Medicine &Gladys Mugambi,Head, Nutrition and Dietetics Unit,Ministry of Healthi

The Kenya National Micronutrient Survey 2011ForewordIn Kenya, like in many developing countries, malnutrition continues to contribute to morbidity andmortality concerns. More than half of the morbidity and mortality cases in children are attributablethe Government of Kenya, through the then Ministry of Public Health and Sanitation (currently Ministryof Health), to institute the Kenya National Micronutrient Survey (KNMS) in 2011 to generate data onfactors.from the Ministry of Health, Kenya Medical Research Institute (KEMRI) and Kenya National BureauMicronutrient Initiative, Global Alliance For Improved Nutrition, World Food Programme, Centre forDisease Control and World Health Organization. Due to the nature of KNMS, covering both medicaland socio-demographic/economic investigations, KEMRI and KNBS as the government lead institutionsof the two types of surveys spearheaded its implementation.establishing the prevalence of micronutrient malnutrition and selected infectious diseases related tomicronutrient interventions.Dr. Yeri Kombe,Principal Investigator,KEMRIii

The Kenya National Micronutrient Survey 2011Prefacesurveys are necessary to understand the changes in the nutrition situation and accommodate newinformation on dietary intake and micronutrients status of the population. Ideally, it is supposed to beresult of the interventions which have been put in place by the Ministry of Health and other supportingA steering committee led by MoH Nutrition Unit and comprising of KEMRI, KNBS and key developmentand implementing partners as lead members was constituted to plan for a national micronutrient surveyand ensure that it was properly implemented. In addition, the steering committee was charged withfundraising for the survey. Alongside this committee, a technical committee led by KEMRI was establishedwhich comprised of the technical personnel from MoH, KEMRI and KNBS, in collaboration withUNICEF, MI, CDC, GAIN, WFP and WHO to design and implement the Kenya National MicronutrientSurvey.collection, laboratory analysis and quality control and data analysis. Chapter three is on response ratesanaemia and associated factors. Vitamin A status is presented in chapter six while Iodine status and zincstatus results are presented in chapter seven and eight respectively. Chapter 9 discusses results on folateand vitamin B12recommendations for the report are presented in Chapter 11.Dr. Jackson Kioko,Director of Medical Services,Ministry of HealthDr. Gerald Mkoji,Ag. Director,KEMRIiii

The Kenya National Micronutrient Survey 2011Report prepared by:Dr. Yeri KombeKenya Medical Research Institute (KEMRI)Dr. Lydia KadukaKenya Medical Research Institute (KEMRI)Mrs. Zipporah Bukania-ApunguKenya Medical Research Institute (KEMRI)Mr. Moses MwangiKenya Medical Research Institute (KEMRI)Mr. Erastus MuniuKenya Medical Research Institute (KEMRI)Mr. Richard MutisyaKenya Medical Research Institute (KEMRI)Mr. Philip NdemwaKenya Medical Research Institute (KEMRI)Mrs. Gladys MugambiHNDU Ministry of Health (MoH)Mr. John Mwai,HNDU Ministry of Health (MoH)Mrs. Lucy Gathigi-MainaHNDU Ministry of Health (MoH)Mr. Benson MusauMinistry of Health (MoH)Mr. Silas MulwaKenya National Bureau of Statistics (KNBS)Mr. James Ng’ang’aKenya National Bureau of Statistics (KNBS)Mr. John NjihiaNational Public Health Laboratory Services (NPHLS)Ms. Louise MwirigiUnited Nations Children’s Fund (UNICEF)Mr. Ismail ArteUnited Nations Children’s Fund (UNICEF)Mr Edward KutondoUnited Nations Children’s Fund (UNICEF)Dr. Jacqueline Kung’uMicronutrient Initiative (MI)Ms. Lucy MurageMicronutrient Initiative (MI)Prof Frits van der HaarMicronutrient Initiative (MI)Mr. James WirthGlobal Alliance for Improved Nutrition (GAIN)Mr. Mutua MutukuGlobal Alliance for Improved Nutrition (GAIN)Dr. Catherine Macharia-MutieGlobal Alliance for Improved Nutrition (GAIN)iv

