Oman National Nutrition Survey 2017 Technical Support Donors Table of Contents Executive Summary I 1. Introduction 1 1.1 Country overview ............................................................................................ 2 1.2 Nutrition situation in Oman ............................................................................. 2 1.3 Programs to combat malnutrition in Oman...................................................... 3 1.4 Survey goals and hypotheses ......................................................................... 3 1.5 Primary objectives and indicators ................................................................... 4 1.6 Secondary objectives and indicators .............................................................. 4 2. Methodology 7 2.1 Study populations............................................................................................ 8 2.2 Sampling procedure........................................................................................ 9 2.3 Sample size determination............................................................................... 9 2.4 Ethical considerations...................................................................................... 10 2.5 Field work and data collection.......................................................................... 10 2.5.1 Training of survey teams................................................................... 10 2.5.2 Field work.......................................................................................... 11 2.5.3 Cold chain and processing of blood samples.................................... 12 2.6 Measurement and definitions of outcomes..................................................... 12 2.6.1 Calculation of wealth index and socio-economic status................... 12 2.6.2 Estimations of flour and oil intake per adult male equivalent............ 12 2.6.3 Anthropometric measurements and indices and indicators of child feeding....................................................................................... 13 2.6.4 Calculation of sun exposure index....................................................... 13 2.7 Biological testing methods............................................................................... 14 2.7.1 Anemia.............................................................................................. 14 2.7.2 Iron, vitamin A, and acute phase proteins......................................... 14 2.7.3 Vitamin D........................................................................................... 14 2.7.4 Plasma folate and vitamin B12.......................................................... 14 2.7.5 Hemoglobinopathies......................................................................... 14 2.8 Case definitions for blood biomarkers................................................................. 15 2.9 Data management and analysis...................................................................... 16 2.9.1 Data entry.......................................................................................... 16 2.9.2 Data analysis.................................................................................... 16 3. Results 41 3.1 Response rates for households, children, and women................................... 42 3.2 Household characteristics............................................................................... 44 3.2.1 Demographic characteristics............................................................. 44 3.2.2 Indicators of household wealth............................................................ 44 3.2.3 Water and sanitation.......................................................................... 45 3.2.4 Household purchases of vegetable oil and wheat flour..................... 46 3.3 Preschool children.......................................................................................... 50 3.3.1 Characteristics.................................................................................. 50 3.3.2 Health indicators............................................................................... 50 3.3.3 Infant and young child feeding indicators.......................................... 51 3.3.4 Consumption of vitamins and supplements...................................... 67 3.3.5 Parent’s perceptions of child’s weight and height............................. 67 3.3.6 Stunting............................................................................................. 68 3.3.7 Wasting............................................................................................. 71 3.3.8 Overweight and obesity..................................................................... 73 3.3.9 Underweight...................................................................................... 75 3.3.10 Anemia, iron deficiency, and iron deficiency anemia........................ 76 3.3.11 Sickle cell and beta thalassemia....................................................... 78 3.3.12 Risk factors for anemia..................................................................... 79 3.3.13 Risk factors for iron deficiency.......................................................... 80 3.3.14 Vitamin A deficiency.......................................................................... 81 3.3.15 Vitamin D deficiency and insufficiency............................................... 83 3.3.16 Correlation between micronutrient deficiencies and growth indices 85 3.3.17 Physical activity and sleep patterns.................................................. 85 3.3.18 Sun exposure.................................................................................... 86 3.3.19 Comparison to 2009 nutrition survey of children less than 5 years of age.................................................................................................... 87 3.4 Non-pregnant women of reproductive age...................................................... 90 3.4.1 Characteristics.................................................................................. 90 3.4.2 Dietary diversity & consumption of vitamins and supplements......... 91 3.4.3 Knowledge and use of fortified foods................................................ 92 3.4.4 Undernutrition and overweight.......................................................... 93 3.4.5 Risk factors for overweight and obesity............................................. 98 3.4.6 Anemia, iron deficiency, and iron deficiency anemia........................ 99 3.4.7 Sickle cell trait and beta thalassemia................................................ 101 3.4.8 Risk factors for anemia..................................................................... 102 3.4.9 Risk factors for iron deficiency.......................................................... 103 3.4.10 Vitamin A deficiency.......................................................................... 104 3.4.11 Folate deficiency............................................................................... 104 3.4.12 Vitamin B12 deficiency....................................................................... 105 3.4.13 Vitamin D deficiency and insufficiency.............................................. 106 3.4.14 Physical activity and sleep patterns.................................................. 108 3.4.15 Sun exposure.................................................................................... 109 3.5 Adolescent women.......................................................................................... 111 3.6 Pregnant women............................................................................................. 112 3.6.1 Characteristics.................................................................................. 112 3.6.2 Dietary diversity and consumption of vitamins and supplements..... 113 3.6.3 Underweight..................................................................................... 114 3.6.4 Anemia............................................................................................. 115 4. Discussion 119 5. Recommendations 125 6. References Appendix Appendix 1. A priori sample size calculations...................................................... 134 Appendix 2. Teams, team members, and supervisors......................................... 135 Appendix 3. Comparison of plasma retinol and retinol binding protein................ 137 Appendix 4. Additional household tables............................................................. 139 Appendix 5. Additional child tables...................................................................... 142 Appendix 6. Additional woman tables................................................................. 145 Appendix 7. Analysis of data quality..................................................................... 151 Appendix 8: Survey questionnaires (English)...................................................... 155 Appendix 9: Survey questionnaires (Arabic)........................................................ 186 List of Tables Table 1. Summary of major dietary and nutritional indicators in children less than 5 years of age, non-pregnant women 15-49 years of age, and pregnant women...................................................................................................... 17 Table 2. Inclusion criteria by targeted population group......................................... 25 Table 3. Clinical cut-off points and classifications for biomarker indicators............ 33 Table 4. Results