Lynnette Marie Neufeld

The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

Low birth weight and maternal anemia remain intractable problems in many developing countries. The adequacy of the current strategy of providing iron-folic acid (IFA) supplements only during pregnancy has been questioned given many women enter pregnancy with poor iron stores, the substantial micronutrient demand by maternal and fetal tissues, and programmatic issues related to timing and coverage of prenatal care. Weekly IFA supplementation for women of reproductive age (WRA) improves iron status and reduces the burden of anemia in the short term, but few studies have evaluated subsequent pregnancy and birth outcomes.

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

Micronutrient deficiency remains a major public health problem in many countries worldwide with important consequences for the health of the populati

There is considerable evidence that micronutrient deficiencies affect child health and well-being. Although the benefits of strategies that improve d

Although evaluation is now an integral part of the design and implementation of public programs in many countries, there is growing recognition that the utilization of evaluation results for improving implementation and decision making, particularly in developing countries, is limited. The objective of this paper is to describe the process by which the external impact evaluation has been used to increase the potential of Oportunidades to improve nutritional outcomes of the beneficiary population through modifications to its design and operation. We will summarize a series of studies that have guided this process and focus on key aspects that have facilitated the utilization of evaluation results for decision making in the program. Implementation of research to document the impact of programs and the publication of such findings in peer reviewed journals, although vital for improving our evidence base and for the advancement of researchers within the current academic system, is not enough to ensure that the program itself will benefit from the evaluation. The use of evaluation results as a basis for modifications to the design and implementation of the nutrition component of Oportunidades was favored by open dialogue among all sectors involved in the program and the evaluation team and a long-term commitment on the part of all those involved. We think that the lessons learnt from this process are relevant for other programs, even where resources may be limited.

National-level data on iron deficiency is not available for most countries and many rely on the prevalence of anemia as a proxy estimate, assuming th