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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.
Multiple-micronutrient supplementation: evidence from large-scale prenatal programmes on coverage, compliance and impact.
Maternal and Child Nutrition. 2017 Dec 22; 1-11.Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyze available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites of major-agencies and through hand-searching of relevant documents. Retrieved documents were screened and potentially relevant reports were critically examined by the authors with the aim of identifying a set of case studies reflecting regional variation, a mix of implementation successes and failures, and a mix of programs and large-scale experimental studies. Information on implementation, coverage, compliance, and impact was extracted from reports of large-scale interventions in Central America, Southeast Asia, South Asia, and Sub-Saharan Africa. The WHO/CDC Logic-Model for Micronutrient Interventions in Public Health was used as an organizing framework for analyzing and presenting the evidence. Our findings suggest that to successfully implement supplementation interventions and achieve sustainable-permanent solutions efforts must focus on factors and processes related to quality, cost-effectiveness, coverage, utilization, demand, outcomes, impacts, and sustainability of programs including strategic analysis, management, collaborations to pilot a project, and careful monitoring, midcourse corrections, supervision and logistical-support to gradually scaling it up.
Do countries rely on the World Health Organization for translating research findings into clinical guidelines? A case study.
Globalization and Health. 2016 Oct 6; 12(1):58.BACKGROUND: The World Health Organization's (WHO) antiretroviral therapy (ART) guidelines have generally been adopted rapidly and with high fidelity by countries in sub-Saharan Africa. Thus far, however, WHO has not published specific guidance on nutritional care and support for (non-pregnant) adults living with HIV despite a solid evidence base for some interventions. This offers an opportunity for a case study on whether national clinical guidelines in sub-Saharan Africa provide concrete recommendations in the face of limited guidance by WHO. This study, therefore, aims to determine if national HIV treatment guidelines in sub-Saharan Africa contain specific guidance on nutritional care and support for non-pregnant adults living with HIV. METHODS: We identified the most recent national HIV treatment guidelines in sub-Saharan African countries with English as an official language. Using pre-specified criteria, we determined for each guideline whether it provides guidance to clinicians on each of five components of nutritional care and support for adults living with HIV: assessment of nutritional status, dietary counseling, micronutrient supplementation, ready-to-use therapeutic or supplementary foods, and food subsidies. RESULTS: We found that national HIV treatment guidelines in sub-Saharan Africa generally do not contain concrete recommendations on nutritional care and support for non-pregnant adults living with HIV. CONCLUSIONS: Given that decisions on nutritional care and support are inevitably being made at the clinician-patient level, and that clinicians have a relative disadvantage in systematically identifying, summarizing, and weighing up research evidence compared to WHO and national governments, there is a need for more specific clinical guidance. In our view, such guidance should at a minimum recommend daily micronutrient supplements for adults living with HIV who are in pre-ART stages, regular dietary counseling, periodic assessment of anthropometric status, and additional nutritional management of undernourished patients. More broadly, our findings suggest that countries in sub-Saharan Africa look to WHO for guidance in translating evidence into clinical guidelines. It is, thus, likely that the development of concrete recommendations by WHO on nutritional interventions for people living with HIV would lead to more specific guidelines at the country-level and, ultimately, better clinical decisions and treatment outcomes.
A Simplified Regimen Compared with WHO Guidelines Decreases Antenatal Calcium Supplement Intake for Prevention of Preeclampsia in a Cluster-Randomized Noninferiority Trial in Rural Kenya.
