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Nutrition advocacy and national development: the PROFILES programme and its application.

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies.

Africa, Western↗

Qualitative evaluation of a health management education partnership.

Results of ongoing cooperation of four educational institutions in the field of Health Management Education in Slovakia are reviewed. The specific benefit of multilateral collaboration for the situation in central Europe is discussed in the context of a Health Management Education Partnership (HMEP). The project is based on a grant from the United States Agency for International Development (USAID) with assistance from the American International Health Alliance (AIHA). The U.S. partner is the University of Scranton, Scranton, Pennsylvania. Three organizations are involved in the partnership from the Slovak Republic: Trnava University, University of Matej Bel in Banska Bystrica and the Health Management School (HMS) in Bratislava, each having specific priority and focus in health management education. The HMEP program is designed to reach about 30 teachers of health administration as well as 200 undergraduates, senior and middle managers from health service organizations every year. The collaborative endeavor stimulates the communication and creation of personal and human relations, not only on an individual and institutional level, but on a community as well as national and international level. The project supports the development of knowledge and skills, professional identity and educational processes in health management. The emphasis is on increasing the quality of education and training in Slovakia through multilateral collaboration, curricula development, professional development, symposia, support of consultancies and accreditation. Specific areas of content are designed to address health policy, law, ethics, insurance and quality improvement.

Accreditation↗

Community environmental health assessment strengthens environmental public health services in the Peruvian Amazon.

In December 1999, the Centers for Disease Control and Prevention (CDC) and the Cooperative for Assistance and Relief Everywhere, Peru Country Office (CARE Peru), initiated the Urban Environmental Health Project (SAU, in Spanish) to strengthen environmental public health services in urban and periurban settlements in Peru. The project received funding from the Woodruff Foundation as part of the CARE-CDC Health Initiative (CCHI). The "Protocol for Assessing Community Excellence in Environmental Health" (PACE EH) guided the development of a community environmental public health assessment (CEHA) process in Cardozo, a settlement in Iquitos, Peru. The project developed a three-phase process that merged scientific understanding and community perception about local environmental health problems. In phase 1, local environmental health technicians assisted the community in understanding environmental health conditions in Cardozo and selecting priorities. During phase 2, local technicians assessed the community-selected priorities: water and sanitation. Results from recent water quality assessments revealed that 82% (9 of 11) of samples from shallow dug wells, 18% (2 of 11) from deeper drilled wells, and 61% (11/18) from household drinking containers were positive for thermotolerant coliforms. Phase 3 activities produced an action plan and an intervention to mitigate health problems associated with inadequate water and sanitation services in the Cardozo community. As a result of the CEHA process, CARE Peru obtained funding from the United States Agency for International Development (USAID) to develop and implement an environmental health risk monitoring system and the proposed water and sewage intervention in the settlement. CDC continues to provide technical assistance to the local environmental health services groups in Iquitos through an agreement with CARE Peru as part of the USAID-funded Urban Environmental Health Models Project (MUSA). Technical assistance activities and the development of the environmental health risk monitoring system have helped to strengthen the local environmental public health services delivery system.

Community-Institutional Relations↗

A review of ten years' experience with surgical equipment in international health programs.

The Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) began in June of 1973 with financial assistance from the Agency for International Development (AID). The purpose of the organization was to provide training and medical equipment to physicians in developing countries to update their education in reproductive health. JHPIEGO began by offering courses in the United States and shortly thereafter began training at centers in the developing countries themselves. Because of its important contributions to gynecological diagnosis in addition to its use in fertility management, laparoscopic equipment has been a major item in JHPIEGO reproductive health training. This paper details the development and role of laparoscopic training in JHPIEGO's program. Laparoscopic training begins with selection of trainees from appropriate institutions. Training itself begins with a didactic session at Baltimore or an in-country center. Trainees then receive clinical training and perform a minimum number of procedures, after which the practitioner, if he or she has successfully completed the clinical practice, can be named eligible to receive medical equipment to be donated to his or her institution. When equipment is installed, a field visit is made by a JHPIEGO consultant to insure the proper use and upkeep of equipment, and the understanding and implementation of standards and procedures. JHPIEGO has trained almost 3000 physicians in laparoscopy techniques between 1973 and 1984.

