Prevention of Micronutrient Deficiencies -- Copyright -- Acknowledgments -- Contents -- Prevention of Micronutrient Deficiencies Tools for Policymakers and Public Health Workers -- 1 Summary -- PROJECT CHARGE -- ORGANIZATION OF THE REPORT -- FINDINGS AND RECOMMENDATIONS -- Findings -- Recommendations -- 2 Key Elements in the Design and Implementation of Micronutrient Interventions -- THE IMPORTANCE OF IRON, VITAMIN A, AND IODINE TO HEALTH -- Iron -- Vitamin A -- Iodine -- THE CONTINUUM OF POPULATION RISK -- OPTIONS FOR SUCCESSFUL INTERVENTIONS -- Supplementation -- Fortification -- Food-Based Approaches -- Other Public Health Control Measures -- COSTS OF INTERVENTIONS -- FEASIBILITY OF INVOLVING KEY SOCIETAL SECTORS IN THE PLANNING AND IMPLEMENTATION OF MICRONUTRIENT IN ... -- ELEMENTS OF SUCCESSFUL INTERVENTIONS ACROSS THE CONTINUUM OF POPULATION RISK -- Interventions for Level IV Populations -- Interventions for Level III Populations -- Interventions for Level II Populations -- INTERVENTIONS FOR LEVEL I POPULATIONS -- Balancing Approaches to Country-Specific Circumstances -- Coordinating Interventions Across Micronutrients -- COMMON ELEMENTS OF SUCCESSFUL MICRONUTRIENT INTERVENTIONS -- Political Will/Stability -- Strategic and Program Planning -- Community Involvement, Participation, and Consumer Demand -- Physical and Administrative Infrastructure -- Communications Strategies -- Use of Appropriate Vehicle -- Sustainability -- Information Systems, Monitoring, and Evaluation -- Biological Indicators -- Background Papers -- 3 Prevention of Iron Deficiency -- DIAGNOSIS OF IRON DEFICIENCY AND ANEMIA -- CAUSES OF IRON DEFICIENCY -- IRON EXCESS -- PREVENTION OF IRON DEFICIENCY IN AT-RISK GROUPS -- Infancy -- Preschool Children (3 to <7 Years of Age) -- School-Age Children and Adolescents -- Women of Childbearing Age -- Pregnant Women.

SUSTAINABLE APPROACHES TO THE ELIMINATION OF IRON DEFICIENCY -- Dietary Improvement -- Improving the Supply and Intake of Food Iron -- Improving the Bioavailability of Food Iron -- Food Fortification -- Fortification Compounds -- Fortification Strategies -- Effectiveness of Iron Fortification -- Iron Supplementation -- During Pregnancy -- Prepregnancy Supplementation -- BENEFITS AND COSTS OF PREVENTING IRON DEFICIENCY -- Prevention of Iron Loss Due to Parasites -- SUGGESTED NATIONAL GOALS -- Short-Term -- Long-Term -- APPENDIX -- Five Studies in Developing Countries Addressing the Effectiveness of Iron Fortification -- The Thai Study -- The India Study -- The South Africa Study -- The Guatemala Study -- The Venezuelan Study -- REFERENCES -- 4 Prevention of Vitamin A Deficiency -- MAJOR HEALTH CONSEQUENCES -- Xerophthalmia and Nutritional Blindness -- Childhood Morbidity and Mortality -- Other Health Consequences -- MAGNITUDE AND EPIDEMIOLOGY OF THE PROBLEM -- Defining Vitamin A Status -- Extent of the Problem -- Risk Factors -- Age -- Gender -- Quality of Diet -- Disease Occurrence -- Seasonality -- Cultural Factors -- Clustering -- ECONOMIC COSTS OF VAD -- INDICATORS OF VAD -- Identification of Groups and Populations -- Monitoring Intervention Impact and Outcome -- CRITICAL ELEMENTS FOR SUCCESSFUL NUTRITION INTERVENTION PROGRAMS -- APPROACHES TO THE PREVENTION OR CORRECTION OF VAD -- Food-Based Approaches -- Dietary Modification: Where Food Sources of Vitamin A Are Available but Underutilized -- Thailand's Experience in Applying a Social Marketing Methodology to Increase the Utilization of Locally Available Vitamin... -- Context -- Design of the Intervention -- Implementation and Evaluation -- Results -- OTHER COUNTRIES' EXPERIENCES -- Other Social Marketing Experiences.

