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SCN Micronutrient Working Group Annex. Compiled by the Iron Deficiency Project Advisory Service (IDPAS) for the International Nutrition Foundation and the United Nations University. March 2003. IDPAS# 1977
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     The United Nations Standing Committee on Nutrition (SCN) 30th meeting was scheduled for 3-7 March 2003 in Chennai, India. This meeting included a session of the SCN Micronutrient Working Group. A global summary report, mainly on activities related to improving iron nutrition was prepared by the International Nutrition Foundation (INF) and the United Nations University. IDPAS, acting as an informal secretariat, solicited information on these topics from national authorities, researchers, non-governmental organizations, bilateral agencies and UN organizations.

     Thanks to the work of the SCN and others, all members of the United Nations General Assembly have accepted a new decade target to reduce the prevalence of anemia including iron deficiency by 20 per cent by 2010. This includes anemia within the full population including young children.

     As noted in this report last year, achieving this decade target will require strong national and international commitment to the lifecycle approach and to the integrated, multiple-intervention model that is strongly endorsed by the SCN. It includes dietary diversification, food fortification, supplementation, infection control and linkages with other public health measures guided by monitoring and research and bolstered by well-planned communication support.

     The past year has been marked by progress and some major achievements in what might be called the basic “infrastructure” of anemia prevention and control. Regarding advocacy, new information became available to support expansion and acceleration of work to prevent and control anemia. This included new data on the extent and consequences of iron deficiency. The WHO experts group analyzing the Global Burden of Disease learned though conservative meta-analysis that in both developing and the poorest countries iron deficiency was among the top ten contributors to Disability Adjusted Life Years. This finding was highlighted in the 2003 World Health Report. New research also pointed more clearly to the impact of iron deficiency on brain and social development in young children. This information links directly with the increased commitment by UNICEF and others to Early Childhood Development. On the basis of this evidence, prevention of anemia should be a higher priority, both for health sectors and education sectors and also for those working to guarantee basic child and women’s rights.

     Several agencies report increasing their commitment and resources to anemia prevention and control or made plans to do so. These include UNICEF which is developing a cross country experience sharing and support effort called the “Alliance Against Anemia,” the World Food Program, which has set up a new high level unit focusing specifically on nutrition, and USAID’s project SUSTAIN which has increased its work in this area during the past year.

     A major achievement in 2002 with implications has been the inauguration and initiation of the GAIN project with initial resources of US$70 million to support national alliances for food fortification in developing countries. By January 2003 some 16 countries had applied for GAIN grants and more proposals will be submitted for a second round of consideration by mid year.

     An Asian Development Bank project based on Japanese funds made substantial progress in Central Asia resulting in new equipment and supplies being procured and installed in some 90 large scale flour mills where a regionally developed multi-micronutrient fortification premix will be used for wheat flour. All necessary regulations allowing for fortified wheat flour are in place. Fortification of wheat flour with iron and other micronutrients also began in 2002 in China, In Brazil a new national policy calling for universal flour fortification was announced. Other countries also reported their progress on cereals fortification.

     A meeting of flour millers and wheat exporters in Mauritius included an added day devoted to the growing movement toward Universal Flour Fortification. UFF has substantial backing from the private sector, the US Centers for Disease Control, the Micronutrient Initiative, UNICEF, the Australian Wheat Board and others.

     Work to improve supplements and the effectiveness of their delivery was ongoing in 2002. Multi-micronutrient supplement trials for pregnant women began in China with support from CDC and UNICEF. Tests of a new “dispersible” tablet for pediatric supplementation with iron, zinc and folic acid began with support from WHO. An evaluation was completed in three countries of the IRIS project that focuses on use of a multi-micronutrient “foodlet” developed by Roche in collaboration with GTZ, and UNICEF. Efficacy testing of micro-encapsulated iron and other micronutrients in the form of “sprinkles,” continues and expanded. Sprinkles developer has made clear that this technology is now ready to be taken to national scale.

     The Working Group on Strategies to Eliminate Iron Anemia in Children Less then Two Years of Age by 2008, which was reported on by Nevin Scrimshaw and Betsy Lozoff in a 2003 SCN Plenary Session, concluded that new alliances with the private sector are essential to substantially reducing anemia among the high risk group of young children.

     One major theme of the 2003 INACG Symposium in February was the linkage of anemia and major infectious diseases, especially hookworm, malaria and HIV/AIDS. With over 50% of the mortality related to these diseases comes from anemia. The importance of an integrated approach to anemia prevention that includes such linkage is reinforced. The INACG meeting demonstrated through its large poster sections that substantial new work is going on at community and provincial level to improve and expand anemia prevention and control. The abstracts of the INACG posters are included on the INACG website and in a file contained in IDPAS Iron World.

     Communication tools and strategies focusing on anemia were further developed and tried during 2002 with new workshops using the CDC’s CDCynergy tools, an INACG sponsored communication workshop in Africa and ADB and UNICEF supported communication strategy workshops in Bishkek, the Kyrgyz Republic and Astana, Kazakhstan.

     In summary, iron deficiency and anemia continue to rise on public health agendas in developing countries and the “evidence base” for powerful advocacy to push from agenda to action continues to grow. The development of interventions contributing to prevention and control iron deficiency for various high risk population groups has improved. Some have reached a state where emphasis should now shift from efficacy toward effectiveness and “going to scale.” However, the well-endorsed, integrated, multiple intervention strategies called for by the SCN and others, remain more accepted in principle than in practice. Current concentration is on the interventions, especially food fortification where substantial resources are available. This is inevitable. However, new and potential alliances among donors, national organizations, NGOs and private sector industries offer new approaches to creating the integrated intervention strategies needed to prevent and control, anemia among all groups at all ages within a national population.

     Continued research to improve interventions and their delivery remains critical, but the information received by IDPAS for this report demonstrates a new element, that is crucial to maintaining the new momentum of work on anemia and iron deficiency. This is active experience exchange. For this exchange there are many channels ranging from publications, to meetings and conferences, to the types of posters found at the recent INACG symposium. Other types of channels are those used to develop this report and the annex where all levels of project and organization can participate. Through these and new channels the new challenge will be to sharing project information on activities, processes and lessons learned.

     Review of the annex of this report, will show that such information sharing is valuable but must be increased and facilitated. In the view of IDPAS this is necessary for the complex issues surrounding anemia prevention and control to be successfully addressed.

 

Iron Deficiency Project Advisory Service International Nutrition Foundation Web site: http://www.micronutrient.org/IDPAS Email: idpas@inffoundation.org Phone (1-617) 636-3770 Fax: (1-617) 636-3781 Project Office: 150 Harrison Street, Boston, MA, 02111 Gerald J. & Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University