Micronutrients are substances of food, which do not provide energy but play a crucial role in the body’s functions, even with very small amount taken daily. Scientific discoveries have enabled us to understand and controlled some serious diseases, which used to occur commonly such as Vitamin C deficiency (Scobut) for seamen, Beriberi (Vitamin B1 deficiency) in the regions where people usually eat excessively polished rice.
Currently, there has been a substantial attention paid to studies and the implementation of programs to control, reduce and gradually eliminate clinical manifestations of major mirconutrient deficiencies, with focus on iodine deficiency leading to goiter and mental retardation, vitamin A deficiency induced xerophthamia and reduced immunology, iron deficiency that leads to nutritional aneamia, and Calcium deficiency that causes osteoporosis. Zinc deficiency, selenium deficiency, effects of micronutritient deficiencies on chronic diseases such as vitamin E deficiency and coronary heart disease, and acid folic deficiency and defect of the neural tube have been becoming of more interest recently.
In the last decades, step-by-step plans have been made within the health sector of Vietnam to study and carry out several activities for controlling deficiencies of the most important micronutrients. Since the 70’s, the control of goiter and iodine deficiency disorders (IDD) has been improved, with the main strategy being promotion of iodized salt use with an acceptable amount of iodine that has been proved by the Government. With effective education and communication programs and supports of the Government, we have achieved the goals of the WHO by the year 2000. However, there is a need to maintain the achieved results and monitor the scientifical supplementation of iodine to salt in prophylactic doses in order to eliminate IDD by the year 2005.
There have been some national epidemiology surveys on Vitamin A deficiency, which causes xerophthamia, which in turn leads to blindness. It was shown that Vitamin A deficiency is still a significant public health problem in Vietnam and since 1988, Ministry of Health has implemented a nation-wide program on Vitamin A deficiency control for children from 6 months to 5 years of age and postnatal women with the collaboration of UNICEF, FAO… Annual day of universal distribution of high dose of vitamin A for children is integrated with National Immunization Day and the community has been involved actively In addition, other activities have been also implemented, such as breastfeeding promotion, guidelines provision of vegetable and fruits in daily food intake for children.
In 1994, the prevalence of clinical xerophthamia in the total sample was lower than that of the WHO criteria to be of a significant public health problem. We have been able to maintain this achievement and gradually will move from periodic distribution of vitamin A capsules to other more sustainable approaches.
Iron deficiency anemia is a major public health problem among mothers and children in Viet nam. Anemia account for 50 percent of pregnant women, 40 percent women of reproductive age and over 50 percent of children under 2 years old. It affects the mother’s health substantially, causes reduced productivity and work performance, increases high risks in pregnancy and delivery, and low birth weight . For many years, with the collaboration of UNICEF and other international agencies, the program for controlling nutritional anemia has been implemented in 113 districts through out the country and gained virtual successes in reducing the prevalence of anemia there and the goals of National Plan of Action for Nutrition (NPAN) in the period 1995-2000 have been achieved.
So far, the main measure for controlling vitamin A and Iron deficiencies have been to maintain the supplementation programs, which include the distribution of high dose vitamin A capsules (for vitamin A deficiency) and iron and folate tablets (for iron deficiency). It has proved of high effects and demonstrated the necessities of implementing this measure in the first period.
In the coming years, greater attention of the health sector should be paid to the problems of micronutrient deficiencies more sustainable measures should be implemented by fortification of micronutrients in food such as vitamin A in sugar, iron in fish sauce and instant noodle with the active participation of industry… Such programs have been implemented widely in many developed countries and have shown many advantages such as affordable prices, and high effects. Besides, it is necessary to focus on long term strategies which include improving meal structure, increasing productivity, and eating food rich in nutrient, etc …
Different from energy malnutrition, micronutrient deficiencies cause a potential and more complicated “hunger”, which would not only occur when there is a shortage of food, but also when foods are sufficient, the prevalence of obesity is increasing due to excessive use of fat, sugar and processed foods that are lack of micronutrients. Therefore, micronutritient deficiency is still a significant problem in the transition period and even in the future. In February 2001, the 20th conference of International Consultant Committee on vitamin A (IVACG) and nutritional anemia (INACG) will be held in Hanoi. This is a high appreciation of our programs in controlling micronutrient deficiencies and also is a good opportunity for experience sharing, and to enhance international collaboration in this field.
Ha Huy Khoi, Prof., MD, Former Director of National Institute of Nutrition