TL_Food_and_nutrition_survey_2013.pdf

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TIMOR-LESTE FOOD AND NUTRITION

SURVEY 2013

The Timor-Leste Food and Nutrition Survey 2013 was conducted with support from the Australian Government and the United Nations Children’s Funds (UNICEF) title page_final.indd 1 5/12/2015 12:49:34 PM

Waiver Statement

This report was written by the Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO-RECFON) Universitas Indonesia subsequent to conducting the fieldwork for the Timor-Leste Food and Nutrition Survey 2013 between the months of May to September 2013. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the Government of Timor-Leste, the Australian Government, or the United Nations Children’s Fund.

Democratic Republic of Timor-Leste (2013). Timor-Leste Food and Nutrition Survey, Ministry of Health.

Final Report 2015. Dili.

Graphic designer: Med Ramos

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Preface

The 2013 Timor-Leste Food and Nutrition Survey (TLFNS) is the first comprehensive food and nutrition survey carried out in the country. The 2013 TLFNS was implemented by the Nutrition Department of the Ministry of Health (MoH) and the Research Cabinet of MoH with the assistance from the United Nations Children’s Fund (UNICEF), Government of Australia and the Southeast Asian Ministers of Education Organization-Regional Centre for Food and Nutrition (SEAMEO

RECFON).

The data collection for this survey was carried out between May and September 2013 among children aged 0-59 months and their non-pregnant mothers (aged 14 – 60 years). The survey assessed the risk factors for undernutrition based on Conceptual Framework of Malnutrition (UNICEF, 1990) which is being used for nutrition programming worldwide for the past 25 years. The prevalence of micronutrient deficiencies (vitamin A, iron, zinc, and iodine deficiency), and the iodine content of household iodised salt and aflatoxin exposure among children (aged 6 – 59 months) and their non-pregnant mothers (aged 14 – 60 years) were also assessed.

On behalf of the Government of Timor-Leste, the Ministry of Health, would like to extend appreciation to the team from SEAMEO RECFON who did the survey, analysis and report writing work. We also would like to thank our partners, particularly the UNICEF for the technical and financial support provided for the survey and Government of Australia for their financial and technical support to implement this survey

The preliminary findings were shared during a press conference held by the MoH in November 2013, followed by presentations at the Ministry of Health technical meetings with relevant partners in April and October 2014 and at the technical meeting of the Council of Food Security, Sovereignty and Nutrition (KONSSANTIL) in Timor-Leste in November 2014. The final report was presented to Council of Minister’s meeting on 14 July 2015. The meeting recommended to conduct a joint inter-ministerial study to identify the source and level of aflatoxin in food and to implement plan of action to reduce aflatoxin exposure; and also to develop and implement behaviour change communication action plan to promote food intake and diversity with a theme “4 Saudáveis 5 Balanço” (Healthy 4 Balance 5).

This report was completed in 2014 during the Fifth Constitutional Government of RDTL. As continuation from the previous government, the survey report is launched by the Sixth Constitutional Government of RDTL.

Findings from the survey will be used in planning and implementing nutrition programmes in Timor-Leste. Furthermore, the results of the survey can also be used as baseline data to monitor the progress towards government initiatives to improve the nutrition situation in Timor-Leste.

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Acknowledgements

The Timor-Leste Food and Nutrition Survey 2013 (TLFNS) is a result of the co-operation and efforts of the MoH, the District Health Officers, District Administrators, Chief of Sub-Districts, Sucos, Aldeias, MoH’s Cabinet of Health Research and Development and the National Laboratory, as well as other stakeholders listed below. Our sincere appreciation for their support and contribution.

Our special thanks and gratitude to SEAMEO RECFON, who conducted and successfully completed the survey.

We express our appreciation for the technical and financial support provided by UNICEF and the Government of Australia.

Special thanks goes to all the willing participants of the survey, who provided the information and data required to make the survey such a success.

