Program

(approach)

Elements

Micronutrient Initiative

(Vitamin A supplementation)

International Potato Centre

(Promotion of orange-fleshed

sweet potato)

Purpose To reduce child mortality by

temporarily improving VA status

To improve serum retinol through

daily intakes of physiological

Effect on VAD Symptom relief; VAD persists Can eliminate VAD and symptoms

Level of impact Individual Individual, family, and community

Behavior Change

Required

Bi-annual visit to health clinic Daily farming and eating habits

Duration of effect Short-term (months) Long-term (generations)

Cost Inexpensive; requiring continuous

investment indefinitely

Resource-intensive at first;

eventually self-sustaining

Impact on food

security

No direct impact Direct impact

Level of complexity Conceptually simple Complex and multisectoral

Main agents of

change

Donor-centred, top-down

approach; dependency upon

outside assistance

Person-centred, bottom-up

approach; ownership by targeted

population

Background: One third of preschool children in Haiti are deficient in Vitamin A (VA). VA deficiency (VAD) is a major public health problem because it can lead to blindness and compromised immunity while contributing to anemia. Supplying adequate VA can drastically reduce child mortality. The World Health Organization has outlined four approaches to help reduce VAD:

• breastfeeding promotion

• food fortification

• VA supplementation (VAS)

• promotion of VA-rich diets

Vanessa Pike (Young), RD, MPH candidate | University of Toronto | NFS1221 Nutrition Programs and Strategies

These two approaches were analyzed in the Haitian context, as explored through two corresponding programs:

• Micronutrient Initiative (MI)• International Potato Centre (CIP)

Micronutrient Initiative (Vitamin A Supplementation):• Bi-annual mega-dosing of children <5 years of age using VA

capsules• Delivered at health facilities and through community-based

health workers• Currently reaching ~54% of children <5 in Haiti • Highly effective in reducing child mortality (23% decrease

when using VAS in areas of full coverage)• “Strongly recommended” by the World Health Organization• Low cost per person reached – as little as $0.02 per capsule

International Potato Centre (Promotion of Orange-Fleshed Sweet Potato, OFSP):• Agriculture-based promotion coupled with education at the community level• Builds micronutrient supply into daily food consumption patterns• Provides access to planting material, technologies, and extension advice• Allows farmers to improve OFSP productivity, and therefore increase income• Works with policy makers, investors, and program designers to create a supportive

environment• Amount of OFSP to ensure adequate VA for children <5 years is about ½ cup or less

Table 1: Comparison of Two Programs Addressing VAD in Haiti

Figure 1: The Health Impact Pyramid (Frieden, 2010)

Conclusion:• VAS is a temporary solution to VAD among children in Haiti • As food-based approaches have not yet reached sufficient

coverage levels in Haiti, VAS through programs such as MI is still currently warranted to prevent childhood morbidity and mortality

• It is simultaneously essential that food-based approaches such as those of CIP be given more priority since they are sustainably empowering and provide much more than just VA

• Multiple methods of addressing VAD should work in tandem • A framework should guide the continuation, scale-up, or

phase-out of each approach at the appropriate time and within appropriate populations

Research Question:What are the similarities and differences between these two program approaches to addressing VAD among Haitian children, and under which circumstances should each approach should be used?

Comparison of Both Program Approaches:• The Health Impact Pyramid (Figure 1) demonstrates that the potential to

improve health at the population level is often inversely correlated with effectiveness at the individual level

• MI is situated near the top of the pyramid, and CIP closer to the bottom• Table 1 allows further comparison of the MI and CIP program approaches