Coordinating Nigeria's micronutrient deficiency control programs is necessary to prevent deficiencies and toxicity risks

Abstract

Nigeria has an alarming prevalence of micronutrient deficiencies that has persisted over decades. National Micronutrient Deficiency Control (MNDC) guidelines describe several interventions to address the issue. This study identified and described currently implemented interventions, assessed coverage and coordination of the interventions, and considered the risk of overdosage and gaps. Methods included reviews of policy and program documents, key informant interviews, market, and pharmacy visits. The study found that an array of MNDC interventions were being implemented, including public health supplementation, mandatory fortification, point‐of‐use fortification, biofortification, promotion of dietary diversity, voluntary fortification, and ad hoc individual supplement use. Insufficient coordination existed for government, private, and civil society interventions within the health sector and between health and other sectors. Dosages of micronutrients supplied by different interventions were set independently of each other and target populations overlapped. Inadequate implementation of various interventions appeared to reduce the risk of excessive micronutrient intakes, but increased the risk of deficiencies. The risk of excessive intakes will likely increase with improved implementation and scale‐up. There is a need to develop effective coordination structures for MNDC in Nigeria that will critically examine the landscape, decide modalities for different interventions, and ensure that both deficiencies and risk of excessive intakes are minimized.

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

“…When fortifying multiple foods with the same nutrient, it is critical to set standards such that the total intake from all fortified foods, as well as other dietary sources and supplements combined, does not consistently exceed the UL in the target population ( 1 ). This has been raised as a potential concern in Nigeria and recent efforts have been made to coordinate the array of existing programs including food fortification and supplementation ( 35 ), underscoring the need for effective program monitoring and enforcement systems to tackle this critical issue. Vitamin A intakes above the UL may have adverse effects; therefore, in all countries it is recommended to review the vitamin A intake results in the context of all vitamin A sources in the diet and adjust fortification standards as needed to ensure safety over time.…”

Barriers and Facilitators to the Implementation of Large-Scale Nutrition Interventions in Africa: A Scoping Review

“…Five studies cited that gaps in policy making and regulations undermined the implementation of nutrition interventions (Anjorin et al 2019;Hodge et al 2015;Mildon et al 2015;Doudou et al 2018;Harris et al 2017). Despite some success in mainstreaming nutrition as a core policy concern (for example, through the World Bank's Scaling Up Nutrition initiative and the UN's ongoing Food Systems Dialogues), malnutrition remains rarely seen as a pressing issue for policy makers; instead, governments are often more interested in solving "visible" issues with tangible solutions, such as fixing infrastructure or building new schools.…”

“…Bureaucracy also hindered the ability for interventions to gain funding, which ultimately delayed the implementation process (Pomeroy-Stevens et al 2016). Eight studies highlighted how supportive policies facilitated the implementation process (Anjorin et al 2019;Carroll et al 2019;Kennedy et al 2016;Mildon et al 2015;Legesse et al 2014;Sanghvi et al 2013;Harris et al 2017;Laar et al 2017;Gillespie et al 2015). For example, supportive policies improved service delivery (Sanghvi et al 2013), strengthened stakeholder commitment (Harris et al 2017), fostered collaborations between organizations, enhanced partnerships, and encouraged the translation of nutrition recommendations into concrete actions (Carroll et al 2019).…”

“…Two studies cited inadequate stakeholder engagement as a barrier for the implementation of large-scale nutrition interventions (Anjorin et al 2019;Blauvelt et al 2018), where issues such as competing agendas (Blauvelt et al 2018) and lack of stakeholder attention to malnutrition (Harris et al 2017) often impede implementation efforts. Poor communication among stakeholders (Anjorin et al 2019), ineffective coordination, and unsupportive leadership (Kennedy et al 2016) were all factors shown to interfere with effective stakeholder engagement. Furthermore, the idea of multisectoral coordination often involves collaboration between different government ministries and organizations.…”

“…Moreover, support from government agencies facilitated meaningful engagement with a range of stakeholders, champions, and community leaders (Sanghvi et al 2013;Blauvelt et al 2018). According to Anjorin et al (2019) and Weber et al (2019), government involvement also legitimized and ensured the sustainability of interventions.…”