Special thanks to the following institutions and individuals for their contributions to the survey report:

Ir. Siti Muslimatun, SEAMEO RECFON Universitas Indonesia Helda Khusun SEAMEO RECFON Universitas Indonesia Dr. Judhiastuty Februhartanty, SEAMEO RECFON Universitas Indonesia Evi Ermayani SEAMEO RECFON Universitas Indonesia Devita Kusuma Rahingtyas, SEAMEO RECFON Universitas Indonesia Dr. Christine Northtop-Clewes, Public Health Nutrition Consultant, Cambridge, UK Sra. Ivonne de Jesus Dos Santos, Executive Director, National Institute of Health Sr. Pedro Canizio Amaral, Head of Research Cabinet, National Institute of Health Sra. Dirce Maria Soares, Head of Training, National Institute of Health Dr. Maria Santina de J Gomes, Executive Director of National Laboratory Sra. Maria Dolores, Director of National Laboratory Sr. Jose Dos Reis Magno, Director General, MoH Sr. Carlito Freitas, National Director Public Health, MoH Sra. Isabel Gomes, Director of Health Education Services, MoH Sra. Norberta Belo, Public Health Adviser, MoH Sr. Joao Bosco da Costa, Head of Nutrition Department, MoH Sr. Duarte Maubuti, Community Nutrition Officer, Nutrition Department, MoH Sra. Epifania Deolinda Marquez, Micronutrient Officer, Nutrition Department, MoH Sr. Mario Dos Reis Moreira, Food Security Officer, Nutrition Department, MoH Dr. Hemlal Sharma, Chief of Health and Nutrition, UNICEF Mayang Sari, Nutrition Specialist, UNICEF Teresinha Soares, Nutrition Officer, UNICEF Elham Monsef, Nutrition Specialist, UNICEF Maria Paulina Goncalves, Nutrition Officer, UNICEF Diana Borges, Nutrition Officer, WFP Elias Sarmento, Nutrition Officer, WFP Sarah Lendon, Counselor, Australian Embassy, Dili, Timor-Leste Desmond Whyms, Senior Health Specialist, Australian Embassy, Dili, Timor-Leste Heather Grieve, Senior Nutrition Specialist, Australian Embassy, Dili, Timor-Leste preliminary_final.indd 2 9/24/2015 9:13:43 AM iiiTimor-LesTe Food and nuTriTion survey 2013

Table of contents

List of Tables ................................................................................................................................... vi

List of Figures .................................................................................................................................... x

List of Acronyms ....................................................................................................................................xi

Summary of Key Findings..............................................................................................................................xiii

Abstract ..................................................................................................................................xvi

1. BACKGROUND

2. OBJECTIVES

3. FRAMEWORK OF THE ASSESSMENT

4. METHODOLOGY

4.1 Study Design

4.9 Data analysis

5. NUTRITION RESULTS

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6. BIOCHEMICAL RESULTS

7. DISCUSSION

8. CONCLUSIONS

9. RECOMMENDATIONS

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REFERENCES

Appendices

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List of Tables

METHODOLOGY

NUTRITION RESULTS

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BIOCHECMICAL RESULTS

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List of Figures

METHODOLOGY

3.1 Framework of nutritional status and its determinant factors (UNICEF, 2013)

NUTRITION RESULTS

BIOCHEMICAL RESULTS

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List of Acronyms

AAS Atomic absorption spectrophotometer AFB-lys Aflatoxin B (1)-lysine AGP α1-acid glycoprotein ANC Antenatal care ARI Acute respiratory infection BMIZ Body Mass Index Z-score CDC Center for Disease Control and Prevention CED Chronic energy deficiency CHC Community Health Services CI Confidence interval CRM Certified reference materials CRP C-reactive protein CV Coefficient of variation DDS Dietary diversity score DHS District Health Service DPHO District Public Health Officer EBF Exclusive breastfeeding ELISA enzyme-linked immune absorbent assay EQA External quality assurance EQUIP Ensuring the quality of iodine procedures FANTA Food and Nutrition Technical Assistance FAO Food and Agricultural Organization FCS Food Consumption Score HAZ Height for Age Z-score HH Household HIV Human immunodeficiency virus HKI Helen Keller International HPLC High performance liquid chromatography IDA Iron deficiency anemia IDD Iron deficiency disorder INACG International Nutritional Anemia Consultative Group IYCF Infant and Young Child Feeding LISIO Livrado Saúde Inanfante hoet Onan- Mother and Child Health Book MNP Multiple micronutrient powder MoH Ministry of Health MSG Mother support group MTA Material transfer agreement NA Not applicable NGO Non-government organization NIST National Institute of Standards and Technology NTT Nusa Tenggara Timur ODF Open-defecation free OR Odds ratio ORS Oral rehydration solution PCA Principal component analysis preliminary_final.indd 11 9/24/2015 9:13:44 AM xii Timor-LesTe Food and nuTriTion survey 2013

