Building on Uganda’s Progress in Reducing Anemia: From Evidence to Action Jack Fiedler, Deepali Godha, Manisha Tharaney, Jolene Wun, Alex Mokori, Sarah Ngalombi Presentation Outline • Anemia Situation in Uganda • Rationale for the Anemia Landscape Analysis • Methods • Findings of the Study • National Stakeholder Meeting • Next Steps 2 Anemia in Uganda • Major public health issue for many years • Earliest national survey in 2001: – 71% of children <5 years – 37% of women of reproductive age • 2002- National Anemia Policy 3 Trends in Anemia in Uganda Children (6-59m) and Non-Pregnant Women (15-49y) 6-59m Women 15-49y 80 72 73 ) % 70 ( a i m 60 +1% e 50 n A 50 41 f -32% o 36 40 e c -32% n e 30 23 l a +14% v e 20 r P -44% 10 0 2000/01 2006 2011 Women’s anemia rates have been about half the rate of children, and have fluctuated relatively more over the 10 year period. 4 Rationale for the Analysis • To assess the plausibility of key anemia prevention and control programs that may have contributed to the decline among women and children • To stimulate cross-program and multi- sectoral discussion around anemia programing • To develop consensus about which programs may have been the largest contributors 5 Data: Uganda Demographic and Health Surveys • DATABASE: 3 Household surveys 2001,2006 and 2011 conducted by the Uganda Bureau of Statistics (UBOS) • SAMPLE: stratified, two-stage cluster – 2000/01: 7,885 households – 2006: 8,807 households – 2011: 10,086 households • REPRESENTATIVENESS: Provides estimates of population and health indicators: – Nationwide, – By rural and urban areas – By regions (definitions change over time) 6 Sample Analyzed UDHS Population 2001 2006 2011 Women 15-49 years Not pregnant at the 7988 3505 3208 time of survey Had at least one birth 7609 3320 2918 at the time of the survey Children 6-59 months Children 6-23 months 2122 2367 2218 Children 24-59 months 3561 4415 4340 7 Changes in the Prevalence of Childhood Anemia by Region m 90 9 81 5 78 - 6 80 72 73 n e r 70 63 d 62 l i h C 60 52 54 50 n i a 50 i m e 40 n 31 A f 30 o -20 ppt -19 ppt -24 ppt -32 ppt -23 ppt e c 20 n e l a 10 v e r P 0 Central Eastern Northern Western Nationwide 2006 2011 The largest gains were in Western—where rates were already the lowest—and in Northern Region. Note: ppt = percentage points 8 Changes in the Prevalence of Childhood Anemia by Mothers' Educational Attainment m 76 80 9 74 5 - 69 2006 2011 6 70 n e r 59 d 60 l hi 52 50 C 46 n 50 i 42 a i m 40 e n A 30 f o e c 20 n e l a v 10 e r P 0 no education primary secondary higher Educational Attainment of Mother Differences in anemia prevalence by educational level narrowed. The uneducated had the largest reductions. Note: ppt = percentage points 9 Changes in the Prevalence of Childhood Anemia by Household Wealth Quintile 90 m 80 9 2006 2011 75 5 80 73 74 - 6 n 70 e 62 61 r d hil 60 53 52 C n 50 i 42 a 38 i m 40 e n A 30 of -21 ppt -32 ppt -23 ppt e 20 c n e 10 l a v e r 0 P poorest poorer middle richer richest Household Wealth Quintile Differences in the anemia prevalence rates by household wealth grew. The two richest quintiles’ rates fell to about 40%, others remained above 50% Note: ppt = percentage points 10