The Role of Political and Governance Factors in Scaling up Maternal and Child Micronutrient Interventions.

Objectives: Scaling up nutrition interventions could save 900,000 lives annually (Bhutta et al, 2013), yet effectively doing so has been slower than expected and the results uneven. There is a growing recognition that technical knowledge alone is insufficient for achieving positive outcomes (Natalicchio et al, 2009) and political and governance factors play a critical role in successfully delivering nutrition interventions (Pelletier, 2002; Pinstrup-Anderson, 1993). However, the governance of the nutrition sector remains an underexplored area (Acosta and Fanzo, 2012) and many are calling for a closer examination of political and policy processes (Gillespie et al, 2013). Our objective is to shed light on this neglected area, specifically as it relates to scaling up micronutrient interventions. Methods: We used Yamey's (2011) article, Scaling Up Global Health Interventions: A Proposed Framework for Success, to identify relevant political and governance factors (including leadership/governance, the state and its relations with non-state actors, the state's ability to facilitate decentralized delivery, and national policies). We then did a literature review using Medline, Web of Science, Econlit, ELDIS, and Google Scholar, focusing on nutrition interventions. This will be complemented with interviews with practitioners working to scale up micronutrient interventions. Results: Our preliminary results suggest that political and governance factors play a critical role, but further research in needed to understand the causal mechanisms for how these act as facilitators of or barriers to scaling up. Conclusions: Successfully navigating political and governance factors will increase the likelihood that intervention coverage can be expanded.

Complementary Interventions for Preventing and Controlling Iodine Deficiencies in Pregnant Women, Infants, and Young Children.

Objectives: Inadequate dietary iodine is the main cause of preventable brain damage, posing a serious threat to intellectual development and productivity throughout the world. Salt iodization is the primary strategy for preventing and eliminating iodine deficiencies, and 76% of households worldwide have access to adequately iodized salt. In several settings, new interventions provide iodine containing products for vulnerable groups - pregnant and lactating women, infants (0-5 months), and young children (6-23 months). However, the extent to which these ‘complementary interventions' meet the iodine requirements of these groups has not been investigated. We therefore examined these interventions to understand whether they meet vulnerable groups' needs. We also estimated the number of recipients reached. Methods: We reviewed literature, household surveys, and guidelines to assess whether salt iodization can meet vulnerable groups' iodine requirements. Then, complementary interventions used in public health contexts were mapped, their iodine contribution estimated, and the number of recipients reached calculated. Results: Our analysis suggests that salt iodization may meet the requirements of pregnant and lactating women, but possibly not all infants and young children. There is great variability in objectives, delivery methods, and iodine contribution of complementary interventions. The coverage of various complementary interventions ranges from 0 to 13% of the vulnerable population groups. Conclusions: There is a need for careful coordination to ensure appropriate amounts of iodine are delivered to recipients. Failing to do so can result in the delivery of too little or too much iodine, which can have negative health consequences.