The Kenya National Micronutrient Survey 2011Table of contentsAcknowledgementsForewordPrefaceTable of contentsList of TablesList of TablesAbbreviations and AcronymsiiiiiivxxiiixivEXECUTIVE SUMMARYBackgroundMethodologySocio-demographic and Economic CharacteristicsNutritional StatusAnaemia, Iron Deficiency and Iron Deficiency AnaemiaVitamin A DeficiencyIodine DeficiencyZinc DeficiencyFolate and Vitamin B12 Deficiency among womenBreastfeeding patternsMicronutrient SupplementationDietary and Nutrient IntakeConclusions and ixxiixxiiixxiiiCHAPTER 1: INTRODUCTION1.1. Introduction1.2. Malnutrition in Kenya1.3. Interventions to combat malnutrition in Kenya1.4. Survey Rationale and Objectives1.4.1. General Objective1.4.2. Specific Objectives1112334CHAPTER TWO: STUDY METHODS2.1. Study design, sample size and sampling processes2.2. Ethical considerations2.3. Training and piloting2.4. Data collection2.5. Adjustment of Haemoglobin Levels for Altitude2.6. Correction of RBP, Serum Zinc and Serum Ferritin for Inflammation2.7. Body Mass Index (BMI) for Adult Men and Non-pregnant Women2.8. Anthropometry Computation2.9. Calculation of Wealth index2.10. Limitations of the Report55556778888v

The Kenya National Micronutrient Survey 2011CHAPTER THREE: RESPONSE RATES AND DEMOGRAPHIC CHARACTERISTICS OFHOUSEHOLDS3.1. Response rates3.2. Demographic characteristics3.2.1. Residence, Household size, Age and sex3.2.2. Household Head Education level1010111111CHAPTER FOUR: NUTRITIONAL STATUS124.1. Overview124.2. Nutritional Status of Children aged 6-59 months4.2.1. Levels of Stunting4.2.2. Levels of Wasting4.2.3. Levels of Underweight4.2.4. Social Economic Status and Nutritional Status of Children4.3. Nutritional status in adults4.3.1. Levels of Malnutrition in Non-pregnant Women4.3.2. Levels of Malnutrition in Men4.3.3. Nutrition Status of Pregnant Women by Mid Upper Arm Circumference121314151515161718CHAPTER FIVE: ANAEMIA, IRON DEFICIENCY, IRON DEFICIENCY ANAEMIAAND ASSOCIATED FACTORS195.1. Introduction195.2.5.3.5.4.5.5.in Pre-School Aged Children (6-59 months)5.2.1. Anaemia in children aged 6-59 months5.2.2.5.2.3.202122225.3.1. Anaemia in School age children5.3.2.5.3.3. Iron D222323245.4.1. Anaemia in non-pregnant women5.4.2.5.4.3.242525265.5.1. Anaemia in pregnant women5.5.2.5.5.3.262728285.6.1. Anaemia in men5.6.2.5.6.3.28292930vi

The Kenya National Micronutrient Survey 20115.7. Factors that contribute to anaemia5.7.1. Infection of pre-school children with helminths5.7.2. Helminths in relation to anaemia in preschool children5.7.3. Helminths among school age children5.7.4. Helminths in relation to Anaemia in School Age Children5.7.5. Helminths among non-pregnant women5.7.6. Helminths in relation to anaemia in non-pregnant women5.7.7. Helminths among pregnant women30313232333435355.8. Malaria and HIV Infections in the Study Population5.8.1. Malaria and HIV infection in relation to anaemia in the study population35365.9. Haemoglobinopathies in the study population5.9.1. Sickle Cell Disease5.9.2. Thalassemia5.9.3. Haemoglobinopathies in relation to anaemia in preschool children5.9.4. Haemoglobinopathies in relation to anaemia among school age children5.9.5 Haemoglobinopathies in relation to anaemia among pregnant women5.9.6. Haemoglobinopathies in relation to anaemia among non-pregnant women5.9.7. Haemoglobinopathies in relation to anaemia among men36363637373838385.10. Nutrient Intake and anaemia in the study population5.10.1. Nutrient intake in relation to anaemia, ID and IDA among preschool children5.10.2. Nutrient intake in relation to anaemia among pregnant women5.10.3. Nutrient intake in relation to anaemia among non-pregnant women38383939CHAPTER SIX: VITAMIN A DEFICIENCY406.1. Introduction406.2. Vitamin A Deficiency in Pre-School Children (6-59 months)406.3. Vitamin A Deficiency in School Age Children (5-14 years)426.4. Vitamin A deficiency in pregnant and nonpregnant women436.5. Vitamin A Deficiency in Men446.6. Relating Dietary and biochemical data44CHAPTER SEVEN: IODINE467.1. Introduction467.2. Iodine Nutrition in Kenya467.3. Methods477.4. Statistical Analysis477.5. Urinary Iodine Concentration (UIC)487.6. Urinary Sodium Concentration (UNaC)507.7 Iodine Content in Consumer Salt53vii

