MICRONUTRIENT DEFICIENCY STATUS AND ITS IMPACT ON CHILD HEALTH IN

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MICRONUTRIENT DEFICIENCY STATUS AND ITS IMPACT ON
CHILD HEALTH IN SOUTH EAST ASIA
Dr Kunal Bagchi Regional Adviser Nutrition
Food Safety WHO SEARO
International Workshop on Micronutrients and
Child Health, 20 23 October 2009
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The public health implications of micronutrient
deficiencies are potentially huge and significant
when it comes to designing strategies for the
prevention and control of diseases and
pathological conditions
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World Health Statistics 2008
Infant Mortality Both sexes / 1000 live births
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World Health Statistics 2008
Under-five mortality probability of dying by
age 5 for both sexes per 1000 live births
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World Health Statistics 2008
Mortality Distribution of causes of death among
children aged lt 5 years ()
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Mortality Distribution of causes of death among
children aged lt 5 years () Selected SEARO
Member States
Bangladesh
India
Thailand
Myanmar
World Health Statistics 2008
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Anemia
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Anemia
Worldwide prevalence of anemia 1993 2005 WHO
Global database on anemia (2008)
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Anemia country estimates of prevalence in
pre-school age children
Proportion of population with Hb lt 110 g/L
Worldwide prevalence of anemia 1993 2005 WHO
Global database on anemia (2008)
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Vitamin A deficiency Prevalence in pre-school
age children
Global Prevalence of vitamin A deficiency in
populations at risk 1995 2005 WHO Global
Database (2009)
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Vitamin A deficiency Prevalence of in pre-school
age children
(Serum retinol lt 0.70 µmol /l)
Global Prevalence of vitamin A deficiency in
populations at risk 1995 2005 WHO Global
Database (2009)
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Iodine Deficiency Disorders
Iodine status worldwide WHO Global Database on
Iodine Deficiency (2004)
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Iodine deficiency National estimates of UI in
school-age children (6 12 years) 2002-3
Iodine status worldwide WHO Global Database on
Iodine Deficiency (2004)
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Micronutrient Deficiencies in SEARO Member States
(selected)
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• Folate (vitamin B9)
• plays a central role in the synthesis and
  methylation of nucleotides that intervene in cell
  multiplication and tissue growth
• role in protein synthesis and metabolism is
  closely interrelated to that of vitamin B12
• the combination of severe folate deficiency and
  vitamin B12 deficiency can result in
  megaloblastic anaemia
• low intakes of folate are also associated with
• higher risk of giving birth to infants with
  neural tube defects
• possibly other birth defects
• with an increased risk of cardiovascular diseases
  and cancer
• impaired cognitive function in adults

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Birth Defects prevalence / 1000 live births
Source March of Dimes Birth Defects Foundation
2006
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Estimated prevalence of birth defects (selected)
in SEARO member states
Source March of Dimes Birth Defects Foundation
2006
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Folic acid in the prevention of birth defects

• A higher intake of folate by some women can
  reduce their risk of delivering an infant with a
  neural tube defect.
• It is generally accepted that women should
  consume an additional 400µg/ day as folic acid in
  fortified foods or supplements peri-conceptionally
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• Increasing intake by just 200µg / day through
  fortification has been shown to be effective in
  improving folate status and in lowering the
  prevalence of neural tube defects in some
  countries.

Guidelines on food fortification with
micronutrients. FAO/WHO 2006
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Preventing micronutrient deficiencies in
populations affected by humanitarian crises
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• Foods fortified with micronutrients as part of
  food rations during humanitarian crises
• fortified foods - corn-soya blend, biscuits
• vegetable oil enriched with vitamin A D
• iodized salt

WHO/WFP/UNICEF -Preventing and controlling
micronutrients in populations affected by an
emergency (2007)
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Composition of multiple micronutrient supplements
for children from 6 59 months of age, pregnant
and lactating women
WHO/WFP/UNICEF -Preventing and controlling
micronutrients in populations affected by an
emergency (2007)
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Integrated Approach towards effective anemia
control

• ? Food based approaches to increase
  micronutrients intake
• Dietary diversification
• Food fortification
• ? Micronutrient supplements to especially
  vulnerable segments of the population,
  particularly pregnant women
• ? Strategies should be built into the primary
  health care system and existing programmes
• Strategies should be evidence based, tailored to
  local conditions, and take into account the
  specific aetiology and prevalence of anaemia in a
  given setting and population group
• Firm political commitment and strong partnerships
  involving all relevant sectors
• Operational surveillance system affordable
  easy-to-use

Focusing on anemia towards an integrated
approach for effective anemia control. WHO /
UNICEF 2004
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THANK YOU