The Report on Maternal Micronutrient Deficiencies.

The report on Maternal Micronutrient Deficiencies
The report on Maternal Micronutrient Deficiencies
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1The report on Maternal Micronutrient Deficiencies
Introduction
Part 1
To maintain a healthy brain, muscles, bones and nerves our body requires an adequate
amount of macro and micro nutrients. The nutrient helps in maintaining a strong immune system
and improving the function of the body parts. Almost 30 micro nutrient consisting of vitamins
and minerals are required sufficiently by the body. The body is not designed to produce this
amount of nutrients by itself thus regular intake of food containing these nutrients is essential for
the functioning of the body. The intake of this micro nutrient increases when a woman is
pregnant (Bailey, West & Black, 2015). The diet taken by the lady should consist of minimum
amount of daily micro nutrient requirement.
The same goes for the Vitamin D micro nutrient, a minimum dose of 15 μg/d of vitamin
D is required daily by an expecting mother. A regular daily dose of the entire essential micro
nutrient is recommended to woman before and after conception. During pregnancy Vitamin D
deficiency becomes very common among 76% of the woman (Haider, & Bhutta, 2017). Vitamin
D is a fat soluble vitamin that is found in milk, juice, green leafs vegetables, eggs and fish. The
kidney in the body requires vitamin D to absorb calcium from the intestines for appropriate bone
mineralization and growth. Severe vitamin D deficiency can result in congenital rickets and
fractures and less developed and week body structure of the baby. It has been seen that if vitamin
D deficiency is found pregnant women, then supplements at level 1000-2000 IU per day should
be given (Schüpbach et al., 2017).
During pregnancy a women should gain weight instead of losing weight. The most
common weight gain is 8-9 kgs at the end of the gestational period. This accounts for fetus,
placenta tissues and amniotic fluid. Pregnancy is also the period of accelerated starvation, when
the body is starving to eat more than regular intake (Kallioinen et al., 2017). It is associated with
number of negetive maternal and child health outcomes. Which include pre-eclampsia,
gestational diabetes mellitus, an increased maternal inflammatory cytokines, and increased
insulin resistance. Incase of the offspring the risk of preterm birth increases, leading to neonatal
hypocalcaemia, rickets in infancy, asthma and increased BMI during childhood.

2The report on Maternal Micronutrient Deficiencies
According to a data the low and middle income group country has seen a huge rise of
vitamin d deficiency in expecting mothers and off springs. But the main reason for VDD is
subject to what kind of life style is followed including the daily dietary intake. Women living in
countries of Asia, Africa and middle east are found to be unable to meet their daily micronutrient
demands during pregnancy due to poor diet (Chen et al., 2019). Low income group women do
not have access to eggs, milk and oily fishes leading to VDD. Specially in major region of Asia
the population is dependent on the vegetarian diet the chances of VDD increase affecting their
health and the health of their offspring (Keats et al., 2019). This is just one micronutrient the
large amount of population in LMIC nation are suffering from multi nutrient deficiency which
can be sometimes fatal, which has gone unnoticed through centuries. According to research done
by NCBI the insufficiency of vitamin D is prevalence (>90%) in Chinese women, which is the
highest. Women from Iran and Pakistan (89.0%) and 80% for the Indian women. The study
conducted in Nigeria resulted in defining that sun is an important factor in synthesizing vitamin
D, only 39.4% of maternal women were found to be vitamin D deficient (Paganini, &
Zimmermann, 2017). The main reason for the VDD is lifestyle and daily food intake. The
regular sun bath and vitamin sufficient food can minimize the birth defects in new born and also
improve the life expectancy of the maternal women.
Part 2
Pregnancy is a time of internal growth and physiological changes in the women and her
developing fetus. The presence of every single nutrient in the body is essentially important. If
any nutrient is not present in an adequate amount in the body then the whole process of
pregnancy and birth can go wrong inviting complications. The mother can experience pregnancy
complications as preeclampsia and infections. A normal intake level of compound vitamin D or
cholecalciferol should be in its metabolite 25-hydroxy-vitamin D or 25(OH)D, this is what a
pregnant women should be maintained throughout the pregnancy. According to a study at
Namibia (Africa) a sample size of 340 individuals inclusive of male and female where check for
the vitamin d level (Omotayo et al., 2018). Only 17.4% of the individuals showed a balanced
level of 25(OH) D level of < 20 ng/ml in the body where as rest of the sample turned positive for
vitamin D deficiency (World Health Organization, 2015). The test where done by collecting
blood samples in serum clot activator tubes for total calcium, inorganic phosphate and albumin.