The Kenya National Micronutrient Survey 2011CHAPTER EIGHT: ZINC DEFICIENCY558.1. R NINE: FOLATE AND VITAMIN B12 DEFICIENCY IN PREGNANTAND NON-PREGNANT WOMEN609.1. Introduction609.2. Folate and B12609.3. Folate and B129.3.1. Folate and B126161CHAPTER TEN: FOOD CONSUMPTION PATTERNS, DIETARY PRACTICES NUTRIENTINTAKES6310.1. Infant Feeding Practices10.1.1. Breast Feeding636310.2. Micronutrient Supplementation10.2.1. Vitamin A Supplementation in Children 6-59 months10.2.2. Iron and folic acid use and de-worming in Children10.2.3. Iron Supplementation in Women of Reproductive Age6363646410.3. Dietary diversity10.4. Nutrient adequacy of women and children using the 24 hour recall10.5. Determinants of variation in energy intake10.6. Relationship of dietary and biochemical data10.7. Dietary sources of micronutrients6570717474747576CHAPTER ELEVEN: CONCLUSIONS AND RECOMMENDATIONS8411.1. Conclusions8411.2. Recommendations85References88Appendix 1: Dietary Reference Intakes (DRI’s) for Minerals and VitaminsAppendix 1a: MineralsAppendix 1b: Vitamins959596viii

The Kenya National Micronutrient Survey 2011Appendix 297Appendix 2a: Sources of dietary energy by food group and age group. When source contributes more than10% of total energy the value is shown in red text.97Appendix 2b: Sources of dietary lipid by food group and age group. When source contributes more than10% of total energy the value is shown in red text.97Appendix 2c: Sources of dietary iron by food group and age group. When source contributes more than10% of total energy the value is shown in red text.97Appendix 2d: Sources of dietary zinc by food group and age group. When source contributes more than10% of total energy the value is shown in red text.98Appendix 2e: Sources of dietary calcium by food group and age group. When source contributes morethan 10% of total energy the value is shown in red text.98Appendix 2f: Sources of dietary vitamin A by food group and age group. When source contributes morethan 10% of total energy the value is shown in red text.98Appendix 3: Dietary Reference Intakes (DRI’s) for Minerals and VitaminsAppendix 3a: MineralsAppendix 3b: Vitamins9999100Appendix 4101Appendix 4a: Sources of dietary energy by food group and age group. When source contributes more than10% of total energy the value is shown in red text.101Appendix 4b: Sources of dietary lipid by food group and age group. When source contributes more than10% of total energy the value is shown in red text.101Appendix 4c: Sources of dietary iron by food group and age group. When source contributes more than10% of total energy the value is shown in red text.101Appendix 4d: Sources of dietary zinc by food group and age group. When source contributes more than10% of total energy the value is shown in red text.102Appendix 4e: Sources of dietary vitamin A by food group and age group. When source contributes morethan 10% of total energy the value is shown in red text.102Appendix 5: Summary of key findings in Kenya National Micronutrient Survey 2011103Appendix 6: Dietary Reference Intakes (DRI’s) for Minerals and VitaminsAppendix 6a: MineralsAppendix 6b: Vitamins104104105Appendix 7: Population groups and the key measurement variables.106Appendix 8: Sample sizes and precision for maximum sample size for each target group107Appendix 9: KEMRI ERC Approvals108Appendix 10: A map of Kenya showing clusters covered in KNMS 2011109Appendix 11: Sampling ErrorsAppendix 11a: Sampling Errors for Rural KenyaAppendix 11b: Sampling Errors for Urban areas of Kenya110110114Appendix 12: LIST OF INVESTIGATORS AND INSTITUTIONAL AFFILIATIONS118Appendix 13: Survey Field Team119ix

