Characterizing Micronutrient Status and Risk Factors among Late Adolescent and Young Women in Rural Pakistan: A Cross-Sectional Assessment of the MaPPS Trial

Abstract

Nutritional deficiencies are a leading underlying risk factor contributing to the global burden of disease. In Pakistan, late adolescence is considered a nutritionally vulnerable period, as micronutrient requirements are increased to support maturation, and dietary staples are nutrient poor. However, there has been limited evaluation of micronutrient status beyond anemia and its determinants. Using cross-sectional data from late adolescent and young women (15–23 years) at enrolment in the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial, we aimed to describe the prevalence of key micronutrient deficiencies of public health concern, and generate hierarchical models to examine associations with proxies for social determinants of health (SDoH). The prevalence of micronutrient deficiencies was high: 53.6% (95% confidence interval (CI): 53.0–54.3%) had anemia; 38.0% (95% CI: 36.4–39.6%) iron deficiency anemia; 31.8% (95% CI: 30.2–33.3%) vitamin A deficiency; and 81.1% (95% CI: 79.8–82.4%) vitamin D deficiency. At least one deficiency was experienced by 91.0% (95% CI: 90.1–92.0%). Few SDoH were maintained in the final hierarchical models, although those maintained were often related to socioeconomic status (e.g., education, occupation). To improve the micronutrient status of late adolescent and young women in Pakistan, a direct micronutrient intervention is warranted, and should be paired with broader poverty alleviation methods.

Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: a synthesis of scoping reviews

“…Other evidence has highlighted the benefits of MMN fortification and supplementation as compared with singlemicronutrient approaches (81) . The recent Lancet Series on Maternal and Child Undernutrition Progress highlighted the strong evidence supporting MMN supplementation during the antenatal period for improved birth outcomes and suggested the potential benefit of extending this into the preconception period for adolescent girls and young women in high-burden contexts (82)(83)(84) . Current WHO guidelines recommend daily Fe-only or weekly Fe and folic acid supplementation in menstruating, non-pregnant women and adolescents, depending on the anaemia burden (82,83,85) .…”

“…The recent Lancet Series on Maternal and Child Undernutrition Progress highlighted the strong evidence supporting MMN supplementation during the antenatal period for improved birth outcomes and suggested the potential benefit of extending this into the preconception period for adolescent girls and young women in high-burden contexts (82)(83)(84) . Current WHO guidelines recommend daily Fe-only or weekly Fe and folic acid supplementation in menstruating, non-pregnant women and adolescents, depending on the anaemia burden (82,83,85) . However, evidence is lacking on implementation strategies to examine the acceptability and effectiveness of supplementation dose, delivery and duration, either for these guidelines or for MMN approaches (8) .…”

Dietary diversity and social determinants of nutrition among late adolescent girls in rural Pakistan

“…We previously developed a conceptual framework to serve as an overarching guide for understanding how SDN can affect the various components that underlie nutritional status among adolescent girls and the downstream consequences ( Appendix S1 ) (Baxter et al, 2021 ). The structure was adapted from the UNICEF conceptual framework on the causes of malnutrition and informed by the WHO Commission on SDoH (Commission on Social Determinants of Health, 2008 ; UNICEF, 1998 ).…”

“…We hypothesized that there were four levels of SDN explanatory variables: (1) socio‐economic status: education, occupation, religion and wealth quintile; (2) household and personal factors: household food security, marital status and parity; (3) health and well‐being: perception of own health, body image, experience of depression‐, anxiety‐ and stress‐like feelings; and (4) actions and practices: self‐efficacy, participation in decision‐making, skipping breakfast and eating dinner with family. For all analyses, the reference for each variable was set as the category at which someone would be likely to experience the greatest nutritional vulnerability (Baxter et al, 2021 ).…”

Characterizing Retail Food Environments in Peri-Urban Pakistan during the COVID-19 Pandemic

“…Based on an observed food insecurity prevalence of 31.1% in Matiari, and using a simple asymptotic formula, a sample size of 224 villages was required to produce estimates at 5% precision and 95% level of confidence ( Table 2 ). A listing of all villages ( N = 585) in the district was generated by a previous intervention trial [ 30 ]. The present study used a random number generator to select villages from this list, and this was further stratified by village size (based on population percentiles, Figure 1 ).…”