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1. Unicef
for
every
child
Micronutrient
Jan 2023
Adama
7/6/2023
1

2. Micronutrients
Vitamins & minerals.
Required in smaller quantities by the body.
Perform essential physiological & structural functions.
7/6/2023 Unicef for every child 2
 Micronutrients are nutrients that do not have to be broken down to smaller units for use by
the body
 Are Vitamins and minerals which our body only needs in small amounts.
 “Hidden Hunger” as adequate food may be present, but the diet contains insufficient amounts
of certain vitamins and minerals

3. Micronutrient Deficiencies in Ethiopia
Unicef for every child
The five most widespread forms of
micronutrient deficiencies are
• Vitamin A deficiency (VAD)
• Iodine deficiency Disorder (IDD)
• Iron deficiency Anemia (IDA)
• Folate deficiency and
• Zinc deficiencies
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4. Prevention of Micronutrient deficiencies in Ethiopia
The various strategies to be used nationally in the prevention and control
of micronutrient deficiencies in Ethiopia are as follows
1. Supplementation
2. Food Diversification
3. Fortification
4. Public Health Interventions to address micronutrient deficiencies
include:
• Promotion of optimal breastfeeding
• Infection prevention and control
5. SBCC: In order for MN interventions to achieve targeted results, emphasis
must be given to SBCC (Desired behavior change catalyze an increase in
service-seeking practices)
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5. 1. Prevention and control of Vitamin-A Deficiency (VAD)
Function of Vitamin A
1. Forms Visual pigment : Combines with purple pigment of retina (opsin) form
rhodopsin, which is necessary for sight in partial darkness.
2. Necessary for growth of bone ,testicular function, ovarian function,
embryonic development, regulation of growth, differentiation of
3. Helps form and maintain healthy skin, hair, and mucous membranes.
4.Immunity- for child survival
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6. Vitamin Deficiency
1. Eye signs:
 Night blindness
 Xeropthamlmia (dryness of the eyes)- due to
Lack of mucus secretion (due to destruction of goblet
cell)
 Bitot’s spots
 Corneal ulceration: Dry, rough skin
 Permanent blindness
2. Changes in mucous membranes (Immunity:
Susceptibility to infection and mortality due to
example Pneumonia, Diarrhea, Measles
3. Poor bone growth & Weak tooth enamel
4. Slow growth
5. Infertility
N
Night blindness
Bitot’s Spots
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7. Food Sources
Plant sources: Vitamin A is generally found in deep green
leafy vegetables(GLV), Papaya, Mango, Carrots, Kale,
fresh Apricots, Red palm oil, Pumpkin, Spinach, Orange
fleshy Sweet potatoes, Watermelon)
Animal sources: found in the form of retinole
Liver
Fish liver oil
Milk and milk products
Egg
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8. Prevention of VAD
1. Vitamin A supplementation for Children 6-59 months biannual
2. Promotion of Breastfeeding: Colostrum has high concentration of
vitamin A, it is called the first immunization of the baby
3. Dietary Modification: Fortification of oil, flour , sugar
4. Dietary Diversification :Fortification of oil, flour , sugar
5. Dietary Diversification; – Behavior change communication on the consumption
of vitamin A friendly foods eg. Growing and consuming Orange fleshy sweet potatoes
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9. 2. Prevention and control of Iodine Deficiency Disorders
(IDD)
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• Iodine is a trace element that combines with the amino acid, tyrosine, to
form the thyroid hormone(T3 and T4) and is necessary for normal thyroid
function.
 Thyroid hormone accelerates cellular reactions, increases oxygen
consumption and basal metabolic rate, influences growth and
development, energy metabolism, differentiation and protein
synthesis.

10. Food sources of iodine
• Foods of marine origin: Sea fish, shell fish, seaweeds
• Dairy products: moderate sources content varies with region, season,
amount of iodine in animal feed; iodophors used in dairy industry
• Cereals when iodized salt or iodates (dough conditioners) used for
bread making
• Losses: during cooking; freezing & freeze-drying

11. Iodine Deficiency Disorders
IDD reduced
o Learning ability
o School performance
o Retention rates
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12. 7/6/2023
Clinical Manifestations
Fetus and Infants
•Depressed growth
•Delayed sexual development
•Mental retardation and learning disability
•Deafness and akinetic mutism
•Abortion and still birth
Adult deficiencies:
•Goiter
•Symptoms of low-thyroid-hormone level (children and adults):
•Listlessness
•Sluggish behavior
Beasts of burden
•Poor reproduction (abortion, still birth)
•Weakness

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Risk factors
•Living in mountainous areas
•Not eating sea foods
•Eating large amounts of raw food that can cause thyroid goiter
(goiterogens), such as spinach, lettuce, turnips, beets, rutabagas, kale are
also at risk of developing iodine deficiency.

14. Intervention
o Universal salt iodization (USI)
o Consumption of iodized salt by the family can be communicated through the
seven contacts of women and children with the health services, (ANC,
delivery, PNC/FP visit, immunization visits, well baby and growth monitoring
and promotion visits and sick child visits.

