www.zincsaveskids.org Zinc deficiency is a significant public health issue. Zinc supplements and fortification are effective and affordable ways interventions and can help prevent the deaths of 800,000 people annually. "Zinc Saves Kids" is an initiative of the International Zinc Association which supports UNICEF's zinc supplement programmes on the ground in Peru, Nepal, Brazil and in Africa.

1. Zinc…essential for life

2. IZA Health and Nutri1on
2000 Zinc and Health Conference, Stockholm, Sweden,
brings together health and nutri1on scien1sts,
governments and NGOs to discuss scien1fic
advances and implica1ons of zinc for public health.
2000 IZA provides funding to establish the Interna1onal
Zinc Nutri1on Consulta1ve Group (IZiNCG), an
interna1onal group of nutri1on scien1sts whose
objec1ves are to promote and assist efforts to
reduce zinc deficiency.
2006 IZA launches an annual conference highligh1ng
zinc’s importance for human health in La1n America.

3. IZA Health and Nutri1on ..cont.
2010 January: IZA launches the 'Zinc Saves Kids'
program in Peru and Nepal
2010 October: IZA announces new commitments to
fund UNICEF programmes in Brazil against zinc
deficiency, and in 2011, to idenGfy an
addiGonal programme in the African
conGnent, where IZA support will be allocated
to region where the most needs are idenGfied.

5. Copenhagen Consensus
• Panel of eight leading economists including five
Nobel Laureates.
• Ranked malnutri1on in children as the most
pressing challenge facing the world today and
concluded that zinc and vitamin A would be the
best investment the world could make for
improvement.
• The benefit for each dollar spent (in terms of
improved health, fewer deaths, and increased
producGvity) was esGmated to be USD $17.

6. Bill Clinton –
Clinton Global Ini1a1ve:
• “Zinc micronutrient deficiency in humans has been
iden1fied as a major global health problem… [It
requires] a comprehensive strategy that includes
dealing with diet, food supplements and
for1fica1ons and agricultural approaches.”
• “There is almost no other strategy on earth that
could save that many lives for that liTle money.”
• “This is something 90 percent of us are unaware of
or wouldn’t have a clue as to what to do about it.”

7. Global causes of under‐five child deaths
Source: Bryce J. et al., Lancet 2005

8. • Improved zinc nutri1on will help lay the
founda1on for greater progress on child
growth and development.
• Access to proper nutri1on helps fight off
illness and disease and is vital to children’s
cogni1ve development and learning.

9. • Zinc‐containing supplements are a quick
and easy, effec1ve and inexpensive
remedy, cos1ng $1‐4 per person per year.
• Therapy for diarrhea requires a 14‐day
supply at a cost of $0.50

10. • UNICEF procurement of zinc tablets
increased from 20 million tablets in 2006
to more than 150 million in 2008. But
this is only a frac1on of what is needed
to treat children affected worldwide.

11. Goal of Zinc Industry
• Raise awareness of the issue
• Reduce infant and child mortality
• Implement a Corporate Social Responsibility
program that will make a difference

12. Zinc supplementa1on plays a key
role in achieving the Millennium
Development Goals (MDGs)
• MDG1: Eradicate extreme poverty and hunger
• MDG4: Reduce child mortality
• MDG6: Combat HIV/AIDS, malaria and other
diseases

13. Zinc’s Role in
Human Nutri1on

14. The role of zinc in human biology
• Essen1al trace element
• Involved in over 300 enzymes in the body
• Zinc “fingers” in transcrip1on proteins determine
binding to DNA
• Intracellular regula1on, e.g., cellular growth,
differen1a1on and death
• Immune func1on ‐ nonspecific immunity, T and B
lymphocytes, cytotoxic ac1vity and an1body
produc1on

15. Effects of Human Zinc Deficiency
• Dwarfism, growth retarda1on
• Derma11s, alopecia
• Mental disturbances
• Decreased immune func1on
• Infec1ons
• Death

16. Zinc deficiency is a significant
public health issue
• 2 billion people worldwide are es1mated to
be zinc deficient
• Zinc deficiency contributes to the deaths of
over 800,000 annually (WHO)
• Approximately 450,000 are children (Brown et.
Al. 2008).

