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In: Prevention of micronutrient deficiencies: tools for policymakers and public health workers, edited by Christopher P. Howson, Eileen T. Kennedy, and Abraham Horwitz. Washington, D.C., National Academy Press, 1998. 45-102.Since iron is an essential nutrient, deficiency of such would result in a wide range of functional consequences including anemia. Development of iron deficiency is indicated by low plasma ferritin, low transferrin saturation and elevated free erythrocyte protoporphyrin, serum transferrin receptors, and low hemoglobin. Iron balance is favored by the ingestion of sufficient iron in food. Improvement of the supply, intake and bioavailability of food iron and food fortification are identified as sustainable approaches to the elimination of iron deficiency. Estimates of relative effectiveness and cost per Disability Adjusted Life Year (DALY) of different supplementation strategies as well as comparison with iron fortification computed by various models are presented by the WHO, UN International Children's Emergency Fund and UNU. Studies of developing countries such as Thailand, India, South Africa, Guatemala, and Venezuela have been conducted addressing the effectiveness of iron fortification.
Washington, D.C., National Academy Press, 1998. xii, 207 p.Globally, micronutrient malnutrition affects approximately 2 billion people and carries adverse sequelae of premature death, poor health, blindness, growth stunting, mental retardation, learning disabilities, and low work capacity. In late 1980s, the US Agency for International Development (USAID) funded a randomized trial of vitamin A supplementation in developing countries. In this regard, the Office of Health and Nutrition of USAID has requested the Institute of Medicine's Board on International Health to evaluate global micronutrient deficiency prevention programs conducted in developing countries. The project was conducted in two phases. The first phase featured a 2-day workshop evaluating approaches to the prevention of micronutrient malnutrition and identified the elements that led to the programs' success. This book presents the findings of the workshop, which will provide the basis of the Phase 2 study. Chapter 1 summarizes the findings and recommendations of the workshop. Chapter 2 discusses key elements in the design and implementation of micronutrient interventions. Chapters 3-5 present the three background papers on iron, vitamin A, and iodine. The appendix contains the workshop study.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.