Intervention Strategies for Improving Iron Status of Young Children and Adolescents in India

Abstract

Despite advances in scientific knowledge regarding multiple etiology, treatment, and potential strategies for combating iron deficiency and deficiencies of other micronutrients, iron deficiency anemia, vitamin A deficiency, and iodine deficiency remain significant public health challenges for growing children and adolescents. The short-term efficient supplementation approach, although technically feasible, has not been successful due to problems with delivery and compliance. Evidence is building that preventive supplementation coupled with nutrition education may be a more effective strategy associated with better compliance and improvement in iron status. Long-term, effective approaches include fortification, dietary modification, public health and disease control measures, and income generation programs. Food fortification can be a cost-effective intervention strategy if technologically feasible, nutritionally sound, culturally acceptable and economically viable food vehicle(s) and fortificant(s) can be identifed. Foods such as wheat, rice, and salt are commonly consumed in India; research is underway to evaluate various fortificants for these foods. Doubly fortified salt with iodine and iron may be particularly promising in the Indian situation as it is affordable, culturally acceptable, and may enhance iron absorption from Indian dietaries containing inhibitors of iron absorption. Feasibility studies are underway to evalute the stability and storage issues as well as bioavailability of fortificant iron. Dietary modification involves increased iron intake, by increasing total food intake and consumption of locally available iron-rich foods, and dietary practices favoring iron absorption. Blood loss associated with worm infestation can be controlled by periodic deworming and reducing reinfestation. Coordinating these major intervention approaches by building partnerships between the community, existing nutrition and health programs, government, industry, and academic institutions is critical for success of these programs. Nutrition education must be integral to all of these strategies discusssed. Primary health care system and school infrastructure and staff, along with school children and community members, can be powerful resources for addressing malnutrition in children and adolescents.

Prevalência da carência de ferro e sua associação com a deficiência de vitamina A em pré-escolares

“…Iron deficiency can be managed with efficient measures in the short, medium and long term. 5,16,30 In the short-term, regular supplementation with iron salts, either as medication or as fortified food as successfully done in some countries constitutes an efficient measure to eliminate this problem. Measures that may have a medium to long-term effect include training and reskilling programs for health professionals, allowing for the early identification of these problems, reduction of fever or diarrhea through good vaccination coverage and the use of anthelmintics, w h e n e v e r n e c e s s a r y , b r e a s t f e e d i n g p r o m o t i o n , improvement of child care follow up and, finally, improvement of the quality of life of the population.…”

“…Measures that may have a medium to long-term effect include training and reskilling programs for health professionals, allowing for the early identification of these problems, reduction of fever or diarrhea through good vaccination coverage and the use of anthelmintics, w h e n e v e r n e c e s s a r y , b r e a s t f e e d i n g p r o m o t i o n , improvement of child care follow up and, finally, improvement of the quality of life of the population. 28,30 Such measures may also have an effect on the deficiency of other micronutrients, including VAD. 3 …”

Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children

“…O combate à CF se faz com medidas de eficácia a curto, médio e longo prazos 5,16,30 . A curto prazo, a suplementação periódica e sistemática com sais de ferro, seja na forma medicamentosa, seja na forma de alimentos enriquecidos como já vem sendo realizado com sucesso em alguns locais constitui medida eficaz no combate desse problema.…”

“…A curto prazo, a suplementação periódica e sistemática com sais de ferro, seja na forma medicamentosa, seja na forma de alimentos enriquecidos como já vem sendo realizado com sucesso em alguns locais constitui medida eficaz no combate desse problema. Promover treinamento e reciclagem dos profissionais de saúde visando à identificação precoce desses problemas, diminuição das doenças febris ou diarréicas através de uma boa cobertura vacinal e uso de vermífu-gos, quando necessário, estímulo ao aleitamento materno, melhoria do seguimento de puericultura e, finalmente, melhoria das condições de vida da população seriam medidas que surtiriam efeitos a médio e longo prazos no combate a esse problema 28,30 . Tais medidas, efetivamente, também teriam efeitos sobre a deficiência de outros micronutrientes, incluindo a DVA 3 .…”

Evidence for Interventions to Prevent and Control Obesity Among Children and Adolescents: Its Applicability to India

“…In a country where under-nutrition persists despite public health and advocacy programs [16,17] focus on over-nutrition has also emerged. Between 2005 and 2006, the prevalence of obesity among adult men and women was 9.3 % and 12.6 %, respectively, with higher prevalence in the Northeast and Southern regions [18].…”