R Shrimpton, Institute of Child Health, London, UK © 2005 Elsevier Ltd. All rights reserved.
Micronutrient supplementation is the distribution of specially formulated preparations of one or more nutrients, usually in the form of a pill, a capsule, or syrup. It seems to be the Cinderella of nutrition interventions, more than capable of dancing but not quite good enough to be invited to the Ball. It is often described as a 'short-term' option and a 'medical' approach and considered more appropriate for the treatment of severe micronutrient deficiencies in those most affected than to prevent deficiencies in whole populations. However, for the half of humanity affected by micronutrient deficiencies, the overwhelming majority of whom are the poor concentrated in the developing world, solving these problems through food-based approaches is only likely to happen in the very long term. The immune system is compromised by vitamin A deficiency in 40% of children younger than 5 years old in the developing world, leading to approximately 1 million deaths each year. In the 6- to 24-month-old age group, mental development is impaired due to iron deficiency in 40-60% of the developing world's children. Severe iron deficiency also causes more than 60 000 deaths of women during pregnancy and childbirth every year. Approximately 18 million infants per year are born mentally impaired as a result of iodine deficiency during pregnancy. Providing vulnerable groups, such as children and women of childbearing age, with low-cost vitamin and mineral supplements is the least that governments can do to protect the growth and development of the next generation as a first step toward realizing the right of every individual to be adequately nourished.
Experience in achieving high coverage of those most at risk with micronutrient supplements is quite varied, with both successes and failures. A good communication strategy is an essential part of achieving high levels of adherence in micronutrient supplementation programs, but these aspects are not particular to nutrition programs and are not considered here. Deficiencies of iodine, iron, vitamin A, and folate are the most commonly recognized deficiencies for which there are programs, but in practice most of those affected have multiple vitamin and mineral deficiencies that overlap and interact at great cost. This article reviews the policy dimensions of the efforts to establish programs aimed at eliminating iodine deficiency, iron deficiency anemia, and vitamin A deficiency through supplementation, and it provides a perspective on zinc supplementation and multiple micronutrient supplementation as future components of nutrition programs in developing countries.
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