Pediatric Zinc as Treatment for Diarrhea
pdf
In May 2004, WHO/UNICEF issued a joint statement recommending the use of
zinc, an essential micronutrient for human growth, development and
maintenance of the immune system, and a new formulation oral rehydration
solution (ORS), with reduced levels of glucose and salt, as a two-pronged
approach to improved case management of acute diarrhoea in children. Zinc supplements reduce the
duration of an episode of diarrhoea and protect against future bouts of
diarrhoea for two to three months after the episode.
This document as
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Every year approximately 1.7 million children die as a result of diarrhea and
dehydration. In the majority of cases, this is preventable through exclusive
breastfeeding, improved hygiene and sanitation and access to clean water, yet
diarrhea is still one of the leading causes of death among children under
five.
In May 2004, WHO/UNICEF issued a joint statement recommending the use of
zinc, an essential micronutrient for human growth, development and
maintenance of the immune system, and a new formulation oral rehydration
solution (ORS), with reduced levels of glucose and salt, as a two-pronged
approach to improved case management of acute diarrhea in children.
Dispersible zinc tablets, which dissolve easily in a tablespoon of clean
water or breastmilk, can be used for zinc supplementation for children aged
one to 59 months. WHO and UNICEF recommend 20 mg of zinc per day for ten -14
days for infants and children, ten mg for infants under six months of age.
For more than 20 years researchers have been assessing the benefit of zinc
supplementation during diarrhea episodes. Studies have shown that zinc
supplementation results in a 25% reduction in duration of acute diarrhea and
40% reduction in treatment failure or death in persistent diarrhea. These
studies also revealed that children receiving zinc experience a decrease in
the severity of their diarrhea episodes. A ten day course has proven to
provide a prophylactic protection against future bouts of diarrhea for two to
three months after the episode.
The combined recommendation of zinc and ORS is a safe, effective and
inexpensive diarrhea treatment for children in the developing world. The only
known side effect of zinc use is vomiting, which is rarely reported and is
typically attributed to a metallic taste in the zinc. Use of high-quality
zinc products easily avert this side effect.
Zinc manufacture requires only simple technology and no expensive
ingredients. Zinc can be produced in both syrup and tablet form. Efforts are
already underway to transfer the technology from French developer and patent
holder, Nutriset/Rodael, to local manufacturers in the developing world, who
will be able to take over production, thus keeping costs affordable for the
poorest of the poor.
Pilot programs have begun in several countries, testing various approaches to
training both health facility staff and community health workers, developing
and delivering behavior change communication messages and consumer
educational materials, and monitoring program progress. Private sector zinc
programs are testing the feasibility of marketing zinc tablets and ORS as
stand alone products or packaging them together as a Diarrhea Treatment Kit (DTK).
For more information visit the POUZN (Social Marketing for Diarrheal Disease
Prevention and Treatment) website:
www.pouzn.com
Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea
in developing countries
A
Public-Private Partnership for the Introduction of Zinc for Diarrhea
Treatment in Benin - Results and Lessons Learned
Fourniture d’une eau potable grâce au programme Aquatabs du POUZN au Bénin - Résultats et leçons apprises
Un partenariat public-privé pour l’introduction du zinc pour le traitement
de la diarrhée au Bénin : Résultats et leçons apprises
Assuring Rural Access to Water Treatment Products in Kenya’s Coast Province - Results and
Lessons Learned
Assuring
Access to Pediatric Zinc for Diarrhea Treatment Through the Private Sector
in Madagascar - Results and Lessons Learned
Assurer l’accès au zinc pédiatrique pour le traitement des diarrhées au
moyen du secteur privé à Madagascar : Résultats et leçons apprises
Passage à
l’échelle du traitement de l’eau au point d’utilisation au moyen de
plusieurs filières au Rwanda : Résultats et leçons apprises
Production of zinc tablets and zinc oral solutions
Guidelines for programme managers and pharmaceutical manufacturers
Authors: World Health Organization, UNICEF, Johns Hopkins Bloomberg School of Public Health, USAID
Number of pages: 28
Publication date: 2007
Languages: English, French, Russian
ISBN: 9241594942 (English), 9789242594942 (French), 9789244594940 (Russian)
English [pdf 668kb]
French [pdf 256 Kb]
Russian [pdf 244Kb]
Overview
These guidelines were prepared to assist policy makers and programme managers in the selection and procurement of quality zinc products (zinc
tablets and zinc oral solutions) for use in the prevention and treatment of diarrhoea in children under the age of five. These guidelines can
also be used by pharmaceutical manufacturers to develop quality zinc products. |
Zinc Supplementation On-line Resources:
Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity,
mortality and incidence of future episodes
Christa L Fischer Walker and Robert E Black
Zinc supplementation for the treatment of diarrhoea has been shown to
decrease the duration and severity of the diarrhoeal episode, diarrhoea
hospitalization rates and, in some studies, all-cause mortality. Using
multiple outcome measures, we sought to estimate the effect of zinc for the
treatment of diarrhoea on diarrhoea mortality and subsequent pneumonia
mortality.
