1. Programs Micronutrient Intervention (MI) Programs ORT (Oral Rehydration Therapy)

2. Program Definition A program is a set of organized activities designed to accomplish a clearly-defined goal. Programs target a specific population, are conducted by governmental or non-governmental organizations, and have evaluation components or measures.

3. Major MI Program Types Supplementation Fortification Dietary diversity Agricultural Education Food assistance

4. Examples—Vitamin A Supplementation—capsules (Pakistan) Fortification—margarine, cooking oil, milk (US, Philippines, Pakistan) Dietary diversity Agricultural—sweet potatoes (Africa) Education—growing food (Nepal) Food assistance—WIC (US)

5. Examples—Iron Supplementation—liquid drops (Ethiopia), oral supplements (India) Fortification—enrichment of flour (Nigeria, Mexico, US) Dietary diversity (many countries) Agricultural Education—iron needs for women, iron pots Food assistance—WIC (US)

6. Examples—Iodine Supplementation—oil capsules (Philippines), “sprinkles” (Pakistan) Fortification—salt, soy sauce

7. Relative Costs and Benefits Supplements Supplements inexpensive and effective Require Clinical support Distribution network Assessment

8. Relative Costs and Benefits Fortification Appropriate fortification programs reach a large target audience with nutrients that are likely low in the general food supply. Infrastructure requirements Equipment Expertise Monitoring Distribution Assessment

9. Relative Costs and Benefits Dietary Diversity Agricultural Subsistence crops v cash crops Improved agricultural methods Farmer education Food processing and storage Education Assessment

10. Relative Costs and Benefits Food Assistance Emergency Long-term Dependency v development

11. Water and ORT Water uses Waterborne diseases Water sanitation and disinfection Oral Rehydration Therapy (ORT)

12. Death from Infectious Disease

13. Water Diseases Pathogens—bacteria, parasites, viruses Guinea Worm Ascariasis Campylobacteriosis Cholera Hepatitis Leptospirosis Onchocerciasis Typhoid Schistosomiasis DIARRHEA and ANEMIA Mosquitoes—malaria, dengue hemorrhagic fever Heavy metals—runoff from mining or manufacturing

14. Water Sanitation and Disinfection Temperature Boiling NEW TREATMENT—solar heating Chemical treatment—largely chlorination

15. Diarrheal Disease In developing countries children typically exhibit diarrhea 2-6 times per year. Children die from diarrheal diseases Approximately 2.2 million children/y under 5 1/20 die from diarrheal disease before age 5 Other issues Impairment of nutritional status Susceptibility to other acute infections

16. Oral Rehydration Therapy (ORT) Hospital v home ORT—defined by WHO in 1993 Increased volume of fluids, either oral rehydration salts (ORS) or other recommended home fluids, along with continued feeding ORS—packet of salt and sugar to increase water absorption (does not destroy disease- causing microorganisms)

17. ORT Saves Lives UNICEF and WHO predict that ORT could save the lives of 90% of the children under 5 who die from diarrheal diseases. Estimates of ORT use in households in developing countries 75% use some ORT 33% use ORT following the 1993 definition

18. Programs as Models Programs work toward achieving measurable goals. Programs include organized activities and evaluations. Programs target specific populations. Data needed for developing program models.

19. Program Examples Diouf (Video 2, Clip 1) Bertini (Video 2, Clips 3, 4)