AZERBAIJAN NUTRITION SURVEY (AzNS), 2013 TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................................... 8 ACRONYMNS .............................................................................................................................. 9 1. EXECUTIVE SUMMARY .........................................................................................................10 2. INTRODUCTION .....................................................................................................................13 2.1. Country context ...............................................................................................................13 2.2. Health and nutrition situation in Azerbaijan......................................................................13 2.3. Programmes to combat malnutrition in Azerbaijan ..........................................................14 3. RATIONALE AND OBJECTIVES ............................................................................................15 3.1. Rationale for the study .....................................................................................................15 3.2. Primary objectives ...........................................................................................................15 3.3. Secondary objectives ......................................................................................................15 4. METHODOLOGY ....................................................................................................................16 4.1. Survey Design ..................................................................................................................16 4.2. Study sites (Geographical) ...............................................................................................16 4.3. Study populations ............................................................................................................17 4.4. Sampling ..........................................................................................................................18 4.4.1. Sampling procedure .................................................................................................18 4.4.2. Sample size determination ......................................................................................19 4.5. Ethical Considerations .................................................................................................... 20 4.6. Field Work and Data Collection ....................................................................................... 20 4.6.1. Community mobilization and sensitization .............................................................. 20 4.6.2. Field Team Composition ......................................................................................... 20 4.6.3. Training of survey teams ......................................................................................... 21 4.6.4. Field work phases .................................................................................................. 23 4.6.5. Cold chain for blood samples ................................................................................. 23 4.6.6. Processing of blood samples at RIHT ..................................................................... 23 4.7. Biomarker testing methods ............................................................................................. 24 4.7.1. Anaemia ................................................................................................................... 24 4.7.2. Iron (plasma ferritin/sTfR), acute phase proteins (CRP, AGP), and vitamin A (RBP) 24 4.7.3. Plasma zinc ............................................................................................................. 25 4.7.4. Anthropometry ........................................................................................................ 25 4.7.5. Presence of iodized salt at the households ............................................................. 26 4.8. Data Management and Analysis ..................................................................................... 26 4.8.1. Data entry ............................................................................................................... 26 4.8.2. Data analysis .......................................................................................................... 27 4.8.3. Definitions of micronutrient markers ...................................................................... 29 4.8.4. Calculation of wealth index and socioeconomic status .......................................... 30 4.8.5. Anthropometry in children 0-59 months of age ...................................................... 30 4.8.6. Anthropometry in non-pregnant women and pregnant women ............................. 31 5. RESULTS ............................................................................................................................... 32 5.1. Household Characteristics .............................................................................................. 32 5.1.1. Response rates and characteristics of households ................................................. 32 5.1.2. Socio-economic status ............................................................................................ 34 5.1.3. Agricultural activities and livestock ownership ........................................................ 34 5.1.4. Cooking arrangement ............................................................................................. 34 5.1.5. Water and sanitation ............................................................................................... 34 5.1.6. Salt iodization .......................................................................................................... 36 2 2013 AZERBAIJAN NUTRITION SURVEY 5.2. Pre-School Age Children ................................................................................................. 40 5.2.1. Response rates and characteristics of respondents ............................................... 40 5.2.2. Recent morbidity and treatment ............................................................................ 42 5.2.3. Infant and Young Child Feeding Indicators .............................................................. 44 5.2.4. Consumption of vitamins and supplements ........................................................... 46 5.2.5. Anthropometry ....................................................................................................... 46 5.2.6. Anaemia, iron deficiency, and iron deficiency anaemia .......................................... 52 5.2.7. Vitamin A deficiency ................................................................................................ 55 5.2.8. Zinc deficiency ........................................................................................................ 57 5.3. Non-Pregnant Women of Reproductive Age ................................................................... 59 5.3.1. Response rates and characteristics of respondents ............................................... 59 5.3.2. Antenatal care and delivery .................................................................................... 61 5.3.3. Knowledge and practices related to fortified flour and salt .................................... 61 5.3.4. Consumption of vitamins and supplements ........................................................... 63 5.3.5. Anthropometry ....................................................................................................... 63 5.3.6. Anaemia, iron deficiency, and iron deficiency anaemia .......................................... 66 5.3.7. Vitamin A deficiency ................................................................................................ 68 5.4. Pregnant Women ............................................................................................................ 69 5.4.1. Response rates and characteristics of respondents ............................................... 69 5.4.2. Anthropometry ....................................................................................................... 70 5.4.1. Anaemia .................................................................................................................. 70 6. CONCLUSION ....................................................................................................................... 72 7. RECOMMENDATIONS ............................................................................................................74 8. REFERENCES ........................................................................................................................ 80 Appendix 1: A priori sample size calculations ........................................................................ 84 Appendix 2: Letters of approval of protocol from MOH and President’s Office .................. 86 Appendix 3: Survey Training Agendas .................................................................................... 88 Appendix 4: Supplementary household tables ...................................................................... 98 Appendix 5: Supplementary child tables ...............................................................................106 Appendix 6: Supplementary non-pregnant and pregnant women’s tables ........................ 115 Appendix 7: List of selected clusters.....................................................................................