A complete and up-to-date list of the following and related resources can be found at
DefeatDD.org Controlling
Diarrheal Disease
Literature on zinc research (2006)
A comprehensive list of research articles and related literature on the benefits
of zinc supplementation, including information on the use of zinc for children
in developing-country settings.
International Centre for Diarrhoeal Disease Research, Bangladesh
Zinc publications and reference materials
Stemming from years of work conducted through the USAID program aimed at
exploring the health benefits of zinc supplementation, this website contains
many helpful resource and research materials.
USAID Micronutrient Program
Clinical management of acute diarrhoea (2004)
This official statement updates previous WHO/UNICEF recommendations on the
management of acute diarrhea, taking into consideration new research findings that indicate the success of interventions incorporating reduced-osmolarity ORS
and zinc supplementation.
World Health Organization (WHO), UNICEF
pdf English 241 kb
Diarrhoea treatment guidelines including new recommendations for the
use of ORS and zinc supplementation for clinic-based healthcare workers (2005)
These guidelines were developed to advise clinic-based health workers on
implementing the latest WHO/UNICEF recommendations for ORS and zinc
supplementation in the clinical management of diarrhoea.
US Agency for International Development (USAID) Micronutrient Program
pdf English 401 kb
Guidelines for new diarrhea treatment protocols for community-based
healthcare workers (2005)
These guidelines were developed to advise community health care workers who
assist parents with home treatment of children with diarrhea with regard to the
latest WHO/UNICEF recommendations.
USAID Micronutrient Program
pdf English 128 kb
General information
The role of zinc in child health (2004)
This report provides an overview of the rationale for providing zinc supplements
to reduce severe diarrheal episodes and as an overall intervention for child
health in the developing world.
The International Zinc Nutrition Consultative Group
pdf English 191 kb
Zinc: From research to programs (2004)
This presentation summarizes research findings on the effects of zinc
supplementation on diarrhea and also discusses advances in policy addressing
diarrhea treatment.
USAID Micronutrient Program
pdf English 60 kb
Treatment guidelines
Introducing zinc in a diarrheal control program: A manual for
conducting formative research (revised 2004)
Originally developed to inform a multicenter zinc trial in Asia and Africa, this
guide is a useful resource for planning zinc intervention trials, as well as the
introduction of zinc and other supplements and/or medicines into clinic or
community settings.
Nichter M, Acuin C, Vargas A.
pdf English 550 kb
Monograph for zinc sulfate tablets (2005)
This proposed monograph is under consideration by the US Pharmacopeia
to ensure quality manufacturing standards for zinc tablets.
US Pharmacopeia
pdf English 62 kb
The Treatment of Diarrhoea. A manual for physicians and other senior
health workers (2005)
Developed for physicians treating infectious diarrhea in young children, this
manual has been updated to include guidelines for the use of reduced-osmolarity
ORS and zinc supplements.
