Letter on micronutrient deficiency management, by Donald McLaren

Dear Editor

I was amazed, and greatly disappointed, to read the report of the workshop on Community Based Approaches to Managing Severe Malnutrition, and the piece on this subject in Field Exchange, March 2004, pp 16-19. Why was there no mention, whatsoever, about any of the micronutrient deficiencies? These almost invariably accompany severe proteinenergy malnutrition, and therefore constitute a very important part of "severe malnutrition". All those concerned should surely know that deficiency of vitamin A, iron, iodine, and zinc, and possibly others, are responsible in large part for the very high rates of mortality and morbidity among young children and pregnant and lactating women, and others, in developing countries. I find it ironic that on the very next pages you have printed an excellent article by Dr Andre Briend, which rightly draws attention to the scandal, and reflects an area in which I was actively involved in over several decades, in trying to combat the criminal micronutrient inadequacy of many refugee rations. The most startling feature of Table 1 in Dr Briend's article is the absence of both vitamins A and C. Even to this day, there are constantly recurring reports of frank scurvy and non-blinding and blinding xerophthalmia.

Yours faithfully

Donald S. McLaren, MD, PhD, FRCP

The ENN would like to point out that the report referred to in the letter above was the proceedings of a meeting summarised by the ENN, and included with issue 21 of Field Exchange. While micronutrient deficiencies were discussed at the meeting, the main focus of discussions was around the 'new' strategy of addressing severe malnutrition through community based care. It should also be noted that all diets used in projects described in the Dublin report used foods that were highly fortified with all micronutrients (along the WHO recommendations for F100 rehabilitation diets). Nonetheless, Dr. McLaren's letter, and the article by Andre Briend to which he refers, do highlight how we can never be complacent about micronutrient deficiencies. Sadly, the steady flow of articles about micronutrient deficiency outbreaks in humanitarian crises received by the ENN and often published in Field Exchange bear testimony to this.