15. 3. Prevention and control of Iron Deficiency Anemia (IDA)
Iron Function
Hemoglobin and myoglobin formation
Immunity (enhancing neutrophil function)
Cognitive development
Metabolic efficiency (cytochrome formation)
Enhances Physical growth of children
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16. 7/6/2023
Food Sources
oBread, enriched
oCheese, cheddar
oGarbanzo beans (chickpeas)
oLentils
oMolasses, black-strap
oMussels
oPumpkin seeds
oSeaweed
oWalnuts
oWheat germ
oWhole-grain products
Animal Source
Egg yolk, meat, chicken,
fish
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17. 7/6/2023
Deficiency
Among pregnant women and children 1-5 five years of age in developing
countries, anemia prevalence is estimated to be 50-60%.
In sub-Saharan Africa the prevalence rate for pregnant women is 50%
while that for non-pregnant women is 40%.
In Ethiopia, 56% of children and 23 percent of women are anemic
(DHS,2016)
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18. What are the causes of iron deficiency?
• Inadequate dietary intakes: anorexia; poor food selection
• Poor absorption: plant-based diets: high in antinutrients (phytate;polyphenols); low in flesh
foods; low in vit C
• Excessive losses: menstruation; frequent blood donations; nose bleeds; parasitosis; hemolysis;
occult blood loss
• High physiological requirements: infancy; adolescence; pregnancy; lactation
• Inflammation caused by infections; malaria; obesity ( hepcidin)
• Vitamin A deficiency: impairs mobilization of Fe from liver stores
• Combinations of above

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Consequences of anemia
In adults, anemia with a hemoglobin concentration of less than 11g/dl leads to
Reduced physical work capacity
Reduced mental (cognitive) performance-Poor attention span and learning
ability in children
Low tolerance to infections
Poor physical growth.
Premature birth, inter-uterine retardation,low birth weight & PPH
When the hemoglobin concentration level falls below 4 g/dl it may result in
death from anemic heart failure.Unicef for every child 19

20. 7/6/2023
Intervention
Supplementation of iron and folic acid
Treatment of severe anemia
Deworming
Bed net distribution
 Dietary diversification – increased production and consumption of
locally available iron rich foods
Dietary modification -Fortification of foods with iron
Supplementation of iron and folic acid
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21. 4. Folic Acid (Vitamin B9)
• FUNCTIONS
1. It is critical to cellular division because it is necessary
in DNA synthesis.
2. Maintains the cell’s genetic code and transfer
inherited traits from one cell to another
3. Promotes normal red blood cell formation.
4. Regulates embryonic and foetal development of
nerve cells.
5. Without adequate folic acid, DNA synthesis and repair
is impaired.
6. Unrepaired DNA leads to diseases like cancer as
suggested by the Ames’ triage theory.
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22. 7/6/2023
Deficiency
•Megalobastic anemia
•Limb defects?
•Folic acid deficiency during pregnancy has been linked to several birth
defects (Neural tube defect)
WHO Recommendation: preventing neural tube defects, supplementation of high risk women
with folate 1 month after and the first 3 months before the onset of pregnancy

23. 6. Prevention and control Zinc Deficiency
Functions of Zinc
Functions as antioxidant…..hence, prevents cancer
Maintains normal taste and smell.
Promotes normal growth and development.
Immunity (decreases the severity of diarrhea in children(
Promotes normal fetal growth.
Helps synthesize DNA and RNA.
Promotes cell division, cell repair, cell growth.
Maintains normal level of vitamin A in blood. Zinc is required to help
transport vitamin A through the body
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24. What are the causes of Zn deficiency?
• Inadequate zinc intakes
• High physiological requirements
• Infancy; adolescence; pregnancy; lactation
• Disease states associated with:
o excessive losses: diarrhea
o impaired absorption/utilization
• Environmental enteropathy

25. 7/6/2023
Deficiency Symptom
Serious
Deficiency:
Delayed bone
maturation
Enlarged spleen or liver
Decreased size of
testicles
Testicular function less
than normal
Decreased growth or
dwarfism
Moderate Deficiency:
Loss of taste and smell
Suboptimal growth in children, low
birth weight
Alopecia
Rashes
Poor taste acuity
Multiple skin lesions (Acrodermatitis
enterohepatica)
Glossitis, Stomatitis, Blepharitis
Paronychia
Sterility, Low sperm count
Delayed wound healing
Acrodermatitis enterohepatica

26. Severe Zn deficiency in adolescence
o Impaired linear growth
o Delayed sexual development
Zinc deficient Egyptian dwarfs. From Prasad et al. (1963)

27. 7/6/2023
Current WHO recommendation on zinc
supplementation
Health workers should provide children
 with 20 mg per day of zinc supplementation for
10–14 days during diarrheal attacks.
(10 mg per day for infants under six months old)
during diarrheal attacks.

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Food Sources
Zinc is found in many foods. However, the rich
sources are
Red meat- the more dark red the color of the
meat the more the zinc content is.
It is also found in other foods of animal and
plant origin.

29. Galatoomaa!