WHO
pdf English 1 mb
Zinc supplementation for the treatment of diarrhea: Moving from
research to practice (2005)
This report provides a brief history of ORS and the inclusion of zinc
supplementation; outlines case studies proving the benefits of zinc for diarrhea
treatment; and discusses programmatic challenge points.
USAID Micronutrient Program
pdf English 81 kb
Research
Substantial reduction in severe diarrheal morbidity by daily zinc
supplementation in young North Indian children (2002)
This study concluded that episodes of severe diarrhea were significantly reduced
when daily zinc supplements were provided to children. The authors also call for
reliable estimates of zinc deficiency levels among children in developing
countries, in order to facilitate intervention with zinc supplementation.
Bhandari N, et al. Pediatrics. 109(6):e86.
Zinc supplementation in acute diarrhea is acceptable, does not
interfere with oral rehydration, and reduces the use of other medications: A
randomized trial in five countries (abstract only; 2006)
This study determined that adding zinc to management of acute watery diarrhea
does not affect overall ORS use and decreases use of antibiotics and other
antidiarrheal medicines.
INCLEN Childnet Zinc Effectiveness for Diarrhea (IC-ZED) Group. Journal of
Pediatric Gastroenterology & Nutrition. 42(3):300-305.
Cost-effectiveness of zinc as adjunct therapy for acute childhood
diarrhoea in developing countries (2004)
This study analyzed the cost-effectiveness of adding zinc to diarrheal disease
treatment interventions, as compared to the cost-effectiveness of oral
rehydration solution as a stand-alone treatment.
Robberstad B, Strand T, Black R, Sommerfelt H. Bulletin of the World Health
Organization. 82(7):523-531.
pdf English 519 kb
Effect of zinc supplementation between 1 and 6 mo of life on growth
and morbidity of Bangladeshi infants in urban slums (2002)
The authors of this study evaluated the effect of zinc supplementation on growth
and morbidity in poor Bangladeshi infants.
Osendarp S, Santosham M, Black R, Wahed M, van Raaij J, Fuchs G. American
Journal of Clinical Nutrition. 76(6):1401–1408.
pdf English 110 kb
Effect of zinc supplementation on clinical course of acute diarrhoea
(2001)
This report reviews published studies addressing the efficacy of zinc
supplementation in reducing severity of diarrheal disease episodes. The report
concludes that sufficient evidence supports the use of zinc supplementation and
also encourages further study.
Bahl R, Baqui A, Bahn M, et al. Journal of Health, Population and Nutrition.
19(4):338-346.
pdf English 118 kb
Effectiveness and efficacy of zinc for the treatment of acute
diarrhea in young children (2002)
This study in India evaluated the administration of three Recommended Daily
Allowances of zinc among children with acute diarrhea in Nepal and recorded
substantial reduction of diarrheal duration. The investigators also determined
that the effect of zinc was not dependent on or enhanced by concomitant vitamin
A administration.
Strand T, Chandyo R, Bahl R. Pediatrics. 109(5):898–903.
pdf English 130 kb
Formative research in preparation for promotion of zinc treatment for
childhood diarrhea: Cross-country comparison of diarrhea treatment practices and
implications for programs (2004)
This summary of research was prepared for a discussion of global planning to
implement zinc for diarrheal treatment, held at the 2004 meeting Planning
for Implementation of Zinc for Treatment of Diarrhea.
Winch P, FitzGerald M. USAID Micronutrient Program
pdf English 126 kb
Lessons learned in a pilot introduction of zinc treatment for
childhood diarrhea in Bougouni District, Mali (2005)
Geared toward program planners and managers who are considering introducing
zinc treatment for diarrhea into existing child health and nutrition
interventions, this report discusses key lessons learned through a pilot project
and offers conclusions and recommendations for future zinc programs.