Developing Countries↗

HIV transmission through breastfeeding: problems and prevention.

The greatest burden of HIV infection in women and their children is disproportionately borne by the poorest countries, especially in sub-Saharan Africa. Breastfeeding is a major health-promoting factor for infants and children in developing countries but the risk of mother-to-child transmission (MTCT) of HIV by this route is challenging traditional practices and health policies in low-resource countries. Maternal and infant factors contributing to the risk of MTCT through breastfeeding are still poorly understood and not well researched. Factors identified include: advanced clinical stages of infection in the mother; high maternal plasma HIV-1 load; presence of mastitis; and infant oral thrush. In many developing countries, international agencies are providing support and recommendations for preventing MTCT of HIV-1 by breastfeeding. Preventive strategies supported by WHO/UNICEF and charitable agencies in some sentinel centres in sub-Saharan Africa include routine antenatal voluntary counselling and testing (VCT), PCR testing of infants of seropositive mothers at 6 weeks of age, various combinations of a shortened period (3-6 mths) of exclusive breastfeeding, perinatal administration of antiretrovirals (ARV) such as nevirapine and provision of affordable and safe infant replacement feeds (presently given free by UNICEF in some centres). Many problems, however, have hindered effective implementation of these interventions. In many poor communities, even where VCT facilities are available, acceptance of HIV testing is low because there is fear of stigmatisation by the spouse, family or community and compliance with complex drug regimens is therefore poor. Other problems include the exorbitant cost of antiretroviral drugs, inadequately resourced health care systems and unavailability or poor acceptance of safe breast-milk alternatives. The rate of mixed feeding is high and so the risk of MTCT is increased. Continued promotion of exclusive breastfeeding for at least 6 months, irrespective of HIV status, followed by a properly prepared, high energy, nutritious complementary diet, with the possibility of early weaning to an animal milk formula, still appears to be the most appropriate option for the poor in countries with high levels of MTCT not deriving any benefit from the above strategies. While a longer period of breastfeeding would probably increase the risk of MTCT in vulnerable communities, a shorter duration would certainly increase infant morbidity and mortality. Results of investigations of the efficacy of ARV for protecting the infants of HIV-infected mothers during the breastfeeding period are awaited.

Antibodies↗

Strengthening capacity in developing countries for evidence-based public health: the data for decision-making project.

Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.

Bolivia↗

Research priorities child and maternal nutrition: a USAID perspective.

This paper presents the views of the United States Agency for International Development, India (USAID/India) on priorities for nutrition research in 2001-2005. Indices of nutrition status in India have been stagnant for 30 years. Although severe malnutrition has declined significantly, there has been little improvement since the 1970s in the percentage of children and/or mothers who are moderately undernourished. USAID views nutrition as a maternal and child survival intervention and focuses programmatic priorities on micronutrient nutrition (specifically vitamin A and iron/folate), integrated community nutrition (MinPak), and improved nutrition status through USAID's Title II program. Major areas of research interest for USAID include the prevalence and etiology of nutrition deficiencies, operations research to improve service delivery, the application of new tools and technologies to improve nutrition, and increasing the role of the private sector (including nongovernmental organizations) in nutrition service delivery. It is concluded that nutrition research must be prioritized to drive programmatic action; research must focus on the key questions; known tools must be widely applied; and elegance should be pursued in all research endeavors.

Adult↗

Risk factors for nightblindness among women of childbearing age in Cambodia.

