Prevention and treatment of micronutrient deficiencies
Micronutrient deficiencies, including deficiencies of vitamin A, iron, iodine, zinc and folic acid, are common among women and children in low- and middle-income countries. Ensuring that women of reproductive age, pregnant women and children have sufficient essential micronutrients improves the health of expectant mothers, the growth and development of unborn children, and the survival and physical and mental development of children up to five years old.
UNICEF partners governments and organizations to address micronutrient deficiencies by seeing that supplements are delivered to specific vulnerable groups around India, and that home fortification of complementary foods (foods given in addition to breastmilk) takes place for children aged six to 24 months, along with fortification of staple foods and condiments in the family home.
Vitamin A supplementation
Globally, one in three preschool-aged children and one in six pregnant women are deficient in vitamin A due to inadequate dietary intake (1995–2005 data). Global evidence indicates that in regions where vitamin A deficiency is prevalent, vitamin A supplementation can reduce child mortality by an average 23 per cent.
Vitamin A is necessary to support the response of the body’s immune system, and children who are deficient face a higher risk of dying from infectious diseases such as measles and diarrhoea. Delivered periodically, Vitamin A supplementation to children aged six months to five years has been shown to be highly effective in reducing deaths by any cause in countries where vitamin A deficiency is a public health problem.
As in other developing countries, where coverage by the routine health system can be weak, in India vitamin A supplements are delivered to children through independent biannual rounds and during integrated health events, such as Village Health and Nutrition Days . This helps to sustain high coverage of vitamin A supplementation even in hard to reach areas.
Iron deficiency predominantly affects children, adolescents and menstruating and pregnant women. Globally, the most significant contributor to the onset of anaemia is iron deficiency.
The consequences of iron deficiency include reduced school performance in children and decreased work productivity in adults. Anaemia is most prevalent in Asia and Africa, especially among poor populations. Global estimates from the World Health Organization (WHO) database suggest that about 42 per cent of pregnant women and 47 per cent of preschool-aged children suffer from anaemia.
UNICEF In Action
• UNICEF expands community outreach mechanisms such as Village Health and Nutrition Days to increase awareness of and demand for vitamin A and iron supplementation for infants and young children.
• Raises awareness about the importance of universal coverage of vitamin A supplementation for the survival and health and nutrition of infants and young children.
• Raises awareness about the importance of universal coverage of iron supplementation to prevent anaemia in young children.
• Scales up and universalizes coverage of vitamin A supplementation and iron supplementation especially among the most vulnerable groups of children: the youngest, the poorest and children belonging to Scheduled Caste and Scheduled Tribe families.
• Ensures that there are no supply gaps in vitamin A and iron supplement programmes.
Vitamin A supplementation: a national good news story
Record coverage attained, with 62 million under-fives protected from vitamin A deficiency in just one year
The World Health Organization (WHO) recommends that in vitamin A-deficient areas, children six months to five years should receive a preventive dose of vitamin A supplementation every six months. While India’s vitamin A programme follows this recommendation, a 2006 National Family Health Survey indicated that only 25 per cent of under-fives were receiving supplementation. Further analysis showed children missed by the programme would benefit greatly, as they were more likely to be undernourished and belong to vulnerable families. The study also showed states with higher under-five mortality rates had lower vitamin A supplementation coverage.
Recognizing the problem, the government that same year adopted biannual supplementation to reach out to children under-five with the following regime:
· children below one year receive the first vitamin A supplementation dose with their routine measles immunization at nine months;
· for children aged one to five years, the subsequent nine doses of vitamin A supplementation be administered twice a year, six months apart, through a biannual large-scale outreach vitamin A supplementation strategy.
Currently, 15 of India’s major states are taking part in this biannual outreach strategy in partnership with UNICEF and others. UNICEF’s role has been to support state governments’ capacities to source and distribute vitamin A supplements to districts and blocks on time while mobilizing families and communities to bring their children to take advantage of the scheme.
As a result of the programme, the proportion of children receiving two doses of vitamin A annually – referred to as “full vitamin A supplementation coverage” – increased from a quarter in 2006 to two-thirds in 2011, with seven of India’s 15 major states reporting full coverage rates of more than 80 per cent. In 2011 alone, a record 62 million children were protected. Importantly, between 2007 and 2011.