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Vitamin and Mineral Deficiencies Technical Situation Analysis Vitamin and Mineral Defi ciencies Technical Situation Analysis ten year strategy for the reduction of vitamin and mineral deficiencies Vitamin and Mineral Defi ciencies Technical Situation Analysis ten year strategy for the reduction of vitamin and mineral deficiencies Produced for: Global Alliance for Improved Nutrition, Geneva By: The Academy for Educational Development (AED) 1825 Connecticut Avenue NW Washington DC 20009 Acknowledgments Th is report was written by the following research team members, who jointly developed the out- line and reviewed the drafts: Tina Sanghvi, John Fiedler, Reena Borwankar, Margaret Phillips, Robin Houston, Jay Ross and Helen Stiefel. Annette De Mattos, Stephanie Andrews, Shera Bender, Beth Daly, Kyra Lit, and Lynley Rappaport assisted the team with data and tables. Th e team takes full responsibility for the contents and conclusions of this report. Andreas Bluethner, Barbara MacDonald, Bérangère Magarinos, Amanda Marlin, Marc Van Ameringen and technical staff of GAIN/Geneva guided the team’s eff orts. Th e report could not have been completed without the contributions of the following persons, whose inputs are gratefully acknowledged: Jean Baker (AED), Karen Bell (Emory University), Bruno de Benoist (WHO), Malia Boggs (USAID), Erick Boy (MI/Ottawa), Kenneth Brown (University of California at Davis), Bruce Cogill (AED/FANTA Project), Nita Dalmiya (UNICEF/ NY), Ian Darnton-Hill (UNICEF/NY), Omar Dary (A2Z Project), Frances Davidson (USAID), Saskia de Pee (HKI), Erin Dusch (HKI), Leslie Elder (AED/FANTA Project), Mark Fryars (MI/ Ottawa), Rae Galloway (Th e World Bank), Gary Gleason (IDPAS), Alison Grieg (MI and UNICEF), Rainer Gross (UNICEF/NY), Scott Hardie (DFID), Phillip Harvey (A2Z Project), Joseph Hunt (ADB), Luc Laviolette (MI/Asia), Glen Maberly (Emory University/FFI), Barbara Main (World Vision/Canada), Nune Mangasaryan (UNICEF/NY), Bonnie McClaff erty (HarvestPlus), Erin McLean (WHO), Alison Mildon (World Vision/Canada), Godfrey Oakley (Emory University), Ibrahim Parvanta (CDC), Barry Popkin (UNC), Josephine Rajasegera (UNICEF), Margaret Saunders (SSDS), Meera Shekar (Th e World Bank), Axel Weber (ADB/Pakistan), and Keith West (Johns Hopkins University). GAIN and the authors wish to thank the members of the Ten Year Strategy Reference Group for their time and expertise in guiding the development of this work. Th e Group comprises Robert Auger, Jean Baker, Shawn Baker, Horwarth Bouis, Frances Davidson, Bruno de Benoist, William Dietz, Darren Dorkin, Kerr Dow, Rainer Gross, Katharine Kreis, Idamarie Laquatra, Venkatesh Mannar, Jane Nelson, Tina Sanghvi, Meera Shekar, Sally Stansfi eld, Admassu Tadesse, Tina Van den Briel, Paulus Verschuren, and Anne Whyte. Vitamin and Mineral Defi ciencies: Technical Situation Analysis Copyright © Th e Global Alliance for Improved Nutrition, 2006. All rights reserved. Any use of information contained in this report is subject to a permission request to be addressed to GAIN, the Global Alliance for Improved Nutrition, to the attention of the Manager, Communications, P.O. Box 55, 1211 Geneva 20, Switzerland, by e-mail at: [email protected] or by fax at + 41 22 749 18 51. Design by Inís—www.inis.ie ten year strategy for the reduction of vitamin and mineral deficiencies Contents Acronyms and Abbreviations . i Foreword . v Summary . .vii Introduction . xv 1 Why is Reducing Vitamin and Mineral Defi ciencies Critical for Development?. 1 Review of the Evidence Iron and iodine defi ciencies aff ect brain development and cognition Vitamin and mineral defi ciencies in children and adults translate into substantial productivity losses Data Sources, Limitations, and Issues Next Steps for Strategic Action and Research Conclusions and Recommendations 2 What Is the Extent of Vitamin and Mineral Defi ciencies? . 11 Magnitude of the Problem Summary of Findings Review of the Evidence Vitamin A defi ciency (VAD) is a public health problem in 118 countries, especially in Africa and Asia Iron deficiency is the world’s most prevalent form of undernutrition Reporting on iodine defi ciency has greatly improved and program coverage has expanded in the past few years Approximately 20 percent of the world’s population is estimated to be at risk for inadequate zinc intake In industrialized countries folate defi ciency may be one of the most prevalent micronutrient defi ciencies What is the evidence that vitamin and mineral defi ciencies have declined? What are the trends in vitamin and mineral defi ciencies for specifi c geographic regions? How are vitamin and mineral defi ciencies identifi ed, and what causes them? Data Sources, Limitations, and Issues Next Steps for Strategic Action and Research Conclusions and Recommendations 3 How Can Vitamin and Mineral Defi ciencies Be Reduced? . 