17. Zinc Deficiency is 5th Leading Cause of Death
and Disease in the Developing World
Risk Factor DALY (in %) *
Underweight 14.9
Unsafe sex 10.2
Unsafe water 5.5
Indoor smoke 3.7
Zinc deficiency 3.2
Iron deficiency 3.1
Vitamin A deficiency 3.0
Blood pressure 2.5
Tobacco 2.0
Cholesterol 1.9
* Disability Adjusted Life Years Source: The World Health Report 2002

18. Areas of Zn deficiency
Source The Lancet Maternal and Child Under nutri1on Series January 2008

19. Impact of Zinc Treatments
• 12 high‐quality trials (efficacy and effec1veness)
across regions (mostly Asia) showed benefit of
zinc treatment
• Age groups: 3‐60 mo
• Dose of zinc: ≈20 mg/d (range 5‐45 mg/d)
• Dura1on: 7‐14 days (treatment)

20. Con1nued…
• ~25% reduc1on in dura1on (n=5) and severity of
acute diarrheal episode
• ~30% reduc1on in mean dura1on of persistent
diarrhea
• Reduced incidence of diarrhea and pneumonia in 2‐3
mo. following treatment; 19% reduc1on in diarrhea
prevalence
• Reduces risk of hospitaliza1on (n=2) , all cause
mortality (n=4) and diarrhea mortality (~23%)
• Reduced mortality by 68% in low birth weight infants
Source: Zinc Inves1gators Collabora1ve Group, AJCN, 2000

21. • WHO issued a recommenda1on for zinc
supplements plus Oral Rehydra1on Salts
(ORS) for the treatment of the disease.
• 50 governments have changed their child
health policies to include zinc for diarrhoea
management.

22. World Map – Zinc Deficiency
Soils
Humans

23. Zinc Applications improved wheat grain yield,
on average, 7 % in 3 locations of Punjab State

24. • Zinc deficiency – in humans and crops is a
cri1cal, global, and linked issue
• Addressing zinc deficiency in soils and crops is an
effec1ve approach
• Benefits include increased food, nutri1on, health
and economics, improved food security

25. STRENGTHENING NATIONAL POLICIES
FOR THE PREVENTION AND CONTROL
OF ZINC DEFICIENCY IN VULNERABLE
POPULATIONS OF PERU
2010 – 2012
“Zinc saves kids campaign”
IZA – UNICEF

26. Evidence: Zinc in human nutri1on
• Adequate zinc nutri1on is essen1al for human
health because of zinc’s cri1cal structural and
func1onal roles in mul1ple enzyme systems
that are involved in gene expression, cell
division and growth, immunologic and
reproduc1ve func1ons.
Fuente: Sonja Y. Hess, et al,Food and Nutri9on Bulle9n, vol. 30, no. 1 (supplement)
© 2009

27. • Zinc deficiency affects children’s physical growth and
the risk and severity of a variety of infec1ons (Brown,
2004)
• Mul1ple community‐based interven1on trials
indicate that zinc supplementa1on decreases the
incidence of diarrhea and pneumonia among young
children (Bhuxa et al 1999).
• Clinical treatment studies have shown that zinc
supplementa1on during diarrhea reduces the
severity and dura1on of such illnesses (Bhuxa,2004)

28. Age:
Age:
2 years 9
2 years 6
months
months
Weigth: 10.7 kg.
Weigth: 11.6 kg.
High: 78.3 cm
High: 86.4 cm
Nutritional
Status: Nutritional
Status:
Stunting
Normal
Children at the same age to Andahuaylas in Peru

29. Zinc interven1on, evidences in Peru
• Adding zinc to prenatal iron and folate tables
improves neuronal fetal development. Fuente:
Merialdi,M; Caulfield,LE; Zavaleta,N; et al, AmJ obstetGynecol 1999
• Maternal zinc supplementa1on reduces
diarrheal morbidity in peruvian infants.
Fuente: LoraL. Iannoe, N Zavaleta, Z Leon, et al, (JPediatrics2010:156:960‐4)

30. Peru is one of the countries with the lowest consump1on
of zinc in children under 4 years in La1n America
Fuente: Food and Nutrition Bulletin 28: 1, 2007. Black, RE. 2003. Management Sciences for Health

