Background
Globally, micronutrient malnutrition in pregnant women is widespread across regions and countries. It is estimated that approximately 32 million pregnant women are anaemic worldwide, 19 million suffer from vitamin A deficiency, and millions suffer from insufficient iron, folate, zinc or iodine stores.
Vitamin and mineral deficiencies have been associated with pregnancy complications and poor birth and infant outcomes. It is calculated that approximately 20 million babies are born weighing less than 2500 g at birth (low birth weight), about 15 million are premature, and many more are born small for their gestational age, increasing their risk of morbidity and mortality during childhood.
Along with other nutrition and health interventions at the population level, the World Health Organization (WHO) has recommended supplementing pregnant women’s with iron and folic acid to prevent and treat gestational anaemia since 1968.
Currently, two WHO guidelines cover this intervention: one for daily supplementation and one for intermittent supplementation. WHO advises that both interventions be part of an integrated programme of antennal and postnatal care. In spite of the evidence supporting the efficacy of these interventions, supplementation programmes in pregnancy, generally implemented in the context of antenatal care programmes, have had less than optimal results in many countries, including low intervention coverage and adherence.
Reasons, among others, include women’s limited access to routine and timely antenatal care due to geographic distance, reduced number of facilities and other gender-related factors affecting women’s access to healthcare, including their beliefs and motivation about the daily use of the supplements and their own expectations of care. In other settings, low motivation, poor interpersonal skills and training of health staff have been limiting factors. Poor quality and insufficient supply of supplements, due to inadequate programme contextualization, may also affect programmes’ success.
Owing to the increased needs of various vitamins and minerals during pregnancy, WHO remarks that iron and folic acid formulations may also include other vitamins and minerals in multiple micronutrient supplements. This intervention is being implemented in a few high, middle and low-income countries, and has also been implemented in emergency settings.
There is evidence suggesting that there may be a decreased risk of low birth weight and small-for-gestational-age in comparison to iron and folic acid supplementation alone. However, before considering the implementation of this nutrition intervention as part of routine antenatal care at large scale, particularly in middle and low-income countries, it is necessary to examine key implementation considerations for helping interested parties to successfully incorporate this intervention into existing programmes through appropriate delivery platforms.
In addition to the ongoing Cochrane systematic review, the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, is seeking to commission 7 review papers and 3 case studies on the topics related to the technical consultation (see ‘List of background papers’ ).
How to submit a proposal
Suitable authors, working independently or as part of working teams, can submit their letter of interest by sending an email to WHO at nutrition@who.int no later than 5 April 2015.
Authors should prepare a proposal containing the following documents:
- A brief curriculum vitae of the author(s), demonstrating their needed technical expertise including a list of relevant publications (3 pages maximum).
- Proposed title of the paper
- A 300-word abstract outlining the issues that will be addressed in the full paper. The abstract should include the topics found in the table on the next page, as well as other relevant issues.
- An expression of commitment to completing the paper no later than 15 July 2015, following WHO instructions for authors.
Selected authors will be notified by 15 April 2015. Small amounts of funding to support the development of the papers may be available.
The Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, in collaboration with the United Nations Children’s Fund (UNICEF) and the Micronutrient Initiative (MI) is convening the ‘Multiple micronutrient supplements in pregnancy: implementation considerations for successful integration into existing programmes’ to examine the programmatic evidence, including successful implementation experiences, best practices and lessons learnt, in order to inform the scale-up of multiple-micronutrient supplementation during pregnancy in antenatal care programmes.
The outcome of this technical consultation will contribute to the Member States’ efforts to strengthen their health systems and provide them with a summary of lessons learnt and a summary of implementation considerations, which can be useful in the integration of this nutrition intervention in antenatal care programmes.
The meeting will take place on 18-20 August 2015, in Geneva, Switzerland. Authors are expected to present their work at this meeting and these papers will be considered for future publication.