OBJECTIVE: To characterize risk factors for nightblindness among nonpregnant women of childbearing age, a group recently recognized to be at high risk of vitamin A deficiency in some developing countries. DESIGN: Case-control study. SETTING: The study included >15 000 households in National Micronutrient Survey of Cambodia conducted in 2000. SUBJECTS: The prevalence of nightblindness among 13 358 nonpregnant women was 2.0%. A total of 328 nonpregnant women with nightblindness were matched by province with 1009 nonpregnant women without nightblindness. METHODS: Univariate and multivariate logistic regression models were used to estimate odds ratios (ORs) as estimates of the relative risk of factors associated with nightblindness. RESULTS: In a final model, materials in the wall of the house (OR 1.4, 95% confidence interval (CI) 0.9-2.0), land ownership < or =0.5 hectares (OR 1.4, 95% CI 1.0-1.9), nightblindness in last pregnancy (OR 44.5, 95% CI 29.2-67.8), parity >3 (OR 1.5, 95% CI 1.0-2.1), diarrhea within the last 2 weeks (OR 1.9, 95% CI 1.3-2.8), maternal body mass index <18.5 (OR 1.8, 95% CI 1.2-2.7), and lack of consumption of vitamin A-rich animal foods in the last 24 h (1-60 retinol equivalents (RE) OR 1.1, 95% CI 0.7-1.6; > or =60 RE, OR 0.7, 95% CI 0.4-1.0) were associated with nightblindness among nonpregnant women. CONCLUSIONS: Women of childbearing age in Cambodia with low socioeconomic status, low consumption of vitamin A-rich animal foods, a history of nightblindness during the previous pregnancy, parity >3, malnutrition, and diarrhea have a higher risk of nightblindness. SPONSORSHIP: United States Agency for International Development (442-G-00-95-00515-00).

Adolescent↗

Cost-effectiveness of USAID's regional program for family planning in West Africa.

Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

Adolescent↗

Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger.

OBJECTIVE: The 1998 evaluation sought to assess the Quality Assurance Project (QAP) in Niger since 1993 and the degree of quality assurance institutionalization in the Tahoua Department, and to summarize lessons from introducing the Integrated Management of Childhood Illness (IMCI) guidelines in a quality management (QM) environment. DESIGN: This evaluation collected data from interviews with staff and managers, from focus groups conducted in the communities, and from medical records. The data were then compared with three sources of evaluation criteria. A pre-project assessment provided a baseline across certain impact indicators for tracking progress. Other measures were derived from the objectives and indicators from the QAP/Tahoua project plan, the joint QAP/BASICS (Basic Support for Institutionalizing Child Survival Project) project plan, and from an additional US Agency for International Development (USAID) objective that the joint project be a model for West Africa. SETTING: The evaluation took place in the two departments of Niger in which the joint project was carried out: Tahoua and Dosso. The QA Project launched a pilot program in Niger in 1993 to strengthen newly decentralized regional and district management, and to improve the quality of primary health care in Tahoua. The principal QA Project approach was QM. The BASICS Project became active in Niger in 1995, helping to improve child health services. In 1997, the projects merged in Niger to form the joint QAP/BASICS Project. The Ministry of Public Health (MPH) planned to implement IMCI in 1998, and wished to determine whether QM facilitated the introduction of IMCI. RESULTS: The evaluation team found that QM had been effectively implemented in Tahoua and that there were related improvements in health program indicators. The team also found that the joint project had met most of its objectives and that QM facilitated the introduction of IMCI. A follow-up evaluation 2 years later found continued practice of QM by Nigerien health care providers. CONCLUSION: Several factors contributed to the success of the Tahoua QA program and the joint project: teamwork, focus on patients, clarity of roles through standards, and synergy between the QA Project and the BASICS Project.

Child Health Services↗

Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project.

