Enriching lives: overcoming vitamin and mineral malnutrition in developing countries

147 Pages·1994·0.54 MB·English

by  World Bank

Enriching Lives : Overcoming Vitamin and
Mineral Malnutrition in Developing
title:
Countries Development in Practice
(Washington, D.C.)
author:
publisher: World Bank
isbn10 | asin: 0821329871
print isbn13: 9780821329870
ebook isbn13: 9780585241241
language: English
Malnutrition--Developing countries,
Avitaminosis--Developing countries,
subject
Minerals in human nutrition--Developing
countries.
publication date: 1994
lcc: RA645.N87E57 1994eb
ddc: 363.8
Malnutrition--Developing countries,
Avitaminosis--Developing countries,
subject:
Minerals in human nutrition--Developing
countries.
Page iii
Enriching Lives
Overcoming Vitamin and Mineral Malnutrition in
Developing Countries
Page iv
© 1994 The International Bank for Reconstruction
and Development / THE WORLD BANK
All rights reserved
Manufactured in the United States of America
First printing November 1994
The Development in Practice series publishes reviews of the World
Bank's activities in different regions and sectors. It lays particular
emphasis on the progress that is being made and on the policies and
practices that hold the most promise of success in the effort to reduce
poverty in the developing world.
The findings, interpretations, and conclusions expressed in this study
are entirely those of the authors and should not be attributed in any
manner to the World Bank, to its affiliated organizations, or to
members of its Board of Executive Directors or the countries they
represent.
Library of Congress Cataloging-in-Publication Data
Enriching lives : overcoming vitamin and mineral malnutrition in
developing countries.
p. cm. (Development in practice)
Includes bibliographical references.
ISBN 0-8213-2987-1
1. MalnutritionDeveloping countries. 2. Avitaminosis
Developing countries. 3. Minerals in human nutritionDeveloping
countries. I. International Bank for Reconstruction and
Development. II. Series: Development in practice (Washington, D.C.)
RA645.N87E57 1994
363.8dc20 94-27022
CIP
Page v
Contents
Foreword ix
Acknowledgments xi
Abbreviations and Acronyms xii
Executive Summary 1
The Need for a Comprehensive Approach 2
Three Types of Approaches 2
Social Mobilization 3
Pharmaceutical Supplementation 3
Effective Regulation and Incentives for the Private Food 4
Industry
Developing Nutritional Awareness and Habits 4
The Need for External Start-up Support 5
1
The Challenge of Dietary Deficiencies of Vitamins and
Minerals 6
The Strategic Importance of Vitamin A, Iodine, and Iron 6
The Scope of Micronutrient Malnutrition 8
Beyond the Reach of Economic Development 9
Good Health Care Systems: Necessary but Not 10
Sufficient
The Need for Special Programs 10
Page vi
2
The Low Costs of Overcoming Vitamin and Mineral
Deficiencies 14
Program Designs 16
Public and Private Financing 18
A Social, Not a Technical, Challenge 19
3
The Delivery of Supplements 20
Training and Support of Health Care Workers 20
Minimizing Supply Problems 21
Supplementation Programs 22
Targeting Special Groups and Using Existing Outreach 22
Programs
4
Successful Fortification 27
Problems with Voluntary Fortification 27
The Importance of Consumer Participation and 29
Education
Universal and Mandatory Fortification 31
5
Dietary Change through Education and Policy 33
Educating Consumers 33
The Influence of Agricultural Policies 34
Policy Support for Subsistence Horticulture 35
Preserving Foraged Foods 36
6
Characteristics of Successful Micronutrient Programs 37
Situation Analysis 37
Setting Priorities 38
Short-Term Supplementation Goals As Part of a Long-
term Dietary Improvement Strategy 39
The Importance of Feedback to Program Evolution 39
Sustainability 40
Habit Formation and Consumer Demand 42
7
Achieving Success within This Decade 44
Raising Awareness 46
Page vii
Institutional Development 46
The World Bank's Role 47
Biochemical and Social Research 50
Summary 50
Notes 53
Appendix A 57
Prevalence Data
Appendix B
Methods and Assumptions for Cost-Effectiveness
Calculations 61
Criteria of Effectiveness 61
Cost-Benefit Analysis 61
Costs and Benefits 62
Bibliography 69
Boxes
1.1 When to Consider Using an Iron Program 12
3.1 Lessons Learned from Supplementation Programs 23
3.2 Supplementation through the Expanded Program on 24
Immunization
4.1 How Fortification Won the West 27
4.2 Lessons of Experience from Fortification Programs 30