Zinc…essential for life
IZA
Health
and
Nutri1on


2000

 
Zinc
and
Health
Conference,
Stockholm,
Sweden,

       
brings
together
health
and
nutri...
IZA
Health
and
Nutri1on

..cont.

2010 
January:
IZA
launches
the
'Zinc
Saves
Kids'

     
program
in
Peru
and
Nepal


201...
Copenhagen
Consensus

 •  Panel
of
eight
leading
economists
including
five

    Nobel
Laureates.

 •  Ranked
malnutri1on
in...
Bill
Clinton
–


Clinton
Global
Ini1a1ve:

•  “Zinc
micronutrient
deficiency
in
humans
has
been

   iden1fied
as
a
major
glo...
Global
causes
of
under‐five
child
deaths






   Source:
Bryce
J.
et
al.,
Lancet
2005

•  Improved
zinc
nutri1on
will
help
lay
the

   founda1on
for
greater
progress
on
child

   growth
and
development.



•  ...
•  Zinc‐containing
supplements
are
a
quick

   and
easy,
effec1ve
and
inexpensive

   remedy,
cos1ng
$1‐4
per
person
per
ye...
•  UNICEF
procurement
of
zinc
tablets

   increased
from
20
million
tablets
in
2006

   to
more
than
150
million
in
2008.
...
Goal
of

Zinc
Industry



•  Raise
awareness
of
the
issue



•  Reduce
infant
and
child
mortality

•  Implement
a
Corporat...
Zinc
supplementa1on
plays
a
key

role
in
achieving
the
Millennium

Development
Goals
(MDGs)

•  MDG1:
Eradicate
extreme
po...
Zinc’s
Role
in

Human
Nutri1on   

The
role
of
zinc
in
human
biology

•  Essen1al
trace
element


•  Involved
in
over
300
enzymes
in
the
body


•  Zinc
“finge...
Effects
of
Human
Zinc
Deficiency

•  Dwarfism,
growth
retarda1on



•  Derma11s,
alopecia



•  Mental
disturbances


•  Decr...
Zinc
deficiency
is
a
significant

public
health
issue


•  2
billion
people
worldwide
are
es1mated
to

   be
zinc
deficient

...
Zinc
Deficiency
is
5th
Leading
Cause
of
Death

and
Disease
in
the
Developing
World


                   Risk
Factor        ...
Areas
of
Zn
deficiency





  Source
The
Lancet
Maternal
and
Child
Under
nutri1on
Series
January
2008

Impact
of
Zinc
Treatments

 •  12
high‐quality
trials
(efficacy
and
effec1veness)

    across
regions
(mostly
Asia)

showed
b...
Con1nued…

•  ~25%
reduc1on
in
dura1on
(n=5)
and
severity
of

   acute
diarrheal
episode


•  ~30%
reduc1on
in
mean
dura1o...
•  WHO
issued
a
recommenda1on
for
zinc

   supplements
plus
Oral
Rehydra1on
Salts

   (ORS)
for
the
treatment
of
the
disea...
World
Map
–
Zinc
Deficiency



                          Soils




                         Humans
Zinc Applications improved wheat grain yield,
on average, 7 % in 3 locations of Punjab State
•  Zinc
deficiency
–
in
humans
and
crops
is
a

   cri1cal,
global,
and
linked
issue


•  Addressing
zinc
deficiency
in
soils...
STRENGTHENING
NATIONAL
POLICIES

FOR
THE
PREVENTION
AND
CONTROL

OF
ZINC
DEFICIENCY
IN
VULNERABLE

      POPULATIONS
OF
PE...
Evidence:
Zinc
in
human
nutri1on

•  Adequate
zinc
nutri1on
is
essen1al
for
human                                        
...
•  Zinc

deficiency
affects
children’s
physical
growth
and    

   the
risk
 
and
severity
of
a
variety
of
infec1ons
 (Brown...
Age:
                                                                 Age:
2 years 9
                                     ...
Zinc
interven1on,
evidences
in
Peru

                                            


•  Adding
zinc
to
prenatal
iron
and
fo...
Peru
is
one
of
the
countries
with
the
lowest
consump1on

            of
zinc
in
children
under
4
years
in
La1n
America



...
The
anemia
prevalence
in
Peru
is
classified
us
an

                          severe
public
health
problem

Anemia prevalenc...
Situa1on
analysis

•  IZiNCG
 es1mates
 that
 Peru
 has
 41.6%
 of
 its

   popula1on
at
risk
of
an
inadequate
zinc
intake...
Infant
and
Neonatal
Mortality
rates,
are
sGll
high





  The 55 % of infant deaths (< 1 year) correspond to neonatal mort...
Anaemia
prevalence
in
Peru
is
a
severe

     public
health
problem
(*)

High
Anemia
prevalence
in
children
between


6‐36
months
affect
the
all
socioeconomic
status





Source:

Na1onal

Ins1tut...
The percentage of children between 6-36 months with
 complete suplemention with ferrous sulphate is very
        low versu...

