Micronutrient Supplementation

	A child in India receives zinc syrup to treat diarrhea. Source: Peter Oyloe/AED N-MARC Director in Nepal

USAID supports evidence-based micronutrient supplementation interventions, including vitamin A supplementation for children 6 to 59 months, neonatal vitamin A supplementation in South Asia, anemia packages for women and children, and zinc with oral rehydration therapy as treatment for diarrhea.

Vitamin A deficiency affects millions of children, impairing their immune systems, causing blindness, and increasing the risk of death associated with diarrhea and measles. It accounts for about 600,000 child deaths each year. Three decades ago, studies funded by USAID demonstrated that giving a high dose of vitamin A twice a year to children 6 to 59 months can reduce child mortality by 23 percent. Today, vitamin A supplementation programs remain one of the most effective child survival interventions in global health.

Since 1999, USAID’s collaboration with international partners like UNICEF and the Micronutrient Initiative has resulted in more than 70 percent of children being fully protected with two doses of vitamin A each year. An estimated 2.1 million lives have been saved due to this intervention. Yet despite the focus on vitamin A supplementation over the past decade, only 30 of 103 priority UN countries attained effective coverage levels (80 percent of children with two rounds of supplementation in the past year). Coverage needs to be sustained for multiple rounds to achieve public health impact. USAID identifies key gaps that hinder vitamin A supplementation programs from achieving sustained high coverage, and it strengthens national twice-yearly vitamin A supplementation programs for children under 5 through sustainable delivery mechanisms.

USAID-funded research in South Asia shows that a neonatal dose of vitamin A, delivered in the first few days of life, can reduce six-month mortality by 15 percent. USAID is using existing delivery platforms to deliver this new intervention in South Asia.

Anemia affects about 2 billion people worldwide. Inadequate iron intake is the primary cause of anemia, and contributes to 22 percent of maternal deaths and 24 percent of perinatal deaths. Anemia in childhood irreversibly compromises cognitive development, leading to lower school attainment and losses in productivity. A recent analysis found the risk of maternal mortality decreases approximately 20 percent for each 1 g/dL increase in hemoglobin. Thus, correcting anemia of any severity can have an impact on maternal and child survival.

USAID combats anemia through comprehensive packages for women, including improved iron intake, de-worming, and malaria control in high-prevalence settings. USAID implements comprehensive anemia reduction packages in Uganda and India at the community level. In India, where 70 percent of pregnant women are anemic, USAID partnered with state governments in Uttar Pradesh and Jharkhand to strengthen iron folic acid supplement supply systems. Because of USAID advocacy, 3.3 million women now have access to these lifesaving supplements.

Given the consequences and prevalence of anemia in children, USAID is also supporting anemia reduction programs in Africa and Asia. USAID worked with the Regional Center for Quality of Health Care and the African Regional Office of the World Association of Girl Guides and Girl Scouts to design the Girl Guides Anemia Prevention Badge Project. This program reaches adolescent girls in Uganda, Swaziland, and Rwanda with information and activities on anemia prevention and control. There are now more than 4,000 Girl Guides (ages 7-18) in these three countries who can earn a badge in anemia prevention through educational programs and community involvement in anemia control. In partnership with the Cambodian government and the World Bank, USAID is testing the effectiveness of an anemia reduction package for young children that will influence national policy development.

Every year more than 1.5 million children under the age of 5 die as a result of acute diarrhea despite the availability of effective low-cost therapies to manage diarrhea cases. Studies show that when children with diarrhea receive zinc for 10-14 days in conjunction with oral rehydration solution (ORS), the duration and severity of the diarrheal episode is lessened, there is a preventive effect for future episodes, and treatment failure or death is reduced by 42 percent.

In partnership with the World Health Organization and UNICEF, USAID is supporting the implementation of global recommendations to provide zinc with ORS for treatment of diarrhea. USAID works with the private sector to make high-quality zinc available at low cost.

Related Links

• A2Z: The USAID Micronutrient and Child Blindness Project
  
The goal of the USAID Micronutrient and Child Blindness Project is to increase the use of key micronutrient and blindness interventions to improve child and maternal health.


• Micronutrient Forum
  The Micronutrient Forum focuses on the micronutrient deficiencies of public health significance, particularly vitamin A, iron, folate, iodine, and zinc.