United Nations System
Standing Committee on Nutrition

Working Group on Micronutrients

held during the ACC/SCN's 30th Session in Chennai, India, March 2003

Co-Chaired by Bruno de Benoist (WHO) and Werner Schultink (UNICEF)

Dr Bruno de Benoist (WHO) presented the latest IDD situation from data available through the WHO Global Databank on Iodine Deficiency. There are 144 countries that have carried out IDD surveys since 1993, out of which 93 surveys were at national level and 51 at subnational level. In addition 9 other countries carried out national surveys before 1993. In America, most countries carried out national surveys whilst in the other regions at leave one half of countries carried out subnational surveys.

As a whole, 79% of the world population is covered by national surveys, whilst only 5% of the world population has never been surveyed. Iodine deficiency affects 7.1% of the population. In absolute numbers, the regions most affected are South East Asia, Eastern Mediterranean and Europe. As a percentage of the total population, the regions most affected are Eastern Mediterranean (19.9%), Africa (10.7%) and Europe (10.2%). In most countries where iodine deficiency is a public health problem, the problem is mild (58 countries). It is moderate in 14 countries and severe in 13 countries. Iodine deficiency is under control in 68 countries. Compared to 1993, the prevalence of iodine deficiency has decreased. The highest decrease was observed in the Americas Region, then comes the Western Pacific region, Africa, Eastern Mediterranean, South East Asia and Europe. With regard to salt iodization, 19 countries claim the universal salt iodization goal is reached as more than 90% of households have access to iodized salt, while in 46 countries salt iodisation coverage in insufficient. As a whole, 68& of households in the world have access to iodized salt, but there are important differences between regions. In the Americas the percentage is 90%, it is 76% in Western Pacific, between 65 and 70% in Africa, Eastern Mediterranean and Asia, and in Europe 27%.

In conclusion there is improvement over the last 15 years, showing the effectiveness of the salt iodisation strategy. However, IDD is still a major public health problem and efforts need to be sustained if the goal of IDD elimination by the year 2005, adopted by the international community, is to be reached.

Gary Gleason (IDPAS Project Director) presented the highlights of a report on global activities related to iron nutrition in the context of the IDPAS project supported by the International Nutrition Foundation and the United Nations University. The report includes information from international and bilateral agencies and their supported projects, national and subnational projects and researchers. Information was obtained on activities in 55 countries, as well as regional and global initiatives. The full report can be found on the Micronutrient Initiative’s website at www.micronutrient.org in the IDPAS Iron World pages. It is also available on the IDPAS Iron World IV CDRom.

Among the key areas of significant activity related to iron nutrition over the past year are advocacy, food-based approaches, dietary diversity, fortification, supplements and “in-home” fortification. Programme design weaknesses include insufficient stress on integrating the multiple-intervention model endorsed by the SCN; insufficient timeframe in may programme designs; danger of unsustainable progress unless “alliances” are real; lack of a phased approach to introducing and integrating interventions; integrated multiple interventions which are critical to effective prevention of iron deficiency. The report also noted that i) iron deficiency and anaemia are rising on public health agendas of governments and international and bilateral organizations, ii) interventions contributing to prevention and control of iron deficiency are improving, iii) the integrated, multiple intervention strategy of the SCN is accepted more in principle than in practice, iv) currently anaemia prevention and control (APC) strategies tend to concentrate on those interventions where substantial resources are available, v) new and potential alliances offer new approaches to creating the integrated intervention strategies for APC, vi) continued research to improve interventions and their delivery remains critical, vii) active experience exchange can help to maintain the new momentum of work on anaemia and iron deficiency, viii) a new challenge is to further develop channels that make use of project information on activities, processes and lessons learned, ix) greater use of electronic channels facilitates projects and organizations and helps to share technical information at all levels.

Werner Schultink (UNICEF) presented the results of a meta-analysis of multiple micronutrient supplementation trials supported by UNICEF and carried out in four countries: Peru, Vietnam, Indonesia and South Africa. Four hundred children aged 6-12 months were enrolled in each site and the study lasted six months. The children were divided into four groups who received respectively one RDA multi-micronutrient supplement daily, two weekly RDA multi-micronutrient supplement, iron supplement and a placebo. The results showed that the group receiving one RDA had increased haemoglobin, ferritin, retinol, zinc and homocysteine.

Prakash Kotecha (Medical College, Vadodara, India) presented an evaluation of an anaemia control project in adolescent girls. This project was supported by UNCIEF and the Department of Preventive Medicine, Medical College, Vadodara, Gujarat, India. The project was carried out in Valodara district amongst 65,000 adolescent girls attending school in rural, tribal and urban areas. In Valodara district 74.7% of adolescent school girls are anaemic. They received a weekly dose of 60mg iron and 500μg folic acid. Supplements were provided through the primary health care system and coverage was 95%. Haemoglobin and serum ferritin concentrations were measured at baseline and after 17 months of intervention. The results showed compliance of 90% and a substantial reduction in anaemia prevalence (23%), especially in the younger group, with a rise in median haemoglobin for all age groups. There was a reduction of severe anaemia by 66%, and of moderate anaemia by 52%. Iron status was improved as reflected by an increase in serum ferritin concentration by 10%. There was no difference according to urban, rural or tribal areas. This project shows that weekly iron supplementation in adolescent girls is a good programmatic approach to control anaemia because it is easy to implement, doable, with a high compliance and effective to control anaemia. A policy to implement iron supplementation in schools is being considered. UNICEF has already started to expand the project in another district in Tamil Nadu and Andhra Pradesh.

Rolf Carriere, Executive Director of the Global Alliance for Improved Nutrition (GAIN) presented the rationale for fortification in the context of micronutrient malnutrition and then described the structure of GAIN and provided information on the composition of the Board and the budget. He said that GAIN received 16 proposals for country programmes, these will be submitted to the Board in March. The next request for proposals will be issued in June 2003, with a due date in mid-October.