The Kenya National Micronutrient Survey 2011List of TablesTable S: 1:Table 1. 1:Table 2. 1:Table 2. 2Table 2. 3:Table 3. 1:Table 3. 2Table 4. 1Table 4. 2:Table 4. 3:Table 4. 4:Table 4. 5:Table 5. 1Table 5. 2:Table 5. 3:Table 5. 4:Table 5. 5:Table 5. 6:Table 5. 7:Table 5. 8:Table 5. 9:Table 5. 10:Table 5. 11:Table 5. 12:Table 5. 13:Table 5. 14:Table 5. 16:Table 5. 17:Summary of Key Findings in Kenya National Micronutrient Survey 2011xxivData on Micronutrient Deficiencies among children 6-59 months old,women of reproductive age and school-age children in Kenya from 1994-20072KNMS 2011 sample allocation5Biological markers assessed per study population7Cut-off points for various key indicators9Response rates for various indicators by study group10Characteristics of participating households, kenya 201111Nutritional status of children aged 6-59 months by height-for-age, weight-for-height,and weight-for-age14Factors associated with nutritional status in non-pregnant women16Status of non-pregnant women (nprg) and men using bmi17Factors associated with nutritional status in men18Nutrition status of pregnant women by mid upper arm circumference18Proposed classification of public health significance of anaemia in populations19Prevalence of anaemia, Iron Deficiency (ID) and Iron Deficiency Anaemia (IDA)in the study population19Anaemia, Iron Deficiency (ID), and Iron Deficiency Anaemia (IDA) among preschool age children (6-59 months) in relation to selected demographic and economiccharacteristics20Anaemia, Iron Deficiency (ID), and Iron Deficiency Anaemia (IDA) amongschool age children (5– 14 years) in relation to selected demographicand economic characteristics23Anaemia, Iron Deficiency (ID), and Iron Deficiency Anaemia amongschool age children (5– 14 years) in relation to selected demographicand economic characteristics25Anaemia, iron deficiency, and iron deficiency anaemia among pregnant women(15–49 years) in relation to selected demographic and economic characteristics27Anaemia, iron deficiency, and iron deficiency anaemia among men (15– 54 years)in relation to selected demographic and economic characteristics29Helminths among pre-school age children (6-59 months) in relation to selecteddemographic and economic characteristics31Anaemia among pre-school age children (6-59 months) in relation to infectionwith helminths32Helminths among school age children (5-14 years) in relation to selecteddemographic and economic characteristics33Anaemia, iron deficiency, and iron deficiency anaemia amongschool age children (5-14 yrs) in relation to infection with helminths33Helminths among non-pregnant women (15-49 years) in relation to selecteddemographic and socio-economic characteristics34Anaemia, iron deficiency, and iron deficiency anaemia among non-pregnantwomen (15– 49 years) in relation to infection with helminths35Percentage of helminths in pregnant women by residence35Hiv and malaria infection in the study population by residence35Sickle cell and thalassaemia in the study population by residence37x

