Minor and trace elements in human milk from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire. Results from a WHO/IAEA joint project.

Concentrations of As, Ca, Cd, Cl, Co, Cr, Cu, F, Fe, Hg, I, K, Mg, Mn, Mo, Na, Ni, P, Pb, Sb, Se, Sn, V, and Zn were determined in human whole milk samples from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire; in most of these countries, three groups of subjects representing different socioeconomic conditions were studied. Analytical quality control was a primary consideration throughout. The analytical techniques used were atomic absorption spectrophotometry, atomic emission spectrometry with an inductively coupled plasma, colorimetry, electrochemistry, using an ion-selective electrode and neutron activation analysis. The differences between median concentrations of Ca, Cl, Mg, K, Na, and P (minor elements) were lower than 20% among the six countries. Among trace elements, concentrations observed in Filipino milk for As, Cd, Co, Cr, Cu, F, Fe, Mn, Mo, Ni, Pb, Sb, Se, and V were higher than for milk samples from other countries. The remaining five countries showed a mixed picture of high and low values. In the case of at least some elements, such as, F, I, Hg, Mn, Pb, and Se, the environment appears to play a major role in determining their concentrations in human milk. The nutritional status of the mother, as reflected by her socioeconomic status, does not appear to influence significantly the breast milk concentrations of minor and trace elements. Significant differences exist between the actual daily intakes observed in this study and current dietary recommendations made by, for example, WHO and the US National Academy of Sciences. These differences are particularly large (an order of magnitude or more!) for Cr, F, Fe, Mn, and Mo; for other elements, such as, Ca, Cu, Mg, P, and Zn, they amount to at least a factor 2. In the opinion of the present authors, these findings point to the need for a possible reassessment of the dietary requirements of young infants with respect to minor and trace elements, particularly for the elements Ca, Cr, Cu, F, Fe, Mg, Mn, Mo, P, and Zn.

Prévenir et combattre l' anémie ferriprive dans le cadre des soins de santé primaire : guide à l' usage des administrateurs de la santé et des responsables de programme / E. M. DeMaeyer, avec la collaboration de P. Dallman ... [et al.] / Preventing and controlling iron deficiency anaemia through primary health care : a guide for health administrators and programme managers

Cet ouvrage fait le point sur l'ensemble des aspects techniques et pratiques à prendre en considération pour l'élaboration de stratégies directes, efficaces et de faible coût destinées à lutter contre l'anémie ferriprive. Notant que cette affection touche plus de 700 millions de personnes dans le monde, les auteurs se sont efforcés de montrer comment les nouvelles connaissances sur les moyens techniques de prévention et de lutte pouvaient être utilisées pour atteindre le plus grand nombre possible de personnes au moindre coût. Tout au long de cette étude, l'accent est mis sur les problèmes et les écueils dont il faut tenir compte, notamment dans les pays en développement, pour choisir les mesures de lutte les plus appropriées

Preventing and controlling iron deficiency anaemia through primary health care : a guide for health administrators and programme managers / E. M. DeMaeyer, with the collaboration of P. Dallman ... [et al.] / Prévenir et combattre l' anémie ferriprive dans le cadre des soins de santé primaire : guide à l' usage des administrateurs de la santé et des responsables de programme

A guide to the full range of technical and practical considerations required for the design of direct, inexpensive, and effective strategies to combat iron deficiency anaemia. Noting that this condition impairs the lives of over 700 million persons worldwide, the book makes a special effort to show how new knowledge about the technical means for prevention and control can be used to reach the largest numbers at the lowest possible costs. Throughout, emphasis is placed on problems and pitfalls, particularly in developing countries, that need to be considered when selecting the most appropriate measures for control. The opening chapters provide essential background information about the complex causes of iron deficiency anaemia, the many factors that influence its etiology, and the corresponding implications for assessment and treatment. A chapter devoted to etiology and epidemiology includes a thorough explanation of iron requirements, intake, and bioavailability useful in understanding why some individuals are at greater risk than others. Details range from a table indicating recommended daily iron intakes to examples of dietary combinations, commonly found in developing countries, that either enhance or inhibit iron absorption. Against this background, the book turns to the practical problems of assessment, treatment, and prevention. A chapter concerned with anaemia screening and the detection of iron deficiency critically compares available laboratory tests, pointing out advantages and drawbacks likely to be encountered under field conditions in developing countries. Readers are then given detailed information on treatment options using iron tablets, liquid preparations, or tablets including folate or ascorbic acid, on he recommended dosage and duration of therapy, and on side-effects associated with specific preparations and known to cause poor compliance. Information on prevention concentrates on four basic approaches involving supplementation with medicinal iron, education and associated measures to increase dietary iron intake, the control of parasitic and other infections, and the fortification of a staple food with iron. The book concludes with a discussion of the costs and benefits of prevention and a guide to the components, goals, and logistics of an anaemia control programme