In
the
last
five
years
the
stunGng
prevalence
in
Peru
has
had
a

                          significant
reducGon


         ...
Acute
respiratory
infec1on
(IRA)
is

decreasing
,

   but

acute
diahorrea
disease
(EDA)
remain

in

                 chil...
DistribuGon
of
the
poverty
by
regions
(2009)





                                     National average: 34.8




        ...
DistribuGon
of
the
Under
Five
Mortality
Rate
by

                 regions
(2009)





                                    ...
DistribuGon
of
under
five
anemia
prevalence
by

                regions
(2009)





                                   Nati...
DistribuGon
of
stunGng
prevalence
by
regions

                   (2009)





                                   National a...
Advances
of
the
country
                             

1.  Strong
poli1cal
commitment
at
na1onal
and

    sub‐na1onal
leve...
Advances
of
the
country
                             

4.  Alloca1on
of
earmarked
resources
from

    na1onal
and
local
go...
Strategy
Development:
ESTRATEGIA
NACIONAL
CRECER

                                                       Horizontal articu...
MNP
Supplementa1on
strategy
in

  Apurimac,
Ayacucho
and
Huancavelica

ObjecGve:
Reduce
the
micronutrient
deficiencies
in
 ...
IZA
PROPOSAL

              GENERAL
OBJECTIVE



Contribute
to
the
improvement
of
child
survival,

  growth
and
developmen...
SPECIFIC
OBJECTIVES

•  Improve
the
zinc
intake
in
children
under
three
years
old
through

   the
mul1‐micronutrient
powde...
THE
GOALS

•  Reduce
en
15%
de
incidence
of
Acute

   Diarrhoeal
Diseases
in
children
<
5
years
old
in

   vulnerable
area...

 165,700
 children
 under
 3
 years
 old

from
 Apurímac,
 
 Ayacucho,
 Cusco,

Huancavelica
y
Ventanilla
regions.


    ...
LINES
OF
ACTION

1.  Advocacy
to
ins1tu1onalize
a
na1onal
policy

2.  Strengthening
the
capaci1es
of
health
and
other

   ...
Children
from
Ayacucho´s
family

    supplemented
with
MNP

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Zinc deficiency is a significant public health issue. Zinc supplements and fortification are effective and affordable ways interventions and can help prevent the deaths of 800,000 people annually. "Zinc Saves Kids" is an initiative of the International Zinc Association which supports UNICEF's zinc supplement programmes on the ground in Peru, Nepal, Brazil and in Africa.

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Oct2010_zinc_saves_kids_london_panel_debate

  1. 1. Zinc…essential for life
  2. 2. IZA
Health
and
Nutri1on

 2000

 
Zinc
and
Health
Conference,
Stockholm,
Sweden,
 
brings
together
health
and
nutri1on
scien1sts,
 
governments
and
NGOs
to
discuss
scien1fic
 
advances
and
implica1ons
of
zinc
for
public
health.
 2000

 
IZA
provides
funding
to
establish
the
Interna1onal
 
Zinc
Nutri1on
Consulta1ve
Group
(IZiNCG),
an
 
interna1onal
group
of
nutri1on
scien1sts
whose
 
objec1ves
are
to
promote
and
assist
efforts
to
 
reduce
zinc
deficiency.
 2006

 
IZA
launches
an
annual
conference
highligh1ng
 
zinc’s
importance
for
human
health
in
La1n
America.

  3. 3. IZA
Health
and
Nutri1on

..cont.
 2010 
January:
IZA
launches
the
'Zinc
Saves
Kids'
 
program
in
Peru
and
Nepal
 2010 
October:

IZA
announces
new
commitments
to
 
fund
UNICEF
programmes
in
Brazil
against
zinc
 
deficiency,
and
in
2011,
to
idenGfy
an
 
addiGonal
programme
in
the
African
 
conGnent,
where
IZA
support
will
be
allocated
 
to
region
where
the
most
needs
are
idenGfied.

  4. 4. Copenhagen
Consensus
 •  Panel
of
eight
leading
economists
including
five
 Nobel
Laureates.
 •  Ranked
malnutri1on
in
children
as
the
most
 pressing
challenge
facing
the
world
today
and
 concluded
that
zinc
and
vitamin
A
would
be
the
 best
investment
the
world
could
make
for
 improvement.

 •  The
benefit
for
each
dollar
spent
(in
terms
of
 improved
health,
fewer
deaths,
and
increased
 producGvity)
was
esGmated
to
be
USD
$17.

  5. 5. Bill
Clinton
–

 Clinton
Global
Ini1a1ve:
 •  “Zinc
micronutrient
deficiency
in
humans
has
been
 iden1fied
as
a
major
global
health
problem…
[It
 requires]
a
comprehensive
strategy
that
includes
 dealing
with
diet,
food
supplements
and
 for1fica1ons
and
agricultural
approaches.”
 •  “There
is
almost
no
other
strategy
on
earth
that
 could
save
that
many
lives
for
that
liTle
money.”
 •  “This
is
something
90
percent
of
us
are
unaware
of
 or
wouldn’t
have
a
clue
as
to
what
to
do
about
it.”

  6. 6. Global
causes
of
under‐five
child
deaths

 Source:
Bryce
J.
et
al.,
Lancet
2005

  7. 7. •  Improved
zinc
nutri1on
will
help
lay
the
 founda1on
for
greater
progress
on
child
 growth
and
development.

 •  Access
to
proper
nutri1on
helps
fight
off
 illness
and
disease
and
is
vital
to
children’s
 cogni1ve
development
and
learning.

  8. 8. •  Zinc‐containing
supplements
are
a
quick
 and
easy,
effec1ve
and
inexpensive
 remedy,
cos1ng
$1‐4
per
person
per
year.

 •  Therapy
for
diarrhea
requires
a
14‐day
 supply
at
a
cost
of
$0.50


  9. 9. •  UNICEF
procurement
of
zinc
tablets
 increased
from
20
million
tablets
in
2006
 to
more
than
150
million
in
2008.
But
 this
is
only
a
frac1on
of
what
is
needed
 to
treat
children
affected
worldwide.

  10. 10. Goal
of

Zinc
Industry


 •  Raise
awareness
of
the
issue

 •  Reduce
infant
and
child
mortality
 •  Implement
a
Corporate
Social
Responsibility
 program
that
will
make
a
difference

  11. 11. Zinc
supplementa1on
plays
a
key
 role
in
achieving
the
Millennium
 Development
Goals
(MDGs)
 •  MDG1:
Eradicate
extreme
poverty
and
hunger
 •  MDG4:
Reduce
child
mortality
 •  MDG6:
Combat
HIV/AIDS,
malaria
and
other
 diseases

  12. 12. Zinc’s
Role
in
 Human
Nutri1on 

  13. 13. The
role
of
zinc
in
human
biology
 •  Essen1al
trace
element
 •  Involved
in
over
300
enzymes
in
the
body
 •  Zinc
“fingers”
in
transcrip1on
proteins
determine
 binding
to
DNA
 •  Intracellular
regula1on,
e.g.,
cellular
growth,
 differen1a1on
and
death
 •  Immune
func1on
‐
nonspecific
immunity,
T
and
B
 lymphocytes,
cytotoxic
ac1vity
and
an1body
 produc1on

  14. 14. Effects
of
Human
Zinc
Deficiency
 •  Dwarfism,
growth
retarda1on

 •  Derma11s,
alopecia

 •  Mental
disturbances
 •  Decreased
immune
func1on
 •  Infec1ons

 •  Death


  15. 15. Zinc
deficiency
is
a
significant
 public
health
issue
 •  2
billion
people
worldwide
are
es1mated
to
 be
zinc
deficient
 •  Zinc
deficiency
contributes
to
the
deaths
of

 over
800,000
annually
(WHO)
 •  Approximately
450,000
are
children
(Brown
et.
 Al.
2008).