Journal of Nutrition. 2017 Oct; 147(10):1986-1991.Background: To prevent preeclampsia, the WHO recommends antenatal calcium supplementation in populations with inadequate habitual intake. The WHO recommends 1500-2000 mg Ca/d with iron-folic acid (IFA) taken separately, a complex pill-taking regimen. Objective: The objective of this study was to test the hypothesis that simpler regimens with lower daily dosages would lead to higher adherence and similar supplement intake.Methods: In the Micronutrient Initiative Calcium Supplementation study, we compared the mean daily supplement intake associated with 2 dosing regimens with the use of a parallel, cluster-randomized noninferiority trial implemented in 16 primary health care facilities in rural Kenya. The standard regimen was 3 x 500 mg Ca/d in 3 pill-taking events, and the low-dose regimen was 2 x 500 mg Ca/d in 2 pill-taking events; both regimens included a 200 IU cholecalciferol and calcium pill and a separate IFA pill. We enrolled 990 pregnant women between 16 and 30 wk of gestation. The primary outcome was supplemental calcium intake measured by pill counts 4 and 8 wk after recruitment. We carried out intention-to-treat analyses with the use of mixed-effect models, with regimen as the fixed effect and health care facilities as a random effect, by using a noninferiority margin of 125 mg Ca/d.Results: Women in facilities assigned to the standard regimen consumed a mean of 1198 mg Ca/d, whereas those assigned to the low-dose regimen consumed 810 mg Ca/d. The difference in intake was 388 mg Ca/d (95% CI = 341, 434 mg Ca/d), exceeding the prespecified margin of 125 mg Ca/d. The overall adherence rate was 80% and did not differ between study arms.Conclusions: Contrary to our expectation, a simpler, lower-dose regimen led to significantly lower supplement intake than the regimen recommended by the WHO. Further studies are needed to precisely characterize the dose-response relation of calcium supplementation and preeclampsia risk and to examine cost effectiveness of lower and simpler regimens in program settings. This trial was registered at clinicaltrials.gov as NCT02238704. (c) 2017 American Society for Nutrition.
Guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women.
Geneva, Switzerland, WHO, 2016. 32 p.The guideline is intended for a wide audience, including governments, nongovernmental organizations, healthcare workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services and their integration into national and subnational public health strategies and programmes. This WHO guideline states that routine use of multiple micronutrient powders during pregnancy is not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes.
Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa.
Journal of Pediatric Gastroenterology and Nutrition. 2017 Mar 22;OBJECTIVES: The World Health Organization (WHO) recommends that HIV-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings. METHODS: We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5–9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population was used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the WHO and Acceptable Macronutrient Distribution Ranges (AMDRs) established by the Institute of Medicine (IOM). RESULTS: The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs. 1196 kcal/day, p=0.002), but proportions below the recommended energy requirement were similar in the two groups (82.5 vs. 85.2%, p=0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared to the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups. CONCLUSIONS: Our findings suggest that the typical diet of HIV-infected children as well as uninfected children in Johannesburg, South Africa does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.
WHO guideline: Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years.
Geneva, Switzerland, WHO, 2016. 60 p.The use of multiple micronutrient powders for point-of-use fortification of foods has been suggested as an alternative to mitigate or overcome the constraints associated with supplementation and mass fortification. They are intended to increase the vitamin and mineral intake of infants and young children aged 6 to 23 months as well as preschool and school-age children aged 2-12 years. This guideline is intended to help Member States and their partners in their efforts to make evidence-informed decisions on the appropriate nutrition actions to improve the nutritional status of infants and children aged 6 months to 12 years. It will also support their efforts to achieve the Sustainable Development Goals, the global targets set by the Comprehensive implementation plan on maternal, infant and young child nutrition, and the Global strategy for women’s, children’s and adolescents’ health 2016-2030. It is intended for a wide audience, including governments, nongovernmental organizations, health-care workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services, and their integration into national and subnational public health strategies and programmes. This guideline provides global, evidence-informed recommendations on the use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6-23 months and children aged 2-12 years.
Selecting desirable micronutrient fortificants for plant-based complementary foods for infants and young children in low-income countries.
Journal of the Science of Food and Agriculture. 2015 Jan; 95(2):221-4.The World Health Organization (WHO) recommends that both breast-fed and non-breast-fed children are fed micronutrient fortified complementary foods designed to meet their high nutrient requirements from aged 6 to 23 months of age. This paper summarises the steps recommended by WHO/FAO to identify the country-specific micronutrient shortfalls in complementary diets and establish desirable levels of bioavailable fortificants for centrally processed plant-based complementary foods for infant and young child feeding. The goal of the WHO/FAO guidelines is to achieve a desirably low prevalence of inadequate micronutrient intakes in the target group whilst simultaneously ensuring minimal risk of excessive intakes. (c) 2014 Society of Chemical Industry.