The Kenya National Micronutrient Survey 2011Table 5. 18:Table 5. 19:Table 5. 20:Table 5. 21:Table 5. 22:Table 5. 23:Table 6. 1:Table 6. 2:Table 6. 3:Table 6. 4:Table 6. 5:Table 7. 1A:Table 7. 1B:Table 7. 2A:Table 7. 2B:Table 7. 3:Table 8. 1:Table 8. 2:Table 8. 3:Table 8. 4:Table 8. 5:Table 8. 6:Table 8. 7:Table 9. 1:Table 9. 3:Table 9. 4:Table 10. 1:Table 10. 2:Table 10. 3:Table 10. 4:Table 10. 5:Table 10. 6:Table 10. 7:Anaemia among pre-school age children (6-59 months) in relation tohaemoglobinopathiesAnaemia among school age children (5-14 years) in relation to haemoglobinopathiesAnaemia among non-pregnant women (15– 49 years) in relation tohaemoglobinopathiesAnaemia among men (15– 64 years) in relation to haemoglobinopathiesAnaemia among pre-school age children (6-59 months) in relation to adequacyin rdi of macro and micronutrientsAnaemia among non-pregnant women (15– 49 years) in relation to adequacyin rdi of macro and micronutrientsNational prevalence of vitamin a deficiency corrected for inflammationDistribution of VAD in Pre-School Children (PSC) by demographic characteristicsDistribution of VAD in school age children (sac) by demographicsDistribution of VAD in non-pregnant women by demographic characteristicsLevels of vitamin a deficiency among pre-school children (6-59 months) and nonpregnant women (15-49 years) in relation to adequacy in rdi of micronutrientsUrinary Iodine Concentration in school age children, KNMS 2011Urinary Iodine Concentration in non-pregnant women, KNMS 2011Urinary Sodium Concentration in school-age children, KNMS 2011Urinary Sodium Concentration in non-pregnant women, KNMS 2011Distribution of salt iodine by demographic characteristics and brandsCut-offs for serum zinc concentration (µg/dl*) for morning and non-fastingDistribution of plasma zinc concentration for pre-school age children (Pre-SAC)Prevalence of serum zinc concentration for school aged children (SAC)Distribution of serum zinc concentration for pregnant women (PW)Distribution of serum zinc concentration for non-pregnant women (NPW)Distribution of serum zinc concentration for menDistribution of low serum zinc concentration by study group, uncorrectedand corrected for inflammationDistribution of folate and B12 deficiency among pregnant women (15-49 years)by residenceDistribution of folate and vitamin B12 deficiency among non-pregnant women(15-49 years) by selected demographic and economic characteristicsFolate and vitamin B12 deficiency among non-pregnant women (15– 49 years)in relation to adequacy in rdi of micronutrientsMicronutrient supplementation among the pre school childrenMean percent of energy intake by food group in children 6-59 monthsoverall and by age group 1 (n 264)Mean percent of energy intake by food group in children 6-59 monthsby area of residence1 (n 264)Mean number of food groups consumed and proportion with low dietary diversity(dds 4) among children 6-59 month, by child characteristic (n 279)Description of number of food items consumed per day among children,by age groupPercentage intake of food groups among children 5-59 months by differentcharacteristicsNumber of meals per day and food items consumed among women 15-49 yearsby age group and physiological 585860616264666667676970

The Kenya National Micronutrient Survey 2011Table 10. 8:Table 10. 9:Table 10. 10:Table 10. 11:Table 10. 12:Table 10. 13:Table 10. 14:Table 10. 15:Table 10. 16:Table 10. 17:Table 10. 18:Table 10. 19:Percentage intake of food groups among women by different characteristics70Average (SD) energy and macronutrients intake among women72Average (SD) energy and macronutrients intake among children 6-59 months72Average (SD) micronutrients intake among women73Average (SD) micronutrients among children 6-59 months73Prevalence of dietary inadequacy of macro and micro-nutrients among womenand children73Of consumption levels of food candidates for fortification.76Questions asked in household survey about quantity of consumption of maize flour,wheat flour, sugar and oil, the categories of answers for each food, and the amount usedfor each category in calculation of daily intakes. The final column shows the percent 77Quantity of salt usually purchased, and frequency of salt purchase in households78Estimated consumption of salt per day78Five parameters that an ideal monitoring tool could measure, the ability of 24 hourdietary recalls and hces to measure these parameters, and the meaning of this for toolvalidation79Summary of the comparisons between the intake estimates from HCES and 24 hourdietary recall for maize flour, salt, wheat flour, sugar and oil.83xii

The Kenya National Micronutrient Survey 2011List of FigureFigure: 7. 1:Figure 10. 1:Iodine content in household salt samples by salt brand and category53The intake of salt (grams per day) as estimated by the hces-like questions in thehousehold survey and by the 24 hour dietary recalls for different age groups (ageboundaries of group shown in horizontal axis labels, m is for males and f for females).80Figure 10. 2a: The intake of wheat flour (grams per day) as estimated by the hces-like questions inthe household survey and by the 24 hour dietary recalls for different age groups (ageboundaries of group shown in horizontal axis labels, m is for males and f for females).81Figure 10. 2b: The intake of sugar (grams per day) as estimated by the hces-like questions in thehousehold survey and by the 24 hour dietary recalls for different age groups (ageboundaries of group shown in horizontal axis labels, m is for males and f for females).82Figure 10. 2c: The intake of oil (grams per day) as estimated by the hces-like questions in thehousehold survey and by the 24 hour dietary recalls for different age groups (ageboundaries of group shown in horizontal axis labels, m is for males and f for females). inthe case of oil, the 24 hour recall intakes are calculated for oil only, and oil plus vegetablefat.82xiii

