06 September 2012

Why Aren't Micronutrients Used?

The development of micronutrient powders provide a simple-yet-effective way to fortify food and ensure that developing children get the nutrients and vitamins that they need.

The WHO recommends as follows:
Micronutrient powders are single-dose packets of iron and other vitamins and minerals in powder form that can be sprinkled onto any ready to eat semi-solid food consumed at home or at any other point of use. The powders are used to increase the micronutrient content in the infant's diet without changing their usual dietary habits.

The WHO recommends the use of multiple micronutrient powders containing at least iron, vitamin A and zinc for home fortification of foods as an option to improve iron status and reduce anaemia in infants and children 6–23 months of age.
A New York Times article this week looks at the history of micronutrients and explores why they are an underutilized intervention. Sam Lowenberg writes:

[M]icronutrient powders (Sprinkles is the name of the original, most common formulation) are being distributed at a national level in just a smattering of countries: Mongolia, Kyrgyzstan, Bolivia and the Dominican Republic. Bangladesh, with a population of 161 million, is using them in about half the country. In the last four years, about 50 countries have begun pilot programs to distribute Sprinkles-like micronutrient powders. But most are only just getting off the ground. Only about 13.6 million of the world’s 300 million iron-deficient children have received Sprinkles (or a differently named equivalent, in some cultures), according to Zlotkin. “We have only scratched the surface,” he said. “There is a long way to go.”

The presence of anemia usually signifies a host of other micronutrient deficiencies that are more difficult to test for. Thus, micronutrient powders like Sprinkles contain not just iron, but 15 essential vitamins and minerals, including iodine, zinc and vitamin A. Children who do not receive these micronutrients in their first thousand days of life can suffer irreversible physical and cognitive development damage. The Copenhagen Consensus, a group of expert economists convened in 2008 to determine the world’s most effective aid interventions, put micronutrient supplements at the top of the list. According to their estimate, the cost of providing vitamin A and zinc to 80 percent of the world’s 140 million children who are lacking them would cost $60 million per year. The benefits of this treatment would be worth more than $1 billion. A recent study by British and Pakistani researchers in the British Medical Journal of 200,000 children found that vitamin A supplements could reduce the risk of death by 24 percent.
Persuading governments to take up the project presents an array of challenges. In the case of Kyrgyzstan, for instance, government officials were concerned that the micronutrient powders might be some kind of ploy, that they were being experimented on. The C.D.C. helped coordinate a local trial project, and there was an enthusiastic response from the mothers who saw that their children became active, got sick less, and generally acted like naughty, healthy children, said Timmer.

Despite having by far the world’s highest concentration of anemia, with two out of three children under 5 affected, African countries have been slow to take up the use of Sprinkles and other iron supplements. Most international attention goes to children who are at risk of death from starvation, while the far larger numbers who suffer from chronic problems like anemia are a lower priority.

A study in Kenya illustrates how difficult getting people to use a seemingly basic intervention like Sprinkles can be. The study, which was run by the C.D.C., looked at 60 villages, with a total population of 80,000, from 2007 to 2010. While the results of the study were strong — anemia rates dropped 27 percent and vitamin A deficiency dropped by 17 percent — getting there took a lot of work.

Sprinkles were distributed by a local organization in the Nyando district of southwestern Kenya — the Safe Water and AIDS Project (SWAP) — in which local women sell subsidized health products ranging from malaria nets to sanitary napkins in their communities. The C.D.C. added Sprinkles to the mix. But making it work was challenging. Some people tried to use them as soap. Others were put off by the packet’s red color, which they associated with disease.
Read the full article here.