BACKGROUND: In response to the growing HIV epidemic in Nigeria, the U.S. Agency for International Development (USAID) initiated the VISION Project, which aimed to increase use of family planning, child survival, and HIV/AIDS services. The VISION Project used a mass-media campaign that focused on reproductive health and HIV/AIDS prevention. This paper assesses to what extent program exposure translates into increased awareness and prevention of HIV/AIDS. METHODS: This analysis is based on data from the 2002 and 2004 Nigeria (Bauchi, Enugu, and Oyo) Family Planning and Reproductive Health Surveys, which were conducted among adults living in the VISION Project areas. To correct for endogeneity, two-stage logistic regression is used to investigate the effect of program exposure on 1) discussion of HIV/AIDS with a partner, 2) awareness that consistent condom use reduces HIV risk, and 3) condom use at last intercourse. RESULTS: Exposure to the VISION mass media campaign was high: 59%, 47%, and 24% were exposed to at least 1 VISION radio, printed advertisement, or TV program about reproductive health, respectively. The differences in outcome variables between 2002 baseline data and the 2004 follow-up data were small. However, those with high program exposure were almost one and a half (Odds Ratio [O.R.] = 1.47, 95% Confidence Interval [C.I.] 1.01-2.16) times more likely than those with no exposure to have discussed HIV/AIDS with a partner. Those with high program exposure were over twice (O.R. = 2.20, C.I. 1.49-3.25) as likely as those with low exposure to know that condom use can reduce risk of HIV infection. Program exposure had no effect on condom use at last sex. CONCLUSION: The VISION Project reached a large portion of the population and exposure to mass media programs about reproductive health and HIV prevention topics can help increase HIV/AIDS awareness. Programs that target rural populations, females, and unmarried individuals, and disseminate information on where to obtain condoms, are needed to reduce barriers to condom use. Improvements in HIV/AIDS prevention behaviour are likely to require that these programmatic efforts be continued, scaled up, done in conjunction with other interventions, and targeted towards individuals with specific socio-demographic characteristics.

Acquired Immunodeficiency Syndrome↗

An outbreak of a food-related illness resembling boric acid poisoning.

An outbreak of an illness suggestive of boric acid poisoning occurred among 51 persons who had eaten lunch at the cafeteria of the United States Agency for International Development in Islamabad, Pakistan, on February 11, 1990. Affected patients had headache and severe myalgias 2 to 4 hours after eating lunch. Fever, nausea and vomiting, red eyes, and photophobia were also reported. Among 25 patients (49%), a sunburn-like inflammation of the skin of the face developed, which subsequently desquamated. One patient required hospitalization for 1 day because of dehydration. Among all patients, the only symptoms remaining 72 hours after the meal were mild headache, fatigue, and peeling skin. Those persons who became ill were more likely to have eaten one particular food item (minestrone soup) for lunch than were those who did not become ill. A similar illness has been described following ingestion of boric acid. However, the results of an analysis of serum samples collected 3 days after the lunch from 24 patients did not show boron above normal background levels. Because of boron's short half-life, however, these data do not rule out the possibility that patients may have had higher boron levels at the onset of the illness.

Boric Acids↗

Local knowledge: research capacity building in international health.

Processes of building research capacity in international health projects and their implications for anthropology are addressed using examples from the Applied Diarrheal Disease Research project funded by the United States Agency for International Development. Two aspects of training are examined: the way interdisciplinary methods--qualitative and quantitative approaches--are presented to researchers, given the context of international health research culture; and how researchers' local knowledge and local concerns in pursuing health research relevant to policy led them to become interested in anthropology. The consequences for anthropology's place and product in future capacity building efforts in international health research are discussed.

Anthropology, Cultural↗

Use of sexually transmitted disease risk assessment algorithms for selection of intrauterine device candidates.

