Micronutrient Deficiency Control Strategies in Vietnam ppsx

Micronutrient Deficiency Control Strategies in Vietnam N.X Ninh, N.C Khan, N.D Vinh and H.H Khoi Introduction Micronutrient deficiencies affect the majority of the population in Asia Though somewhat lower than in other countries in the region, micronutrient deficiencies remain p r eva len t in Vie tna m The prevalence of xerophthalmia, or clinical vitamin A deficiency (VAD), is now lower than the cut-off point established by the World Health Organization (WHO) to indicate a significant public health problem However, the prevalence of sub-clinical VAD as measured by low serum retinol exceeds 10% for children under five and pregnant women It is well established that sub-clinical VAD may contribute to high mortality, morbidity and growth retardation among young children The success of the VAD control program in Vietnam is attributed mainly to the effectiveness of high dose vitamin A supplementation, as the fortification program has not yet been established Control of iodine deficiency disorders (IDD) has been achieved with remarkable results This was facilitated by government approval of universal salt iodization in 1999 Iron deficiency anemia (IDA) affects over half of all women of childbearing age, infants, and young children in Vietnam Iron deficiency worsens during periods of growth and pregnancy, or with parasitic infections (e.g., malaria, hookworm) Other nutritional deficiencies such as folic acid and vitamin C can also contribute to anemia and poor iron absorption Iron deficiency, before the onset of anemia, may have adverse effects on function such as work performance For every 10% deficit in hemoglobin The authors are affiliated with the National Institute of Nutrition, Hanoi, Vietnam concentration, there is a 10-20% deficit in work performance Once anemia occurs, there can also be impairment of cognitive performance and behavior, lowered immunity, and pregnancy complications Anemia is devastating not only to the individual, but also to the economic and intellectual capacity of the whole nation The current strategy of combating iron deficiency in Vietnam is through iron supplementation, covering about 15-20% of the communities in the country The iron fortification program has just started with a pilot study Zinc deficiency is likely to be as widespread as iron deficiency anemia Vitamin B1 deficiencies are additional deficiencies of potential public health importance Clearly, micronutrient deficiencies must be controlled and prevented Correcting iodine, vitamin A and iron deficiencies can improve the populationwide IQ by 10-15 IQ points, reduce maternal deaths by one-third, decrease infant and childhood mortality by 40%, and increase strength and work capacity by almost 50% Investment into the elimination of these deficiencies will result in reduced health care costs and education expenditures, improved work capacity and productivity, equity, increased economic growth and national development The Vietnamese diet, disproportionately comprised of staple foods at the expense of dietary diversity, places the population at risk for micronutrient deficiencies Diets with high consumption of rice and low consumption of animal products may provide inadequate amounts of micronutrients as well as inhibit their absorption Recent years have seen improvements in dietary quality and diversity, with higher consumption of N.X Ninh et al protein rich foods and lower consumption of staple foods However, to ensure the population-level consumption of the RDA of micronutrients, national nutritional programs are needed Previous program approaches based upon dietary diversification and supplementation have contributed to the reduction of micronutrient malnutrition, but the progress has not reached national objectives For this reason, a more costeffective and sustainable strategy is sought to overcome the problem of micronutrient malnutrition Vitamin A deficiency (VAD) Initiation of the program The national vitamin A supplementation program was launched in 1988 with an orientation workshop to raise awareness among policy makers and mass media organizations regarding VAD Steering and technical committees were then established to run the program The key collaborators were the National Institute of Nutrition (NIN) and the Institute of Ophthalmology The program was started as a pilot project funded by UNICEF in seven districts, and was expanded in 1993 to a nationwide level Program implementation The core elements of the program included the following: Universal distribution of high dose vitamin A capsules (VAC) to children 6-36 months of age twice annually, in collaboration with National Immunization Days (NIDs); distribution of VAC to women after delivery; and targeted distribution of VAC to individuals at high risk for VAD such as malnourished children, and children with diarrhea, measles, or respiratory infections The high dose vitamin A capsules are distributed through the primary health care system and health care facilities Promotion of nutrition education with emphasis on breastfeeding, complementary feeding practices, dietary diversity and growth monitoring Promotion of the production and consumption of a diverse diet to increase vitamin A intake at the household level, through activities such as gardening, aquaculture and animal husbandry Establishment of a program implementation network from community to central levels, based on a strong preventive health structure with the active participation of mass organizations like the Vietnam Women’s Union (VWU), the education sector and other groups Development and dissemination of IEC materials such as posters, booklets and videotapes, combined with employment of mass media channels to implement regular education and communication activities Provision of training and information on micronutrient deficiencies to program staff to improve staff’s knowledge, attitudes and practices Program coverage It was expected that with the strong health system in place, Vietnam should be able to achieve a high coverage rate of VAC distribution to target groups However, a survey conducted in 2000 shows the mean distribution of high dose vitamin A for children 6-36 months of age to be 77%, and for women post-partum to be 52% (Figures 1, 2) The variation in coverage rates among regions can be explained, in part, by constraints to the quantity and quality of the health services at the local level, as well as by the accessibility of health centers (e.g., road conditions) This is demonstrated in difficult to access areas, including isolated mountain areas such as the Central Highlands and the Northern Highlands, where the coverage rates for post-partum women are lowest (23.5% and 42.2% respectively) (Figure 2) Prevalence and trends The prevalence of xerophthalmia (X2/X3) in children under five years of age appears to Micronutrient Deficiency Control Strategies in Vietnam have declined since 1988, based upon data from national nutrition surveys (Table 1) The national survey completed in 1988 reports a xerophthalmia (X2/X3) prevalence seven times higher than the cut-off point established by WHO as a public health problem (i.e., 0.07% vs 0.01%) However, by 1994 a national survey reported a prevalence of 0.005% The data in the 1998 survey also show clinical symptoms of xerophthalmia that were lower than the WHO criteria for a public health problem National trends in night blindness in children under five years of age suggest that significant improvements were gained from 1988 to 1994 (i.e., a reduction of approximately 86%) Though rates increased from 1994 to 1998, the national prevalence remains relatively low at 0.20% Similarly, maternal night blindness increased from 0.58% to 0.9% from 1994 to 1998, remaining lower than the reference threshold of 10% In terms of sub-clinical VAD, serum retinol data has only been collected on the subnational level The prevalence of subclinical vitamin A deficiency (serum retinol