31. The anemia prevalence in Peru is classified us an
severe public health problem
Anemia prevalence (Hb < 11g/dL) in children under 2 years classified
by severity criteria as health public problem
Sever Moderate Mild
(> 40.0%) (20.0 - 39.9%) (5.0-19.9%)
Bolivia (83.8%) México (37.8%) Chile (8.8%)***
Haití (83.3%) Costa Rica (37.2%)
Ecuador (72.7%) Argentina (24.0%)**
Nicaragua (29.4%)
Perú (61.0%)*
Venezuela (63.8%)** Anemia prevalence (Hb < 11g/dL) in children under 5 years
Cuba (56.7%)** classified by severity criteria as health public problem
Brasil (55.1%)**
Sever Moderate Mild
Guatemala (55.6%)
(> 40.0%) (20.0 - 39.9%) (5.0-19.9%)
Colombia (53.2%)
Panamá (52.5%) Haití (65.8%) Guatemala (39.7%) El Salvador (19.8%)
Ecuador (57.9%) Uruguay (36.1%)*** Nicaragua (17.0%)
Honduras (45.3%)
Bolivia (51.6%) Panamá (36.0%)
El Salvador (40.0%) Venezuela (36.0%)**
Perú (49.6%)* Colombia (33.2%)
Jamaica (48.2%) Brasil (31.4%)**
* DHS 2009 Guyana (47.9%) Honduras (29.9%)
** Children of selected areas of the country. Costa Rica (26.3%)****
*** Estimated values. Chile (1.5%): it
Rep. Dominicana not represent
**** Included children under 7 years ( Hb<12 g/ (25.0%)*** health public
dL).
México (23.7%) problem
Source: Argentina (22.4%)**
Elaborated by WFP with data of OMS, 2007. Vitamin and Paraguay (22.0%)
Mineral Nutrition Information System (VMNIS) y Últimas
Encuestas Nacionales. Cuba IHNA 2005.
Cuba (20.1%)**

32. Situa1on analysis
• IZiNCG es1mates that Peru has 41.6% of its
popula1on at risk of an inadequate zinc intake.
• There is not an official sta1s1c of zinc deficiency in
Peru but anaemia and stun1ng prevalence may
suggest a risk.
• Peru has high prevalence of anemia, especially in
children under three years old.
• The problem affect all the socioeconomic status
popula1ons
• Lower coverage of ferrous supplementa1on in
children.
• Low acceptability of ferrous sulfate syrup
• Deep dispari1es in stun1ng prevalence between
urban and rural areas

33. Infant and Neonatal Mortality rates, are sGll high
The 55 % of infant deaths (< 1 year) correspond to neonatal mortality
( < 28 days of born)
Fuente: ENDES 1992-1996-2000-2004-2009

34. Anaemia prevalence in Peru is a severe
public health problem (*)

35. High Anemia prevalence in children between
6‐36 months affect the all socioeconomic status
Source: Na1onal Ins1tute of Sta1s1c and Informa1on INEI ‐ DHS 2009

36. The percentage of children between 6-36 months with
complete suplemention with ferrous sulphate is very
low versus the high anemia prevalence
Puno 78.5
Cusco
5.1
73.1
Huancavelica
10.5
66.9
Pasco
21.7
65.5
Ayacucho 64.6
12.9
21.4
64.2
Madre de Dios 14.0
64.2
Apurimac 32.1
59.6
Loreto 17.1
Tumbes 59.3
12.9
Junín 58.2
5.6
La Libertad 57.8
6.0
Moquegua 56.2
4.1
Lambayeque 55.4
10.9
Huánuco 55.4
15.1
Cajamarca 54.2
14.4
San Mar1n 54.1
13.8
Áncash 54.1
15.6
Tacna 51.6
8.2
Lima 51.0
10.6
Ica 50.6
6.7
Arequipa 50.6
12.9
Ucayali 49.9
13.4
Piura 49.0
8.5
Amazonas 48.5
6.2
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
90.0
Suplementa1on Anemia
Source: Na1onal Ins1tute of Sta1s1c and Informa1on INEI – DHS 2005‐2007

37. In the last five years the stunGng prevalence in Peru has had a
significant reducGon
(Percentage)
Source: Na1onal Ins1tute of Sta1s1c and Informa1on INEI ‐ DHS 200, 2005, 2007, 2008, 2009

38. Acute respiratory infec1on (IRA) is decreasing ,
but acute diahorrea disease (EDA) remain in
child under five .
Source: DHS 200,2004-2006, 2007-208, 2009

39. DistribuGon of the poverty by regions (2009)
National average: 34.8
Source: ENDES 2009

40. DistribuGon of the Under Five Mortality Rate by
regions (2009)
National average: 31
Source: ENDES 2009

41. DistribuGon of under five anemia prevalence by
regions (2009)
National average: 37.2
Source: ENDES 2009

42. DistribuGon of stunGng prevalence by regions
(2009)
National average: 18.3
Source: ENDES 2009

43. Advances of the country
1. Strong poli1cal commitment at na1onal and
sub‐na1onal level: President Garcia sets the
goal of reducing stun1ng from 25% to 16% in
5 years‐ 2006 to 2011 (July 2006)
2. Development of a na1onal strategy against
child malnutri1on: CRECER
3. Redesign of na1onal social programs around
nutri1onal outcomes: PRONAA, JUNTOS,
FONCODES

