United Nations System
Standing Committee on Nutrition

 

Working Group on Micronutrients

LaBouisse Hall, UNICEF, 3 UN Plaza, New York, Thursday 25 March 2004 0945-1130

Co-Chairs: Dr Frances Davidson, USAID Dr Bruno de Benoist, WHO Dr Ian Darnton-Hill, UNICEF

Focussing this year on one of the key purposes of the working groups - to share innovations and programs information, the Micronutrient Working Group began with presentations from three managers of micronutrient country programs that have demonstrated success: Dr. Josefina Bonilla, “Supplements and Fortified Foods in Nicaragua” (vitamin A, iron and iodine); Ms. Rosanna Agble, “Micronutrient deficiencies in relation to MDGs - The Ghana Experience” (vitamin A, anemia, iodine); and Mr. Ram Shrestra, “Nepal National Vitamin A Program.” Participation of these presenters was organized by MOST, the USAID Micronutrient Program.

In all three programs, supplementation, particularly vitamin A supplementation, is the most mature intervention. Food fortification is well developed in Nicaragua, starting in Ghana and only in preliminary stages in Nepal. The degree of development of other food-based strategies is variable, although nutrition communication is a component of all programs.

Key points from the presentations and the subsequent discussions include:

  • It is recognized that vitamin A supplementation (VAS) can no longer be considered as a short-term intervention. Strategies for sustaining VAS for the long term are important. Phasing out of VAS has to be done with great prudence and with a strong evidence base. None of the 3 countries has chosen to phase out VAS, even Nicaragua despite advances in other strategies. Post-partum VAS is less well developed than VAS for children 6-59 months.
  • In all cases, strong partnerships bringing together all stakeholders were key elements in the success of micronutrient programs. These partnerships have leveraged implementation resources beyond the health sector (communities, local governments, media, schools, industry, etc.). Micronutrient program infrastructure has been leveraged to implement other public health programs (Nepal) and conversely, existing public health campaigns have been leveraged to include micronutrient programs (Nicaragua).
  • Micronutrient nutrition of the young child (under 2 years of age) remains a great concern, with anemia levels of young children of particular concern. We need improved knowledge of young children’s micronutrient intake, technologies for enriching their diets and improving complementary feeding. It was reiterated that breastfeeding promotion and support are key elements of control of micronutrient malnutrition.
  • All successful programs have included strong communication strategies, including a combination of approaches (community radios, television, interpersonal communications, schools, etc.). Development of very specific, compelling messages that resonate with the target populations is important.
  • All successful programs have included strong training components that reach beyond health workers.
  • Food fortification requires understanding of private sector’s needs and should move towards fortifying an array of food products, including those that can reach young children. Specific concerns were raised concerning using sugar as a vehicle for vitamin A. Communication has focused on having consumers choose VA-fortified sugar over non-fortified sugar, and to consume only the levels they are used to consuming.
  • In all cases, the micronutrient deficiency control programs are making major contributions to several Millennium Development Goals (MDGs).
  • Promotion of production and consumption of micronutrient-rich foods is included to a greater or lesser extent in all 3 programs. There is a need for a more systematic identification of potential for food-based strategies and the evaluation of their impact beyond knowledge of micronutrient-rich foods.
  • In all 3 programs, including the most mature one (Nicaragua), it is recognized that external technical and financial resources continue to be necessary. Mobilizing increasing levels of national resources to maintain and expand micronutrient deficiency control remains a challenge. Level of national resources committed for micronutrient programs is a critical indicator of success.

In plenary, a brief presentation showed that micronutrient interventions contribute to all eight MDGs and that successful control of micronutrient malnutrition will be essential for achieving the MDGs. Two key recommendations for action reported back to the plenary were:

  • Improved knowledge of young children’s micronutrient intake, technologies for enriching their diets and improving complementary feeding are greatly needed. Food fortification should move towards fortifying an array of food products, including those that can reach young children. Efforts to mobilize national investments in micronutrient programs must be enhanced. Level of national resources committed for micronutrient programs is a critical indicator of success.
  • Ongoing or planned activities should be reported by working group participants and collated by an informal secretariat (UNICEF, USAID, WHO, HKI). This will constitute the working group’s work plan and will be reported on in a year’s time at the next SCN.