  16. 16. Zinc
Deficiency
is
5th
Leading
Cause
of
Death
 and
Disease
in
the
Developing
World
 Risk
Factor DALY
(in
%)
* Underweight 14.9 Unsafe
sex 10.2 Unsafe
water 5.5 Indoor
smoke 3.7 Zinc
deficiency 3.2 Iron
deficiency 3.1 Vitamin
A
deficiency 3.0 Blood
pressure 2.5 Tobacco 2.0 Cholesterol 1.9 *
Disability
Adjusted
Life
Years
 Source:
The
World
Health
Report
2002

  17. 17. Areas
of
Zn
deficiency
 Source
The
Lancet
Maternal
and
Child
Under
nutri1on
Series
January
2008

  18. 18. Impact
of
Zinc
Treatments
 •  12
high‐quality
trials
(efficacy
and
effec1veness)
 across
regions
(mostly
Asia)

showed
benefit
of
 zinc
treatment
 •  Age
groups:

3‐60
mo
 •  Dose
of
zinc:

≈20
mg/d
(range
5‐45
mg/d)
 •  Dura1on:
7‐14
days
(treatment)

  19. 19. Con1nued…
 •  ~25%
reduc1on
in
dura1on
(n=5)
and
severity
of
 acute
diarrheal
episode

 •  ~30%
reduc1on
in
mean
dura1on
of
persistent
 diarrhea
 •  Reduced
incidence
of
diarrhea
and
pneumonia
in
2‐3
 mo.
following
treatment;
19%
reduc1on
in
diarrhea
 prevalence

 •  Reduces
risk
of
hospitaliza1on
(n=2)
,
all
cause
 mortality
(n=4)
and
diarrhea
mortality
(~23%)
 •  Reduced
mortality
by
68%
in
low
birth
weight
infants
 Source:

Zinc
Inves1gators
Collabora1ve
Group,
AJCN,
2000

  20. 20. •  WHO
issued
a
recommenda1on
for
zinc
 supplements
plus
Oral
Rehydra1on
Salts
 (ORS)
for
the
treatment
of
the
disease.

 •  50
governments
have
changed
their
child
 health
policies
to
include
zinc
for
diarrhoea
 management.

  21. 21. World
Map
–
Zinc
Deficiency
 Soils Humans
  22. 22. Zinc Applications improved wheat grain yield, on average, 7 % in 3 locations of Punjab State
  23. 23. •  Zinc
deficiency
–
in
humans
and
crops
is
a
 cri1cal,
global,
and
linked
issue
 •  Addressing
zinc
deficiency
in
soils
and
crops
is
an
 effec1ve
approach
 •  Benefits
include
increased
food,
nutri1on,
health
 and
economics,
improved
food
security

  24. 24. STRENGTHENING
NATIONAL
POLICIES
 FOR
THE
PREVENTION
AND
CONTROL
 OF
ZINC
DEFICIENCY
IN
VULNERABLE
 POPULATIONS
OF
PERU
 2010
–
2012
 “Zinc saves kids campaign” IZA – UNICEF
  25. 25. Evidence:
Zinc
in
human
nutri1on
 •  Adequate
zinc
nutri1on
is
essen1al
for
human 
 health

because
of
zinc’s
cri1cal
structural
and 
 func1onal
 roles
 in
 mul1ple
 enzyme
 systems 
 that
 are
 involved
 in
 gene
 
 expression,
 cell 
 division
 and
 growth,
 immunologic
 
 
 and 
 reproduc1ve
func1ons.

 
Fuente:
Sonja
Y.
Hess,
et
al,Food
and
Nutri9on
Bulle9n,
vol.
30,
no.
1
(supplement)
 ©
2009

  26. 26. •  Zinc

deficiency
affects
children’s
physical
growth
and 
 the
risk
 
and
severity
of
a
variety
of
infec1ons
 (Brown, 2004)

 •  Mul1ple
 community‐based
 interven1on
 trials 
 indicate
 
 that
 zinc
 supplementa1on
 decreases
 the
 incidence
 of
 diarrhea
 and
 pneumonia
 among
 young 
 children
(Bhuxa
et
al
1999).
 •  Clinical
 treatment
 studies
 have
 shown
 that
 zinc
 supplementa1on
 during
 diarrhea
 reduces
 the 
 severity
and
dura1on
of
such
illnesses
(Bhuxa,2004)

  27. 27. Age: Age: 2 years 9 2 years 6 months months Weigth: 10.7 kg. Weigth: 11.6 kg. High: 78.3 cm High: 86.4 cm Nutritional Status: Nutritional Status: Stunting Normal Children at the same age to Andahuaylas in Peru
  28. 28. Zinc
interven1on,
evidences
in
Peru
 
 •  Adding
zinc
to
prenatal
iron
and
folate
tables
 improves
neuronal
fetal
development.
Fuente:
 Merialdi,M;
Caulfield,LE;
Zavaleta,N;
et
al,
AmJ
obstetGynecol
1999
 •  Maternal
zinc
supplementa1on
reduces
 diarrheal
morbidity
in
peruvian
infants.
 