25 Implementing Proven Interventions at Scale Summary of Findings Review of Evidence vitamin and mineral deficiencies: technical situation analysis Fortifi cation of foods can provide a substantial proportion of the required nutrients without changing food habits. What is the evidence of eff ectiveness in large-scale programs? Lessons learned about scaling up How have micronutrients been delivered during emergencies? Data Sources, Limitations, and Issues Next Steps for Strategic Action and Research Conclusions and Recommendations 4 What Are the Costs of Interventions? . .47 Program Costs Vary by Type of Intervention, Country Setting, and Methodology Summary of Findings Review of Evidence Why Do Cost Analysis? What Do Interventions Cost? How Diff erent Are Program Structures and Th eir Related Costs? Cost Structures of Supplementation Programs Cost Structures of Fortifi cation Programs Why Do Cost Estimates Vary? How Are Cost Estimates Aff ected by Country Characteristics? Supplementation Programs How Do Costs Vary by Program Characteristics? Variations Due to Diff erences in Costing Methodologies Data Sources, Limitations, and Issues Next Steps for Strategic Action and Research Conclusions and Recommendations 5 What Is the Role of International Agencies in the Micronutrient Sector? . 61 A Broad Range of Agencies Provides Technical and Financial Support in All Regions But Th ere Are Major Funding Gaps Summary of Findings Review of the Evidence Data Sources, Limitations, and Issues Next Steps for Strategic Action and Research Conclusions and Recommendations ten year strategy for the reduction of vitamin and mineral deficiencies 6 Conclusions and the Way Forward . 75 Rationale for Investing in Reducing Vitamin and Mineral Defi ciencies Magnitude of the Problem Implementing Programs at Scale Costs of Interventions External Assistance in the Micronutrient Sector References . 79 Additional Reading Powerpoint Presentations Annex A: Tables on Country Indicators for Micronutrients . .95 Introduction Tables A.1: Prevalence . 96 Table A.1.1 Prevalence: Vitamin A Defi ciency Among Young Children (Pre-school Age Children) Table A.1.2 Prevalence: Vitamin A Defi ciency Among Young Children (Pre-school Age Children) Table A.1.3 Prevalence: Vitamin A Defi ciency Among Pregnant Women Table A.1.4 Prevalence: Vitamin A Defi ciency Among Pregnant Women Table A.1.5 Prevalence: Anemia in Young Children (6–59 months unless otherwise noted) Table A.1.6 Prevalence: Anemia in Older Children Table A.1.7 Prevalence: Anemia in Pregnant Women 15–49 years(unless otherwise noted) Table A.1.8 Prevalence: Anemia in Women 15–49 years(unless otherwise noted) Table A.1.9 Prevalence: Anemia in Men Table A.1.10 Prevalence: Iodine Defi ciency in the Population Table A.1.11 Prevalence: Risk of Zinc Defi ciency in the Population Tables A.2: Coverage . 195 Table A.2.1 Coverage: Vitamin A Supplementation in Young Children and Women Table A.2.2 Coverage: Iron Supplementation in Pregnant Women Table A.2.3 Coverage: Iodization of household salt Tables A.3: Health Conditions & Services . 221 Table A.3.1 Mortality Rates and Infectious Disease Prevalence Table A.3.2 Health Services Coverage and Use vitamin and mineral deficiencies: technical situation analysis Tables A.4: Anthropometry & Child Feeding Health Conditions & Services . 238 Tables A.5: Demographic Indicator . 246 Annex A: Explanatory Notes . 254 Annex A: References . 263 Health and Productivity Impacts of Vitamin and Mineral Defi ciencies . 275 Table B.1 Functional Consequences of Micronutrient Malnutrition: Vitamin A and Iodine Table B.2 Functional Consequences of Micronutrient Malnutrition: Iron Table B.3 Functional Consequences of Micronutrient Malnutrition: Zinc Table B.4 Economic Productivity Consequences of Iron, Iodine and Zinc Table B.5 Health Consequences of Vitamin A, Iron, Iodine and Zinc Defi ciencies Technical Notes . 290 Evidence on Infectious Diseases and VMDs Institutions . 295 Annex D.1 Institutions Involved in Micronutrient and other Nutrition Programs Annex D.2 Mandate and focus of development partners in nutrition (including micronutrient programs) Methodological Notes . 312 List of Key Agencies and Organizations Contacted for MN Financing Information ten year strategy for the reduction of vitamin and mineral deficiencies Acronyms and Abbreviations A2Z USAID Micronutrient and Blindness Project ADB Asian Development Bank AED Academy for Educational Development ARI acute respiratory infection BAFF Business Alliance for Food Fortifi cation CDC Centers for Disease Control and Prevention CDD control of diarrhoeal diseases CHD coronary heart disease CHW child health week CI confi dence interval CIDA Canadian International Development Agency DALY disability-adjusted life year DFID Department for International
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