Gilroy K, Kuszmerski N, Winch P. USAID
pdf English 566 kb
Low risk of adverse effects from zinc supplementation (2005)
This brief reviews evidence on the safety of zinc supplementation in children,
including reports of adverse effects from both long-term and short-term studies,
and concludes that zinc supplementation is a safe and effective treatment for
diarrhea.
Fischer C, Harvey P. USAID Micronutrient Program
pdf English 85 kb
Randomized control trial of zinc supplementation in malnourished
Bangladeshi children with acute diarrhea (1997)
This study determined that zinc supplementation is a safe and effective method
for management of acute diarrhea in children who are malnourished.
Roy SK, Tomkins AK, Akramuzzaman SM, Haider R, Mahalanabis D, Fuchs G.
Archives of Disease in Childhood. 77:196–200.
pdf English 183 kb
Therapeutic and preventive effects of zinc on serious childhood
infectious diseases in developing countries (1998)
This review provides details on the therapeutic and preventive effects of zinc
supplementation on diarrheal disease episodes, as evidenced by published
studies. The author also briefly discusses the effects of zinc on malaria and
acute lower respiratory infections.
Black R. American Journal of Clinical Nutrition. 68(suppl):476S–479S.
pdf English 138 kb
Therapeutic effects of oral zinc in acute and persistent diarrhea in
children in developing countries: Pooled analysis of randomized controlled
trials (2000)
The authors of this review performed a comprehensive analysis of published
studies to determine the efficacy of zinc supplementation given during episodes
of acute diarrhea.
Zinc Investigators’ Collaborative Group, American Journal of Clinical
Nutrition. 72:1516-1522.
pdf English 99 kb
Zinc therapy for diarrhoea increased the use of oral rehydration
therapy and reduced the use of antibiotics in Bangladeshi children (2004)
This study conducted by partners from the Johns Hopkins School of Public Health
and the International Centre for Diarrhoeal Disease Research concluded that use
of zinc supplementation during diarrheal episodes led to a reduction in the use
of antibiotics, overuse of which has been shown to increase antimicrobial
resistance in developing countries.
Baqui A, Black R, El Arifeen S, et al. Journal of Health, Population and
Nutrition; 22(4):440-442.
pdf English 116 kb
A complete and up-to-date list of the
following and related resources can be found at
http://www.mostproject.org/whatsnew.htm
ZINC Publications and Reference Materials In May 2004, a WHO/UNICEF
Joint Statement on the Clinical Management of Acute Diarrhea was issued.
This statement called for the adoption of new recommendations for zinc
supplementation together with a new ORS formula for the clinical management
of diarrhea. On behalf of USAID, MOST is supporting the rapid scale-up of
this high impact, child survival intervention. A component of this support
is to increase the accessibility of information about the use of zinc
supplementation as an adjuvant treatment for diarrhea.
Key Documents
The first
eight documents provide key evidence in support of USAID's decision to
encourage the rapid global rollout of this new, high-impact child survival
intervention.
The WHO/UNICEF Joint Statement May 2004
on the Clinical Management of Acute Diarrhoea. These new recommendations,
formulated by UNICEF and WHO in collaboration with USAID and experts
worldwide, take into account new research findings while building on past
recommendations.
PDF file
Bhutta et al. Am J Clin Nutr 2000. Presents the meta-analyses of
efficacy studies demonstrating that 10-14 days of zinc supplementation
reduce the duration and severity of diarrhea episodes.
PDF
Baqui et al. BMJ 2002. Presents evidence
from a community-based trial confirming the shorter duration of diarrhea
with zinc supplementation, and other benefits of zinc including reduced
incidence of both diarrhea and acute lower respiratory tract infections, and
fewer admissions to hospital in children with diarrhea.
PDF
Robberstad et al. Bull WHO 2004.
Presents a cost-effectiveness analysis in terms of DALYs and child deaths
averted using a simulation technique with cost data from health facilities
in Tanzania. The authors concluded that zinc for diarrhea treatment is
highly cost-effective.