Dissemination of WHO guidelines and recommendations on micronutrients: policy, practice and service delivery issues. Report of a regional meeting, Bangkok, 14-16 October 2014.
New Delhi, India, WHO, Regional Office for South-East Asia, 2015.  p. (SEA-NUT-195)The public health implications of micronutrient deficiencies are very important since these deficiencies adversely affect fetal and child growth, cognitive development of infants, children and adolescents, women of reproductive age and the elderly, and lower their resistance to infection. Of all the micronutrient deficiencies, anaemia is the most common in the South-East Asia Region and an estimated 55% of preschool children, 45% of pregnant women and 40% of women of child-bearing age are anaemic. Low intake of iron and other important nutrients in the diet, parasitic infections and low bioavailability of iron from plant-based diets are considered to be the causative factors. In recent years, WHO has produced or updated several evidence-based guidelines and recommendations on a large number of nutrients of public health importance. These evidence-based guidelines for nutrition action will assist the Member States to focus on key areas of intervention and develop a harmonized monitoring framework to assess the impact of such interventions on the prevalence of micronutrient deficiencies. A regional meeting on dissemination of WHO guidelines and recommendations on micronutrients: policy, practice and service delivery issues, was organized by the World Health Organization’s Regional Office for South-East Asia in collaboration with the Department of Nutrition for Health & Development, WHO Headquarters, the Institute of Nutrition – Mahidol University, Thailand and the Micronutrient Initiative, in Bangkok, Thailand from 14-16 October 2014. The overall objective of the meeting was to discuss the effective dissemination and incorporation of WHO guidelines and recommendations on micronutrients in national control and prevention programmes highlighting the following topics: i) dissemination of current WHO guidelines and recommendations on micronutrients; ii) overview of recent strategies and approaches for addressing anaemia in different population groups; and iii) review of national protocols for the control and prevention of micronutrients deficiencies, with particular focus on anaemia.
Guardian. 2015 Mar 9;  p.A growing body of evidence documents the importance of multiple micronutrient supplements during pregnancy to improve the health and survival of newborns and their mothers. When mothers take micronutrient supplements during pregnancy -- instead of iron-folic acid alone -- their babies are born later and born bigger, giving them a stronger start in life. We call on the WHO to update their guidelines.
American Journal of Clinical Nutrition. 2011 Dec; 94(6):1683S-1689S.To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A, the current recommendation for a single high dose of vitamin A in HIV-infected women within 6 wk of delivery should be reviewed.
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)
[Geneva, Switzerland], World Health Organization [WHO], 2006. 9 p.The purpose of this paper is to examine the nutritional aspects of feeding home-modified milk. This paper focuses only on non-breastfed children aged 0 to 6 months with no access to infant formula. Feeding older non-breastfed infants is described in another WHO document. Other problems, including the risk of dilution error when modifying the milk, the risk of bacterial contamination, and the risk that it will cause occult bleeding in the gut if not adequately boiled are acknowledged, but will not be discussed here. (excerpt)
New and Noteworthy in Nutrition. 2002 Sep 13; (38):3-4.The last two issues of NNN have devoted considerable column space to HIV/AIDS. This is because the pandemic is one of the major nutritional problems the world is currently facing. There is now considerable evidence of how AIDS precipitates and exacerbates other determinants of malnutrition. As Peter Piot, UNAIDS Director, said at the XIV International AIDS Conference in Barcelona .The only effective treatment at present is antiretrovirals. However, inadequate media attention has been given to the importance of good nutrition. Other treatments and prophylaxis especially, have been neglected. It doesn't make a headline, it is not a sexy story. (excerpt)
Feeding of nonbreastfed children from 6 to 24 months of age: Conclusions of an informal meeting on infant young child feeding organized by the World Organization, Geneva, March 8-10, 2004.
