Situation Analysis of Nutrition Conditions of Pregnant Women and Children in Albania

A contribution from the
Geneva WHO Collaborating Centre for Research in Human Reproduction

MINISTRY OF HEALTH
DIRECTORATE OF PRIMARY HEALTH CARE (PHC)
REPRODUCTIVE HEALTH SECTOR (RHS)

Petrit Vasili, Director, PHC
Nedime Ceka, Chief, RHS

edited by

Eva Mathur, Consultant,
WHO Collaborating Center for Research in Human Reproduction, Geneva

The nutritive conditions and major nutritive problems of pregnant women and children

Little analytical data is available on the nutritional status of women. The United Nations Development Programme (UNDP) Human Development Report, Albania 1995, underlined that although caloric intakes approached the norm, fat and protein were very low, with nearly 75% of calories provided by carbohydrates, mainly bread. Also, protein intake was mainly from poorer quality plant protein. Fat intakes reached only 55% of the norm.

Another survey carried out by the Food and Agriculture Organisation (FAO) in 1988-90, revealed that a typical Albanian consumes 2586 Kcal/day. Carbohydrate consumption was 68 % of the daily calorie intake. Protein and fat content of the diet is below the recommended standard and the consumption level of fruit and vegetables are the lowest in all the European countries.

In 1992, a World Bank mission estimated that wheat consumption for 1991 would still meet 55% of total caloric requirements. The mission also found records in a district hospital to show about 7% of live births to be below 2,5 kg.

One of the principal causes of these underweight births must be related to maternal nutrition during pregnancy.

Currently, the availability of food is not a problem in Albania. Now, Albania as an open democratic country, and with the introduction of the market economy, there are all kinds of food and products available (rice, meat, potatoes, fruit, vegetables, milk products, eggs, etc.).

Although there may be sufficient food in the country as a whole, the low income system and the escalation of poverty, especially in rural zones, are likely to further impact the nutritional status of this vulnerable group of the population.

As for micronutrient deficiency, the situation is far worse.

A Ministry of Health (MOH) report states that in 1989, 23 % of pregnant women had anæmia. Data from the National Programme on Nutrition shows that up to 53 % of pregnant women in 1990 had anæmia. Out of this, the 25-29 age group contains the highest proportion of anæmia sufferers.

During the period 1990-1993, iodine deficiency levels were found to comprise 53 % of cases examined in the highland districts. Cretinism affected less than 0,1 % of the population studied, while 22 % of the population showed "first grade" goitre, 62 % "second grade", and the remaining 16 % showed "third grade" goitre. For females in the reproductive years, the corresponding percentages for first, second and third grade goitres are below 1%, 2-3 % and 1-2 % respectively.

A national survey on iodine deficiency carried out in 1993 by the Unitd Nations Children Fund (UNICEF), revealed the severity of the situation in Albania. A sample of 2395 primary school children from 32 districts was studied for iodine determination in urine, and 227 new-borns from the Maternity Hospital in Tirana for TSH determination. Ten out of 32 districts showed moderate and 22 regions showed severe iodine deficiencies. Among the new-borns severe IDD was also shown. Goitre affected 28,9 % of the children in the north-eastern region.

After this survey, in 1993, Albania started a National program for Control of IDD supported by UNICEF.

The principal strategies of this programme are:

Short term strategy
- Distribution of iodine ampoules in districts which had major iodine deficiencies (north-eastern Albania).
Long term strategy
- Iodisation of salt in Albania. There are no factories for producing national salt and all salt is imported. For this reason, an Order exists, signed by Ministers Council, which states that all salt imported to Albania must be iodised.

Malnutrition, while not particularly severe, is widespread among children in Albania. The first survey on malnutrition carried out during the transition period dates back to 1991. It was conducted by the Paediatric Hospital of the University of Tirana, and a sample of 6720 children, 0-3 years old from 11 districts, was taken. Adopting the weight for age anthropometric standards of WHO - NCHS, the study showed that 1/3 of the children were underweight, out of which 2 % were severely underweight. According to the age, the 1-2 years old category presented the highest percentage of malnutrition, reflecting inappropriate weaning practices and low food availability. Children living in mountainous regions showed a higher (32 %) malnutrition rate than those living on the plains (24 %) did. Major differences in malnutrition rates were also observed between the South (18 %) and the Centre-North (30 %), reflecting different economic conditions and morphological characteristics.

Growth monitoring has also started in Albania, through a National Programme of Nutrition conducted by the Institute of Public Health and financed by UNICEF.

The attitude and knowledge of mothers are key factors in children’s nutrition. About half of the mothers surveyed in the National Nutrition Programme in 1993, in Durres district, did not know about the nutritive values of vegetables, fruit, meat and eggs. The other half, while not able to give exact explanations, knew about the importance of providing a varied diet for their children. Mothers' ignorance of nutritive values is less widespread in the cities (25 %), which generally explains the lower level of malnutrition reported in urban areas.

Studies carried out in Albania during the last five years showed that up to 12 months of age, children appeared to receive adequate caloric intake. However, older children presented a caloric deficit. Protein intake was adequate among all age groups; however the diet seemed to be poor in carbohydrates and rich in fat. The intake of vitamin D and calcium was lower than international recommendation levels among all age groups. Up to 20 % of the children showed signs of rickets. The risk of rickets appeared to be eight times higher in rural areas as compared to urban ones.

In Albania about 75 % of children of 0-1 years are breast-fed.

The measures against nutritive problems

Since 1993, the Ministry of Health has conducted a National Programme of Nutrition, with priority on children's and women's health. This programme is run by the Institute of Public Health and some of its activities are financed by UNICEF.

The principal strategies and actions of this programme are:

Assessing, analysing and monitoring the nutrition situations of women (especially those of reproductive age) and children in Albania;
Management of malnutrition in children;
Promoting breast feeding, and healthy feeding among infants and young children especially 0-5 years old;
Preventing and controlling specific micronutrient deficiencies, especially IDD;
Promoting appropriate diets and healthy lifestyles;
Preventing and managing infectious diseases;
Improving household food security. Editor : Eva Mathur