United Nations System
Report of the Meeting of the Working Group on Micronutrients
Wednesday 12 April 2000, Washington DC
In accordance with the instructions of the Interim Steering Committee, the agenda devoted 45 minutes to the restructuring and streamlining of the three working groups previously dealing with micronutrients separately. The remaining time was devoted to presentations of reports and discussion. To maximize this discussion, the three rapporteurs had consolidated input from the different agencies and groups working on vitamin A, iron deficiency anaemia and iodine deficiency. Each update was presented for about 15 minutes and then opened up to discussion from the floor.
The aims of the new combined Working Group on Micronutrients and its structure were introduced. A form was distributed to facilitate feedback.
Vitamin A Deficiency
Werner Schultink presented an overview consolidated from five agency reports covering status of vitamin A programming and coverage, the work of involved partners, and future actions and perspectives. The presentation covered prevalence estimates and highlighted the difficulty is establishing reliable prevalence estimates of vitamin A deficiency. Current published estimates range from 100 to 250 million. This issue had been discussed by the Group in previous meetings.
Types of programming interventions were reviewed and constraints were outlined, including the issue of identifying what kind of evidence is necessary to establish the efficacy of dietary approaches. Supporting activities, such as improving field assessment and laboratory capacity, were mentioned. Data gaps identified included the lack of recent impact data on fortification, as well as impact and outcome assessment on capsule distribution. Challenges to improving supplementation coverage were also outlined, including the need for a second yearly intervention in addition to National Immunization Days, and on reaching people in remote rural areas or areas of civil conflict. The need for further discussion on distribution methods and mechanisms was expressed. The establishment of a task force on dietary approaches as the definitive answer to vitamin A deficiency was suggested.
Iron deficiency anaemia
Bruno de Benoist addressed the issue of iron deficiency anaemia. His report touched upon research and programming activities including evidence on the permanent cognitive impairment of young children who suffer from anemia, new multi-nutrient supplements for young children and increased international support for wheat flour fortification with iron. Some constraints noted included the need for better data on iron status of populations, assessment methods and research on the causal relationship between iron deficiency and health outcomes; the importance of integrating interventions including iron supplementation, food fortification and education for dietary change and of linking these interventions to other public health and nutrition activities including those addressing reproductive health and nutrition, malaria control and integrated management of childhood illness.
Action areas identified included: the need to learn more about why some programmes are not effective, the need for more acceptable preparations of iron, definition of safe fortification levels and the need to involve the private sector. Areas of focus should include the prevention of iron deficiency in adolescent girls and young women, reaching under two-year olds, awareness-raising among health personnel, and advocacy across the broad range of interventions, including supplementation, fortification and dietary approaches.
Venkatesh Mannar presented a consolidated report on the work of agencies involved in the area of IDD elimination through salt iodization, including the Salt 2000 industry conference in the Netherlands in May 2000. Remaining challenges in the area of iodine deficiency included low coverage rates in parts of Eastern Europe and sub-Saharan Africa and the process of sustaining universal salt iodization while phasing out external assistance to salt producers. The need to develop strategies to reach those as yet un-reached, as well as to address expressed medical concerns about salt intake, was also identified.
Focus areas for the future would include assessment of the impact of salt iodization and addressing procurement, advocacy, monitoring and quality assurance issues. Adjusting salt iodization strategies to a changing environment, along with stocktaking of iodine deficiency in industrialized countries, were also activities that should be undertaken in the future. Areas of future action should include support for the creation of regional salt producers’ networks, securing compliance by small producers on salt iodization, harmonizing iodization levels across regions, developing a network of reference laboratories, and large-scale efforts to doubly fortify salt with iron and iodine.
A complementary update of programmatic experiences, as well as emerging recognition of urinary iodine as the prime indicator and how this might be done more efficiently was also addressed, as was the use of the neonatal TSH levels to demonstrate program success.
The advisability in terms of efficacy and effectiveness of multi-micronutrient supplementation was discussed. It was agreed this would be a future topic of discussion of the Working Group, given the 11-country LBW prevention programme initiated by UNICEF recently. Zinc was also addressed and the need for there to be further work on programmatic aspects of zinc deficiency.
There was general concern about the lack of success of programmes to prevent and control iron deficiency anemia, compared with vitamin A and iodine deficiency prevention and control programmes.
It was generally felt that to achieve its aims this Working Group needs more time to treat certain topics in depth. Several suggestions, including separate working groups were discussed and put to a vote. There was overwhelming support for an integrated approach. It is hoped some of the written feed-back will expand on this. Most felt the need for further discussion of programmatic issues, while still capturing scientific advances, and identifying constraints, that will promote the effectiveness of programmes.
It was agreed that the Working Group would continue to meet during the year, and to make the results of the feedback questionnaire available to its member through e-mail in advance of the next SCN session in order to facilitate and enhance the work of the Group at the meeting. Working Group core members would at least consist of representation from United Nations agencies (UNICEF and WHO) and this year’s chair from HKI, representing civil society. Other help was, or would be, solicited as needed.
No task forces were established, however, the Group agreed to report back next year on five issues: