Micronutrients
Ensure that children receive adequate amounts of micronutrients (vitamin A, iron and zinc, in particular), either in their diet or through supplementation.
Vitamin A. In Vitamin-A-deficiency areas, vitamin A supplementation has been shown to reduce child mortality by over 20% in children 6 months to 5 years old (Family and community practices that promote child survival, growth and development: a review of the evidence). The benefits of vitamin A supplementation may apply also to areas with significant biochemical deficiency and no clinical manifestations.
Supplementation approaches have included supplementation—usually a high dose every 4-6 months—and food fortification.
Vitamin A supplementation from 6 months of age has been recommended as an intervention that reduces child mortality (The Lancet series on maternal and child undernutrition, 2008) and has been confirmed as one of the key evidence-based interventions to reduce child mortality.
A summary of additional, recent evidence on vitamin A supplementation in children is provided in this document:
Vitamin A supplementation for infants and children 6-59 months of age
Iron. Iron supplementation in children with reduced iron stores has been shown to restore iron stores and improve haemoglobin levels, attention and appetite.
Public health interventions in this area include among others intermittent iron supplementation, dietary diversification and food fortification. Intermittent iron supplementation has been recommended in pre-school and school-age children in areas where the prevalence of anaemia in these age groups is 20% or higher as an intervention to improve iron status and reduce the risk of anaemia.
In malaria-endemic areas, iron supplementation should be provided in conjunction with adequate measures to prevent, diagnose and treat malaria.
“Iron sprinkles”—powdered micro-encapsulated ferrous fumarate sprinkled on semi-liquid food—have been shown to be “as efficacious as … iron drops for the treatment of anaemia in young children” (The Review). In The Lancet series on maternal and child undernutrition (2008), an analysis of studies of these preparations found an increase in haemoglobin concentration and a reduction in iron-deficiency anaemia in children younger than 2 years with the use of dispersible micronutrients.
Food fortification—effective in reducing iron deficiency in developed countries—has targeted wheat flour, sugar and salt.
Intermittent iron supplementation in pre-school and school-age children
Zinc. The recommendation on micronutrients currently includes also zinc, as zinc deficiency is highly prevalent in children in developing countries and in view of research findings showing that zinc supplementation reduces diarrhoea and pneumonia incidence, and improves growth in children.
Zinc supplementation given during an episode of acute diarrhoea (10 mg/day for children less than 6 months old and 20 mg/day for children 6 to 59 months) reduces the severity and duration of the episode. When given for 10-14 days, it lowers the incidence of diarrhoea in the following 2-3 months (WHO/UNICEF joint statement on clinical management of acute diarrhoea).
A review published in The Lancet estimated that Zinc administration as a treatment measure could have prevented 4% (about 400 000) of under-five deaths in the 42 countries which totally contributed to 90% of global under-five deaths (Lancet 2003; 362:65-71).
As observed for iron, it appears difficult for infants and young children to meet their zinc requirements from food alone. Research to increase the bioavailability of zinc from food staple crops is under development.
Related links:
WHO/UNICEF joint statement on clinical management of acute diarrhoea
Implementing the new recommendations on the clinical management of diarrhoea
The Lancet Child survival series
