Identifying Nutritional Need for Multiple Micronutrient Interventions,

Abstract

Micronutrient deficiency remains a major public health problem in many countries worldwide with important consequences for the health of the population and child growth and development. The objective of this article is to review information that should be taken into consideration in identifying the need for and in designing micronutrient programs. We review information that could be used to identify nutritional need, including the prevalence of deficiency and evidence of inadequate dietary intake as well as potential data sources and some strengths and weakness of such data for program decision-making. We also review factors that might modify the potential impact of programs and that should therefore be taken into consideration in their design. For example, such factors may include access to formal and informal health systems, quality of health provider training, and behavior change communication and complementary or overlapping interventions. Nationally representative data on micronutrient deficiencies and dietary intake are most useful for identifying unmet needs. Although the burden of micronutrient deficiencies lies in low-income countries, few have detailed information on specific deficiencies beyond anemia, and nationally representative dietary intake data are scarce. Nationally representative data may still mask considerable within-country variability by geographic, economic, or ethnic group. Some efforts designed to promote coordination in nutrition programming within countries utilizing information on prevalence, intake, and program coverage and utilization are also reviewed. Improving the quality of such data and ensuring continual updates are vital to guide decision making and to ensure that programs can appropriately respond to needs.

Multiple Micronutrient Interventions Are Efficacious, but Research on Adequacy, Plausibility, and Implementation Needs Attention ,

“…This is an important contribution because indicators of deficiency are inadequate for many micronutrients, as reviewed in this workshop (17,18). In fact, efficacy trials are fundamental tools for demonstrating remediable deficiencies, and, when they are well designed (6), they can also identify those who benefited from the supplementation.…”

“…In conclusion, a review of the current situation with respect to improving micronutrient status of populations shows that, in addition to addressing important biological questions, research on this critical health issue needs to include studies on how to establish and maintain effective research-programmatic coordination, beginning with specification of the basic principles about conducting research for policy decisions and program implementation (40), and designing and testing models of coordination (17,37). The methodology for designing and testing these models is now a dream.…”

“…In a population with endemic under-nutrition there will always be some individuals who are not deficient and others whose deficiencies are so moderate that they will have only a marginal response at best. Clearly, these individuals dilute the impact of the intervention, but it may not be easy to identify them because measures for MMN deficiencies are inadequate (17). Others may not respond because of genetic influences on absorption and utilization [e.g., (21)].…”

Barreras y facilitadores a la suplementación con micronutrientes en polvo. Percepciones maternas y dinámica de los servicios de salud

“…Respecto a las barreras referidas al producto, algunos estudios han mostrado que los suplementos de MNP pueden presentar resistencias iniciales a su consumo, si es que no existe una estrategia de mercadeo social, que comunique de forma clara y sencilla, que es el suplemento, como se usa y sus beneficios (22)(23)(24) . Otras barreras relacionadas al MNP, como la percepción de que es un medicamento, sabor desagradable, efectos secundarios o la asociación a tierra, no se han reportado en otros estudios de Perú (12)(13)(14) .…”

Recomendaciones para intervenciones con suplementos de hierro: lecciones aprendidas en un ensayo comunitario en cuatro regiones del Perú

“…Es indispensable analizar las diversas opciones disponibles para cerrar estas brechas, las características de los grupos objetivo, los roles de los diferentes actores involucrados, las posibles estrategias de entrega, alianzas locales y otros factores del contexto local que pueden influir en la implementación de una nueva intervención (23) . Esta información permite evaluar de manera objetiva la viabilidad operacional, elaborar una planificación realista y tener mayor probabilidad de realizar una implementación adecuada (24) .…”