7. 4 major micronutrient deficiencies
• Iron Anemia and decreased
intelligence
• Iodine Goiter and cretinism
• Vitamin A Xeropthalmia,
blindness, and death
• Zinc Multiple disorders
8. 8
Assessment of micronutrient
deficiencies in emergencies
• 2 ways to assess
– Indirect assessment- estimation of nutrient intakes at a
population level and assessing from this the risk of
deficiency and likely prevalence and public health
seriousness of MDD
– Direct assessment- involves the measurement of actual
clinical or sub-clinical deficiency in individuals and then
using that info to give a population estimate of the
prevalence of the MDD
Which do you think is most feasible in emergencies?
9. 9
Clinical signs and symptoms
The percentage of women affected by pellagra and niacin deficiency is shown as an example.
These data were collected during a survey in the Kuito area of central Angola in 2004.[1]
[1] Seal, A. J. et al. (2007) Low and deficient niacin status and pellagra are endemic in postwar Angola. Am J Clin
Nutr 85: 218-224.
10. Overview of micronutrient
deficiencies
• Deficiencies are difficult to recognize
– Symptomatic cases often represent tip of
iceberg
– Laboratory assessment difficult & expensive
11. 11
Biochemical testing
• Advantages:
provides objective
measures of
micronutrient status
• What is a biological
test?
– Analysis of a
biological sample
• Urine
• Blood
– Ex: Serum
retinol
12. 12
Inclusion of nutrient rich foods in rations
• Groundnuts as part of ration - good source
of niacin (vitamin B3) and cost effective
approach to improve micronutrient content
of rations
• Malawi experience in 1989-1990
– 5-6 mo disruption in supply of ground nuts led
to pellagra outbreak, 6.3% of population
13. 13
Provision of food supplementation
products for home-based fortification
• Food supplementation products are intended to be
used at home and added to the household diet or that
of their children
• Effective education/messages crucial to programmes
to ensure proper use
• Examples
– Multiple Micronutrient powders (MNPs)
– Spreads
– Foodlets
– Sauces
• Effectiveness of these products has not yet been
proven in all cases - ongoing research
14. 76
83
72
45
41
30
47
20 18
0
10
20
30
40
50
60
70
80
90
60-day 90-day 120-day
Intervention group
%
Anemic
Baseline End 6-mo f/u
60 sachets of
Sprinkles given
over 120 days can
protect a child at
least for a period
of 12 months
14
Effect of three administration models delivering 60
sachets of Sprinkles in children 6-24 months:
Bangladesh
Source: Ip et al, European Journal of Clinical Nutrition; 26 Sept 2007
15. 15
UNICEF standard
MNP (15 minerals
and vitamins)
Nutrient levels based on WHO RNI and RDAs for children 6- 24 mo.
16. Issues and constraints to MNP
use/scale-up
• Product registration-
Food or pharmaceutical
• Composition
• Packaging
• Production capacity
• Does sharing occur?
• Need more operational
experience
• Need programme
guidance
• Need quality
documentation of scale-
up experiences 16
17. 17
Policies and guidance on
micronutrients in emergencies
• UN Joint Statement on Preventing and
controlling micronutrient deficiencies in
populations affected by an emergency
(WHO, WFP, UNICEF)
• Guiding principles for the use of multiple
vitamin and mineral preparations in
emergencies (WHO, WFP, UNICEF)
18. 1
8
CAUTION
• This should not be a long term intervention and
evaluation should be done to put communities
back on food based approaches as soon as it is
possible.
• Operational and usage issues need to be
streamlined.
• In fact the statement is very strong on
monitoring and exit.
20. 20
Other approaches to prevent
micronutrient disease in emergencies
• Provision of fresh food items
• Increasing the size of the general ration to
facilitate dietary diversification by exchange
or trade
• Promotion of homestead food production
• Income generation and improving access to
markets
• Promotion of recommended infant feeding
practices
21. Mean days per week consumption of food by
categories
6.6
1.9
1.6
3.5
3.0
2.8
1.6
3.3
6.8 6.8 6.8
6.8
1.8 1.8
3.1 3.2
2.8
1.6
3.6
6.9 6.9 6.8
6.7
1.8 1.7
3.3
3.1
2.8
1.6
3.5
6.9 6.8 6.8
1
2
3
4
5
6
7
Number
of
Days
Food
Food Consumed
Mean number of days per week
Severe affected Moderate affected Overall
22. Summary
• The 4 major deficiencies are anemia,
iodine deficiency, vitamin A
deficiency, and zinc deficiency
• Major risk factors include poor
dietary intake, communicable
diseases, poor relief diets
• Treatment and prevention include
food fortification, supplementation,
and dietary diversification