Fuente:
LoraL.
Iannoe,
N
Zavaleta,
Z
Leon,
et
al,

(JPediatrics2010:156:960‐4)

  29. 29. Peru
is
one
of
the
countries
with
the
lowest
consump1on
 of
zinc
in
children
under
4
years
in
La1n
America

 Fuente: Food and Nutrition Bulletin 28: 1, 2007. Black, RE. 2003. Management Sciences for Health
  30. 30. The
anemia
prevalence
in
Peru
is
classified
us
an
 severe
public
health
problem
 Anemia prevalence (Hb < 11g/dL) in children under 2 years classified by severity criteria as health public problem Sever Moderate Mild (> 40.0%) (20.0 - 39.9%) (5.0-19.9%) Bolivia (83.8%) México (37.8%) Chile (8.8%)*** Haití (83.3%) Costa Rica (37.2%) Ecuador (72.7%) Argentina (24.0%)** Nicaragua (29.4%) Perú (61.0%)* Venezuela (63.8%)** Anemia prevalence (Hb < 11g/dL) in children under 5 years Cuba (56.7%)** classified by severity criteria as health public problem Brasil (55.1%)** Sever Moderate Mild Guatemala (55.6%) (> 40.0%) (20.0 - 39.9%) (5.0-19.9%) Colombia (53.2%) Panamá (52.5%) Haití (65.8%) Guatemala (39.7%) El Salvador (19.8%) Ecuador (57.9%) Uruguay (36.1%)*** Nicaragua (17.0%) Honduras (45.3%) Bolivia (51.6%) Panamá (36.0%) El Salvador (40.0%) Venezuela (36.0%)** Perú (49.6%)* Colombia (33.2%) Jamaica (48.2%) Brasil (31.4%)** * DHS 2009 Guyana (47.9%) Honduras (29.9%) ** Children of selected areas of the country. Costa Rica (26.3%)**** *** Estimated values. Chile (1.5%): it Rep. Dominicana not represent **** Included children under 7 years ( Hb<12 g/ (25.0%)*** health public dL). México (23.7%) problem Source: Argentina (22.4%)** Elaborated by WFP with data of OMS, 2007. Vitamin and Paraguay (22.0%) Mineral Nutrition Information System (VMNIS) y Últimas Encuestas Nacionales. Cuba IHNA 2005. Cuba (20.1%)**
  31. 31. Situa1on
analysis
 •  IZiNCG
 es1mates
 that
 Peru
 has
 41.6%
 of
 its
 popula1on
at
risk
of
an
inadequate
zinc
intake.
 •  There
 is
 not
 an
 official
 sta1s1c
 of
 zinc
 deficiency
 in
 Peru
 but
 anaemia
 and
 stun1ng
 prevalence
 may
 suggest
a
risk.
 •  Peru
 has
 high
 prevalence
 of
 anemia,
 especially
 in
 children
under
three
years
old.
 •  The
 problem
 affect
 all
 the
 socioeconomic
 status
 popula1ons
 •  Lower
 coverage
 of
 ferrous
 supplementa1on
 in
 children.

 •  Low
acceptability
of
ferrous
sulfate
syrup
 •  Deep
 dispari1es
 in
 stun1ng
 prevalence
 between
 urban
and
rural
areas

  32. 32. Infant
and
Neonatal
Mortality
rates,
are
sGll
high
 The 55 % of infant deaths (< 1 year) correspond to neonatal mortality ( < 28 days of born) Fuente: ENDES 1992-1996-2000-2004-2009
  33. 33. Anaemia
prevalence
in
Peru
is
a
severe
 public
health
problem
(*)

  34. 34. High
Anemia
prevalence
in
children
between

 6‐36
months
affect
the
all
socioeconomic
status
 Source:

Na1onal

Ins1tute
of
Sta1s1c
and
Informa1on
INEI
‐
DHS
2009

  35. 35. The percentage of children between 6-36 months with complete suplemention with ferrous sulphate is very low versus the high anemia prevalence
 Puno
 
 78.5 
 Cusco
 5.1 
 
 73.1 Huancavelica
 10.5 
 66.9 
 
 Pasco 
 21.7 65.5 
 Ayacucho
 64.6
 12.9 21.4
 
 64.2
 Madre
de
Dios 14.0
 64.2
 Apurimac
 32.1
 
 59.6
 Loreto 17.1
 Tumbes
 59.3
 12.9
 Junín
 58.2
 5.6
 La
Libertad
 57.8
 6.0
 Moquegua
 56.2
 4.1
 Lambayeque
 55.4
 10.9
 Huánuco
 55.4
 15.1
 Cajamarca
 54.2
 14.4
 San
Mar1n
 54.1
 13.8
 Áncash
 54.1
 15.6
 Tacna
 51.6
 8.2
 Lima
 51.0
 10.6
 Ica
 50.6
 6.7
 Arequipa
 50.6
 12.9
 Ucayali
 49.9
 13.4
 Piura
 49.0
 8.5
 Amazonas
 48.5
 6.2
 0.0 
 10.0
 20.0
 30.0
 40.0
 50.0
 60.0
 70.0
 80.0 
 
 90.0 Suplementa1on
 Anemia
 Source:

Na1onal

Ins1tute
of
Sta1s1c
and
Informa1on
INEI
–
DHS
2005‐2007

  36. 36. 
In
the
last
five
years
the
stunGng
prevalence
in
Peru
has
had
a
 significant
reducGon

 (Percentage) 
 Source:

Na1onal

Ins1tute
of
Sta1s1c
and
Informa1on
INEI
‐
DHS
200,
2005,
2007,
2008,
2009

  37. 37. Acute
respiratory
infec1on
(IRA)
is

decreasing
,
 but

acute
diahorrea
disease
(EDA)
remain

in
 child
under
five
.
 Source: DHS 200,2004-2006, 2007-208, 2009
  38. 38. DistribuGon
of
the
poverty
by
regions
(2009)
 National average: 34.8 Source: ENDES 2009
  39. 39. DistribuGon
of
the
Under
Five
Mortality
Rate
by
 regions
(2009)
 National average: 31 Source: ENDES 2009
  40. 40. DistribuGon
of
under
five
anemia
prevalence
by
 regions
(2009)
 National average: 37.2 Source: ENDES 2009
  41. 41. DistribuGon
of
stunGng
prevalence
by
regions
 (2009)
 National average: 18.3 Source: ENDES 2009
  42. 42. Advances
of
the
country 
 1.  Strong
poli1cal
commitment
at
na1onal
and
 sub‐na1onal
level:
President
Garcia
sets
the
 goal
of
reducing
stun1ng
from
25%
to
16%
in
 5
years‐
2006
to
2011
(July
2006)
 2.  Development
of
a
na1onal
strategy
against
 child
malnutri1on:
CRECER

 3.  Redesign
of
na1onal
social
programs
around
 nutri1onal
outcomes:
PRONAA,
JUNTOS,
 FONCODES

  43. 43. Advances
of
the
country 
 4.  Alloca1on
of
earmarked
resources
from
 na1onal
and
local
governments:
In
2008
 Ministry
of
Finance
creates
two
result‐based
 budgetary
programs:
“Ar9culado
Nutricional”
 and
“Maternal
and
Neonatal
Health”
 5.  New
evidence‐based
technical
norms
and
 protocols:

 –  Technical
Norm
063‐2008:
defines
priority
health
and
nutri1on
 interven1ons
(ref.
Lancet
Series)
 –  Ministerial
Resolu1on
N°
648‐2008/MINSA:
prepara1on
of
a
na1onal
 ac1on
plan
for
mul1micronutrient
supplementa1on
(Sprinkles,
 Chispitas,
Estrellitas).

  44. 44. Strategy
Development:
ESTRATEGIA
NACIONAL
CRECER
 Horizontal articulation What
is
CRECER?

 •  Integrated
strategy
against
chronic
malnutri1on
 and
poverty,
launched
in
July
2007.
 ObjecGves
and
targets:

 •  Reduce
chronic
malnutri1on
from
25%
to
16%
by
 2011

 •  Axend,
by
2011,
one
million
of
under‐5
children
 and
150,000
pregnant
women
 •  Increase
access,
coverage
and
quality
of
basic
 services
in
880
districts
of
extreme
poverty.

