Small but Essential for Growth
Dr Shamim Ahmed
33.8 percent children are suffering from Iodine deficit. Photo: Zahedul I Khan
Micronutrients are nutrients required by life in small quantities to support a whole range of physiological functions, but which the organism itself cannot produce. They include microminerals and vitamins. They include dietary minerals in amounts generally less than 100 micrograms/day - as opposed to macrominerals which are required in larger quantities. The microminerals or trace elements include at least among others iron, iodine and zinc. The micronutrients also include vitamins. Vitamins such as Vitamin A and Vitamin C are organic chemicals that a given living organism requires in trace quantities for good health, but which the organism cannot synthesise, and therefore must obtain from its diet.
At the 1990 World Summit for Children, deficiencies in three micronutrients were identified – iodine, iron and vitamin A - as being particularly common and posing public health risks in developing countries. The Summit set goals for elimination of these deficiencies by 2015.
Bangladesh has one of the highest under-five mortality rates in the world. The prevalence of stunting is 36 percent; wasting 16 percent and underweight being 46 percent. The micronutrient deficiencies are rampant. Children deficient with Iodine (less than 100 mcg iodine/L of urine) account for 33.8 percent according to the third IDD Survey 2004-05. The prevalence of anaemia among infants 6-11 months is 92 percent and among children 6-59 months is 68 percent. The principal causes of death in the under-five age group are diarrhoea and pneumonia.
Micronutrient deficiencies can cause blindness, stunted growth and permanent cognitive impairment. The consequences of this “hidden hunger” are self-perpetuating cycle of poverty and suffering. Anemia, mostly due to iron deficiency, is the most frequent nutritional deficiency and a serious public health problem in the country
The Multiple Micronutrient Powder (MNP) packets contain multivitamins and minerals approved by WHO and UNICEF that can be added to a child food by parents or caregiver. Formulations may be changed to meet the nutritional need of children in various countries. The Micronutrient Powder (MNP) contains iron to prevent anaemia, zinc to mitigate the effects of diarrhoea, iodine to enhance brain development and Vitamin A to prevent night blindness as well as other minerals and multi-vitamins.
The MNP is an important tool to address vitamin and mineral malnutrition.
Micronutrients assistance delivers real economic benefits. Leading economists determined that eliminating micronutrient deficiencies in children offers a high rate of return and is extremely cost effective.
Anemia is a serious public health problem in the country. Photo: Zahedul I Khan
The Multiple Micronutrient Powder (MNP) popularly known as “Sprinkles” is tasteless dry powder that is packaged into a single-serve sachet containing multiple micronutrients appropriate for children aged six to 24 months. When added to complementary foods, there is no appreciable change in taste or consistency of food. This home based fortification of complementary food using MNP is safe and cost effective.
Two Sprinkles formulations have been developed; a nutritional anemia formulation (containing five ingredients – Vitamin A, Vitamin C, Iron, Folic Acid and Zinc) and a multiple micronutrient formulation (containing 15 ingredients including Vitamin A, C, D. E, B complex, Iron, Iodine and Zinc) based on the WHO/RNI model.
Efficacy trials show that providing 60 sachets over a period of at least 60 days and up to six months provide adequate levels of iron to young children aged six to 24 months when mixed with locally used complementary foods. Sixty sachets can treat a child with anemia and other vitamin and mineral deficiencies.
Many initiatives have recently been undertaken in the country at public/private level to address micronutrient malnutrition. The Directorate General of Family Planning (DGFP) with the financial support of UNICEF and technical assistance of ICDDRB has already initiated a project to provide MNP (five ingredients) to children 6-23 months in two selected upazilas from six divisions – total 12 upazilas to prevent and control anaemia and improve infant and young child feeding (IYCF) practices. The project is, however, in the preparatory stage and is expected to be fielded soon.
UNICEF is providing MNP (five ingredients) to children under three years in the para centres in all the three districts of Chittagong Hill Tracts with the support of ICDP.
The Social Marketing Company (SMC) has introduced a small sachet of micronutrient powder, manufactured by Renata Pharmaceuticals in the brand name of “MoniMix” to address childhood Iron Deficiency Anemia (IDA).
BRAC is also marketing MNP labeled as “Pushtikona” (containing 15 ingredients), manufactured by Renata Pharmaceuticals, through its health workers (Shasthyo Shebika) at a nominal price.
It is hoped that the impact of MNP would be visible soon and MNP supplementation would eventually be integrated in the GOB child survival programme through the community clinics.