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malnutrition. Although some of these interventions have been successful, a majority have not. Nevertheless, there had been no systematic examination of the reasons for these successes or constraints in program outcome. Recognizing this, the Office of Health and Nutrition of USAID decided that there was a need to bring together research scientists and project implementers to examine past approaches that had—or had not—been successful and to identify the elements of success or constraint. USAID requested that the Institute of Medicine's Board on International Health oversee this activity and draft a report directed to those funding U.S. and international programs to alleviate micronutrient malnutrition. Given this audience, the report does not offer recommendations on how to alleviate specific micronutrient deficiencies—such recommendations are already available through the publications of diverse organizations, including USAID, the Micronutrient Initiative, the World Bank, the United Nations Childrens' Fund (UNICEF), and the World Health Organization (WHO). Rather, this report provides a conceptual framework based on past experience that will allow funders to tailor programs to existing regional/country capabilities and to incorporate within these programs the capacity to address multiple strategies (i.e., supplementation/fortification/food-based appro-aches/public health measures) and multiple micronutrient deficiencies.
To respond to USAID's request, the Board on International Health—in consultation with the Food and Nutrition Board—constituted an expert committee of eleven members with broad expertise related to micronutrient nutrition, diet, and health, especially as these relate to iron, vitamin A, and iodine, and to the conduct and evaluation of global micronutrient deficiency prevention programs. The committee focused on iron, vitamin A, and iodine because they believed there was sufficient literature and program experience on each to warrant review. Although the project concentrates on these three micronutrients, it is hoped that similar reviews of other key micronutrients—for example, zinc, folate, and vitamin B12—will be conducted as literature and experience accumulate. In addition, while the background papers focus on interventions conducted in developing countries, the committee broadened its conceptual framework and recommendations to encompass at-risk populations in industrialized countries as well.
The eight-month project was conducted in two phases. Phase 1 featured a two-day workshop to evaluate successful approaches to the prevention of micronutrient malnutrition and to identify the elements that had led to this success. Workshop participants included committee members and additional experts with research and program expertise related to the committee's task. In planning the workshop, the committee recognized that while there is an array of potential alternative strategies to deal with micronutrient malnutrition, it is unlikely that any one intervention, by itself, will solve all the micronutrient deficiencies in a given region or country. Thus, the mix of scientists and project implementers invited to the workshop was designed to help ensure identification of the optimal combinations