Prevalence of Anemia among Pregnant Women and its Determinants in Northern Nigeria.

Objectives: We conducted a baseline survey in Northern Nigeria to determine the coverage, adherence, prevalence, barriers and facilitating factors affecting utilization of prenatal iron and folate supplementation (IFAS) from service delivery and recipient perspectives. Methods: The survey employed both quantitative and qualitative methods. Anemia (hemoglobin concentration Hb<110 g/L. g/L, Hemocues®) was measured among 1664 pregnant women 15-45 years. Results: The prevalence of anemia was high across all states surveyed (Jigawa 71.1%, Katsina 61.4%, Yobe 88.8%, Zamfara 62.2%). Although 70% of women from all states received some IFAS in their last pregnancy, <50% reported consuming IFAS ≥90 days. Utilization of IFAS among pregnant women was affected by such factors as misconception about IFAS, influences of male spouse and older women. Religion and cost were not found to constitute barriers to IFA utilization. Knowledge of health workers on how to track IFAS utilization was generally low. Most health facilities surveyed reported no IFA stock-out in the three-month preceding the survey. Over 55% of interviewed women knew the benefits of ANC in pregnancy from all the state and >60% knew the benefits of IFAS in pregnancy. Conclusions: This study has confirmed that anaemia is a problem among pregnant women in Nigeria. Despite awareness about ANC and IFAS and relatively high coverage of distribution of IFAS, utilization is relatively low. Neither the awareness of IFAS nor ANC attendance translates to IFA utilization. There is a need to address some misconceptions about IFAS resulting from cultures, beliefs and influence of male spouses and older women through Behaviour Change Communication (BCC) interventions.

Validation of a Photo Atlas for Food Portion Estimation for a National 24-hr Recall Dietary Survey in Kenya.

Objectives: Reliance on respondents’ individual recall ability for accurate dietary data collection is always a challenge. We developed a photo atlas to aid respondents in recall of foods eaten during the interactive 24 hr recall multiple pass approach for data collection during the Kenya National Micronutrient Survey 2011. Photographs of foods are preferred for estimating portion sizes because the amount eaten is easier for the respondent to visualize. However, it was necessary to validate the photo atlas before using it. Methods: Seven common Kenyan food items were chosen for validation of the atlas: cassava root, tomatoes, eggplant, raw chicken wings and legs, watermelon and fried dough. Each color photo displayed three differently sizes of each food item to capture “large,” “medium,” and “small”. Actual food portions were used for comparison with the photos. Volunteers were asked to rate the level of similarity between the actual-life food item and the item in the photograph on a scale of 1 to 5. Five indicated “Perfect Match” and one indicated “Not a Match.” 84 volunteers from KEMRI and Kibera were conveniently selected for the validation exercise. Results: Exact matches were highly observed in all sizes of whole foods (onions (52.4; 61.9%; 59%), tomatoes (59.5%; 58.3%; 63.1%) and eggplants 35.7%; 27.4% and 63.1%) compared to sliced food items. No significant differences observed between female and male matches of food items. Conclusions: Identification of difficult to recall foods can be presented as food albums and used as dietary data collection tools.