Dietary Sources of Iron in
Uganda
Data from the 2009/2010 Uganda
National Panel Survey
Jack Fiedler, Leanne Dougherty, Celeste Sununtnasuk
Uganda National Panel Survey
2009/10 UNPS
• A national survey representative at the
regional level
• Modules: Household, Agriculture,
Community
• Sample size: 2,898 households
• The 2010/11 survey of the same
households has just been released.
• Another survey is currently being done
Uganda National Panel Survey
2009/10 UNPS
• Household food consumption
– 61 food items
– Source: purchases, own productions, gifts
• Household crop production
– 57 crops, including 49 food crops
– Livestock and small animal ownership, fishing
What information does the UNPS contain
that could be useful in fighting anemia?
The consumption module can be used to
estimate:
1. Dietary diversity
2. Identify the sources of iron-rich foods
being consumed
3. Iron intake levels
a. The prevalence of inadequate iron
intake (usual daily intake and EAR)
b. The magnitude of the iron intake gap
UNPS Consumption Module
4. Coverage of food fortification vehicles
5. Commercial fortification impact
simulations
UNPS Agricultural Module
1. The sources of iron-rich foods being
produced
2. What happens to the food that is
produced (eaten, sold, stored, etc.)
3. Animal ownership and raising: potential
food sources of high bioavailable
(heme) iron
UNPS: Consumption Module
61 Items
Dietary Diversity and Nutrition
• Household Food and Diet Diversity
– Number of unique food groups consumed
over a given reference period
• Highly predictive of micronutrient intake
adequacy of women
• Highly correlated with hemoglobin
concentrations in women and children
U5 (and children’s anthropometric
measures, caloric and protein adequacy
and birth weight)
Common Food Groups
Cereals
Fruits
Roots and Tubers Legumes
Vegetables
Nuts
Eggs
Milk
Meat and Poultry
Fish
Fat and Oils Sugar and Sweets
HarvestPlus Food Composition Table (FCT)
Nutrient content per 100g of edible food for more than 700 food descriptions
Top 20 Food Sources for Iron Intake
in Uganda, Nationwide
Rank
Food Item
%
Cumulative %
Rank
Food Item
%
Cumulative %
1
Sweet Potatoes
14.7
14.7
11
Millet
2.3
76.7
2
Matooke
12.5
27.2
12
Tomatoes
2.2
78.9
3
Beans, dry
9.3
36.5
13
Beans, fresh
2.0
80.9
4
Cassava
8.4
44.9
14
Beef
2.0
82.9
5
Cassava Flour
7.8
52.7
15
Mango
1.8
84.7
6
Dodo (Amaranth)
5.2
57.9
16
Fish, smoked
1.6
86.3
7
Maize Flour
5.1
63.0
17
Nuts
1.2
87.5
8
Sorghum
4.7
67.7
18
Eggs
1.2
88.7
9
Vegetables, other
4.4
72.1
19
Irish Potatoes
1.1
89.8
10
Bread
2.4
74.5
20
Sesame
1.1
90.9
95% are plant sourced
Top 10 Food Sources for Iron Intake
by Region
Kampala
%
Central
%
Eastern
%
Northern
%
Western
%
Matooke
14.3
Matooke
22.0
Sweet Pot.
19.5
Cassava
12.5
Matooke
22.6
Bread
13.2
Sweet Pot.
16.6
Cassava Fl.
11.5
Cassava Fl.
12.4
Sweet Pot.
15.9
Beans (d)
10.4
Beans (d)
11.3
Matooke
7.1
Sorghum
12.1
Beans (d)
11.6
Sweet Pot.
7.9
Cassava
8.0
Maize Fl.
6.7
Veg (other)
10.5
Dodo
8.3
Maize Fl.
6.2
Maize Fl.
6.8
Beans (d)
6.5
Sweet Pot.
9.7
Cassava
6.5
Beef
4.5
Tomatoes
3.3
Dodo
6.2
Beans (d)
8.9
Cassava Fl.
6.2
Cassava
3.8
Bread
3.2
Sorghum
5.7
Dodo
4.1
Maize Fl.
4.5
Eggs
3.8
Dodo
3.0
Cassava
5.5
Sesame
3.8
Millet
3.8
Tomatoes
3.8
Beef
2.6
Veg (other)
4.2
Maize Fl.
2.9
Beans (f)
3.2
Veg (other)
3.5
Beans (f)
2.4
Millet
2.6
Mango
2.5
Irish Pot.
