Friday, September 07, 2012

Micronutrient fortifications and supplements

Following up on an article in New York Times Easier Than Taking Vitamins which bemoans the delay in the spread of the use of Sprinkles, I came across the interesting article Taken with a Grain of Salt? Micronutrient Fortification in South Asia

"Abstract: This paper reviews the research on fortification of food in the context of South Asia, with an emphasis on avenues for future research in economics and policy. We argue that while the efficacy of fortified foods in controlled settings is well established, more research is needed to evaluate the take-up and effectiveness of fortified foods distributed through standard channels. In addition, we argue that more research is needed to understand the determinants of long-term demand for fortified foods."
Some sample passages about the problems of policies and distribution in India:
"Political support in India for micronutrient interventions and fortification, specifically, has been slow and inconsistent.......
 Some states, such as Tamil Nadu, have already made progress on the distribution of DFS, but these recent developments signal headway towards resolving one nation-wide obstacle in the use of fortified foods: the absence of a directive from the Central Government on the regulation of fortified foods and their use. Without such a directive, NGOs working in this area often find it difficult to motivate local governments to allocate money towards fortifying food in schools

There are important target groups not reached through schools. For example, there is evidence that children
younger than school age are more likely to benefit from nutrition programs (Adelman, Gilligan,and Lehrer, 2008). In India, 70% of children under the age of five and 56% of ever-married women age 15-49 are anemic, making reaching these at-risk groups imperative.

Another way to provide fortification is through hospital or clinic distribution, although this might be a more natural channel for supplementation. In theory, the advantage to this strategy is that there is existing infrastructure to promote health awareness and possibly better targeting of households at-risk of micronutrient deficiencies. However, the performance of health clinics across India does not inspire confidence in either of these tasks. Health providers are absent on average 40% of the time and absence rates are higher in poor places (Chaudhury et al., 2006), where households are also more likely to be micronutrient deficient. Despite public health mandates to provide iron and folic acid syrup to pregnant women and vitamin A supplements to  children, these treatments do not reach all of their intended beneficiaries: in India, 65% of pregnant women were given or purchased iron and folic acid syrup, but only 23% took it for more than 90 days, and only 25% of children receive regular vitamin A supplements
(International Institution for Population Sciences, 2007). This is likely due in part to lack of demand for clinic services, these facilities being closed unpredictably and to the health facilities not being adequately stocked even when they are open. Research on how to improve the health care sector’s performance and how to increase awareness among households on when to visit health clinics and what care to expect, are important open questions. There is little evidence on this, although one notable exception suggests that contracting to non-governmental organizations, where payment and contract renewal depend on achieving health targets, such as how many children receive vitamin A supplements, improved performance (Bhushan et al.,2007)."

A government document of India also says that the targets for the tenth five year plan were not reached.


Paul Hafalla said...

Interesting post. It is essential to read. I was wonder what other supplements our brain might need.

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