The Kenya National Micronutrient Survey 2011Abbreviations and AcronymsB12Vitamin B12B6Vitamin B6BMIBody Mass IndexCDCCentre for Disease ControlCPHRCentre for Public Health ResearchCRPC-Reactive proteinDBSDry Blood SpotDCDistrict CommissionerDODistrict OfficerDONDivision of NutritionDRIsDaily Recommended IntakesDSODistrict Statistics OfficerEAsEnumeration AreasEDAExploratory Data AnalysisEPSEMEqual Probability Selection MethodERCEthical Review CommitteeFDFolate DeficiencyGAINGlobal Alliance for Improved NutritionGDPGross Domestic ProductGOKGovernment of KenyaHbHaemoglobinHhHHousehold headHhsHouseholdsHIVHuman Immunodeficiency VirusHPLCHigh Performance liquid chromatographyId IdentityIDIron deficiencyIDAIron Deficiency AnaemiaIQIntelligent QuotientIQRInter Quartile rangeITNsInsecticide Treated NetsKDHSKenya Demographic Health Surveyxiv

The Kenya National Micronutrient Survey 2011KIEKenya Institute of EducationKIHBSKenya Integrated Household Budget SurveyKMISKenya Malaria Indicator SurveyKNBSKenya National Bureau of StatisticsKNMSKenya National Micronutrient SurveyLSCLaboratory Sub-CommitteeLSSCLogistics, Training, and Supplies Sub-CommitteeMCHMother Child HealthMDGsMillennium Development GoalsMIMicronutrient InitiativeMOHMinistry of HealthMOPHSMinistry of Public Health and SanitationMOSMeasure Of SizeMOUMemorandum of UnderstandingMUACMid Upper Arm CircumferenceNASCOPNational AIDS & STI Control ProgrammeNASSEPNational Sample Survey and Evaluation ProgrammeNPHLSNational Public Health Laboratory ServicesNPLNon-Pregnant LactatingNPNLNon-Pregnant Non LactatingNPWNon-pregnant WomenNSCNational Survey CoordinatorPCProvincial CommissionerPCAPrincipal Components AnalysisPCRPolymerase Chain ReactionPDSCProtocol Development Sub-Committee of the Scientific CommitteePIPrincipal InvestigatorPPMOSProbability Proportional to Measure Of SizePSCPre-School ChildrenPSUsPrimary Sampling UnitsPWPregnant WomenQA/QCQuality Assurance/Quality ControlRBCRed Blood CellsRBPRetinol Binding Proteinsxv

The Kenya National Micronutrient Survey 2011RDTsRapid Diagnostic TestSACSchool Age ChildrenSDStandard DeviationSFSerum FerritinSOPsStandard Operating ProceduresTfRSerum TransferritinsSVISwiss Vitamin InstituteUIEUrinary Iodine ExcretionUNICEFUnited Nations Children’s FundVAVitamin AVADVitamin A DeficiencyVCTVoluntary Counseling and TestingWFPWorld Food ProgrammeWRAWomen of Reproductive Agexvi