PDF
Application for the inclusion of zinc sulphate in
the WHO Model List of Essential Medicines. Approved March 2005.
It presents an update to March 2003 of further efficacy studies published
and presents more detail on safety.
PDF
Low
Risk of Adverse Effects from Zinc Supplementation. This brief reviews the
available evidence on the safety of zinc supplementation in children,
summarizes reports of adverse effects from both long-term and short-term
studies, and concludes that zinc supplementation is a safe and effective
treatment for diarrhea.
PDF
US Pharmacopeia. The definition of the zinc tablet is developed
to enable quality assurance.
PDF
| The dispersible 20 mg
zinc tablets now recommended by WHO and UNICEF for use with ORT in
treating all forms of diarrhea may be obtained from Nutriset at
www.nutriset.fr or by e-mail at
[email protected]. USAID grantees and cooperative
agreements are able to use USAID funds to purchase the tablets from
NUTRISET under a waiver available for that purpose. For information
on the waiver write to Jill Boezwinkle at
[email protected]. |
Manuals, Guidelines, Statements Concerning Diarrhea Treatment
Guidelines for Clinic-Based Health Workers -
Not yet field tested.
Guidance on how to implement the new WHO/UNICEF recommendations for the use
of ORS and zinc supplementation in the clinical management of diarrhea. The
guidelines presented in this document are generic; that is, they will be
most effective when modified to support the particular strategy being used
to introduce the new recommendations in each country. (no. 135) (PDF
file in English),
(PDF
file in Spanish)
Introducing Zinc in a Diarrheal Control Program:
A Manual for Conducting Formative Research. Describes the methods used for
formative assessment in a multi-country clinical trial coordinated by INCLEN.
The purpose of the trial was to assess acceptance by the global community of
zinc supplementation as an adjuvant treatment to ORS prior to its
introduction as a policy. The manual was developed to provide a standardized
approach to developing appropriate and effective messages to use both ORS
and zinc together. This clinical trial was conducted in seven sites: 1)
Lucknow and 2) Nagpur in India, 3) Manila, Philippines, 4) Pretoria, South
Africa, 5) Cairo, Egypt, 6) Addis Ababa, Ethiopia, and 7) Fortazena, Brazil.
(Available at
http://www.inclentrust.org. Look under What's New.)
The Treatment of Diarrhoea – A manual for physicians
and other senior health workers has been
updated to include these changes and should serve as the reference
for the management of diarrhoea. This guide is
distributed by WHO
UNICEF/WHO Joint statement on
ORS, March 2002. This document was
prepared to inform national authorities on the position of the United
Nations Children’s Fund (UNICEF) and of the World Health Organization (WHO)
with respect to issues such as flavoring, coloring, and rice-based ORS. It
is based on a document first published in July 1996 that was revised to take
into account results of studies on ORS formulation and zinc supplementation.
PDF
Other Zinc Links and Documents
Lessons learned in a pilot introduction of zinc treatment for childhood
diarrhea in Bougouni District in Mali. This April 2005 report is
written for program managers and planners interested in the lessons learned
about operational issues in the pilot introduction of zinc supplementation
as an adjunct treatment for childhood diarrhea in Mali.
PDF
Zinc
Supplementation for the Treatment of Diarrhea: Moving from Research to
Practice. A
five-page document describing the history of ORS and the inclusion of zinc
supplementation, case studies proving the benefits of zinc, using zinc for
diarrhea treatment, and programmatic challenge points.
PDF
MOST summary article
2005. Cost-effectiveness of zinc supplementation as
an adjunct treatment for childhood diarrhea
PDF
New diarrhea treatment guidelines could save more
lives,
article on pages 3-4 of
the 2004/4 Nutriview Newsletter
Effect of Zinc Supplementation on Clinical Course of
Acute Diarrhoea.
Report of a Meeting, New Delhi, 7-8 May 2001
SUZY - Scaling Up Zinc Treatment for Young Children with Diarrhoea in
Bangladesh. A large national
program to introduce new guidelines for the management
of diarrhea in Bangladesh.