3The report on Maternal Micronutrient Deficiencies
A 4000 rpm Centrifugation for 5 min was done. Namibia being close to equator gets whole year
adequate sunlight and sunlight is a producer of vitamin d in the skins. But the dark complexion
of the African population makes the vitamin D synthesis difficult for them. The poor diet and
low sun light benefits can be a major reason for the deficiency. Even the blame can be put on the
sun scream as SPF 30 and above sun scream prevents the production of vitamin D by 95% .
Over many years there has seen several interventions in places of Africa. This time the
intervention was done by its government with the support of WHO. The target group population
was Namibia and target sample was pregnant women and their off springs (Mwangi et al., 2015).
The intervention was aimed to rising awareness and cause of case of vitamin D defiance
pregnant women. The intervention first recorded the sample size and then tested it for the VDD.
As much as 80% of the population was found VDD. The objective of the intervention was to
treat people with VDD and specially as much as pregnant women and children of Nairobi.
Namibia is a country in LMIC nations that suffers with a huge amount of financial,
medical and other food shortage problems. Namibia is not having all basic amenities along with
health of its people it lacks tremendously. World health organization with the help of the local
government planned a survey to understand the level of deficiency of multi nutrients in the
pregnant women of Namibia. It was found out that about 70% of the population was at the risk of
micronutrient deficiencies. The sample also included school going kids and kids as young as 1
year (Omotayo et al., 2018). The population is at risk of deficiencies of folate, thiamin, vitamin
B12, and vitamin D. With a specifically developed program to control the increasing case of
Vitamin D deficiency birth the governmental body followed certain planned steps.
The intervention was developed taking all major considerations of minimizing the impact
of vitamin D deficiency in women and child. The program was dived into three major parts. The
health education and promotion, The fund raising, and vitamin and multi nutrients
supplementation.
Time frame
The planning of the intervention -3 months
Forming of the body -1 months

4The report on Maternal Micronutrient Deficiencies
Marking territory-2 months
Eduacting-2 months
Funding -3 months
Data collection- 2 moths
Prevention and control
The important factor is to somehow educate the population about the risky impact of
vitamin deficiency. To educate them with the help of local government a program to be designed
to attract the attention of the women. They are to be educated about the consequences of the
vitamin deficiency. To develop a sustainable program that can be used year on year to create
awareness. An improved diet was provided to the people by educating them about improving
their agriculture, home gardens, small livestock holdings, and horticulture to increase their food
availability (Omotayo et al., 2017). They were also told about the food storage and cooking
methods. The major part was played by the local government in providing the families with
necessary requirements.
Raise Fund for the cause.
The affluent countries in the west part of the world that has found their vitamin
deficiency bravely was now going to take part in improving the health of heir neighbors. WHO
has developed program to create awareness among the other half of the world to contribute to
cure the world. The funds was arranged from UNICEF, WHO, World Food Program and other
philanthropy organizations. The funding was used to improved the agricultural and farming
capacities of the population. That was very impactful in bring down the food shortage. The
funding also helped in sorting other nutrient related problems. The multi nutrient deficiency was
addressed by just addressing the vitamin D deficiency. Other major problems faced by the
pregnant women are the deficiency of more than 10 to 20 micro nutrients including a very
important component of Folic acid (Omotayo et al., 2018). By improving the food production
one particular area helps in improving the quality of life of millions of people and proving food
security.

5The report on Maternal Micronutrient Deficiencies
Supplementation and fortification
Supplementation and fortification has been developed to carve the vitamin deficiency and
is supported by UNCEF. In many countries the supplementation is done for vitamin A. using
several other process and varying stages to include the intake of vitamins in the food. Deficiency
of vitamins and other micro nutrient increase the rate of mortality specially in children under the
age of 5. Vitamin supplementation programs have considerably decreased the consequences of
deadly decease. It has reduced fatality rates by 50% from rickets and approximately 40% from
severe calcium deficiency. The supplementation programs with 2 doses per year initiated by
UNICEF cure the deficiency internationally. Efforts have been made to make supplementation
days part of routine community care for young children. This effort has helped Namibia to be
able to improve the weak health system and minims the mortality rate in the children (World
Health Organization, 2015). The women who are pregnant are given regular tablets of vitamin d
and other micro nutrients to compensate the deficiency.
Earlier it was common in USA but now it is implemented worldwide to fortifying
selected food items like oil, commercial foods with vitamins. Over 80 years the use of
fortification has been successful in eliminating micronutrients deficiency. LMIC countries are
newly getting involved in the fortification custom. A measurable improvement was seen in the
pregnant women and young kids who consumed vitamin fortified food items. Major countries
had made fortification compulsory to provide balance food to their population (World Health
Organization, 2015).
The outcome
The outcome has been measured by the same procedure as used earlier and the results are
wonderful. A proper data cant be presented but the data from the medical centre and nursing
homes has given proof that 50% of the women population has seen a difference in health. The
deficiency of some vitamins including vitamin D has minimized. The reported case of weak
bones and other calcium related diseases has seen a fall. As the intervention is not very old and it
may take some time to impact positively a large population.
Strength