Food and Nutrition Bulletin. 2004; 25(4):403-406.According to current United Nations recommendations, infants should be exclusively breastfed for the first six months of life and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will stop before the recommended period of two years or beyond. A group that calls for particular attention consists of the infants of mothers who are known to be HIV positive. To reduce the risk of HIV transmission, it is recommended that when it is acceptable, feasible, affordable, sustainable, and safe, these mothers give replacement feeding from birth. Otherwise, they should breastfeed exclusively and stop as soon as alternative feeding options become feasible. Another group includes those infants whose mothers have died, or who for some reason do not breastfeed. (excerpt)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S69-S77.The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress. (author's)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S91-S98.While traditionally associated with cretinism and goiter, iodine deficiency has broad effects on central nervous system development that can occur in the absence of either condition. Any maternal iodine deficiency results in a range of intellectual, motor, and hearing deficits in offspring. This loss in intellectual capacity limits educational achievement of populations and the economic prowess of nations. Progress made since the historic World Summit for Children in 1990 has been outstanding. Approximately 70% of households in the world used iodized salt by 2000, compared with less than 20% in 1990. It is estimated that at least 85 million newborns out of 130 million annual births are protected from a loss in learning ability that would otherwise have occurred. The elimination of iodine deficiency, by expedient production, marketing, and universal consumption of iodized salt, represents a significant development effort in public nutrition. Although globally iodine nutrition has greatly improved, 20% to 30% of pregnancies and thus newborns still do not fully benefit from the use of iodized salt. Countries where success is in evidence could rapidly revert back to deficiency if vigilance is not maintained. Just as success came through concerted public-private-civic actions, making sure that this is expanded and will steadily go on requires continuous collaboration. (author's)
International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle, Lima, Peru, May 30-June 1, 2001.
Food and Nutrition Bulletin. 2002; 23(3):309-316.Thirty-one representatives from international organizations, nongovernmental organizations, government agencies, universities, and the private sector participated in a three-day workshop in Lima, Peru, organized by the Universidad Nacional Agraria La Molina and supported by the Ministry of Health Peru, UNICEF, and the World Health Organization. The objective of the workshop was to develop a protocol for a comprehensive micronutrient supplementation program for populations in developing countries that suffer from deficiencies of several micronutrients. The workshop consisted of two components: presentation of preliminary results of the multicenter study on infant supplementation and recommendations on the policy and community, monitoring and impact evaluation, and research aspects of supplementation programs. This paper provides the summary reports of the second component. (author's)
Food and Nutrition Bulletin. 2001; 22(4):466-.Fortification of appropriate foods is an important component of a comprehensive food-based approach toward sustainable control of micronutrient malnutrition, particularly vitamin A deficiency disorders. There are several aspects to be considered and issues to be resolved before investing in food fortification. Key issues discussed by participants included the following: Need for food-consumption survey data to identify micronutrient problems, target groups for interventions, and appropriate food vehicle(s) that could be fortified, including staple foods, complementary foods, and post-weaning foods; Importance of evaluating risks of fortification versus doing nothing and communicating information to policy makers and the scientific community. (excerpt)
Journal of the Indian Medical Association. 2006 May; 104(5): p..Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatment of diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness. (author's)