IZiNCG Technical Document
– The first IZiNCG
Technical Document has been compiled by the Steering Committee, and
published as a supplement to the United Nations University Food and
Nutrition Bulletin (March, volume 25, supplement 2:S94-S204;
2004).
Effectiveness and cost of facility-based
Integrated Management of Childhood Illness (IMCI) in Tanzania.
Lancet. 2004 Oct 30;364(9445):1583-94.
Integrated Management of Childhood Illness (IMCI) in Bangladesh:
Early findings from a cluster-randomized study. Lancet. 2004 Oct
30;364(9445):1595-602.
Summary Document from June
2004 Zinc Implementation Meeting in Baltimore,
the purpose of which was
to bring together experts
in zinc research and program design/implementation to review recent research
on zinc in treatment of diarrhea; learn about WHO/UNICEF/USAID plans for
rolling-out zinc for treatment of diarrhea; and strategize next steps for
the scaling up of zinc supplementation through NGOs, public and private
sectors
PDF file
In preparation
for promotion of zinc treatment for childhood diarrhea: Cross-country
comparison of diarrhea treatment practices and implications for programs.
Summary document developed for the June 2004 Zinc Implementation Meeting in
Baltimore.
PDF
PowerPoint
presentation given at USAID
in September 2004 regarding zinc and ORS. Document is in the form of a
handout, six slides to a page.
PDF
FAQs
A series of questions, to date, that has arisen in the field
regarding the promotion of ORS/zinc treatment.
PDF file
Frequently
asked questions concerning the "NEW ORS"
- i.e. low osmolarity ORS. Developed by WHO, May 2004.
PDF file (in English),
PDF file (in French)
Zinc Links
Weekly zinc supplements can reduce deaths in young children
Giving young children in developing countries a weekly dose of zinc can
substantially reduce their risk of illness and death, according to a study
published online today (Tuesday August 23, 2005) by THE LANCET...
New diarrhea
treatment guidelines could save more lives,
article on pages 3-4 of the
2004/4 Nutriview Newsletter
Effectiveness and cost of facility-based Integrated Management of Childhood
Illness (IMCI) in Tanzania. Lancet. 2004 Oct
30;364(9445):1583-94.
Integrated Management of Childhood Illness (IMCI) in Bangladesh: Early findings from a
cluster-randomized study. Lancet. 2004 Oct 30;364(9445):1595-602.
Therapeutic effects of oral zinc in acute and persistent diarrhea in children in
developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000
Dec;72(6):1516-22.
Effect
of Zinc Supplementation on Clinical Course of Acute Diarrhoea. Report of a Meeting,
New Delhi, 7-8 May 2001
The
Treatment of Diarrhoea – A manual for physicians and other senior health workers has been updated to include
these changes and should serve as the reference for
the management of diarrhoea. This guide is distributed by WHO
SUZY - Scaling Up Zinc Treatment for Young Children with Diarrhoea in Bangladesh. A large national program to
introduce new guidelines for the management of diarrhea in Bangladesh.
IZiNCG
Technical Document – The first IZiNCG Technical Document has been
compiled by the Steering Committee, and published as a supplement to the United
Nations University Food and Nutrition Bulletin (March, volume 25, supplement
2:S94-S204; 2004).
IVACG 2004
The following publications were distributed at the 2004 meetings of the
International Vitamin A Consultative Group (IVACG), the International
Nutritional Anemia Consultative Group (INACG), and the International Zinc
Nutrition Consultative Group (IZiNCG), held in Lima, Peru, November 15-19, 2004.
A Strategic Approach to Anemia Control.
Describes the MOST Project’s
experiences together with the options now available for addressing anemia in
developing countries. (no. 133)
PDF file
Improving the Performance of Maternal Anemia Interventions in Africa.
Describes the process used to develop a comprehensive
program to control anemia in pregnant women in four districts of Uganda in 2002.
