Rainer Gross

Zinc deficiency: what are the most appropriate interventions?

Zinc deficiency is one of the ten biggest factors contributing to burden of disease in developing countries with high mortality.1 Since the problem was highlighted in the World Health Report 2002 , calls have increased for supplementation and food fortification programmes.2 3 Zinc interventions are among those proposed to help reduce child deaths globally by 63%.4 Populations in South East Asia and sub-Saharan Africa are at greatest risk of zinc deficiency; zinc intakes are inadequate for about a third of the population and stunting affects 40% of preschool children.5 Zinc is commonly the most deficient nutrient in complementary food mixtures fed to infants during weaning.6 Improving zinc intakes through dietary improvements is a complex task that requires considerable time and effort.7 The case for promoting the use of zinc supplements and for fortifying foods with zinc, especially those foods commonly eaten by young children, therefore seems strong. However, global policies or recommendations for zinc interventions are few. The World Health Organization recommends zinc only as a curative intervention, either as part of the mineral mix used in the preparation of foods for the treatment of severe malnutrition, or more recently in the treatment of diarrhoea.8 We review current evidence that improving zinc intake has important preventive or curative benefits for mothers and young children and examine the programme implications for achieving this in developing countries. We searched PubMed and the databases of WHO and Unicef for information on zinc supplementation and zinc fortification. We examined existing reviews of the evidence for benefits of zinc supplementation and zinc fortification and recent papers reporting the results of randomised controlled trials. These findings were further considered in the light of international policy recommendations for supplementation and fortification of other micronutrients such as iodine, iron, and vitamin …

Wasting time for wasted children: severe child undernutrition must be resolved in non-emergency settings

International solidarity has rarely been as impressive as the response to the 2004 tsunami catastrophe. As many as 300 000 lives were lost as a result of the combined effects of the earthquake and tidal waves. Fortunately generous pledges of assistance (public and private) prevented further deaths in the crisis aftermath which ensured that Indonesia Sri Lanka and other affected countries could quickly begin the process of reconstruction. Such catastrophes often stir public action on a grand scale. Another example is the Sudanese region of Darfur still plagued by violence and massive population displacements where alarming rates of wasting (defined in terms of low weight-for-height against international standards) were reported during 2004 in pre-school children (aged 6 months to 5 years). (excerpt)

Low environmental selenium availability as an additional determinant for goiter in East Java, Indonesia?

Iodine deficiency, which is most visibly indicated by goiter, is highly prevalent in Indonesia. Since 1994, Indonesia has a decree that all salt used for human, livestock, and industry must be iodized. However, despite the increased distribution of iodized salt, pockets with significantly higher prevalence of goiter still remain. This situation may be consequence of selenium (Se) deficiency. This study aimed to assess the Se level in the environment of goiter prevalent areas. Five hundred eleven school children participated in this study. Goiter was measured using both ultrasound and palpation. Ninety-nine eggs were collected from free-living chicken in 11 villages, and the Se contents of egg yolk and egg white were determined by neutron activation analysis. In the villages studied, Se concentration in egg yolk ranged from 0.15 to 1.52 Μg/g and in egg white from 0.18 to 2.97 Μg/g. The prevalence of goiter measured by palpation ranged from 18.4% to 70% and by ultrasound from 0% to 100%. Because of the inconsistency of goiter rate measured by palpation and ultrasonography, the question remains whether low availability of Se in the environment might be an additional contributing factor for goiter.

Increase in Compliance with Weekly Iron Supplementation of Adolescent Girls by an Accompanying Communication Programme in Secondary Schools in Dar-Es-Salaam, Tanzania:

Insufficient compliance has been identified as a major contributing factor to the low effectiveness of iron-supplementation programmes. An experimental community trial was conducted to observe the effect of a communication programme on compliance with weekly iron supplementation in urban Tanzanian adolescent schoolgirls. A sample of 237 girls aged 14 to 17 years was randomly recruited from five schools in Dar-es-Salaam, and randomly assigned to three groups. Group A (schools 1 and 2) received one tablet weekly containing 65 mg of elemental iron with 0.25 mg of folic acid for eight consecutive weeks and participated in weekly communication sessions. Group B (school 3) received the same supplementation without communication sessions. Group C (schools 4 and 5) served as the control group, without supplementation or communication. Reported and observed compliance was checked by pill counting and stool analysis. Haemoglobin levels were determined by the cyanmethaemoglobin method before and after intervention. A knowledge test on iron-deficiency anaemia (causes, effects, and treatment) was carried out before and after intervention. Venn diagrams were drawn to identify the most influential persons. Three focus group discussions with the girls and the teachers were conducted at different stages during the study. in the group receiving supplementation and communication, the prevalence of anaemia decreased significantly (p < .001) from 49% to 5% in school 1 and from 54% to 23% in school 2. the prevalence of anaemia did not change significantly in schools 3 and 4 but increased significantly in school 5. the reported and observed compliance was 90% and 94%, respectively, in school 1, 89% and 75% in school 2, and 48% and 50% in school 3. the participants’ knowledge of iron-deficiency anaemia increased significantly in all schools after the intervention (p < .001) but was highest in schools 1 and 2, which received supplementation and communication. It is concluded that comprehensive communication strategies can influence the ingestion of iron supplements and therefore help to reduce anaemia in adolescents.

A Life-Cycle Approach to Multi-Micronutrient Supplementation: Rationale and Programme Concept

The effectiveness of nutrition education and unsupervised daily iron supplementation on iron status was studied in adolescent schoolgirls of low socio-economic status. Baseline knowledge, attitudes, and practices related to nutrition and iron status were assessed in 915 girls attending schools in an urban and a rural area of Sri Lanka. Girls in intervention schools received nutrition education and ferrous sulphate or a placebo and were requested to take one tablet per day. Subjects in control schools did not receive any intervention. All subjects were reassessed after 10 weeks. Educational intervention resulted in significant increases in knowledge of nutrition and in iron status among girls in both areas. Good compliance was noted with both iron supplements and the placebo. Iron status was more improved in the groups receiving iron supplementation than in the groups receiving education only, indicating the effectiveness of unsupervised supplementation when combined with nutrition education. The short-term sustainability of intervention was higher in the rural area than in the urban area.The effectiveness of nutrition education and unsupervised daily iron supplementation on iron status was studied in adolescent schoolgirls of low socio-economic status. Baseline knowledge, attitudes, and practices related to nutrition and iron status were assessed in 915 girls attending schools in an urban and a rural area of Sri Lanka. Girls in intervention schools received nutrition education and ferrous sulphate or a placebo and were requested to take one tablet per day. Subjects in control schools did not receive any intervention. All subjects were reassessed after 10 weeks. Educational intervention resulted in significant increases in knowledge of nutrition and in iron status among girls in both areas. Good compliance was noted with both iron supplements and the placebo. Iron status was more improved in the groups receiving iron supplementation than in the groups receiving education only, indicating the effectiveness of unsupervised supplementation when combined with nutrition education. The short-term sustainability of intervention was higher in the rural area than in the urban area.

Guidelines for the Development of Research Proposals following a Structured, Holistic Approach for a Research Proposal (SHARP)

SHARP (a Structured, Holistic Approach for a Research Proposal) is a structured method for developing a research proposal that can be used either by individuals or by teams of researchers. The eigh...The purpose of this study was to assess the effect of humidity and packaging materials on the stability of iodine in typical salt samples from countries with tropical and subtropical climates, under controlled climatic conditions. Initially we examined eight samples. In the second phase we expanded the study to salts from 18 sources and attempted to correlate the observed stability with salt impurities naturally present in these samples. High humidity resulted in rapid loss of iodine from salt iodized with potassium iodate, ranging from 30% to 98% of the original iodine content. Solid low-density polyethylene packaging protected the iodine to a great extent. High losses were observed from woven high-density polyethylene bags, which are often the packaging material of choice in tropical countries. Impurities that provided moisture at the salt surface had the most deleterious effect. Although clear correlations were not obtained, the presence of reducing agents, hygroscopic compounds of magnesium, and so forth seemed to have the most adverse effects on the stability of iodine. Surprisingly, carbonates had little effect on stability over the range present in the samples. Packaging salt in low-density polyethylene bags, which provided a good moisture barrier, significantly reduced iodine losses, and in most cases the iodine content remained relatively stable for six months to a year. The findings from this study indicate that iodine can be highly unstable, and in order to ensure the effectiveness of local salt-iodization programmes, countries should determine iodine losses from local iodized salt under local conditions of production, climate, packaging, and storage. Stability of iodine in iodized salt used for correction of iodine-deficiency disorders. II