 Vertical articulation Coverage:
 •  At
present,
CRECER
covers
638
districts,
500,000
 under‐5
children
and
120,000
pregnant
women.

 Financing:
 •  Public
funds
from
par1cipa1ng
ministries
and
 social
programs.
 •  Strategic
budgetary
programme
of
Ministry
of
 Finance
“Ar9culado
Nutricional”

 •  Regional
and
municipal
budgets

 •  Private
funding
and
Interna1onal
coopera1on
 45

  45. 45. MNP
Supplementa1on
strategy
in
 Apurimac,
Ayacucho
and
Huancavelica
 ObjecGve:
Reduce
the
micronutrient
deficiencies
in
 
 









 







children
under
three
years
old,
especially
 


















anemia
through
intersectorial
interven1on.
 
 








The
strategy
has
begun
in
October
2009
 Area:
Ayacucho,
Apurimac
and
Huancavelica
 Strategic
components:
 Provision

 Educa1on
and
communica1on
 Monitoring
and
evalua1on
 Target:

109,
496
children
under
3
years
old.
 Advances:

At
june
2010,
70%
of
children

have

 










 received
de
suplement.

  46. 46. IZA
PROPOSAL
 GENERAL
OBJECTIVE

 Contribute
to
the
improvement
of
child
survival,
 growth
and
development
in
Peru,
through
the
 strengthening
of
na1onal
policies
for
the
 preven1on
and
control
of
micronutrient
 deficiencies
‐
with
a
special
emphasis
on
zinc
‐
 and
through
suppor1ng
its
implementa1on
 na1onwide

  47. 47. SPECIFIC
OBJECTIVES
 •  Improve
the
zinc
intake
in
children
under
three
years
old
through
 the
mul1‐micronutrient
powder
supplementa1on
and
the
 promo1on
of
adequate
complementary
feeding
in
four
regions.

 •  Reduce
the
incidence
and
severity
of
diarrhea
diseases
in
children
 under
five
years
old
in
vulnerable
areas,
through
the
therapeu1c
 zinc
supplementa1on
in
four
regions.
 •  Reduce
the
anaemia
prevalence
in
children
under
three
years
old
 through
the
mul1‐micronutrient
supplementa1on
and
the
 promo1on
of
adequate
complementary
feeding
in
four
regions.
 •  
Improve
the
knowledge
about
effec1ve
zinc
interven1ons
in
public
 programmes
of
survival,
growth
and
child
development
in
four
 regions.


  48. 48. THE
GOALS
 •  Reduce
en
15%
de
incidence
of
Acute
 Diarrhoeal
Diseases
in
children
<
5
years
old
in
 vulnerable
areas.
 •  Increase
in
40%
the
coverage
of
children
<
3
 years
old
suplemented
with
 mul1micronutrient
with
zinc
in
vulnerable
 areas.
 •  Reduce
in
30%
the
anaemia
prevalence
in
 children
<

3
years
old
in
vulnerable
areas.

  49. 49. 
 165,700
 children
 under
 3
 years
 old
 from
 Apurímac,
 
 Ayacucho,
 Cusco,
 Huancavelica
y
Ventanilla
regions.
 REGION CHILDREN <
3
years LIMA (Ventanilla) 15,000 APURIMAC 22,000 AYACUCHO 35,700 CUSCO 64,000 HUANCAVELICA 29,000 
TOTAL

 165,700
 Source:

Proyected
PopulaGon
of
the
MoH
based
in
2007
 Census

  50. 50. LINES
OF
ACTION
 1.  Advocacy
to
ins1tu1onalize
a
na1onal
policy
 2.  Strengthening
the
capaci1es
of
health
and
other
 social
sector
personnel
 3.  Strengthening
social
communica1on
strategy
to
 promote

family
prac1ces

of
micronutrients
 consump1on




 4.  MNP
supplementa1on
as
part
of
the
care
 package
for
children,
zinc
supplementa1on
as
 adjunc1ve
therapy
for
diarrhoea
in
children
and
 local
produc1on
of
MNP
and
zinc
supplement
 5.  Monitoring,
evalua1on
and
research

  51. 51. Children
from
Ayacucho´s
family
 supplemented
with
MNP

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