(no. 134)
PDF file
Overcoming Barriers to Effective Anemia Interventions
during Antenatal Services in Uganda .
[Reprinted] Describes the process and results
of a study undertaken to identify barriers to implementation of effective
interventions aimed at addressing anemia in pregnancy.
(no. 131)
PDF file
Elements of a National Food-Fortification Program / Bangladesh. This
study’s primary objective is to identify major elements of a food-fortification
strategy in Bangladesh, including micronutrient formulation for the food
vehicles as suitable for fortification. (no. 138)
PDF file
Micronutrients Lead the Way: Making Gains in Nutrition and Health.
Discusses options and strategies for improving micronutrient health in deficient
populations. Provides details on USAID's efforts to reduce micronutrient
deficiency through supplementation, fortification, and food-based programs.
Updated in 2004 to include zinc as a significant public health issue.
(no. 118)
PDF file
Cost Study Synthesis - Ghana, Zambia and Nepal. Although a variety of vitamin A supplementation programs
have been implemented in developing countries, little is known to date about
their costs. The major objective of this study is to provide researchers and
policymakers with that cost information. (no. 136)
PDF file
Ghana Cost Study. [Reprinted] The
overall objective of this study is to provide the Ministry of Health in Ghana
with cost information on the vitamin A supplementation program. The MOH intends
to use this information to integrate the vitamin A supplementation program into
routine primary health care services over the next five years.
(no. 128)
PDF file
Zambia Cost Study. This study provides
policymakers in Zambia with cost information on vitamin A supplementation —
information that may help answer questions concerning the efficiency and
sustainability of the campaign approach vis-à-vis other modes of delivering
vitamin A supplementation. Specific objectives are to document the Child Health
Week and National Immunization Days programs as they presently operate, and to
analyze the two programs’ cost structures. (no. 137)
PDF file
Modules for the Induction Training of Anganwadi Workers in Uttaranchal.
These are training modules aimed at developing
capacity in community day care centers, which are an important source for
extending nutrition and health-related service in the remotest areas of India’s
Uttaranchal state among children up to six years of age, adolescent girls, and
pregnant/lactating women. (no. 141)
PDF file
Zambia Five Year Strategy. This five-year
strategic plan to prevent and control vitamin A deficiency in Zambia serves as a
model of a comprehensive strategic plan for any country wishing to develop a
micronutrient deficiency prevention and control program. (no. 143)
PDF file
National Micronutrient Survey 2000 Summary Report – Nicaragua. The
Government of Nicaragua has paid special attention to micronutrient
deficiencies, particularly those of vitamin A, iron, and iodine, since the 1993
National Micronutrient Survey. This summary report of the subsequent 2000 survey
provides information about the evolution of these deficiencies, which are
considered to be significant public health problems in Nicaragua. (no. 139)
PDF file
Prototipo de Sistema de Gestión Logística de Suplementos de Micronutrientes / El
Salvador
El objetivo del presente
documento, preparado por el proyecto USAID/MOST como resultado de la experiencia
reciente en El Salvador, es presentar y divulgar un prototipo de sistema de
gestión logística de suplementos de micronutrientes que se ha implantado
exitosamente por el Ministerio de Salud y Asistencia Social (MSPAS), con
asistencia técnica de USAID/MOST, y que podría ser útil como modelo para ser
adaptado en otros países. (no. 140)
PDF file
Enquête sur
la carence en vitamine A / Madagascar.
L’objectif de l’enquête est de fournir: (a) Des
données de référence représentatives au niveau national pour la carence en
vitamine A chez les enfants de 6 à 59 mois, (b) Des données de référence
représentatives au niveau national pour la carence en vitamine A chez les femmes
de 15 à 49 mois, (c) Données de référence sur l’anémie chez les écoliers de 6 à
14 ans par rapport auxquelles le projet SEECALINE peut évaluer l’impact de ses
activités de nutrition scolaire. (no. 142)
PDF file
