Intervention strategies for improving iron status of young children and adolescents in India

Despite advances in scientific knowledge regarding multiple etiology, treatment, and potential strategies for combating iron deficiency and deficiencies of other micronutrients, iron deficiency anemia, vitamin A deficiency, and iodine deficiency remain significant public health challenges for growing children and adolescents. The short-term efficient supplementation approach, although technically feasible, has not been successful due to problems with delivery and compliance. Evidence is building that preventive supplementation coupled with nutrition education may be a more effective strategy associated with better compliance and improvement in iron status. Long-term, effective approaches include fortification, dietary modification, public health and disease control measures, and income generation programs. Food fortification can be a cost-effective intervention strategy if technologically feasible, nutritionally sound, culturally acceptable and economically viable food vehicle(s) and fortificant(s) can be identifed. Foods such as wheat, rice, and salt are commonly consumed in India; research is underway to evaluate various fortificants for these foods. Doubly fortified salt with iodine and iron may be particularly promising in the Indian situation as it is affordable, culturally acceptable, and may enhance iron absorption from Indian dietaries containing inhibitors of iron absorption. Feasibility studies are underway to evalute the stability and storage issues as well as bioavailability of fortificant iron. Dietary modification involves increased iron intake, by increasing total food intake and consumption of locally available iron-rich foods, and dietary practices favoring iron absorption. Blood loss associated with worm infestation can be controlled by periodic deworming and reducing reinfestation. Coordinating these major intervention approaches by building partnerships between the community, existing nutrition and health programs, government, industry, and academic institutions is critical for success of these programs. Nutrition education must be integral to all of these strategies discusssed. Primary health care system and school infrastructure and staff, along with school children and community members, can be powerful resources for addressing malnutrition in children and adolescents.