Global HealthLink. 2005 Mar-Apr; (132):8-9.HELEN KELLER INTERNATIONAL (HKI), a 90-year old organization with established programs worldwide that combat the causes and consequences of blindness and malnutrition, is focusing its tsunami disaster relief efforts on assisting survivors in Indonesia through two assistance activities with both immediate and long-term implications. These disaster response efforts are based on strategies and techniques that the agency already implements, capitalizing on its skills, expertise and experience. The most immediate threat facing the survivors of the earthquake and tsunami is the spread of water-borne and infectious diseases. Many of the survivors are displaced and living in accommodations with poor sanitation and hygiene, making them even more vulnerable to disease. Children are particularly vulnerable to disease and death in the aftermath of disasters, and diarrhea, pneumonia and malaria can become life-threatening problems. Yet, vitamin A and zinc &given to children under five years of age reduce mortality from diarrhea, measles and other causes by 23 percent to 50 percent, and lessen the severity and likelihood of contracting diarrhea, pneumonia and malaria by 30 to 40 percent. (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)
Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality. [Étude randomisée sur l'effet de différentes doses de vitamine A sur la morbidité et la mortalité infantiles]
BMJ. British Medical Journal. 2005 Dec 17; 331(7530):1428-1432.The objectives were to determine whether the dose of vitamin A currently recommended by the World Health Organization or half this dose gives better protection against childhood morbidity and mortality. Design: Randomised study. Setting: A combined oral polio vaccine and vitamin A supplementation campaign in Guinea-Bissau, Africa. Participants: 4983 children aged 6 months to 5 years. Interventions: One of two doses of vitamin A (recommended and half); oral polio vaccine. Main outcome measures: Mortality and morbidity at six and nine months. Mortality was lower in the children who took half the recommended dose of vitamin A compared with the full dose at both six months (mortality rate ratio 0.69, 95% confidence interval 0.36 to 1.35) and nine months (0.62, 0.36 to 1.06) of follow-up. There was a significant interaction between sex and dose, the lower dose being associated with significantly reduced mortality in girls (0.19, 0.06 to 0.66) but not in boys (1.98, 0.74 to 5.29). The lower dose of vitamin A was consistently associated with lower hospital case fatality in girls (0.19, 0.02 to 1.45). Paradoxically, in children aged 6-18 months, the low dose was associated with slightly higher morbidity. Half the dose of vitamin A currently recommended by WHO may provide equally good or better protection against mortality but not against morbidity. (author's)
BMJ. British Medical Journal. 2005 Feb 12; 330:347-349.Zinc deficiency is one of the ten biggest factors contributing to burden of disease in developing countries with high mortality. Since the problem was highlighted in the World Health Report 2002, calls have increased for supplementation and food fortification programmes. Zinc interventions are among those proposed to help reduce child deaths globally by 63%. Populations in South East Asia and sub-Saharan Africa are at greatest risk of zinc deficiency; zinc intakes are inadequate for about a third of the population and stunting affects 40% of preschool children. Zinc is commonly the most deficient nutrient in complementary food mixtures fed to infants during weaning. Improving zinc intakes through dietary improvements is a complex task that requires considerable time and effort. The case for promoting the use of zinc supplements and for fortifying foods with zinc, especially those foods commonly eaten by young children, therefore seems strong. However, global policies or recommendations for zinc interventions are few. The World Health Organization recommends zinc only as a curative intervention, either as part of the mineral mix used in the preparation of foods for the treatment of severe malnutrition, or more recently in the treatment of diarrhoea. We review current evidence that improving zinc intake has important preventive or curative benefits for mothers and young children and examine the programme implications for achieving this in developing countries. (excerpt)
Washington, D.C., Pan American Health Organization [PAHO], Division of Health Promotion and Protection, Food and Nutrition Program, . 37 p.Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development. Longitudinal studies have consistently shown that this is the peak age for growth faltering, deficiencies of certain micronutrients, and common childhood illnesses such as diarrhea. After a child reaches 2 years of age, it is very difficult to reverse stunting that has occurred earlier. The immediate consequences of poor nutrition during these formative years include significant morbidity and mortality and delayed mental and motor development. In the long-term, early nutritional deficits are linked to impairments in intellectual performance, work capacity, reproductive outcomes and overall health during adolescence and adulthood. Thus, the cycle of malnutrition continues, as the malnourished girl child faces greater odds of giving birth to a malnourished, low birth weight infant when she grows up. Poor breastfeeding and complementary feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first two years of life. For this reason, it is essential to ensure that caregivers are provided with appropriate guidance regarding optimal feeding of infants and young children. (excerpt)