micro-nutrient deficiencies: new challenges for central asia nune mangasaryan, unicef cark,
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Micro-nutrient Deficiencies: New Challenges for Central Asia Nune Mangasaryan, UNICEF CARK, Workshop on Policies on Food Fortification, and Monitoring and Evaluation, 7-9 April 2003, Bishkek, Kyrgyz Republic. - PowerPoint PPT PresentationTRANSCRIPT
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Micro-nutrient Deficiencies:New Challenges for Central Asia
Nune Mangasaryan, UNICEF CARK, Workshop on Policies on Food Fortification, and Monitoring and Evaluation, 7-9 April 2003, Bishkek, Kyrgyz Republic
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Current Estimates of Iodine Deficiency in CIS
Population affected by iodine deficiency
%
Number of people affected
Armenia
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DHS 199750 % women73% childrenDHS 199559 % women81% childrenDHS 199672 % women81% childrenDHS 200047 % women36% childrenDHS 199936 % women36% childrenDHS ExperienceTadjikistan:Women - > 60%Children - 69% U3) (MOH)
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Anemia in CARK
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Vit. A deficiency in CARK
Indicator, Children
< 6 years
Public health concern
Survey result
Serum Retinol < 0.70(mol/L
> 20 %
Kazakhstan
26.9%
Serum Retinol < 0.70(mol/L
> 20 %
Tajikistan
27.6%
(
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Chart1
6221
6128.3
8947
7424
5218.9
DHS/MICS/other
STATE
per 1,000 live births
Official and survey estimates of IMR
Sheet1
KAZA 1999 (DHS)KIRA 1997 (DHS)TADA 1993 (MICS)TUKA 2000 (DHS)UZBA 2000 (MICS)
DHS/MICS/other6261897452
STATE2128472419
Sheet1
6221
6128.3
8947
7424
5218.9
DHS/MICS/other
STATE
per 1,000 live births
Official and Survey IMR estimates
Sheet2
Sheet3
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Causes of Death Among Pre-School Children in Non-Industrialised Countries, 2000Malnutrition60%Ref.;WHO 2002
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Causes of Death Among Pre-School Children in Non-Industrialised Countries, 2000Malnutrition60%Ref.;WHO 2002Vitamin A Deficiency Increases risk of mortality with 23 %
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Strategies to review
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CARK Anemia Prevention and Control Programme StrategyEducation for dietary changeFlour fortificationWeekly supplementation6-24 monthsAdolescents and childbearing age womenPregnant womenResearch agenda of key studies and monitoring activitiesIMCINut. Act. PlanBFReprod. Health.
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There are serious levels of anaemia in all the CARK countries.
These high prevalences will cause developmental problems in children most affected, pregnancy-related outcome problems in women, etc
The experience gained starting 1990s in APC and certain achievements and accomplishments (in all strategic directions) provide a good basis for further expansion and scaling up with significant outcome within 3-4 years. Strategic planning: APC
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This is a real opportunity and should be aggressively pursued over the next few years.
