Food and Nutrition Surveillance
and Response in Emergencies
Session 22
Strategies to Prevent
Micronutrient Deficiencies
1
Introduction
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Micronutrient malnutrition results from a
biological deficiency of one or more
micronutrients essential for normal growth
and development
•
Most common micronutrient deficiencies of
serious public health significance are Vitamin
A, Iodine, Iron, Folic acid and Zinc
(recently)
2
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In emergencies, micronutrient malnutrition is
commonly manifested as conditions like:
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Scurvy (vitamin C) – East and the Horn of Africa
vitamin A deficiency - south Asia & Africa
Anemia (iron deficiency) - worldwide
goitre (iodine Deficiency) – world wide
Pellagra (niacin deficiency) – Southern Africa
3
•
Micronutrient inadequacies, even without
appearance of classical deficiency disease,
increase disease and mortality rates in
populations relying solely on long-term food
assistance programmes
4
Overview of risk factors for micronutrient
deficiencies among emergency affected people
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Economic, political and technical factors
factors – deteriorate diet quality
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–
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Social environment
–
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Availability of external assistance/resources for
humanitarian action
Accessibility to population
Marginalisation of specific groups
Seasonality e.g. scurvy in Somali camps in
Kenya
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•
Phase of emergency
–
•
Duration of stay in camp e.g. in Ethiopia and
Tanzania
Health care and sanitation/crowding
–
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Availability of potable drinking water
Communicable infections etc.
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Ration-Related Micronutrient Risks
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Inadequate nutritional quality and quantity of
general ration – fresh vegetables rarely
distributed
Diet monotony – loss of appetite
Acceptability of the ration
Distribution and targeting problems
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Strategies to prevent micronutrient
deficiencies in emergencies
•
In emergencies, micronutrient deficiencies
are likely to be amplified where there may be
restricted access to food.
•
Micronutrient needs of malnourished
refugees and displaced persons in need of
nutritional rehabilitation are higher than
those of normal populations
8
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The three broad approaches to control of
micronutrient deficiencies include:
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–
–
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Supplementation – using capsules
Food fortification or food enrichment
Dietary diversity and quality improvement
The UNHCR and WFP have implemented a
number of strategies – that fall under the
above broad approaches - to prevent
micronutrient deficiencies occurring in atrisk populations.
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•
I order of priority:
1. Promoting production of fresh fruit and
vegetables e.g. in Nepal
2. Providing fresh food items in general ration, e.g.
vegetables in the Balkans region
3. Adding a food to the ration that is rich in
vitamins and minerals e.g. fortified blended
foods/premixes
4. Promoting access to sources of food rich in
micronutrients e.g. groundnut as a source of
niacin in a maize-based ration
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5. Providing fortified foods in the ration e.g.
iodized salt and vegetable oil fortified with
vitamin A
6. Distributing a prophylactic dose of vitamin A to
infants and young children every six months in
refugee and displaced populations
7. Research assessing how wild indigenous food
foods may be used to prevent micronutrient
deficiencies
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Other support strategies:
1. Pre-positioning of relief foods for faster access
and delivery to relief situations
2. Preparation of memoranda of understanding for
acceptable nutritional responses (by WFP,
UNHCR, UNICEF and others)
3. Issuance of minimum standards for relief
response, including standards for food and
nutrition (by SPHERE and others)
4. Monitoring, evaluation and reporting of
nutritional situations – make response and action
more accurate
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WHO, WFP and UNHCR have identified the
following requirements for refugees in the
initial phase of an emergency:
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Vitamin A
Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Vitamin C
Vitamin D
Iron
–
Iodine
- 1666 IU (or 0.5 mg RE)
- 0.9mg (or 0.4mg/1000 kcal)
- 1.4mg (or 6.6mg/1000 kcal)
- 12mg (or 6.6mg/1000 kcal)
- 28.0 mg
- 3.2 – 3.8 µg calciferol
- 22 mg
(low bioavailability 5- 9%)
- 150 µg
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Constraints to implementing some of the
strategies exist esp. promoting access to food
through food production or other means
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Hence, investments in a range of strategies
are likely to be more effective
•
Choices may vary according to the situation
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Despite the strategies employed,
micronutrient deficiencies persist in refugee
and displaced populations – implying need
for more effort.
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Major challenge – HIV and infant feeding
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