The Kenya National Micronutrient Survey 2011EXECUTIVESUMMARYdistribution of micronutrient malnutrition,including nutritional status and a number ofrelated diseases. The aim of the survey wasto establish the prevalence of micronutrientdeficiencies, protein-energy malnutrition, andinfectious diseases among the Kenyan populationin order to provide policy makers and programmemanagers with the information they need toeffectively plan and implement micronutrientinterventions. Specifically, the survey set out:BackgroundMalnutrition associated with micronutrientdeficiencies (vitamins and minerals) is a majorcause of morbidity and mortality, and negativelyaffects human productivity and economic growth,especially in developing countries. About 45percent of child deaths and 10 percent of totalglobal disease burden is attributed to maternaland child under nutrition. It is for this reasonthat improving nutrition has been indicated asthe precondition to achieving a number of theMillennium Development Goals. Studies haveshown that investing in nutrition can increase acountry’s Gross Domestic Product (GDP) by atleast 2-3 percent each year. Nutrition science ingeneral, and micronutrient science in particular,have continued to gain visibility and to drawattention locally, regionally and internationally.This has continued to shape policies andinterventional programs towards improvingnutrition in communities. Despite notablenutrition science achievements, many nations inthe developing world continue to register grimstatistics; many children worldwide die dailyfrom malnutrition while others live through theirchildhood in a state of chronic malnourishmentresulting in unhealthy growth and poor braindevelopment, poor immunity to disease, low IQ,resulting in poor educational performance andreduced quality of life.(i)To determine the prevalence of wasting,stunting and underweight among children6-59 months of age and prevalence ofthinness and overweight/obesity of womenin Kenya;(ii)To establish the prevalence of anaemia,iron deficiency and iron deficiency anaemiaamong all population groups in Kenya,(iii) To determine the magnitude of infection(malaria, parasites, hemoglobinopathies,HIV) and its relation to anaemia among allpopulation groups.(iv) To determine prevalence of vitamin Adeficiency among all population groups inKenya;(v)To determine the prevalence of Folate andvitamin B12 deficiencies in pregnant andnon-pregnant women;(vi) To determine the prevalence of zincdeficiency in the study population.(vii) To assess the micronutrient supplementationcoverage in Kenya;(viii) To assess the patterns of household and/or individual dietary consumption andnutrient intakeIn Kenya, like in many developing countries,malnutrition continues to raise morbidityand mortality concerns. Kenya does not haverepresentative micronutrient data at eithernational or sub-national levels. This positionprompted the Government of Kenya, throughthe Ministry of Public Health and Sanitation(currently Ministry of Health) to institute theKenya National Micronutrient Survey (KNMS)in 2011to generate data on the magnitude and(ix) To establish the relative roles of salt in readyto-eat processed foods and of salt consumedin households on the Iodine status of surveyrespondents;(x)xviiTo determine the prevalence of iodinedeficiency in school age children and nonpregnant women

The Kenya National Micronutrient Survey 2011The sample size required for each stratum wasbased on the estimated prevalence for eachnutritional indicator, the desired precision foreach indicator, an assumed design effect of 2.0,and a non-response of 10 percent (includingrefusals) at the household level, and 10 percentat the individual levels for children 6-59 monthsof age and non-pregnant women. An additionalnon-response rate of 10 percent (for a total 30percent non-response rate) was assumed for themen and school age children (SAC) 5-14 yearsold. The sample size was determined based on theparameters that required the highest sample size(Zinc, Iodine, Anaemia) for each target group.Fisher’s formula for estimating the minimumsample size for prevalence descriptive studies wasused. The KNMS survey protocol was reviewedand approved by the KEMRI Scientific and theNational/Ethical Review Committee (ERC).As per the national research policies, informedwritten consent was received from all individualsparticipating in the survey.MethodologyThe design of KNMS 2011was cross sectionalusing a two-stage stratified cluster samplingmethodology that produced representativeestimates for the following three domains: (i)Kenya as a whole; (ii) Rural areas of Kenya; and(iii) Urban areas of Kenya. The sampling frame forthe 2011 KNMS was based on the National SampleSurvey and Evalua

5.10.2. Nutrient intake in relation to anaemia among pregnant women 39 5.10.3. Nutrient intake in relation to anaemia among non-pregnant women 39 CHAPTER SIX: VITAMIN A DEFICIENCY 40 6.1. Introduction 40 6.2. Vitamin A Deficiency in Pre-School Children (6-59 months) 40 6.3. Vitamin A Deficiency in School Age Children (5-14 years) 42 6.4 .

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diet plans Jayson B Calton Abstract Background: Research has shown micronutrient deficiency to be scie ntifically linked to a higher risk of overweight/ . Methods: Suggested daily menus from four popular diet plans (Atkins for Life diet, The South Beach Diet, the DASH diet, the DASH diet) were evaluated. Calorie and micronutrient content of .