A Framework for Developing Effective Advocacy and Communication to Support Universal Salt Iodization.

Objectives: Tremendous progress has been made toward achieving universal salt iodization (USI). Nonetheless, in some countries USI's momentum has stalled. UNICEF and GAIN have created a Partnership, under Gates Foundation funding, to revitalize and innovate for reaching the "last mile" of coverage in such countries and to ensure sustainability of past achievements. Under this initiative, USI advocacy and communications (A&C) activities were assessed in 13 countries to create a framework for guiding national programs in the creation of effective A&C strategies. Methods: Countries were selected based on low USI coverage or questionable sustainability of current coverage. Assessments examined legislation and enforcement, current coverage, salt manufacturing, and the consumer market, analyzed the salt distribution chain in detail, and identified priority needs and recommended approaches for expanding coverage. Results: As expected, constraints to stalled progress were unique to each country, requiring recommendations tailored to the local situation. Nonetheless, the exercise generated a framework, modifiable for use in any country, detailing a process for assessing legislation and enforcement; pinpointing links of the salt distribution chain; identifying key actors, actions, and communications needs at each link; and obtaining information about these actors and actions. The framework's summary matrix allows prioritization of A&C initiatives for greatest impact using available resources. Conclusions: This "salt chain" approach creates new opportunities for expanding A&C beyond the usual focus of simply targeting producers and consumers, and the new framework provides a useful tool for country programs to use when assessing A&C needs, formulating strategy and prioritizing A&C activities.

Seeking optimal means to address micronutrient deficiencies in food supplements: A case study from the Bangladesh Integrated Nutrition Project.

In seeking to improve the micronutrient contents of a food supplement used in a major community-based nutrition project in Bangladesh, operations research was conducted to compare the provision of needed micronutrients through additional food sources (fresh or dried fruits or vegetables), a micronutrient multi-mix, and a combination of the two. Micronutrient gaps (the difference between micronutrient requirements and actual micronutrient intake) were estimated for four groups of project beneficiaries, with target intakes defined as requirements for iron, calcium, zinc, vitamin A, vitamin C, riboflavin, niacin, and vitamin B12 recommended by the Food and Agriculture Organization/World Health Organization. Primary focus was placed on iron and vitamin A. Cost and bulk constraint analyses, based on cost of supplement, feasibility of delivery, and serving volume needed to achieve micronutrient targets, were used for comparing the supplement options. In terms of these analyses, the micronutrient multimix proved, by far, to be the most advantageous. Food options, however, are arguably desirable in that they provide dietary benefits additional to that of known micronutrients and may increase demand to boost production of domestic fruits and vegetables for the population as a whole. The study concludes that it is cost-effective to use powdered micronutrient mixes for such specific purposes as enrichment of supplementary food and food fortification, but encourages production and consumption of micronutrient-rich foods through programme messages and activities.