Sexually transmitted diseases (STD) are an important contraindication for intrauterine device (IUD) insertion. Nevertheless, laboratory testing for STD is not possible in many settings. The objective of this study is to evaluate the use of risk assessment algorithms to predict STD and subsequent IUD-related complications among IUD candidates. Among 615 IUD users in Kenya, the following algorithms were evaluated: 1) an STD algorithm based on US Agency for International Development (USAID) Technical Working Group guidelines: 2) a Centers for Disease Control and Prevention (CDC) algorithm for management of chlamydia; and 3) a data-derived algorithm modeled from study data. Algorithms were evaluated for prediction of chlamydial and gonococcal infection at 1 month and complications (pelvic inflammatory disease [PID], IUD removals, and IUD expulsions) over 4 months. Women with STD were more likely to develop complications than women without STD (19% vs 6%; risk ratio = 2.9; 95% CI 1.3-6.5). For STD prediction, the USAID algorithm was 75% sensitive and 48% specific, with a positive likelihood ratio (LR+) of 1.4. The CDC algorithm was 44% sensitive and 72% specific, LR+ = 1.6. The data-derived algorithm was 91% sensitive and 56% specific, with LR+ = 2.0 and LR- = 0.2. Category-specific LR for this algorithm identified women with very low (< 1%) and very high (29%) infection probabilities. The data-derived algorithm was also the best predictor of IUD-related complications. These results suggest that use of STD algorithms may improve selection of IUD users. Women at high risk for STD could be counseled to avoid IUD, whereas women at moderate risk should be monitored closely and counseled to use condoms.

Adult↗

Task analysis in education and evaluation: an application among midwives in the Republic of Yemen.

The political union between the countries of North and South Yemen prompted nurse-midwife educators to re-examine the midwifery curricula of both countries and define the roles midwives play as members of the health team, based on the unique circumstance in which Yemeni midwives operate within the health care system. The faculty of the Health and Manpower Institute (HMI), the main educational institution for the education of midwives, recognised that the delineation of tasks attributed to the practice of midwifery varied widely within Yemen, and between Yemen and other countries, despite the existing international definition of the role. In 1992, the Agency for International Development (AID) funded a workshop for the HMI faculty. Nineteen midwives, nurses and other health care professionals used task analysis techniques to define key knowledge, skills and attitudes that a midwife should be taught in Yemen. Task analysis, a psychometric (test development) technique, is a process that can be used to develop specific role delineations. This article describes in detail the process of task analysis in identifying key skills, knowledge and attitudes to be taught to student midwives in Yemen, clarifying the role of midwives and identifying the usefulness of a derived task listing in educational development and student evaluations.

Curriculum↗

An ecosystem report on the Panama Canal: monitoring the status of the forest communities and the watershed.

In 1996, the Smithsonian Tropical Research Institute and the Republic of Panama's Environmental Authority, with support from the United States Agency for International Development, undertook a comprehensive program to monitor the ecosystem of the Panama Canal watershed. The goals were to establish baseline indicators for the integrity of forest communities and rivers. Based on satellite image classification and ground surveys, the 2790 km2 watershed had 1570 km2 of forest in 1997, 1080 km2 of which was in national parks and nature monuments. Most of the 490 km2 of forest not currently in protected areas lies along the west bank of the Canal, and its management status after the year 2000 turnover of the Canal from the U.S. to Panama remains uncertain. In forest plots designed to monitor forest diversity and change, a total of 963 woody plant species were identified and mapped. We estimate there are a total of 850-1000 woody species in forests of the Canal corridor. Forests of the wetter upper reaches of the watershed are distinct in species composition from the Canal corridor, and have considerably higher diversity and many unknown species. These remote areas are extensively forested, poorly explored, and harbor an estimated 1400-2200 woody species. Vertebrate monitoring programs were also initiated, focusing on species threatened by hunting and forest fragmentation. Large mammals are heavily hunted in most forests of Canal corridor, and there was clear evidence that mammal density is greatly reduced in hunted areas and that this affects seed predation and dispersal. The human population of the watershed was 113 000 in 1990, and grew by nearly 4% per year from 1980 to 1990. Much of this growth was in a small region of the watershed on the outskirts of Panama City, but even rural areas, including villages near and within national parks, grew by 2% per year. There is no sewage treatment in the watershed, and many towns have no trash collection, thus streams near large towns are heavily polluted. Analyses of sediment loads in rivers throughout the watershed did not indicate that erosion has been increasing as a result of deforestation, rather, erosion seems to be driven largely by total rainfall and heavy rainfall events that cause landslides. Still, models suggest that large-scale deforestation would increase landslide frequency, and failure to detect increases in erosion could be due to the gradual deforestation rate and the short time period over which data are available. A study of runoff showed deforestation increased the amount of water from rainfall that passed directly into streams. As a result, dry season flow was reduced in a deforested catchment relative to a forested one. Currently, the Panama Canal watershed has extensive forest areas and streams relatively unaffected by humans. But impacts of hunting and pollution near towns are clear, and the burgeoning population will exacerbate these impacts in the next few decades. Changes in policies regarding forest protection and pollution control are necessary.