44. Advances of the country
4. Alloca1on of earmarked resources from
na1onal and local governments: In 2008
Ministry of Finance creates two result‐based
budgetary programs: “Ar9culado Nutricional”
and “Maternal and Neonatal Health”
5. New evidence‐based technical norms and
protocols:
– Technical Norm 063‐2008: defines priority health and nutri1on
interven1ons (ref. Lancet Series)
– Ministerial Resolu1on N° 648‐2008/MINSA: prepara1on of a na1onal
ac1on plan for mul1micronutrient supplementa1on (Sprinkles,
Chispitas, Estrellitas).

45. Strategy Development: ESTRATEGIA NACIONAL CRECER
Horizontal articulation
What is CRECER?
• Integrated strategy against chronic malnutri1on
and poverty, launched in July 2007.
ObjecGves and targets:
• Reduce chronic malnutri1on from 25% to 16% by
2011
• Axend, by 2011, one million of under‐5 children
and 150,000 pregnant women
• Increase access, coverage and quality of basic
services in 880 districts of extreme poverty.
Vertical articulation
Coverage:
• At present, CRECER covers 638 districts, 500,000
under‐5 children and 120,000 pregnant women.
Financing:
• Public funds from par1cipa1ng ministries and
social programs.
• Strategic budgetary programme of Ministry of
Finance “Ar9culado Nutricional”
• Regional and municipal budgets
• Private funding and Interna1onal coopera1on
45

46. MNP Supplementa1on strategy in
Apurimac, Ayacucho and Huancavelica
ObjecGve: Reduce the micronutrient deficiencies in
children under three years old, especially
anemia through intersectorial interven1on.
The strategy has begun in October 2009
Area: Ayacucho, Apurimac and Huancavelica
Strategic components:
Provision
Educa1on and communica1on
Monitoring and evalua1on
Target: 109, 496 children under 3 years old.
Advances: At june 2010, 70% of children have
received de suplement.

47. IZA PROPOSAL
GENERAL OBJECTIVE
Contribute to the improvement of child survival,
growth and development in Peru, through the
strengthening of na1onal policies for the
preven1on and control of micronutrient
deficiencies ‐ with a special emphasis on zinc ‐
and through suppor1ng its implementa1on
na1onwide

48. SPECIFIC OBJECTIVES
• Improve the zinc intake in children under three years old through
the mul1‐micronutrient powder supplementa1on and the
promo1on of adequate complementary feeding in four regions.
• Reduce the incidence and severity of diarrhea diseases in children
under five years old in vulnerable areas, through the therapeu1c
zinc supplementa1on in four regions.
• Reduce the anaemia prevalence in children under three years old
through the mul1‐micronutrient supplementa1on and the
promo1on of adequate complementary feeding in four regions.
• Improve the knowledge about effec1ve zinc interven1ons in public
programmes of survival, growth and child development in four
regions.

49. THE GOALS
• Reduce en 15% de incidence of Acute
Diarrhoeal Diseases in children < 5 years old in
vulnerable areas.
• Increase in 40% the coverage of children < 3
years old suplemented with
mul1micronutrient with zinc in vulnerable
areas.
• Reduce in 30% the anaemia prevalence in
children < 3 years old in vulnerable areas.

50. 165,700 children under 3 years old
from Apurímac, Ayacucho, Cusco,
Huancavelica y Ventanilla regions.
REGION CHILDREN
< 3 years
LIMA (Ventanilla) 15,000
APURIMAC 22,000
AYACUCHO 35,700
CUSCO 64,000
HUANCAVELICA 29,000
TOTAL 165,700
Source: Proyected PopulaGon of the MoH based in 2007
Census

51. LINES OF ACTION
1. Advocacy to ins1tu1onalize a na1onal policy
2. Strengthening the capaci1es of health and other
social sector personnel
3. Strengthening social communica1on strategy to
promote family prac1ces of micronutrients
consump1on
4. MNP supplementa1on as part of the care
package for children, zinc supplementa1on as
adjunc1ve therapy for diarrhoea in children and
local produc1on of MNP and zinc supplement
5. Monitoring, evalua1on and research

52. Children from Ayacucho´s family
supplemented with MNP