Children can be routinely given micronutrient interventions, which contain one or more micronutrients, to ensure they meet their daily micronutrient requirements. These interventions can include iron supplements, micronutrient powders, and small-quantity lipid nutrient supplements. Each of these interventions should be considered in the context of other interventions to avoid exceeding daily micronutrient requirements. Give either iron supplements, micronutrient powders, or lipid nutrient supplements, but not more than one at a time. High-dose vitamin A supplementation, a non-routine intervention to address morbidity and mortality in children, is addressed in the High-dose Vitamin A Supplementation for Children section.
Iron supplementation during childhood can effectively reduce the risk of iron deficiency and anemia. See Table 6 for the World Health Organization (WHO) recommendations for iron supplementation.
Table 6: Iron Supplementation for Children
|Anemia||Recommendation for Children Age 6–23 Months||Recommendation for Children Age 24–59 Months||Recommendation for Children Age 5–12 Years|
|20-40%||-||25 mg iron once per week
Given throughout calendar year or three months on, three months off
|45 mg iron once per week
Given throughout calendar year or three months on, three months off
|>40%||10–12.5mg daily||30 mg daily||30–60 mg daily|
Micronutrient powders, a mixture of vitamins and minerals, enclosed in single-dose sachets that are stirred into a child’s portion of food immediately before consumption; they have been shown to reduce anemia and iron deficiency. Micronutrient powders are sometimes called “sprinkles,” and the process of adding them to complementary foods is often referred to as home fortification or point-of-use fortification. Micronutrient powders contain at least 10 to 12.5 mg iron, 300 mcg retinol (see Vitamin A Deficiency), and 5 mg zinc (see Zinc Deficiency), but often contain up to 22 micronutrients. WHO recommends using iron-containing micronutrient powders for children age 6–23 months in areas where anemia rates for children under 2 or children under 5 are above 20 percent, and for children age 2–12 years when anemia prevalence among school-age children is 20 percent or higher (WHO 2016b). Programs should target 90 sachets or doses over a six-month period.
Using small-quantity lipid-based nutrient supplements adds micronutrients, essential fatty acids, and a small amount of protein to the diets of young children. While larger quantities are often used to treat severe and moderate acute malnutrition, rations of about 20 grams (g) (around 110 kcal) per day are used to prevent malnutrition and to promote growth and development. While it is usually available in 20g sachets, some research studies suggest that 10g sachets provided twice daily may improve adherence, especially in younger children who may have trouble consuming the entire packet at one time; as well as preventing the consumption of partial sachets that can attract pathogens when left open (FANTA 2016).
In addition to the interventions described above, to improve the micronutrient and macronutrient intake of young children (de Pee and Bloem 2009), fortified blended foods, or fortified commercial infant cereals, can also be used. While these interventions can be costly, experience in Latin America suggests that these programs can be effective and they demonstrate a role for the public and private sectors in promoting these fortified foods (Lutter and Rivera 2003).
In malaria-endemic settings, the provision of iron through iron supplements, micronutrient powder, or small-quantity lipid nutrient supplements should occur in conjunction with appropriate efforts to prevent, diagnose, and treat malaria (WHO 2011, 2016a, 2016b; Neuberger et al. 2016).
Measurement and data sources
Population-based surveys typically report the percentage of children (usually 6–59 months) who received iron tablets, syrups, or micronutrient powders (i.e. sprinkles) in the seven days preceding the survey. However, some surveys will provide additional details on the types and timing of iron supplementation, as well as micronutrient powder or lipid nutrient supplements intake. Coverage of these interventions for children 6 months and older in the previous seven days can be disaggregated by age and gender.
Surveys that collect information related to the micronutrient interventions coverage include—
- Demographic and Health Surveys
- Multiple Indicator Cluster Surveys
- National Micronutrient Surveys
- Knowledge, Practice, and Coverage Surveys
- other research or evaluation activities.
Health monitoring information systems may include coverage estimates of micronutrient interventions, usually from distribution activities, which are compared against the total target population to obtain coverage estimates. Most implementers who conduct micronutrient interventions, often the government or specific organizations, will have detailed reports on distribution. In addition to these routine sources, the Home Fortification Technical Advisory Group provides information on micronutrient powder and lipid nutrient supplements intervention measurement and data collection, as well as a database of interventions, by country.
- Coverage of these interventions is not the same as adherence—and adherence to the correct dosing regimen is necessary to have the intended impact. Children may receive the appropriate supply, but may not adhere to the minimum dosage. Adherence intake is a challenge and may not easily be captured by the data in other than year-end reports or research studies aimed at assessing coverage and adherence.
- Routine micronutrient interventions for children are often not included as part of administrative data collection, such as the country’s health monitoring information system.
De-Regil, L. M., P. S. Suchdev, G. E. Vist, S. Walleser, and J. P. Peña-Rosas. 2011. “Home Fortification of Foods with Multiple Micronutrient Powders for Health and Nutrition in Children Under Two Years of Age.” Cochrane Database of Systematic Reviews (9): CD008959.
FANTA. 2016. “Meeting Report: Evidence and Programmatic Considerations for the Use of Small-Quantity Lipid-Based Nutrient Supplements for the Prevention of Malnutrition.” Washington, DC: FHI 360/FANTA.
Lutter, Chessa K., and Juan A. Rivera. 2003. “Nutritional Status of Infants and Young Children and Characteristics of Their Diets.” The Journal of Nutrition 133 (9): 2941S–9S.
Neuberger, Ami, Joseph Okebe, Dafna Yahav, and Mical Paul. 2016. “Oral Iron Supplements for Children in Malaria-Endemic Areas.” Cochrane Database of Systematic Reviews 2 (CD006589). doi:10.1002/14651858.CD006589.pub4.
Pee, Saskia de, and Martin W. Bloem. 2009. “Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children.” Food and Nutrition Bulletin 30 (3 Suppl): S434-463.
UNICEF-CDC. 2013. Global Assessment of Home Fortification Interventions, 2011. Geneva, Switzerland: Home Fortification Technical Advisory Group. http://www.hftag.org/resource/global-assessment-of-home-fortification-in....
WHO. 2011. “Guideline: Intermittent Iron Supplementation in Preschool and School-Age Children.” Geneva, Switzerland: WHO.
———. 2016a. Guideline: Daily Iron Supplementation in Infants and Children. Geneva: World Health Organization.
———. 2016b. “WHO Guideline: Use of Multiple Micronutrient Powders for Point-of-Use Fortification of Foods Consumed by Infants and Young Children Aged 6–23 Months and Children Aged 2–12 Years.” Guideline. Geneva: World Health Organization. http://www.who.int/nutrition/publications/micronutrients/guidelines/mmpo....