Lessons Learned in Behavior Modification Where Vitamin A-Rich Foods Are Available -- Dietary Modification: Home and Community Provisioning to Increase Availability of Vitamin A-Rich Foods -- Experiences in Bangladesh with Promotion of Home Gardens -- West Bengal, India: Experience with Horticultural Interventions in a Drought-Prone and Poverty-Stricken Rural Area -- Vietnam Gardening Project to Increase Production and Consumption of Vitamin A-Rich Foods* -- Lessons Learned from Successful Gardening Projects -- Small Animal Husbandry and Fish Production to Increase Household and Community Availability of Preformed Vitamin A Sources -- Multi-Mix Complementary and Weaning Foods -- Genetic Selection and Engineering to Improve Vitamin A Activity of Vegetables and Staple Crops -- Can Vitamin A Nutriture Be Improved by Feeding Plant Sources of Provitamin A? -- Fortification -- Vitamin A-Fortified Sugar in Guatemala: A Successful National Experience -- Indonesian Experience with Fortified Monosodium Glutamate: A National Failure -- The Philippines Experience with Fortified Margarine: A Promising Government and Private-Sector Partnership -- Other Fortification Efforts -- Food-to-Food Fortification -- Lessons Learned from Fortification Experiences -- Emergency and Food-Aid Programs -- Supplementation -- National Delivery Systems -- The Experience of Northeast Brazil with Community-Supported Supplement Distribution -- The Experience of Bangladesh with an Immunization-Linked, Prophylactic Supplementation Program for Infants -- Possibilities for Low-Dose, Community Supplementation -- Lessons Learned from Supplementation Programs -- Public Health Interventions -- Lessons Learned from Public Health Interventions for Disease Control -- COMPLEMENTARITY OF INTERVENTIONS -- Phasing in Vitamin A Interventions -- Vitamin A with Other Micronutrient Initiatives.

COSTS AND BENEFITS -- BALANCING APPROACHES TO COUNTRY-SPECIFIC CIRCUMSTANCES -- Two National Case Studies -- Indonesia -- Tanzanian Experience -- SUMMARY -- REFERENCES -- 5 Prevention of Iodine Deficiency -- REQUIREMENTS FOR IODINE -- CONSEQUENCES OF IODINE DEFICIENCY AND ITS CORRECTION -- Goiter -- Mental and Neuromotor Retardation -- Reproductive Impairment -- Impaired Agricultural Productivity -- Economic Stagnation -- Physical Growth -- CONSEQUENCES OF THE CORRECTION OF IODINE DEFICIENCY -- INTERACTION WITH OTHER MICRONUTRIENTS -- EXTENT OF IODINE DEFICIENCY -- Assessment Techniques* -- Goiter Rates -- Urinary Iodine -- Measurements of TSH -- Thyroglobulin -- Iodine in Food and Water -- Extent and Distribution of Iodine Deficiency -- Economic Costs of Iodine Deficiency -- INDICATORS OF IODINE DEFICIENCY AND IMPACT OF PREVENTION -- Identifying Target Populations -- Monitoring Intervention Programs and Their Impact -- PREVENTION AND CORRECTION -- Fortification -- Salt* -- Iodinated Bread -- Iodinated Water -- Supplementation -- Drops and Tablets of Iodine -- Iodinated Oil -- Summary Statement on Fortification and Supplementation -- NATIONAL PROGRAMS: SOME EXAMPLES OF SUCCESS AND FAILURE -- Ecuador -- Context -- Results -- Nigeria -- Context -- Results -- Bolivia -- Context -- Results -- Guatemala -- Context -- Results -- United States -- Context -- Results -- Bhutan -- Context -- Results -- Zimbabwe -- Context -- Results -- STRUCTURE OF PREVENTIVE PROGRAMS -- Assessment -- Salt Industry -- Education -- Legal Approaches -- IMPEDIMENTS TO IDD CONTROL -- In the Domain of Policy -- Inadequate Political and Popular Support -- Inadequate Involvement of the Salt Industry in Achieving Local or Universal Iodization of Salt -- Insufficient Education -- Insufficient Monitoring -- Complacency -- In the Domain of Programs -- In the Domain of Research.

In the Domain of Financial Support -- Conditions -- Costs and Benefits -- ACTION PLANS FOR THE INTERNATIONAL AGENCIES -- Independent Evaluation -- Strengthening Monitoring -- Strengthening the Role of Regional and Country Program Directors -- Enhancing Cooperative Efforts among Agencies -- Pursuing Relevant Research -- Extension of a Micronutrient Database -- Extending and Expanding Communications -- Extending Advocacy -- Closing Gaps in Knowledge of the Extent of ID and IDDs -- Conferences and Workshops at the Country, Regional, and International Levels -- Resource Development -- Dedicated Team Approach -- SUMMARY -- APPENDIX: ICCIDD GUIDELINES FOR ASSESSMENT OF PROGRESS TOWARD IDD ELIMINATION -- REFERENCES -- Appendix: Workshop Agenda.