Lessons from Successful Micronutrient Programs Part I: Program Initiation

Abstract

Internationally recognized research findings on the potential health benefits of preventing micronutrient deficiencies--especially reduced child mortality from vitamin A deficiency and prevention of in utero developmental damage and mental retardation from iodine deficiency--have contributed to raising the awareness of deficiencies and the commitment of many governments to their reduction or near-elimination. The procedures undertaken to decide on large-scale programs followed conventional patterns in the 12 countries included in this study (11 Asian countries plus South Africa). Thus, a sequence of national surveys, institutional arrangements through intersectoral technical committees, legislation, incorporation of programs into national plans, and resource mobilization, including external assistance, was similar for all three micronutrients. Vitamin A supplementation twice yearly to children, then to women postpartum, has reached the national level. Iodized salt is universally adopted at the national level in most countries, with a need for continuing efforts to reach underserved populations and to implement legislation and quality control. Iron programs, usually aiming at daily supplementation during pregnancy, have been pursued, but with less intensity. However, it is clear that these procedures have succeeded in creating a rapid expansion of large-scale deficiency-control programs, which while evolving are generally being maintained.

Puberty and Pubertal Growth in Healthy Turkish Girls: No evidence for secular trend

“…(1) On the other hand, the difficulties in producing normative data in a developing country are well known and only a sample from the upper strata of the population will suit the recommendations of the World Health Organization (WHO) for obtaining reference values. (13, 14, 15) We believe that the reliability of the data in our study is high, due to the longitudinal design of the study and also due to the fact that the subjects consisted of the upper strata of the population. It must be added that the mixed population of Istanbul city is quite representative of the whole of Turkey.…”

Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children

“…The design of the studies summarized in this paper largely conforms to the criteria suggested by Waterlow and adopted by WHO, requiring that the reference population be well-nourished, the sampling procedure clearly defined and reproducible, the sample of adequate size, the measurements relevant and of good quality, and the data adequately treated. WHO also recommends that measurements be taken at one month intervals in early infancy ( 17 , 18 , 19 , 20 ). In view of the fact that in Turkey, a country where large differences in economic means and lifestyle still exist among SEC, a nationally representative sample would be likely to include many children whose health has been compromised by unfavorable economic, educational, and environmental conditions and not reflect the growth potential of the population, the study population is a selective one and consists of children of well to do families.…”

Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues

“…However, iron supplementation programs tend to be less well developed than programs aimed at other micronutrients, such as iodine or vitamin A. As a result, limited data are available on iron supplementation programs at the international level [16], and we were unable to find any recent global reviews on how many countries have such programs.…”

“…Coverage is reasonably equitable in Nigeria and Ethiopia, but in India there are marked inequalities. India used to have a nationwide law for salt iodization, but this legislation was subsequently rescinded, and the adoption and enforcement of laws governing salt iodization is now decided at the state level [16]. Kits for testing iodine content in salt are accurate for showing the presence of any iodine and relatively inaccurate for measuring quantity [17].…”