Animals↗

The potential of various foods to serve as a carrier for micronutrient fortification, data from remote areas in Indonesia.

OBJECTIVE: To estimate the potential of various industrially produced foods, to serve as a carrier for micronutrient fortification based on the frequency of their consumption in different socio-economic strata; to determine the role of fortified instant noodles as a source of micronutrients; to assess the contribution of plant foods, animal foods and fortified foods to vitamin A intake. SETTING: A survey was conducted in rural South Sulawesi and urban South Kalimantan between November 1996 and January 1997. SUBJECTS: Households (1500 in South Sulawesi; 2112 in South Kalimantan) were selected randomly by multi-stage cluster sampling. From each household, data were collected from the mother and her youngest child (0-5 y). DATA COLLECTION: Mothers were interviewed on various topics, including socio-economic status, food consumption, receipt of high-dose vitamin A capsules, health and nutritional status. RESULTS: Monosodium glutamate and salt were consumed daily in almost all households in both areas, and consumption was not associated with socio-economic status. Instant noodles were consumed in nearly all households in both areas, but consumption of fortified noodles was related to socio-economic status; it was highest among households of government employees and private investors, and lowest among farmers and share-croppers. Vegetables were the most important source of vitamin A in rural South Sulawesi, while foods of animal origin were the most important source in urban South Kalimantan. CONCLUSIONS: The results support double or triple fortification of salt and/or monosodium glutamate with iodine, vitamin A and/or iron. Efforts to overcome associated technical and logistical difficulties are urgently needed. SPONSORSHIP: Opportunities for Micronutrient Interventions (OMNI); United States Agency for International Development (USAID). European Journal of Clinical Nutrition (2000) 54, 822-827

Adult↗

Haemoglobin status of adult non-pregnant Kazakh women living in Kzyl-Orda region, Kazakhstan.

OBJECTIVE: To estimate the prevalence of anaemia among adult non-pregnant women in the Kzyl-Orda region of Kazakhstan, and to determine the association between haemoglobin concentration and anthropometric, socioeconomic, reproductive and dietary factors. DESIGN: A cross-sectional study using a randomly selected sample. Subjects were interviewed, and finger-prick blood samples and anthropometric measurements were collected. Associations between haemoglobin concentration and anthropometric and questionnaire data were evaluated by sequential linear regression analysis. SETTING: Health centres in Kazalinsk, Djalagash and Zhanakorgan districts of Kzyl-Orda region, Kazakhstan. SUBJECTS: Three-thousand six-hundred and twenty-five non-pregnant women aged 18-45 y randomly selected from health centre records. RESULTS: Iron deficiency anaemia, as reflected by low haemoglobin levels (Hb<12 g/dl), was detected in 40.2% of the total sample. There was a significant curvilinear relationship between haemoglobin concentration and age, with the nadir of the curve in the 30-40 y age-group. Haemoglobin concentration was found to be positively associated with body mass index (BMI) and socioeconomic factors. Significant negative associations were found between haemoglobin concentration and duration of menses, use of the intra-uterine contraceptive device and the consumption of tea. CONCLUSIONS: This study demonstrates that iron deficiency anaemia is present at considerable levels among adult women living in Kzyl-Orda region, Kazakhstan, and provides important baseline information for future research and public health interventions. SPONSORSHIP: Funding was provided by the United States Agency for International Development, Office of Nutrition, the United Kingdom Department for International Development, and the Polden-Puckham Trust.

Adolescent↗