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Module 5. Micronutrient
Supplementation
during Emergencies
 Overview

This module deals with the importance of

micronutrient supplementation for the
different specific age groups and the
necessary micronutrient supplementation
during disasters and emergency
situations.
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 Learning Objectives
At the end of this module, the participants
should be able to:
• Review the common micronutrient deficiencies.
• Discuss the importance of micronutrient
supplementation as one of the interventions for
micronutrient deficiencies
• Determine the correct micronutrient
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supplementation during disasters and

emergency situations.
• Explain the contraindications and side effects of
specific micronutrient supplementation in
specific population and/or conditions.
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SESSION 5.1

Common Micronutrient
Deficiencies
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Module 5. Micronutrient
Supplementation
during Emergencies
 Common Micronutrient
Malnutrition Problems

• Vitamin A deficiency (VAD)

• Iron deficiency Anemia (IDA)

• Iodine Deficiency Disorders (IDD)

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• Folate Deficiency (neural tube defects)

 Vitamin A Deficiency (VAD)
• Condition that results from prolonged
inadequate intake of Vitamin A resulting in
Vitamin A level that is below a defined
acceptable range.

• Clinical signs and symptoms

- Nightblindness
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- Bitot’s Spot
- Corneal Xerosis
- Keratomalacia
- Corneal Scar
Fighting Hunger Worldwide A child with VAD
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Bitot’s spot: yellowish,

cheesy appearance
 Iron Deficiency Anemia (IDA)
• A condition resulting from inadequate iron in
the body. It is the most common nutritional
deficiency and the leading cause of anemia.

• Clinical signs and symptoms

- Palmar pallor
- Pale conjunctiva
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- Pale nailbeds
- Pale buccal mucosa
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Normal Pink
Pale Conjunctiva
 Iodine Deficiency Disorders
• Refers to the abnormalities that result when the
body does not get enough iodine. It is the most
common cause of mental retardation

• Abnormalities include:
- goiter
- miscarriage
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- stillbirth
- congenital anomalies
- growth and mental retardation
- physical and motor abnormalities
 Grade 3 goiter with
mental retardation
(woman on the
right)
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 Folate Deficiency

• Anemia that is caused by a deficiency of

folate is often accompanied by iron-
deficiency anemia

• Consequences:
- neural tube defects-spina bifida
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anencephaly
- megaloblastic anemia
 Neural Tube Defects (NTD)
• A group of birth anomalies resulting from failure
of fusion of the neural tube around the 28th day
after conception, at a time when most women
do not know they are pregnant.
• Include:
– Anencephaly – most common – literally ‘no brain’
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– Spina bifida (with or without meningomyelocele)

– Encephalocele

– Others: meningocele, myelocele, etc

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Anencephaly – 19 weeks
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Anencephaly - term
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Spina bifida
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SESSION 5.2

Effectiveness of Micronutrient
Supplementation
 3 -pronged strategy addressing
micronutrient malnutrition

• Diet diversification which refers to the

promotion of consumption of variety of foods
rich in micronutrients thru nutrition education
and food production
• Food fortification which refers to the addition of
nutrient/s to staple foods (rice, flour, cooking
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oil, and sugar), in salt and processed food

products.
• Micronutrient supplementation which refers to
the provision of doses of micronutrients such as
Vitamin A, iron, iron -folic acid, iodine, and
others.
 Effectiveness of Micronutrient
Supplementation
• Vitamin A supplementation has been shown
to reduce child mortality by 23-34%. It reduces
the severity of illness, thus decreasing
childhood mortality. Specifically, Vitamin A
supplement

• reduces deaths due to measles by about 50%

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• reduces deaths due to diarrhea by about 40%

• reduces illness due to malaria by 30%
 Iron Supplementation

• increases hemoglobin concentration and

reduces iron deficiency anemia.

