Multi-stakeholder’s Analysis of Micronutrient Intervention Strategies and Public Health Measures to Prevent Micronutrient Deficiencies in South East Asia (SMILING Project).

Objectives: The SMILING EU project aims at introducing state-of-the-art knowledge into policy to alleviate micronutrient malnutrition in women of reproductive age (WRA) and young children in five SEA countries: Cambodia, Indonesia, Laos PDR, Thailand and Vietnam. The objective of the present study was to appraise multi-stakeholders viewpoints on intervention strategies to prevent micronutrient deficiencies. Methods: Multi criteria mapping (MCM) was used to evaluate stakeholder’s point of views on asset of priority interventions for an appropriate, timely, feasible and effective prevention of micronutrient deficiencies. MCM technique was realized through a face-to-face computer-assisted interview. Twenty interviews have been conducted in each 5 SEA countries. Stakeholders were selected: government, academic, civil society, NGO, private sector and international institutions. Results: The number of interventions presented to stakeholders differed between SEA countries (6 in Indonesia, 8 in Lao PDR, 9 in Cambodia and Thailand and 11 in Vietnam) and was country specific. Interventions were grouped into 6 clusters; supplementation, fortification, food based approach, educational initiatives, indirect interventions and global strategies, allowing comparison among countries. Cambodia included specific options on education; Lao PDR appraised the homestead food production system and Vietnam the intermittent supplementation. Conclusions: Each SEA country had specific approach and focused on different strategies to prevent micronutrients deficiencies. Stakeholder’s analysis allowed to underline consensus and differences between the different groups of stakeholders and to define the best strategy to be implemented in each of the five SEA countries. Funding: European Commission, FP7, GA-2896-16.

A North-South-South Collaborative Action to Prevent Micronutrient Deficiencies in Women and Young Children in South-East Asia: The SMILING Project.

Objectives: SMILING "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional status and General Health in Asia" (FP7), is a transnational collaboration of research institutions and implementation agencies in five SEA countries: Cambodia, Indonesia, Laos PDR, Thailand and Vietnam, with European partners, to introduce state-of-the-art knowledge into policy to alleviate micronutrient malnutrition in SEA women of reproductive age (WRA) and young children. Objectives were to: build capacity on problem analysis; identify priority interventions and develop roadmaps for national policies. Methods: SMILING has been built around a consortium that worked on Optifood software to identify nutrient gaps; nutritional problem analysis and potential interventions by reviewing current situation and program, and knowledge on effective interventions and multi-criteria mapping for stakeholder analysis to develop national guidelines. Results: Iron, zinc, vitamin A and iodine deficiency remain common in SEA. Even though the five SEA countries differ in nutritional situation and stages of development, iron intake in young children in all countries was inadequate, as folate intake in WRA, even with theoretical best possible diets. Consequently, interventions including supplementation, food-based strategies and public health measures were appraised through multi-stakeholder analysis. Successful experiences and lessons in implementing nutrition programs in these countries were also critically reviewed. Policy roadmaps by country are being drafted accordingly. Conclusions: SMILING conducted an analysis of nutrition situation in each SEA country. Gaps in intake of several micronutrients cannot be currently solved by dietary solution and e.g. food fortification needs to be considered. Roadmaps for each country policy-makers are being formulated. Funding: European Commission-FP7, GA-2896-16.

The Contribution of Wheat Flour Fortification to Reducing Anemia in Indonesia.

Objectives: Mandatory wheat flour fortification with iron, zinc, thiamine, riboflavin, and folic acid became effective in Indonesia in 2002. There are no evaluations of its effectiveness on reducing anemia. This study estimated the contribution of fortified wheat flour to changes in hemoglobin concentration and anemia prevalence from the period before to after the introduction of mandatory fortification. Methods: The Indonesian Family Life Survey is a longitudinal study that followed over 30,000 Indonesians. Data from 6,488 non-pregnant women of child-bearing age with hemoglobin measurements in 1997, 2000, and 2007 were analyzed. Anemia prevalence was calculated, adjusting for smoking status and altitude. Households were categorized by their food purchases. Logistic regression was used to predict the effect of covariates on anemia status, while linear regression was used for hemoglobin concentration. Results: Mean hemoglobin significantly increased (p<0.0001) and anemia prevalence significantly decreased (p<0.0001) from the pre-fortification period during 1997-2000 (12.35 g/dL & 34.0%) to the post-fortification period in 2007 (12.67 g/dL & 25.1%). The proportion of weekly household food expenditures spent on foods containing heme iron and flour remained constant from 1997 to 2007. The percentage of household-purchased foods containing heme iron and flour, only heme iron, only flour, or neither in the past week was not significantly associated with hemoglobin concentration or anemia status. Conclusions: Wheat flour fortification does not appear to have significantly contributed to the reduction in anemia prevalence among women of child-bearing age in Indonesia. It is recommended that the fortification iron source be changed from electrolytic iron to a more bioavailable form.