Micronutrients for children 6–59 months

Vitamin A:

• Vitamin A supplements should be delivered to children 6–59 months of age twice yearly during health contacts. This should be marked on the child health card, or integrated into other public health programmes aimed at improving child survival, such as polio or measles national immunisation days, or biannual child health days delivering a package of interventions such as deworming, distribution of insecticide–treated mosquito nets and immunisations.
• Many countries have successfully integrated strategies to deliver vitamin A supplements to infants and children in their national health policies, including delivery during routine health visits and immunisations.
• Using community–based campaigns (such as twice–yearly Child Health Days where these operate) to deliver vitamin A supplements has been a key strategy over the last two decades.

Therapeutic zinc:

• Therapeutic zinc should be delivered by health workers as part of the clinical management of diarrhoea in children. This is usually part of IMCI and other child health programmes delivered by Government and non– Government agencies.

Multiple micronutrient powders (MNPs):

• Programme target of 90 sachets/doses over a six–month period is recommended. Delivered though MCHN services or programmes.

• In countries/contexts with evidence of vitamin A deficiency, biannual vitamin A supplementation in children aged 6–59 months is recommended.
• Zinc supplements are recommended along with low osmolarity oral rehydration solution for diarrhoea management among children 6–59 months living in populations with high prevalence of zinc deficiency.
• In populations where anaemia is a public health problem point–of–use fortification of foods/complementary foods with iron containing micronutrient powders in children aged 6–59 months is recommended, to improve iron status and reduce anaemia. MNPs are single–dose packets or sachets that contain multiple vitamins and minerals in powdered form and are designed to be mixed with semi– solid foods for children six months of age and older.

• In populations where anaemia and other forms of undernutrition are a problem, SQ-LNS for children 

  (see complementary feeding) 

  can improve growth and iron status vs MNPs alone.

• Use of MNPs alone are not effective as an approach to address stunting and wasting.
• Programmes of point–of–use fortification with micronutrient powders should include a behaviour–change strategy that promotes awareness and correct use of this product, proper and hygienic preparation, feeding of complementary foods for children older than six months and a healthy diet for children older than two years. Recommended breastfeeding practices, hand washing with soap, prompt attention to fever in malaria settings and measures to manage diarrhoea should also be included. Further, these programmes should include training for healthcare workers or other types of workers to adequately provide nutrition counselling and demonstrate the correct use of multiple micronutrient powders.
• Use of home fluids for preventing dehydration is still recommended and the criteria for the selection of an appropriate home fluid remains unchanged. However, children with diarrhoea treated at home with home–based fluids should also receive zinc supplements for 10–14 days.