The experience of fortification started recently and lessons learned provide a good basis for further expansion and scaling up with significant outcome within 3-4 years. All efforts have to be applied to call for government, partners, donors attention to support the initiative. Like all the approaches this will not be the total answer, but will help elevate the national average intakes of iron (and other micronutrients) and allow resources and attention to be given in a more targeted way to those still deficient. Fortification: Flour fortification
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Enforce National Legislation and regulations on flour fortification (including prohibition of export of non fortified flour)
To enforce communication strategy
Develop monitoring system of iron fortification in grain mills. Further support of monitoring system
Main interventions for wheat flour fortification
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Initiate mass production of fortified flour at all large mills in countries, thus ensuring access to fortified flour for at least 90% of women and children
Procurement of equipment and consumables to maintain sustainability of fortification process at the pilot mills and to extend experience to the large mills
Technical consultancy and support, including experience exchange from the Countries reaching flour fortification during the first stages of real implementation of flour fortification. Main interventions for wheat flour fortification
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Continue Iron supplementation with review of target group, strengthening of all interventions proposed at desk review until fortification is taken to the scaleImprove management and organisation, supply distribution, build capacities, IEC with strong monitoring component at all levelsReview preventive supplementation and treatment guidelinesSupplementation
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Conditions Required for an Effective Salt Iodization Programme To reach USI within a year or two and be sustainable:Commitment of the Government and salt industryNeed of partnershipLegislationWorking enforcement mechanismsReliable surveillance system for monitoring quality control and quality Assurance
To have a large population coverage, including the population groups the most at riskMonitoring of household coverageStrengthen Communication component
To correct iodine deficiency by ensuring adequate iodine intakeAssessment of iodine status (UIE) every 3-4 years
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Steps to reach USI in CARK To ensure USI:
Support to salt producer: capacities for salt iodisation, marketing, testing, involvement in policy and decision making process
Three-level surveillance system:Reliable surveillance system for monitoring quality control and quality AssuranceMarket monitoring Monitoring of household coverage, with attention to population groups the most at risk
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Steps to reach USI in CARK
To be sustainable
Commitment of the Government and salt industryNeed of partnershipLegislation - to adopt and introduce mechanisms for effective enforcement Consumer education
To correct iodine deficiency by ensuring adequate iodine intake
Assessment of iodine status (UIE) every 3-4 years
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Government agenciesAssociations of producersNGOsConsumer organisationsMediaInternational organisations Scientific groups
Solutions through Partnerships in the country
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National communication plans: to review, enrich, and operationalise Ownership and commitment of government: advocacy has to be reached through advocacy efforts : politicians, media.More tools for decision makers: cost-effectiveness and other economic implications Communications
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The economic costs of undernutrition are high: productivity losses
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Relative Cost Effectiveness of Micronutrient InterventionsSource: UNICEF/UNU/WHO/MI, 1999
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Iron deficiency costs around 0.9% of the GDP
Over $US350 millions to the CARK countries
Kazakhstan $142.2 million; Kyrgyzstan $11.7 million; Uzbekistan $159.3 million; Turkmenistan $28.8 million; Tajikistan $17 million.
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1. Production: Quality assurance and quality control2. Market3. Households and schools4. Import: customs Monitoring and evaluation
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Government high-level Leadership to play a role of coordination between different agencies: MOH/SES, MoEd, Industry, Agriculture, NGOsNational plans need further development and enrichment to include recommendations for USI, UFF, and successful elimination of VAD The government support, ownership, and investment for the processStrategic planning
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Measures to Correct Vitamin A DeficiencyDietary DiversificationPublic Health MeasuresFood Fortification SupplementationAll approaches are complementary and should not be used in isolation
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Supplementation: prevention AdvantagesEasy to implementFast improvement of vitamin A status Easy to target vulnerable populations Low-cost (2 cents per capsule)Easy to do - minimal training and equipment required
ConstraintsShort term approach Distribution every 6 monthsRequires heavy logistics
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Food FortificationGlobally a growing interest for food fortification Has turned out to be more feasible than expected in non industrialised countries (eg mass fortification in Central America, Morocco, Zambia)
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Food FortificationAdvantagesWide coverageEasy to implementNo active participation of populationCheap
ConstraintsEntire population is exposed The target groups - pre school age children and pregnant women - may not be reached Requires centralised food industryRequires effective surveillance system (quality control, biological impact)
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Dietary Diversification
AdvantagesLong term approach to control VADRelies onAvailability of vitamin A rich food (fruits, vegetables and animal products)ConstraintsSmall scale projectsLimited population coverage
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Complementary Public Health MeasuresIntegrated management to control infections diseases (IMCI)Immunisation (EPI)Safe motherhood interventionsImprove malnutrition and other micronutrient deficiencies Iron deficiencyIodine DeficiencyPromotion of breast feeding Improve water and sanitationPoverty alleviation programmes
Fortunately, public health measures such as food fortification and supplementation are feasible and effective in eliminating this public health burden (from about 10 cents/person/year for iodizing salt to $2/person/year for daily iron supplementation)