Overview of Hidden Hunger in Asia
Asia has a very high burden of hidden hunger.1 2 More than 13 million babies are born with mental impairment, accounting for 72% of the annual global burden of iodine deficiency disorder (IDD), and the number of households consuming iodized salt varies widely, from 15% in Afghanistan and 55% in Pakistan, to 95% in Bhutan and 93% in China. Many countries in Asia are achieving high levels of vitamin A supplementation for children, but some are still lagging behind. So, as many as 500,000 children under five die each year due to vitamin A deficiency (VAD). An estimated 33,000 women die due to severe anemia each year, and the estimated prevalence of iron deficiency anemia in children under five varies across the region, with nine countries close to or above 50%, and other areas as high as 75% to 80%. Folic acid deficiency and zinc deficiency also have serious negative consequences. An Indian study published in The Lancet revealed that India has a prevalence of birth defects 16 times the global average.
MI Initiatives
In 2006, MI programs in Asia reached an estimated 337 million people.
Vitamin A supplementation continues to be a major focus for MI throughout Asia. Notable efforts in this area include successful collaborative advocacy to increase the upper age limit for vitamin A supplementation programs in India to the international standard of 5 years, dramatically increasing the number of children who will be reached and protected. In addition to supporting the supply of vitamin A syrup, MI also supported vitamin A delivery in six Indian states with emphasis on strategies for reaching the hard to reach. In Indonesia, MI works with the Government of Indonesia, UNICEF and SEAMEO-TROPMED University of Indonesia to support the national vitamin A supplementation program. MI also supports the delivery of VAS in Bangladesh, Nepal, Afghanistan and Pakistan. A special effort was made in Bangladesh for "hard-to-reach" children.
MI continued to work throughout Asia to stimulate and support the development of strong national nutrition policies and micronutrient programs. For example, MI is working closely with the World Bank in Pakistan to provide technical support for the development of the Nutrition PC-1 plan in Pakistan and MI launched the India Micronutrient National Investment Plan in 2006. The Investment Plan seeks to protect 206 million people per year from hidden hunger over a five-year period. It was developed in consultation with government departments, academic institutions, nongovernmental organizations, the private sector, and other international organizations; and it has been influential in the development of the Government of India's 2007-2011 five-year plan. MI has recently committed to support the Ministry of Public Health in Afghanistan in the development of a National Micronutrient Investment Plan. Commitments to address hidden hunger are also strong and growing in Pakistan and Nepal, where governments have developed and launched national action plans.
Other areas of focus include salt iodization, with significant progress in Pakistan, Bangladesh, India and Sri Lanka. MI supported the Government of Pakistan's design of a national iodine deficiency control program and worked with small-scale salt producers in 65 districts to encourage salt iodization. MI also helped Sri Lanka upgrade its two main salt iodization plants that have enough capacity to meet 80% of the country's needs. MI's work in Bangladesh has included support for significant improvements to the salt iodization capacity of the country, with encouraging results. in 2006, iodized salt reached nearly 7.7 million people in Bangladesh. MI supports an extensive network of laboratories in India to test salt iodization quality and support salt processors to produce a better product. MI also provides other support to processors, mainly small ones, in the form of fortificant (KIO3), as well as equipment and technical assistance.
MI's efforts to prevent iron deficiency anemia through wheat flour fortification include collaboration with the Government of Pakistan, the World Food Programme (WFP), and the Global Alliance for Improved Nutrition (GAIN) to scale up flour fortification in Pakistan, and development of MI's award-winning gravity-operated fortification device that helps village millers in rural Nepal add essential vitamins and minerals to the cereal flour they produce. MI also supported the installation of a double fortified salt (DFS) manufacturing facility at the Tamil Nadu Salt Corporation (TNSC) plant, and currently provides 2 tons of iron premix every month as free subsidy to TNSC. TNSC produces 300 tons of DFS, catering to as many as 3.6 million school children in 29 Tamil Nadu districts through the Noon Meal Scheme, which helps low-income children.
Double-fortified salt is also a high priority for the MI in Asia. MI supported the installation of a double fortified salt (DFS) manufacturing facility at the Tamil Nadu Salt Corporation (TNSC) plant, and currently provides 2 tons of iron premix every month as free subsidy to TNSC. TNSC produces 300 tons of DFS, catering to as many as 3.6 million school children in 29 Tamil Nadu districts through the Noon Meal Scheme, which helps low-income children. The MI´s global DFS premix production operation has been transferred from Canada to India, where it is well poised to meet rapidly growing global demand.
MI also supported the development and scaling up of innovative micronutrient products for children. These products include Vita Shakti™, a multi-micronutrient powder that can be used to fortify food on-site for most types of institutional feeding settings such as the ICDS in India, emergency programs and school feeding programs. Another product that is being used in India in ICDS are fortified lozenges (fortified with Vitamin A, iron and other nutrients), which has proven to be feasible at scale and highly acceptable to beneficiaries. The biological impact of the intervention has also been impressive.
MI also developed a product called Anuka™, which is a single serving sachet of micronutrient powder that is to be added to the complementary food consumed by children 6-24 months of age. The acceptability and feasibility of this product has been well proven and MI is currently testing the efficacy in India and Indonesia. In collaboration with UNICEF, MI completed a study in 2007 to assess the feasibility of using Anuka (sachets of multi-nutrient powder) in Rajasthan's Integrated Child Development System (ICDS). The pilot was so successful that UNICEF plans to expand the project to the entire State.
In collaboration with UNICEF, MI completed a study to prove the feasibility of using Anuka (sachets of multi-nutrient powder) in Rajasthan's Integrated Child Development System (ICDS). The test was so successful UNICEF plans to expand the project to the State of Orissa.
MI's New Delhi office continues to support the development of the MI India Trust, which is now fully operational. Today, the Trust has more than 50 committed professionals working towards intensifying the vitamin A supplementation programs in two states, networking with the small salt producers to deal with iodine deficiency disorders, and implementing innovative programs to address iron deficient anemia in the country. In addition to being MI's prime implementation partner in India, the Trust has provided efficient procurement services for MI programs in other countries throughout Asia, Africa, and Latin America.
MI Asia Regional Office
11 Zamroodpur Community Centre
Kailash Colony Extension
New Delhi, India
110048
Tel: 91 11 4100 9801
Fax: 91 11 4100 9808
Melanie Galvin, Asia Regional Director
Deepika Chaudhery, Coordinator, Programs, Asia
Anand Lakshman, Coordinator Planning and Knowledge Management, Asia
Pankaj Jain, Regional Program Manager - Salt Programs, Asia
1. UNICEF, SOWC 2005.
2. UNICEF/MI. Vitamin & Mineral Deficiency - A Global Progress Report. 2003.
3. Cherian,Anil, Siju Seena, Robyn K Bullock, A´sok C Antony.Incidence of neural tube defects in the least-developed area of India: a population-based study. Lancet 2005; 366: 930-31