• enhances the cognitive and motor

development of young children.
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• increases work performance and

productivity.
 Iron/Folic Acid Supplementation
• Iron/Folic acid supplementation prevents neural
tube defects among women of reproductive age
beginning from one month prior to conception

• Folate/folic acid is important for the

development of neural tube during fetal
development.
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• Iron/folic supplementation lowers the risk of

deaths during childbearing by preventing severe
anemia which is highly associated with severe
bleeding.
 Zinc Supplementation in the
Management of Diarrhea

• Zinc supplementation as an addition to the

management of diarrhea, such as giving zinc in
addition to the reformulated ORS (oral
rehydration solution) has been shown to
significantly reduce the duration and severity of
diarrhea compared to ORS alone.
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• Zinc also decreases the number of episodes of

diarrhea within 2-3 months after the
supplementation regimen.
 Multiple Micronutrient Powder
(MNP)

• Multiple micronutrient powder (MNP), also

known as VITA MIX is a premix of vitamins and
minerals in powder form which may be
sprinkled once daily into the semi-liquid/soft
foods of 6-23 month old children and can be
extended up to 59 months, without changing
the color, taste or texture of the food.
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• Evidence has shown that MNP is adequate to

rapidly improve hemoglobin concentrations.
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SESSION 5.3

Micronutrient Supplementation
during Emergency Situations
 Correct MS during disasters and
emergencies situations

• Ensure that infants, children, pregnant and

lactating mothers and women of reproductive
age continue to receive the recommended
routine micronutrient supplementation.
• Give additional Vitamin A to 6-11 month-old
infants (100,000 I.U.) and 12-59 month-old
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children and post-partum women (200,000 I.U.

as well as children with persistent diarrhea,
severe pneumonia and severely underweight,)
unless they have received a similar dose in the
past 4 weeks. Children with measles should be
given VAC regardless when the last dose was
given.
 MS during emergency situations
• Ensure that 6-23 month-old children receive the
Micronutrient Powder (MNP) supplement. Babies
aged 6-11 months need 60 sachets of MNP
while children aged 12-23 months need 120
sachets. MNP can be given starting at 6 months
during the introduction of complementary foods
within the period of 6 months. MNP can be
mixed with soft or semi-solid food before
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feeding the child. Do not add MNP to any food

before or during cooking for nutrient retention.

• If available, expand the provision of MNP to 24-

59 month-old children as well as to pregnant
and lactating women.
 • If a child has diarrhea, give reformulated ORS
and zinc. Zinc supplement should be given for
not less than 10 days.

• Provide nutrient-fortified food products with

micronutrients during disasters.
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 MS during emergency situations

• Ensure that micronutrient supplementation

supplies are available during disasters and
emergencies. Evacuees must be provided with
adequate supplies of required micronutrient
supplements once they return to the residences
to ensure continuity of supplementation until
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they have settled back home.

 Contraindications and Side Effects of
Micronutrient Supplementation

Vitamin A Supplementation
• Usually it has no side effects if given according
to recommended dose
• If child complains of loss of appetite, vomiting,
headache, nausea, these are temporary and will
disappear within 24 hours.
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Precautions:
• Always ask the patient when his/her last dose of
Vitamin A was taken to avoid overdose
• Never give Vitamin A supplement to pregnant
women except for cases with xerophthalmia
 Contraindications/side effects
Iron supplementation
Iron is best absorbed with an empty stomach, but
this will present more side effects. Thus:
• Take ½ dose daily for one week then resume
full dosage
• Take iron supplement during or after meals
• If stool turns black, explain that this is due to
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ferrous sulphate
• Take more fiber-rich food (vegetables and
fruits) and 8-10 glasses of water to prevent
constipation.
 Key Messages
• Micronutrient supplementation has been proven
to be an effective intervention in reducing
illnesses and deaths

• Vitamin A has been shown to reduce child

deaths by 23-34%. Additional Vitamin A
capsules are given to 6-11 month old infants,
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12-59 month-old children and post partum

mothers unless they received similar dose in the
past 4 weeks.
 Key Messages
• Children with measles should be given Vitamin
A (VAC) regardless when the last dose of VAC
was given.

• Children with diarrhea should be given with

Reformulated ORS and Zinc supplements.
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• It is important that micronutrient supplies are

available during disasters and emergencies.
Evacuees should be given with adequate
supplies of needed micronutrients once they
return to their residences to ensure continuity
of supplementation.
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THANK YOU!