Proceedings of the Nutrition Society

International and Public Health Nutrition Group Symposium on ‘Achieving a balanced diet in the developing world: strategies to meet micronutrient needs’

Can supplements help meet the micronutrient needs of the developing world?

Roger Shrimptona1 c1 and Werner Schultinka2

a1 Helen Keller International and Centre for International Child Health, Institute of Child Health, University College, London, 30 Guilford Street, London WCIN IEH, UK

a2 Nutrition Section, Programme Division, UNICEF, New York, USA

Abstract

Supplementation has many potential advantages over fortification and dietary approaches for improving micronutrient intake. Pregnant and lactating women and infants are most likely to benefit from supplementation. Recent experience with vitamin A supplementation in young children has proved to be remarkably successful. Demonstrated efficacy of vitamin A supplements for improved child survival in many settings and a technical consensus on how to implement interventions were major factors in achieving this success. Bilateral and UN agencies worked together so that in 1999 80 % of children under 5 years of age in the least-developed countries received a vitamin A capsule in the last 6 months. At least one million child lives saved were associated with the increase in coverage in the last 2 years of the 1990s. Experience with Fe-folate supplements has not been as successful. Whilst a technical consensus has been reached on how to implement programmes to control Fe deficiency, the lack of convincing evidence of efficacy of Fe-folate supplements in terms of maternal and child survival outcomes has undoubtedly contributed to the limited pursuit of effective action. A new multiple micronutrient supplement for se amongst women of reproductive age in developing countries has been formulated. UNICEF is employing the supplement in programmes aimed at helping to prevent low birth weight. The new supplement is likely to be more efficacious than Fe-folate supplements for both maternal and child survival and development outcomes. Successful completion of rigorous efficacy trials will be critical for creating the political support needed to achieve universal coverage.

Correspondence:

c1 Roger Shrimpton, fax +44 1904 425 998, email Roger.Shrimpton@ich.ucl.ac.uk