Correspondingly little work, however, has been done on the elements of effective micronutrient interventions. While the design and implementation elements of effective micronutrient interventions may be identical to macronutrient nutrition interventions in general, it is worth taking a systematic look at the factors that account for—or constrain—their effectiveness.
This chapter draws on the discussions of the two working groups in the 5–7 December 1996 workshop (see the Appendix for agenda). Working Group I was charged with evaluating past experience with approaches to the prevention or correction of micronutrient malnutrition. The approaches examined included food-based strategies such as dietary change and fortification, supplementation, and other public health measures, including parasite control and delayed umbilical cord ligation. Working Group II looked more broadly at the major elements of success and constraint in past programs.
This chapter first describes the importance of iron, vitamin A, and iodine to health. It then considers options for successful interventions based on the level of development of the target country. The costs of interventions are also briefly reviewed.
In drafting this summary, the committee has followed two general rules. First, while elements of past experiences may differ among the specific micronutrients, the committee paid special attention to successful examples of strategies incorporating more than one micronutrient or including improvement in public health measures. Second, the committee and workshop participants agreed to base all findings and recommendations in this report on the data provided in three background papers, because these documents provided the substantive basis for discussion at the workshop. "Conventional wisdom" was not considered a sound basis for judgment in the absence of acceptable evidence. To streamline discussion, no references are provided in this chapter; the interested reader is encouraged to read the supporting papers.
The health and vitality of human beings depend on a diet that includes adequate amounts of certain vitamins and minerals that promote effective functioning of physiologic processes, including reproduction, immune response, brain and other neural functions, and energy metabolism. The body needs relatively minute quantities of these elements—i.e., measured in micrograms or milligrams—thus supporting their description as micronutrients. These elements are essential; they cannot be manufactured by the human body and must be obtained through dietary means. Deficiencies of most micronutrients are known to have devastating effects on health. They increase risk of overall mortality and are associated with a variety of adverse health effects, including poor intellectual development and cognition,