The Micronutrient Initiative ARCHIV 107 387 The Micronutrient Initiative The Micronutrient Initiative (MI) was established in 1992 as an international secretariat within the IDRC in Canada, by its principal sponsors: Canadian International Development Agency (CIDA), International Development Research Centre (IDRC), United Nations Children's Fund (UNICEF), United Nations Development Programme (UNDP), and the World Bank. The MI's mission is to advance global efforts to eliminate micronutri- ent malnutrition. The MI provides support in five areas considered critical to national and global efforts in eliminating micronutrient malnutrition: advocacy and alliance building; development and appli- cation of technologies; regional and national initiatives; capacity building; and resolution of key operational issues. For further information please contact: The Micronutrient Initiative, C/o IDRC, PO Box 8500, 250 Albert Street, Ottawa, Ontario, Canada, K1G 31-19. Tel:(613) 236-6163; Fax:(613) 567-4349; e-mail: [email protected] This document may be reproduced without prior permission, but please attribute to the Micronutrient Initiative. Cover photo - IDRC: N. McKee Publication design - Bob Albery, 3rd Dimension Graphics Concept for "concentric circles" graphics - PAMM Contents An amazing reality ..................................................................... 1 Iron deficiency ........................................................................... 5 Vitamin A deficiency .................................................................. 9 Iodine deficiency ...................................................................... 13 Solutions ................................................................................. 17 References and some key resources ........................................... 25 Some key organizations ............................................................ 28 1 An amazing reality What would the people of the earth do if faced with a serious problem that affects millions in many areas of their lives and that could be obliterated quickly, painlessly, effectively and economically? Obviously, we would take action to correct the situation, right? Perhaps riot; because such a situation exists with respect to micronutrient malnutrition. One of the greatest evils, one of the most com- pelling challenges confronting humanity today is micronutrient malnutrition. This is A third of people on the earth are something too few are aware of, and even affected by deficiencies of iron, fewer talk about. Yet, over 2 billion people, vitamin A or iodine. a third of earth's inhabitants, are affected by deficiencies of iron, vitamin A or iodine. Magnitude of the problem 2 billion people are affected by iron deficiency- 35% of world population 1.6 billion live in iodine deficient areas, 655 million have goitre, 11 million are affected by cretinism 254: million children under 5 years of age have clinical or severe or moderate subclinical vitamin A deficiency source: World Health Organization (1992, 1994, 1995) The impact of this form of malnutrition extends beyond considera- tions of only health. Labour productivity, the ability of those affected by micronutrient malnutrition to learn and to function as part of society, and the ability of whole societies to satisfy their economic needs can all be adversely affected. "The numbers of humans affected by micronutrient malnutrition are truly staggering," said Dr. V. Ramalingaswami of the All India Insti- Joining Hands to End Hidden Hunger 2 tute of Medical Sciences in New Delhi. Dr. Ramalingaswami was The numbers affected, and the speaking as Chair of the historic conference on "Ending Hidden effects Hunger" held in Montreal in October, 1991. Examples of the stag- themselves, are gering numbers he referred to include the fact that: staggering 13 million people suffer night blindness or total blindness due to vitamin A deficiency. Iron deficiency reduces work capacity in adults by 30% and learning ability in children by up to 60%. Iodine deficiency is the leading cause of intellectual deficiency on the planet. Over 43 million people worldwide have mild brain damage result- ing from iodine deficiency. By themselves, these figures disclose a major human tragedy. What is truly unimaginable is that these deficiencies should rob so many children and adults of their lives and their dreams when the solutions to the deficiencies are: available; feasible; and affordable. But what is micronutrient malnutrition? It is a quiet hunger. It is a largely hidden public health problem. Unlike the gnawing hunger that results from going without food, the hunger of micronutrient malnutrition often goes unnoticed, even by those affected. There are usually no visible signs of deficiency, at