Academic journal article Public Health Reviews; Rennes

Public Health Interventions to Combat Micronutrient Deficiencies

Academic journal article Public Health Reviews; Rennes

Public Health Interventions to Combat Micronutrient Deficiencies

Article excerpt

INTRODUCTION: THE IMPORTANCE OF ACTION

Micronutrient deficiencies rank among the top twenty risk factors for morbidity and impaired quality of life worldwide, with particular burdens falling on populations in poor countries, on children, and in the case of iron deficiency, on women of childbearing age.1 Amelioration of these deficiencies is among the most cost-effective of public health interventions in improving overall health, the outcomes of common infectious diseases, and quality of life.2,3

There are a number of approaches that have been utilized at different times and in different populations, most often in attempts to deliver single nutrients known to be limiting for a population, but increasingly with attention to multiple micronutrients and to integrated public health programs. The reader is referred to the most comprehensive review to date of interventions to improve nutrition with a focus on maternal and child nutrition, namely that of Bhutta et al.4 (2008 Lancet Series on Maternal and Child Undernutrition). The present review will mention several of these approaches, followed by attention to the successes of integrated programs.

EDUCATION AND DIETARY DIVERSIFICATION

While information and education are clearly valuable and valued among populations at nutritional risk, there are few instances of documented substantial impact from this approach alone. The chances of success are good only when there are no other serious constraining factors in terms of access to foods, when the target audience is motivated and when the educational intervention is well designed and delivered. The major advantage to education and behavior change is sustainability. By definition, any changes in knowledge and practices will be within the economic and social capabilities of the target audience and transmissible to the next generation. This makes it possible to address multiple nutrient deficiencies simultaneously without risk of antagonistic interactions. There is some evidence that in relatively advantaged populations, targeted educational approaches can work well.5,6

In the context of more impoverished environments, there is a growing literature supporting home- and food-based approaches to improve micronutrient status, as recently reviewed by Gibson and Anderson.7 The approaches they review focus on improvement of dietary zinc availability through encouragement of home production and use of animal source foods and home food processing strategies such as germination and fermentation to improve mineral availability. Their review provides an example of a successful dietary diversification/modification program developed and implemented in West Africa by Helen Keller International, along with consideration of requirements for scaling up such programs.

ECONOMIC GROWTH, POVERTY ERADICATION AND MICRONUTRIENT MALNUTRITION

Since the root cause of most malnutrition is poverty, there is always a policy-related argument that if economic growth can be achieved in poor countries, diets will improve with increased incomes and will preempt the need for additional public health interventions. While there is some basis for this argument, the weight of evidence points to a need for additional nutritional "safety nets." There is wide but not universal agreement that the virtual disappearance of iodine, niacin and other micronutrient deficiencies (excepting iron) in the period surrounding and following the Second World War was a combination of economic recovery after the Great Depression and of fortification of staple grains with micronutrients and of salt with iodine.8

However, the occurrence of economic shocks demonstrably set back progress against malnutrition in Southeast Asia in the late 1990s. The recent (2008) economic crisis has by recent estimates added several hundred million to the count of the world's malnourished within a very short period of time.9 Even if it were more predictable, general economic growth is a lagging predictor of nutritional improvement. …

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