Successful food-based programmes, supplementation and fortification.

This review highlights interventions and delivery mechanisms to alleviate macro- and micronutrient deficiencies in preschool children. These deficiencies can be addressed through an integrated combination of improved dietary intake, supplementation, commercial and home-based fortification of complementary foods. Several developed and developing countries have implemented successful approaches to eliminate protein-energy malnutrition and micronutrient deficiencies with sustained impact. These include provision of oral supplements in capsule, tablet or syrup form. Certain micronutrients (eg, vitamin A) can be provided as high-dose supplements twice per year. Most other vitamins and minerals (eg, iron, zinc, iodine) need to be provided in daily doses. Fortified complementary foods provided through public feeding programmes and commercially marketed foods have also made a positive impact. There is growing evidence of the impact of home-based fortification of complementary foods using premixes in single-serving sachets. The fortification of commercially marketed staple foods such as cereal flours, cooking oils and dairy products could have a small but significant impact on preschool children. Cereal flours with iron, folic acid and other nutrients have expanded rapidly, with evidence of impact. A key need is to deliver micronutrients to remote and impoverished populations in an affordable and sustainable manner. Government commitment, clear policy and programme direction, advocacy and communication combined with a strong public-private partnership is essential for successful programmes. Often a period of voluntary fortification needs to be followed by mandatory requirement to ensure full compliance and sustained impact. The review concludes that proven technologies, communications and infrastructure can be harnessed to ensure that the nutrient needs of preschool children are met. When administered systematically with the commitment of and participation by the public and private sectors, most of the major deficiencies can be bridged on a sustained basis, contributing to improved health and well-being of millions of children around the world.