least to the untrained eye, and even the person affected may not be aware that a problem exists. The term micronutrient refers to vitamins and minerals. Most of these cannot be made in the body. They must be part of the diet or taken as supplements. The human body only needs them in tiny Joining Hands to End Hidden Hunger 3 amounts. For example, a person needs no more than a teaspoon of iodine over an entire lifetime. Hence the prefix "micro." However, failure to ensure an adequate intake of these small quantities could lead to devastating effects. There are dozens of these micronutrients. Three of them require our most urgent attention. Firstly, because they are the ones most often found to be deficient in people's diets. Secondly, their deficiency leads to grave health, social and economic consequences. Thirdly, there are cost-effective strategies to overcome the deficiencies. These three deficiencies are iron deficiency, vitamin A deficiency, and iodine deficiency. Whatever the cause of them, the problem is a Effects of Deficiency of Micronutrients Physical Mental Socio-Cultural Economic * growth retardation brain damage loss of self esteem lost hours of work fatigue impared brain isolation work capacity function lethargy neurologic dysfunctions discrimination 1 family income apathy l IQ non-participation 1 national economy visual impairment llearning skills stigma associated with T health care costs disability speech and hearing 1 psychomotor skills T no. of unskilled T custodial care disabilities workers pallor no. of unemployed T educational costs (special education or grade repetition) ime for caring 1 academic achievement by children Joining Hands to End Hidden Hunger 4 Micronutrient universal human concern. The struggle to overcome micronutrient malnutrition- malnutrition is one which people in all lands, North and South, it's a social cannot afford to lose, and which demands involvement of all sectors- problem, a industry, nongovernmental organizations, government, consumer universal human associations, and academics. There is every reason to get rid concern of this plague in our midst. And there is no reason not to. Its existence hurts us all-either physically, economically or ethically. Its removal responds to our collective, universal self-interest. Our failure to act is amazing. Joining Hands to End Hidden Hunger 5 Iron deficiency So, what's the problem? Iron deficiency is the world's most common nutritional disorder. It affects around 2 billion people. Half of that number suffer iron defi- ciency anemia. In developing countries, 51% Anemia Among Pregnant and Non-Pregnant Women of children under the age of four years, 40% by Region, 1980s loo of all women and 51% of pregnant women 90 are affected. 80 Iron deficiency anemia reduces the ability of the blood to carry oxygen from the lung to the brain, muscles and other organs. This phenomenon results in reduced capacity to work and to learn. Fatigue, shortness of breath even after slight exertion, dizziness, 1 South Southeast Sub- Near Middle China South headache, and loss of appetite are also com- Asia Asia Saharan East/ America America Africa North mon with anemia. Africa ACC/SCN (1992). Second Report on the World Nut. Situation: Global & One of the greatest dangers posed by iron regional results Vol 1. ACC/SCN, Geneva deficiency is that it diminishes the ability to fight infection and thus increases vulnerability to transmissible diseases. Anemic expectant mothers face the risk of death resulting either from spontaneous abortion, the stress of labour or other delivery complications. Up to 200,000 of the half million women who die in childbirth each year do so because of the effects of anemia. Even in developed countries, 18% of pregnant women suffer from iron deficiency anemia. Mater- nal anemia almost always leads to infant anemia. The babies of severely anemic mothers suffer from low birth weight and confront a greater than average risk of early death. Mental and motor develop- ment is impaired in anemic infants and children, and apathy, inactiv- ity and significant loss of cognitive abilities can occur. The effects on a child's development can be irreversible. ------------- Joining Hands to End Hidden Hunger Up to 200,000 There are many women die of childbirth causes of iron defi- complications ciency. The main attributable to anemia one is low levels of iron in the diet, and 350 poor absorption of million the iron that is 2 billion affected by preschool iron deficiency and consumed. These school age children factors may be suffer impeded accentuated by learning increased iron needs Source: ACC/SCN, 1992 and Viteri, F. 1991 during pregnancy, and rapid growth in children and adolescents, or chronic iron loss resulting, for example, from excessive