6The report on Maternal Micronutrient Deficiencies
The intervention had the capacity to reach a large audience as it was backed by WHO. The local
government was working towards one common goal and that made the intervention a success.
Limitation
The people of the country are uneducated and follow traditional methods to treat deceases. That
is a point where the interventions fail to explain the benefits of the medical aids. The poor
population is not interested in getting educated.
Conclusion
The world wide problem of vitamin deficiency is a big issue in the present for the LMIC.
This needs a more attention and more resources to address the problem and eliminate it from the
planet. Vitamin D has taken many lives and can take more if not treated. Countries like Namibia
are battling from these problems since centuries and never got a proper solution. But even one
such intervention has the power to minimize the consequences by 60%. The lives that can be
saved will be innumerable.
Reference
Bailey, R. L., West Jr, K. P., & Black, R. E. (2015). The epidemiology of global micronutrient
deficiencies. Annals of Nutrition and Metabolism, 66(Suppl. 2), 22-33.

7The report on Maternal Micronutrient Deficiencies
Chen, S., Li, N., Mei, Z., Ye, R., Li, Z., Liu, J., & Serdula, M. K. (2019). Micronutrient
supplementation during pregnancy and the risk of pregnancy-induced hypertension: A
randomized clinical trial. Clinical nutrition, 38(1), 146-151.
Haider, B. A., & Bhutta, Z. A. (2017). Multiple‐micronutrient supplementation for women
during pregnancy. Cochrane Database of Systematic Reviews, (4).
Kallioinen, M., Ekström, E. C., Khan, A. I., Lindström, E., Persson, L. Å., Rahman, A., &
Selling, K. E. (2017). Prenatal early food and multiple micronutrient supplementation
trial reduced infant mortality in Bangladesh, but did not influence morbidity. Acta
Paediatrica, 106(12), 1979-1986.
Keats, E. C., Haider, B. A., Tam, E., & Bhutta, Z. A. (2019). Multiple‐micronutrient
supplementation for women during pregnancy. Cochrane Database of Systematic
Reviews, (3).
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Omotayo, M. O., Dickin, K. L., Pelletier, D. L., Martin, S. L., Kung'u, J. K., & Stoltzfus, R. J.
(2018). Feasibility of integrating calcium and iron–folate supplementation to prevent
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Omotayo, M. O., Dickin, K. L., Pelletier, D. L., Mwanga, E. O., Kung'u, J. K., & Stoltzfus, R. J.
(2017). A simplified regimen compared with WHO guidelines decreases antenatal
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Omotayo, M. O., Martin, S. L., Stoltzfus, R. J., Ortolano, S. E., Mwanga, E., & Dickin, K. L.
(2018). With adaptation, the WHO guidelines on calcium supplementation for prevention
of pre‐eclampsia are adopted by pregnant women. Maternal & child nutrition, 14(2),
e12521.

8The report on Maternal Micronutrient Deficiencies
Paganini, D., & Zimmermann, M. B. (2017). The effects of iron fortification and
supplementation on the gut microbiome and diarrhea in infants and children: a
review. The American journal of clinical nutrition, 106(suppl_6), 1688S-1693S.
Schüpbach, R., Wegmüller, R., Berguerand, C., Bui, M., & Herter-Aeberli, I. (2017).
Micronutrient status and intake in omnivores, vegetarians and vegans in
Switzerland. European journal of nutrition, 56(1), 283-293.
World Health Organization. (2015). WHO global strategy on people-centred and integrated
health services: interim report (No. WHO/HIS/SDS/2015.6). World Health Organization.

9The report on Maternal Micronutrient Deficiencies
Appendix
1. Child mortality rates
2. Need for nutrient during pregnancy
3. Donor in the world.

10The report on Maternal Micronutrient Deficiencies
4.