Management of acute malnutrition and micronutrient deficiencies standard 3: Micronutrient deficiencies
Micronutrient interventions accompany public health and other nutrition interventions to reduce common diseases associated with emergencies and address micronutrient deficiencies.
Key actions (to be read in conjunction with the guidance notes)
Train health staff in how to identify and treat micronutrient deficiencies (see guidance notes1–2).
Establish procedures to respond effectively to the types of micronutrient deficienciesfrom which the population may be at risk (see guidance note 2).
Key indicators (to be read in conjunction with the guidance notes)
Cases of micronutrient deficiencies are treated according to current best clinical practice (see guidance notes 1–2).
Micronutrient interventions accompany public health interventions to reduce common diseases associated with emergencies such as measles (Vitamin A) and diarrhoea (zinc) (see guidance notes 3–4).
- Diagnosis and treatment of clinical micronutrient deficiencies: Diagnosis of some clinical micronutrient deficiencies is possible through simple examination. Clinical indicators of these deficiencies can be incorporated into health or nutritional surveillance systems, although careful training of staff is required to ensure that assessment is accurate. Case definitions are problematic and in emergencies can often only be determined through the response to supplementation by individuals who present themselves to health staff. Treatment of micronutrient deficiencies should involve active case-finding and the use of agreed case definitions and guidelines for treatment. Case-finding and treatment should take place both within the health system and within feeding programmes (see Food security and nutrition assessment standard 2, guidance note 6). Where the prevalence of micronutrient deficiencies exceeds public health thresholds (see Appendix 5: Measures of the public health significance of micronutrient deficiencies), blanket treatment of the population with supplements may be appropriate. Scurvy (Vitamin C), pellagra (niacin), beriberi (thiamine) and ariboflavinosis (riboflavin) are the most commonly observed epidemics to result from inadequate access to micronutrients in food aid-dependent populations. With this is mind, deficiencies should be tackled by population-wide interventions as well as individual treatment.
- Diagnosis and treatment of sub-clinical micronutrient deficiencies: Sub-clinical micronutrient deficiencies can have adverse health outcomes but cannot be directly identified without biochemical examination. An exception is anaemia, for which a biochemical test is available which can be undertaken relatively easily in the field (see Food security and nutrition assessment standard 2, guidance note 6 and Appendix 5: Measures of the public health significance of micronutrient deficiencies). Indirect indicators can be used to assess the risk of deficiencies in the affected population and determine when an improvement in dietary intake or the use of supplements may be required (see Food security and nutrition assessment standard 2, guidance note 6 and Appendix 5: Measures of the public health significance of micronutrient deficiencies).
- Prevention: Strategies for the prevention of micronutrient deficiencies are briefly described in the Food security– food transfers section (see Food security– food transfers standard 1). Prevention also requires the control of diseases such as acute respiratory infection, measles and parasitic infections such as malaria and diarrhoea that deplete micronutrient stores (see Essential health services - child health standard 1 and Child health standard 2). Preparedness for treatment will involve the development of case definitions and guidelines for treatment, and systems for active case-finding.
- Use of micronutrients in the treatment of common diseases: Micronutrient supplementation should be integrated in the prevention and treatment of certain diseases. This includes the provision of Vitamin A supplementation alongside measles vaccination and inclusion of zinc with oral rehydration salts (ORS) in guidelines to treat diarrhoea (see Essential health services - child health standard 1 and Child health standard 2 and Infant and young child feeding standard 2).