Hidden Hunger: Approaches to 
Tackling Micronutrient 

Deficiencies
Judith Hodge



http://nourishingmillions.ifpri.info/

Micronutrient interventions (1 of 2)
• More than 2 billion people suffer from micronutrient malnutrition, 

known as “hidden hunger.”
• “The big 3”

• Vitamin A deficiency – leading cause of blindness in children
• Iodine deficiency – causes 18 million babies to be born mentally impaired 

each year
• Severe anemia (iron deficiency) – associated with 115,000 deaths of 

women during childbirth per year
• Targeting prevention/treatment to pregnant and lactating women, 

infants, and young children yields higher rates of return by 
improving health, nutritional status, and cognition later in life.



http://nourishingmillions.ifpri.info/

Micronutrient interventions (2 of 2)
• Global efforts to ensure access to iodized 

salt reduced the number of iodine-deficient 
countries from 130 before 1990 to 32 in 2011.

• Vitamin A supplementation was scaled up 
to improve coverage rates of children from 
16% in 1994 to 77% in 2009.

• Distribution of micronutrient powder 
sachets by UNICEF and the World Food 
Program rose from 50 million to 350 million 
from 2008-2010.

Micronutrient Initiative



http://nourishingmillions.ifpri.info/

Micronutrient case study: universal salt 
iodization in China (1 of 2)
China successfully scaled up universal salt iodization through the 
National Iodine Deficiency Disorders Control Program, forming a 
partnership between the Ministry of Health and the salt industry.

Impact
• Consumption of iodized salt increased from 20% in 1990 to >97% of 

salt consumed in 2005.
• Production and distribution of salt in China rose from 5 million tons 

(not all iodized) to 8 million tons of iodized salt in under 7 years.



http://nourishingmillions.ifpri.info/

Micronutrient case study: universal salt 
iodization in China (2 of 2)
Factors contributing to success
• High-level political leadership recognized the impact of iodine deficiency 

on children’s intelligence and the implications for human and economic 
development.

• The State Council established a special fund of US$125 million to upgrade 
production facilities for iodized salt and re-centralized the salt industry 
as a state monopoly with legal enforcement systems to prohibit the sale 
of non-iodized edible salt.

• Iodized oil supplementation and subsidies for iodized salt reached 
vulnerable populations.

• A shift from national to provincial standards addressed areas at risk of 
iodine excess.



http://nourishingmillions.ifpri.info/

Micronutrient case study: “Sprinkles” in 
Mongolia (1 of 2)
Mongolia’s Ministry of Health collaborated with development partners to 
deliver an integrated nutrition package, including micronutrient powders 
called Sprinkles, targeted to pregnant and breastfeeding women and 
children <5 yrs to address alarming rates of anemia and rickets.

Impact
• Anemia prevalence fell from 55% to 33% during the pilot phase, 2002-

2004
• Rickets prevalence fell from 62% to 25% and stunting fell from 26% to 9% 

during the 2nd phase, 2005-2010
• Program scaled up to national level reaching 50,000 children 6-24 

months old



http://nourishingmillions.ifpri.info/

Micronutrient case study: “Sprinkles” in 
Mongolia (2 of 2)
Factors contributing to success
• Powder wrapped in culturally acceptable packaging with local 

language instructions and artwork
• Adjustments to pilot program included new amounts of nutrients 

in Sprinkles, vitamin D supplementation, behavior change 
initiatives, reduced production costs, and volunteer mothers to 
mobilize communities

• Micronutrient working groups established at national, provincial, 
and district levels



http://nourishingmillions.ifpri.info/

Micronutrient interventions: Lessons learned

• Staged approaches – from pilot to district to national levels – 
afford opportunities to iron out issues such as the levels of 
micronutrients required by different populations.

• Nutrition champions in influential positions help ensure support 
and government buy-in for interventions.

• Integrating micronutrient interventions into existing health 
programs and training community volunteers can help make them 
more sustainable.

• Ongoing monitoring and evaluation is crucial for gauging whether 
interventions are still relevant.


	Slide Number 1
	Hidden Hunger: Approaches to Tackling Micronutrient Deficiencies
	Micronutrient interventions (1 of 2)
	Micronutrient interventions (2 of 2)
	Micronutrient case study: universal salt iodization in China (1 of 2)
	Micronutrient case study: universal salt iodization in China (2 of 2)
	Micronutrient case study: “Sprinkles” in Mongolia (1 of 2)
	Micronutrient case study: “Sprinkles” in Mongolia (2 of 2)
	Micronutrient interventions: Lessons learned