Vitamin A supplementation for refugees and famine victims.

Reports about recent famine victims and refugees have described the occurrence of xerophthalmia and resultant blindness related to severe vitamin A deficiency. These populations are subject to high prevalences of childhood protein-energy malnutrition and infectious diseases, pre-existing marginal vitamin A status, and inadequate levels of vitamin A in relief rations. In order to prevent unnecessary morbidity and mortality when any of these risk factors arise, famine victims or refugees should receive vitamin A supplements as an early and essential component of the nutritional support provided by relief agencies. Such supplementation should not await the results of nutrition or blindness surveys but rather should be a standard component of the maternal and child health care provided to the affected population until sufficiency of dietary vitamin A has been clearly established.

The WHO programme of prevention and control of vitamin A deficiency, xerophthalmia and nutritional blindness.

The vast extent and the world wide distribution of vitamin A deficiency is discussed. Its epidemiology is reviewed and sources of vitamin A in diets recorded, along with the high requirements of children. Strategy for prevention is described under three headings--short, medium and long term steps. Strategies in many countries received notice.

PIP: Conservative estimates project over 500,000 cases/year of new active corneal lesions and 6-7 million cases of noncorneal xerophthalmia attributable to vitamin A deficiency on a worldwide basis. Vitamin A deficiency affects growth, the differentiation of epithelial tissues, and immune competence. The most dramatic impact, however, is on the eye and includes night blindness, xerosis of the conjunctiva and cornea, and ultimately corneal ulceration and necrosis of the cornea. Vitamin A deficiency occurs when body stores are exhausted and supply fails to meet the body's requirements, either because there is a dietary insufficiency, requirements are increased, or intestinal absorption, transport and metabolism are impaired as a result of conditions such as diarrhea. Vitamin A deficiency is the single most frequent cause of blindness among preschool children in developing countries. The younger the child, the more severe is the disease and the higher the risk that corneal destruction will be followed by death. The most important step in preventing vitamin A deficiency is ensuring that children's diets include adequate amounts of carotene containing cereals, tubers, vegetables, and fruits. An overall strategy designed to prevent and control vitamin A deficiency, xerophthalmia, and nutritional blindness may be defined in terms of action taken in the short, medium, and long term. A short-term, emergency measure includes the administration to vulnerable groups of single, large doses of vitamin A on a periodic basis. In the medium-term, the fortification of a dietary vehicle (e.g., sugar or monosodium glutamate) with vitamin A can be initiated. Increased dietary intake of vitamin A through home gardening and nutrition education programs comprises the longterm solution to this problem. The World Health Organization plans to launch a 10-year program of support to countries where vitamin A deficiency is a significant public health problem.

[Epidemiology, treatment and prevention of iron deficiency and iron deficiency anaemia (author's transl)]. / Epidémiologie, traitement et prévention de la carence en fer et de l'anémie ferriprive.

The iron losses/requirements of children, adolescents, adult men and women, pregnant and lactating women are presented and interpreted in the light of present information concerning the intestinal iron absorption. This helps to explain the high frequency of iron deficiency during childhood and in fertile women. The problems affecting treatment as well as the various approaches to iron deficiency prevention are also discussed.

Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.

Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, whith folate deficiency also playing a role in some population groups, especially in preganant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritional anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance ot member countries.