PPS Probability proportional to size PSF Promotores Saude Familia - Community Health Volunteers QC Quality control RBP Retinol-binding protein rCSI Reduced coping strategy index SCM Sweetened condensed milk SD Standard deviation SEAMEO RECFON South East Asian Ministers of Education Organization Regional Center for Food and Nutrition SES Socio-economic class SFP Supplementary feeding programme SISCa Serviço Integrado da Saúde Comunitária - Integrated Community Health Services SPE Solid phase extraction sTfR Soluble transferrin receptor SUN Scaling-up nutrition The CLMV Cambodia, Lao, Myanmar, Vietnam TLDHS Timor-Leste Demographic Health Survey TLFNS Timor-Leste Food and Nutrition Survey UIE Urinary iodine excretion UL Upper level UNICEF The United Nations Children's Fund UNU United Nations University USA United States of America VAD Vitamin A deficiency VITAL-EQA Vitamin A Laboratory External Quality Assurance WASH Water, Sanitation, and Hygiene WAZ Weight for age Z-score WFP World Food Program WHIZ Weight for height Index Z-score WHO World Health Organization WHZ Weight for height Z-score WRA Women of reproductive age preliminary_final.indd 12 9/24/2015 9:13:44 AM xiiiTimor-LesTe Food and nuTriTion survey 2013

Summary of Key Findings

INDICATORS PERCENT

Nutritional status of children (aged 0 – 59 months) Underweight Moderate and severe (<-2 SD WAZ) 37.7 Severe (<-3 SD WAZ) 10.1 Stunting Moderate and severe (<-2 SD HAZ or -2SD LAZ for children < 2 years) 50.2 Severe (<-3 SD HAZ) 20.4 Wasting Moderate and severe (<-2 SD WHZ or -2SD WLZ for children <2 years) 11.0 Severe (<-3 SD WHZ) 1.9 Overweight Overweight (>+2 SD WHZ) 1.5 Overweight ≥2 SD BMIZ) 1.5

Micronutrient status of children (aged 6 – 59 months)

Severe (Hb< 70 g/L) 0.9

Aflatoxin exposure among children (aged 6 – 59 months)

Nutritional status of non-pregnant mothers (aged 14 – 60 years) Underweight (Thinness)

Micronutrient status of non-pregnant mothers (aged 14 – 60 years)

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INDICATORS PERCENTAGE

Moderate (70 ≤Hb ≤109 d/L) 16.9 Severe (Hb< 70 g/L) 0.7

Aflatoxin exposure among non-pregnant mothers (aged 14 – 60 years)

Iodized salt utilization Salt adequately iodised (iodine level ≥15 ppm) 42.7

IYCF indicators

Morbidity (0 – 59 months, in the previous 2 weeks)

Fever and cough 37.0 Suspected pneumonia 9.3

Water and Sanitation

Health and nutrition services for children

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INDICATORS PERCENTAGE

Appropriate diarrhoea management (for children who had diarrhoea) Had proper feeding, received ORS and zinc tablet 6.7

Maternal health services received during the last pregnancy

Household Food Consumption Score (FCS)

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Abstract

The objectives of the Timor-Leste Food and Nutrition Survey (TLFNS) conducted in 2013 were to assess the nutritional status of children (aged 0–59 months) and their non-pregnant mothers (aged 14–60 years), and to determine the risk factors for malnutrition. In addition, the micronutrient status and aflatoxin exposure of children (aged 6–59 months) and their non-pregnant mothers was assessed.

The survey was approved by the Ministry of Health (MoH), Democratic Republic of Timor-Leste and implemented under the supervision of the MoH.

The 2013 TLFNS was a cross-sectional survey…