Somalia Vitamin A

South Africa

Iron

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EPIDEMIOLOGICAL DATA
   
Anemia
Most Recent Anemia Survey  
Date: October 1994
Groups Surveyed: National survey conducted in all 9 provinces (rural and urban areas) among children 6 – 71 months.  Assessments included hemoglobin serum ferritin and MCV
Sample Size: 11 430
Sampling Method: National probability sample with disproportionate stratification by province. A total of 360 cluster of households  studied of which 358 were available for analysis.  A total of 18,219 households (19 003 families) selected.  Age and gender and rural/urban groups fairly equally distributed
Estimated Anemia Prevalence:  National and provincial prevalence's only available for children 6 – 71 months.  No national and provincial representative data are available for women.

Area/Location/Group:   

Sample Size

Prevalence/Indicator

National (children 6-71 months)

4494

21,4% (Hb<11g/dL)

National (children 6-71 months)

4456

9,8% (Ferritin <12mg/L)

National (children 6-71 months)

4206

5% (Hb<11g/dL; Ferritin <12mg/L)
 
 

POLICY AND LEGISLATION
Legislation on IDA
     South Africa has legislation on IDA.  There are regulations related to fortification (See relevant section).  Draft regulations for mandatory fortification to be published within the next two months.  Final regulations will be published by the end of 2002.  Enforcement of the regulations will come into effect early in 2003. 
    

There is national policy on iron supplementation for pregnant women.  Prophylaxis (Hb = 10g/dL): Ferrous sulphate 200 mg daily, to be given to all pregnant women.  Treatment for severe anemia (Hb <7 g/dL):  ferrous sulphate 200 mg, 3 times daily.  Treatment for mild anemia 7.0 - 9.9 g/dL): 200 mg 3 times daily.

 
     There is national policy on iron supplementation for children. 

Iron drops

(ferrous lactate 25 mg per ml):

Age / Weight

Therapeutic (5mg/kg/d in 3 doses)

Prophylactic (1.5mg/kg once a day)

1 wk up to 4 weeks of age or2.0 kg to < 3kg

0.2 ml  3 x per day

0.3 ml once a day

4 wks up to 2 months/3.0 kg up to 4 kg

0.4 ml 3 x per day

0.6 ml once a day

 

Iron syrup

(ferrous sulphate 30 mg elemental iron per 5 ml):

Age / Weight

Therapeutic (5 mg/kg/d in 3 doses)

Prophylactic (1mg/kg once a day)

2 months up to 4 months of age

1.5 ml 3 x per day                           

1 ml once a day

4 months up to 12 months of age                                                         

2.5 ml 3 x per day                          

1.5 ml once a day

 

12 months up to 3 years of age                                                             

4.0 ml 3 x per day                          

2 ml once a day

 

3 years up to 5 years of age (14 - 19kg)                                              

5.0 ml 3 x per day

3 ml once a day                        

 
 
Government Agency to Address IDD
     The government agency that deals with IDA is the Department of Health.  The agencies function is coordination, monitoring and funding.
     Contact information:  Director: Nutrition, Private Bag X828, Pretoria, 0001, South Africa
     
     

PROGRAM DATA
   
 Supplementation - (Women)
Targeting

    

Pregnant women

    

Number targeted is 935,800.
   
Capsule Information

    

Ferrous sulphate 200 mg daily (see protocol given above).

    

Folic acid 5 mg daily for the first trimester.
Implementation

    

Supplements are distributed in antenatal clinics.

    

The intended frequency of supplementation is daily doses to all pregnant women for the duration of the pregnancy.
   
Supplementation - (Children)
Targeting

    

Same as above.

    

Coverage of prophylactic supplementation varies between provinces.  An estimated 1,328,090 are targeted for treatment.
Capsule Information

    

Iron tablets are distributed at clinics, health centers and hospitals.

    

Intended frequency of dosing is daily.
 
Fortification

    

Fortification is with a mixture of micronutrients; including vitamin A, thiamin, riboflavin, niacin, B6, folic acid, iron and zinc.  The fortification of maize meal and wheaten flour will be mandatory for all maize meal and wheaten flour and the programme will be monitored. The standards for fortification is  37mg iron/kg maize meal and 43 mg iron/kg wheaten flour. The compound is reduced (electrolytic iron).

    

Exact figures on the amount of iron fortificant that is being produced are not available.  Iron is used by private companies for the manufacture of animal feeds, micronutrient supplements, food supplements and for the voluntary enrichment of food.

    

Food Companies are enriching bread and maize meal and other food commodities on a voluntary basis.  Exact figures are therefore not available.   Approximately 3,179,416 MT maize meal and 1,864 622 MT wheat flour will be fortified with iron (premix specification:  178.57g iron/kg  wheaten flour/maize meal.  Dosage: 200g premix per ton wheaten flour/maize meal)

Which foods are now fortified?

Yes

No

Status of program (e.g. legislated, piloted, implemented)

Approx. % commodity fortified

Level of fortification/ iron content

Is fortification monitored?

YES*

NO

Bread

Y

 

Current enrichment voluntary

Few companies enrich voluntary

Varies

 

No

Biscuits

Y

 

Voluntary enrichment

Few brands

Varies

 

No

Fish Sauce

 

No

 

 

 

 

 

Soy Sauce

 

No

 

 

 

 

 

Wheat Flour

 

 

Current enrichment voluntary

Draft mandatory regulations ready for publication

Few companies enrich voluntary

Varies

 

No

Maize

 

 

Current enrichment voluntary

Draft mandatory regulations ready for publication

Few companies enrich voluntary

Varies

 

No

Other (specify)

 

 

 

 

 

 

 
 
Dietary Change

    

A nutrition campaign to promote improved iron status via dietary change is scheduled for April 2002.

    

Community-based organizations can apply for government funding to start projects that would improve iron status, e.g. food gardens.
Other Programs
     The Department of Health is implementing  malaria control programmes.
     Parasite control programmes are also implemented in 3 affected provinces (KwaZulu-Natal, Mpumalanga, and the Western Cape).
     
     
 

MONITORING
 
Anemia
Current monitoring activities for iron deficiency anemia:
    

All pregnant women should have an Hb measurement at the first antenatal visit and again at 28 and 36 weeks.  Essential data, including hemoglobin test results should be collected on a regular basis (weekly or monthly) at all centers providing maternity care (clinics to community health centers to level 1, level 2 and level 3 hospitals) .  Data are presented to the maternity staff at audit meetings and also be sent to the provincial maternal and child health directorates to facilitate planning of health services.
     An impact evaluation is planned for 2004/2005.
     There is facility-based monitoring of anemia.

    

A portable haemoglobinometer or copper sulphate test are used for field tests.

    

Coverage of iron supplementation currently does not form part of the minimum essential data set of the District Health Information System.

    

A monitoring system for the fortification programme will be developed in 2002, and will be in place in 2003, when enforcement commences.
     
     

PROGRAM RESOURCES
Donor and Implementing Agencies

    

Unicef and MI provide technical support, support of training, capacity-building and IEC.