2.0
Estimating iron consumption
• Combining the UNPS food list data with
food composition tables allows
estimating the apparent household
intake of iron
• With an assumption about how the
food is distributed within the household
distribution, these estimates can
provide a proxy measure of individual
iron intakes
Average Daily Iron Intakes and
Inadequacies (mg/day)
Mean
SE
95% CI
# Inadequate
% Inadequate
A2Z-GAIN-WFPMakerere Survey
Kampala
11.5
0.58
10.3
12.6
1,148
87.6
89
Central
10.7
0.54
9.6
11.7
3,820
87.2
Eastern
14.2
0.54
13.1
15.2
3,485
76.1
Northern
13.6
0.64
12.4
14.9
3,430
77.9
71
Western
13.4
0.43
12.6
14.2
3,249
80.0
65
NATIONAL
12.8
0.27
12.3
13.4
15,175
81.0
Average Daily Iron Intakes and
Inadequacies by Type of HH
# People
Mean II
95% CI
# Inadequate
% Inadequate
NonAgricultural
Households
3,093
10.3
9.4
11.1
2,756
89.1
Agricultural
Households
15,641
13.3
12.7
13.9
12,450
79.6
NonLivestock
Households
4,846
11.7
10.9
12.4
4,095
84.5
Livestock
Households
13,888
13.2
12.6
13.8
11,083
79.8
Agricultural
Households
w/
Livestock
13,393
13.3
12.7
13.9
10,647
79.5
NATIONAL
18,734
12.8
12.3
13.4
15,175
81.0
Percent of Ugandans in Households Purchasing
Iron Food Fortification Vehicles
Kampala
Central
62%
Wheat Flour
61%
45%
26%
Eastern
27%
20%
Northern
19%
12%
Western
39%
8%
Uganda
34%
20%
Region
Maize Flour
Coverage and Additional Iron Intake
with Alternative Fortification Vehicles
Portfolio
1: Maize
2: Wheat
10: Maize + Wheat
Percent of
Households
Covered
34%
20%
43%
Iron
Iron
(mg)
(mg)
Mean Median
5.50
3.30
1.60
1.00
2.10
0.00
Estimated Average Requirements of iron:
Non-pregnant woman 19-30y: 8.1; Children 1-3: 3.0
A modest contribution, but with the increase in
anemia vulnerability, a potentially important one.
UNPS agricultural module
•
•
•
•
•
Food crops
Animal ownership
Livestock, poultry, fish
Animal products
Biofortified crops? (Could model
adoption and production of orange
flesh sweet potato-with minor
modifications)
UNPS: Agriculture Module
57 Crops
Production of Top Iron-Source Crops
Percent of households producing some of the crop, first or second season
Sweet
Potatoes
Matooke
Beans
Cassava
Dodo
Maize
Sorghum
Kampala
3.7%
4.1%
4.5%
4.1%
0.8%
5.7%
0.0%
Central
45.2%
51.6%
55.2%
50.9%
0.9%
58.1%
1.4%
Eastern
50.1%
28.7%
46.9%
67.5%
1.0%
71.2%
25.9%
Northern
44.4%
7.9%
55.9%
66.2%
0.4%
61.5%
51.5%
Western
52.6%
65.9%
83.4%
44.3%
0.2%
52.3%
15.0%
NATIONAL
44.3%
35.1%
55.4%
53.1%
0.6%
56.3%
21.8%
Farmer iron-production profiles
• Under-development: Estimates of the
total iron availability in the food crops
produced by individual farming
households
• Method: Combine information from
the Uganda food composition table
with the quantity of each food crop
produced by season
Households that owned or raised
livestock in the previous 12 months
Livestock, Poultry, Fish
Households owning or raising livestock, small animals, or that fish
Cattle
Goats
Pigs
Sheep
Chicken
Fish
Kampala
2.9%
3.3%
2.0%
0.0%
4.1%
0.0%
Central
26.3%
28.7%
27.3%
4.4%
38.2%
3.0%
Eastern
43.0%
48.0%
16.7%
7.2%
69.0%
4.1%
Northern
38.9%
54.9%
10.1%
14.5%
63.5%
3.0%
Western
23.0%
44.9%
17.2%
8.9%
48.0%
0.9%
NATIONAL
30.5%
40.8%
16.5%
8.1%
50.6%
2.6%
(Livestock & fish: last 12m; chickens: last 3m; others: last 6m)
Production of Animal Products
Percent of households producing in past 12 months
Meat
Eggs
Milk
Ghee
Kampala
0.0%
1.2%
1.6%
0.4%
Central
0.3%
5.6%
12.5%
1.3%
Eastern
0.4%
9.8%
18.4%
0.6%
Northern
0.8%
2.5%
11.0%
0.7%
Western
1.4%
5.9%
13.8%
1.3%
NATIONAL
0.7%
5.5%
12.9%
0.9%
Nutrition Programs are Generally Managed as
Stand-alone, Independent Interventions
Biofortified Food
Programs
Insecticide Treated
Bednets
Food Fortification
Programs
Nutrition
Status
Point-of-Use
Fortification (MNP)
Programs
Deworming
Iron Supplementation
Programs
26
An Integrated Nutrition Policy Requires an
Understanding of the Programs’ Interactions and
Their Harmonization as a Portfolio
Biofortified Food
Programs
Insecticide Treated
Bednets
Food Fortification
Programs
Nutrition
Status
Point-of-Use
Fortification (MNP)
Programs
Deworming
Iron Supplementation
Programs
27
UNPS and Anemia Strategies
• Anemia rates in Uganda:
– 49% of children under 5 years
– 23% of women 15-49 years
• The UNPS can help identify:
– Prevalence of inadequate iron intake across
regions and populations
– Consumption patterns of iron-rich foods
– Production patterns of iron-rich foods
– Potential iron fortification vehicles
Going Forward
• Could UBOS, MAAIF and MOH regularly
produce a UNPS report on agriculture
and food security issues?
• Could a working group of UBOS,
MAAIF, MOH, Makerere strengthen the
UNPS as a tool for addressing food and
nutrition issues?
Thank You
Questions or Comments?