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Maternal and Child Nutrition. 2017 Dec 22; 1-9.The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a “Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes,” which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programs. Currently, global surveillance and monitoring data show that overall IFA supplementation programs suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programs-include weak supply chains, low access to antenatal care services, low-quality behavior change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programs. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programs, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programs. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews.
Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement.
Geneva, Switzerland, WHO, .  p.Iron deficiency with its attendant anaemia is the most prevalent micronutrient disorder on a worldwide basis. In 2001, the UN General Assembly at the Special Session on Children recommended that the prevalence of iron deficiency and anaemia be reduced by one third in children by the year 2010. If achieved, this would contribute greatly to the realization of the Millenium Development Goals. In most countries, national policies have been implemented to provide iron supplements to pregnant women, and to a lesser extent to young children, as the primary strategy for preventing iron deficiency and anaemia. Although the benefits of iron supplementation have generally been considered to outweigh the putative risks, there is some evidence to suggest that supplementation at levels recommended for otherwise healthy children carries the risk of increased severity of infectious disease in the presence of malaria and/or undernutrition. (excerpt)
Journal of Tropical Pediatrics. 2006 Apr; 52(2):75-77.As a result of accumulating evidence about the benefits of exclusive breastfeeding, the World Health Organization issued a statement recommending exclusive breastfeeding for 6 months. This document advised that further studies are needed for assessment of the risk of micronutrient deficiencies, especially in susceptible infants. These infants include those living in areas where iron, zinc and vitamin A deficiencies are prevalent. Upon this word of caution and with recommendations that iron supplementation be started at 4–6 months of age in breastfed infants, such supplementation has been started in some developing countries such as Turkey and Brazil. However current evidence regarding the actual need for this supplementation is inadequate. (excerpt)