Can Food-Based Strategies Help Reduce Vitamin A and Iron Deficiencies? A Review of Recent Evidence

Tables Table 1. Summary of intervention and evaluation designs of recent studies reviewed, 1995–99 12 Table 2. Summary of information gaps and research needs relative to the efficacy and effectiveness of food-based approaches for reducing vitamin A deficiencies 44 Table 3. Summary of information gaps and research needs relative to the efficacy and effectiveness of food-based approaches for reducing iron deficiencies 46 Box Box 1. Common evaluation problems and solutions for improving impact analysis of food-based interventions 24 Foreword M icronutrient malnutrition is still a problem of unacceptable proportions in developing countries. Iron and vitamin A deficiencies are the most widespread nutrition deficiencies in the world today, affecting perhaps as many as 3.5 billion people. Because they disproportionately affect children and women during their reproductive years, these deficiencies hinder the development of human potential and nations' social and economic development. It is now well recognized that no single strategy—or " magic bullet " —exists to eliminate micronutrient deficiencies globally. Supplementation, fortification, agricultural interventions, and education to improve dietary quality are all necessary but insufficient approaches. Coordination between sectors is crucial. Multidisciplinary teams must join together to design and implement global strategies to attack the problem in a sustainable way. Investments in reducing micronutrient malnutrition have traditionally focused disproportionately on supplementation and fortification programs and policies to the detriment of food-based approaches, which focus on increasing the amount of micronutrients consumed in the diet and on making a larger share of these nutrients bioavailable (readily absorbed by the human body). Food-based approaches are complex and require collaboration between a variety of sectors, including agriculture , nutrition, education, and economics. They are long-term strategies because they usually involve significant behavior changes on the part of the recipients, and thus they may need to be implemented and evaluated over periods of 5 to 10 years. Because donors are usually driven by the need to demonstrate impact quickly, sup-plementation and fortification approaches have often been given priority over food-based interventions in research funding. And their expense and complexity frequently has discouraged researchers and donors from carrying out the necessary in-depth evaluations of food-based approaches. As a result, a dearth of information exists on their efficacy and effectiveness. Without conclusive evidence on how well these approaches work, donors continue to hesitate to invest in large-scale programs. Although they are indeed long-term strategies, food-based approaches are essential to the fight against micronutrient deficiencies. Of all the …