COVERAGE OF NUTRITION-SPECIFIC INTERVENTIONS


Coverage of nutrition-specific interventions is crucial for under- nutrition reduction (Bhutta et al. 2013a), but coverage data for these programs are scarce.


Table 5.1 summarizes 12 nutrition-specific interventions: the 10 nutrition-specific interventions in Bhutta et al. (2013a), plus zinc treatment for diarrhea (Bhutta et al. 2013b) and universal salt iodization (also a proven nutrition-specific intervention). It is clear that the coverage data are in scarce supply. Data are only readily available for more than a handful of countries for vitamin A supplementation for children 6–59 months old and universal salt iodization. There are data on iron–folic acid supplementa- tion during pregnancy (but not for all women of reproductive age and not during the periconceptual period), on practices re- lated to breastfeeding promotion (exclusive breastfeeding rates), and on practices relating to complementary feeding programs (minimum acceptable diet and minimum dietary diversity indica- tors for children 6–23 months old). We were not able to locate and verify the data on zinc treatment for diarrhea before this report went to press. Although The Lancet Nutrition series in 2008 and 2013 recommended preventive zinc supplementation, many countries have so far failed to implement this measure on a national scale. Moreover, no countries have introduced multi- ple micronutrient supplementation or calcium supplementation in pregnancy at scale. For other interventions, such as treatment of moderate or severe acute malnutrition, programs exist, but data on geographic coverage are not systematically collected or comparable.


Iron and folic acid during pregnancy


Iron supplementation during pregnancy is associated with reduced maternal anemia, and folic acid supplementation at the time of conception is associated with reduced neural tube defects in the brain and spinal cord (Black et al. 2013; Bhutta et al. 2013a).


Data on the percentage of women who receive iron–folic acid tablets or syrup for at least 90 days during pregnancy are avail- able for 58 countries from 2003 onward from the Demographic and Health Surveys.2


As Table 5.2 shows, the range of coverage is


very wide (from 0.1 percent for Turkmenistan to 78.9 percent for Nicaragua). According to these surveys, mean coverage is only 26 percent, which is consistent with the findings of others (Hodgins and D’Agostino 2014). All subregions for which sufficient data are available have coverage rates well below 50 percent with the exception of the Caribbean (Figure 5.1).


Exclusive breastfeeding


Chapter 3 described regional trends on exclusive breastfeeding rates; this section summarizes country trends. For countries with data on exclusive breastfeeding, the two latest surveys show that many more countries have rising annual average rates of increase (AARI) than falling rates (Figure 5.2). In some coun- tries, increases in rates are extremely rapid, although typically from low bases (such as in Côte d’Ivoire, Dominican Republic, Thailand, and Trinidad and Tobago). This is not always the case, however. Burkina Faso and Georgia, for example, show rapid in- creases from rates nearer the WHA global target of 50 percent. The wide variation in country progress needs to be better under- stood and offers much scope for learning among countries.


TABLE 5.1 STATE OF COVERAGE DATA FOR NUTRITION-SPECIFIC INTERVENTIONS Time period Preconception


Intervention Folic acid supplementation/fortification Pregnancy


Balanced energy-protein supplementation Calcium supplementation


Multiple micronutrient supplementation Breastfeeding Preventive Promotion of breastfeeding (including early initiation)


Complementary feeding for food-secure and -insecure population


Vitamin A supplementation for children 6–59 months old Preventive zinc supplementation Curative Zinc for treatment of diarrhea


Feeding for children with moderate acute malnutrition Therapeutic feeding for severe wasting


All Universal salt iodization Source: Authors, based on Bhutta et al. (2013a). 30 GLOBAL NUTRITION REPORT 2014


Status of data on coverage


Data are only available on coverage of iron–folic acid supplementation during pregnancy (not for all women of reproductive age or during periconceptual period, as modeled in Bhutta et al. 2013a).


No program data exist as far as we know. Few programs exist as far as we know.


There are no national programs for multiple micronutrient supplementation in pregnancy.


Data are available on exclusive breastfeeding, early breastfeeding initiation, and continued breastfeeding. Note that these are practices, not program coverage.


Data are available on practices, minimum acceptable diet (MAD), and minimum diet diversity (MDD). There are no data on program coverage.


Coverage data exist for many countries.


There are no preventive zinc supplementation programs globally, and so currently coverage is zero.


Data are available for 58 countries; for 50 countries the coverage rate is < 5 percent. No programs for moderate acute malnutrition exist presently at scale.


Geographic data are available but are not very meaningful. Direct coverage data are not national.


Coverage data exist for many countries.


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