Iron Deficiency in Sri Lanka

Dr. Renuka Jayatissa (M.B.B.S., M.Sc, M.D.) Nutrition Specialist, UNICEF

Major micronutrient deficiencies in Sri Lanka

1.Vitamin A

2.Iodine

3.Iron

Supplementation with vitamin A capsules since year 2000

Bitot’s spot

Blindness

Vitamin A Deficiency

Fortification of salt with Iodine since 1995 and elimination of IDDSuccessful programme of public and private partnership

Fortification of salt with Iodine since 1995 and elimination of IDDSuccessful programme of public and private partnership

Iodine Deficiency

Renuka/SL/2014

Goitre

Anaemia and Iron deficiency

Renuka/SL/2014

Renuka/SL/2014

Trends in the prevalence of anaemia among under five children

(Source: MRI 1973, 1996, 2001, DHS 2006 & MRI 2009, 2012)

70

45

29.9 30.625.4

15.1

0

10

20

30

40

50

60

70

80

1973 1996 2001 2006 2009 2012

Anaemia

Not much improvement since 2001. Only 0.6% reduction per year.

Trends in the prevalence of Anaemia in Sri Lanka

(Source: Mudalige and Nestel, 1996, MRI-1970, 1989, 1998, 2001, 2009, 2012 & DHS 2006

Reduction of anaemia in all age groups over 39 years. Still around 20% of the population has anaemia. When the prevalence of anaemia is >5% it will be considered as a public health problem by WHO. Renuka/SL/2014

Millions of anaemic children, adolescent girls and women in Sri Lanka

Renuka/SL/2014

Iron is critical for the early development of a child because it improves learning ability, physical coordination, and emotional development. Irreversible damages.

Prevalence of Anaemia in different sectors and age groups in Sri Lanka

(Source: Medical Research Institute 1996, 2001, 2009)

High in urban sector among children and high in plantation sector among adult female Renuka/SL/2014

Prevalence of anaemia in children aged 6-59 months of age by District IN 2012

26.9%25.6%

23.1%21.5%

20.3%18.6%

18.1%17.1%

16.9%16.2%

16.0%15.9%15.8%

15.4%15.3%

15.1%14.7%

14.3%13.6%

13.3%12.9%

11.1%10.0%

9.7%8.9%4.9%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

KillinochchiMonaragalaTrincomalle

PolonnaruwaPuttalam

JaffnaVauvniyaColombo

KandyAnuradhapura

KurunegalaBadulla

GampahaMannar

BatticaloSri LankaKalutara

MullativeAmpara

Nuwara EliyaMatale

RathnapuraMatara

HambantotaGalle

Kegalle

Renuka/SL/2014

Perc

en

tag

e

Renuka/SL/2014

Anaemia in Women 15-49 years of age by Districts in 2009Source- MRI 2009

Causes of anaemia – 6-59 months children in 2012

48%

12%

30%

5%5%

%

Iron Deficiency

Haemoglobinopathies

Abnormal red cell indices

Infections

Unkown

Renuka/SL/2014

Prevalence of Iron deficiency (serum ferritin <12µg) in children aged 6-59 months by District (n=5741)

45.443.2

4238.4

37.736.436.2

35.434.4

34.234.1

32.331.1313130.830.7

30.329.729.729.5

27.723.5

22.821.619.1

0 10 20 30 40 50

MatalePuttulum

MataraGalle

AnuradhapuraGampahaColombo

HambanthotaKillinochchi

KandyMonaragala

Sri LankaRatnapura

JaffnaBadulla

PolonnaruwaAmapara

NuwaraeliyaVavuniya

KurunegalaMannarKalutara

TrincomaleeBatticaloe

KegalleMullative

Renuka/SL/2014

Causes of Anaemia in adults

Population group No Anaemia ID

Free trade zone female garment workers in 2004

652 44.7% 66.6%

Adult female (20-39 years) in central province in 2005

863 27.7% 41.4%

Source: MRI 2004, 2005

It estimates that major cause of anaemia is iron deficiency

Renuka/SL/2014

Iron deficiency (serum ferritin <12µg) among children age 6-59 months, by wealth quintile (MRI 2012)

30.332.1 32.4 33.7 33.2 32.3

0

5

10

15

20

25

30

35

40

Poorest Poor Middle Rich Richest National

%

Not much variation between wealth quintiles.

Renuka/SL/2014

Why Should Fighting Iron Deficiency Anemia be a National Priority?

For each US $1 spent on an iron supplementation program for pregnant women, there is a US $24 return in increased lifelong wages and decreased disability,

For each US $1 spent on iron fortification of food there is a US $84 return in increased productivity and decreased disability of the consumer,

Work output in many occupations can increase 10 to 30% when workers are given iron supplementation,

Prevention and treatment of iron deficiency and anemia can raise national productivity by 20%.

Thank you