Meeting report

Vitamin D and Other Micronutrients in Maternal and Child Health Conference, Amman Jordan March 28-29 2014.

Organized by the University Of Jordan In collaboration with the Jordan MOH.

Sponsored by UBS foundation.

Main Findings: Vitamin D (VD) is a Key micronutrient for Child Health and Development: Jordanian Children are deficient.

Introduction:

Considering the importance of VD in child health the University of Jordan Medical School convened a group of scientists and clinicians from around the world to discuss the wide ranging effects of VD on child health and assess the information available from Jordan on VD status of Jordanian children and recommend potential actions based on the local information.  

The group included:  Dr. Zulfiqar Bhutta, AKU Pakistan, Dr. Najwa Khuri-Bulos University of Jordan and Vanderbilt University, Dr. Manfred Eggersdorfer DSM, Gregg Garret GAIN, Dr. Miriam Yiannakis . World Vision, Dr. Natasha Halasa Vanderbilt University, Dr. Douglas Heimburger Vanderbilt University, Dr. Bruce Hollis MUSC, Grenville Hopkinson, One World, Dr. Jonathan McCullers St Jude Hospital, and Vanderbilt University, Dr. Fernando Pollack, Vanderbilt University, Dr. Ricardo Uauy London School of Tropical Medicine and Hygiene, Dr.Sten Vermund Vanderbilt University.  

During the meeting an overview of vitamin D and its importance in health and its relationship to infections was extensively made. In addition regional review of the subject was provided by the WHO. The role of this and other micronutrients in health and in disease were also reviewed.  During the meeting an overview of vitamin D and its importance in health and its relationship to infections was extensively made. In addition regional review of the subject was provided by the WHO. The role of this and other micronutrients in health and in disease were also reviewed.  

The expert group also considered the present situation of children in Jordan.  The available information from Jordan reveals that 94 % of children at birth are below the normal (<50nm/L) and 67 % are markedly deficient (<20 nm/L).  Based on the available information we can state that these levels are associated with impaired immunity, increased incidence and severity of pneumonia, and decreased resistance to Tuberculosis and other chronic infections. This is of great relevance to growing children. In addition vit D is also required for normal bone mineralization and linear growth, thus prevention is necessary to avoid skeletal and joint malformations.  These medical problems will have lifelong consequences for these children, their families and will burden the health care budget of the nation.  Moreover, vit D deficiency can be avoided by simple and cost effective measures such as providing vit D supplements to infants and young children and securing the women of reproductive age are also sufficient before conception.

There are several manners of providing vit D to women of reproductive age that are considered safe and effective. Despite abundant solar UV exposure women are not commonly exposed to UV rays as demonstrated by the results of the most recent micronutrient surveys. However Vit D can be incorporated in the micronutrient supplementation of women before pregnancy; which at the very least should include Folate, iron, iodine, vit D and other vitamins or minerals considered insufficient based on dietary consumption or biochemical data of the respective population. The cost and consequences of inaction exceeds by far what is expended in providing these micronutrient starting at the pre-conceptional visit (present knowledge indicates that the key to a healthy pregnancy and neonate is preparing for it before it occurs). What we fail to do during this critical period has life consequences for infants and mothers. These far outweigh the costs.

In light of the antecedents provided,  the expert group recommends:

  1. The need to maintain active surveillance of vit D status of the Jordanian population in order to take timely action and prevent the human and economic costs of inaction. 
  2. Define a specific program, duly supported with human and material resources to act based on the surveillance information. These health professionals can be of various disciplines but at least include ( pediatricians, public health experts, nurses, medics, nutritionists)  and be supported by health economists in order to assess best (most cost effective) actions for the given situation. 
  3. Periodic evaluations and reporting of progress of actions taken to eradicated vit D deficiency. For example information on the progress of flour fortification started in 2010 is not public domain. Need to address the progress of Micronutrient Deficiency Survey. Need for inclusion of Pregnant women, infants and elderly the in the National Micronutrient status data base.
  4. Implement actions based on the surveys and the recommendations of national and international experts, consider the absolute need for evaluation of implementation process and outcomes as needed. Include professional associations in this process.
  5. Ministry of Health should secure administrative and economic support for these initiatives with local funds or international cooperation. 
  6. . The group also considered the recent focus on nutrition by the Asian Football Confederation. This creates a unique opportunity to mobilize the public for better nutrition outcomes especially as Jordan prepares to host the FIFA U17 World Cup in 2016. The group recommended that Jordan take this opportunity to host a conference that examines global progress towards improving the nutrition of women, mothers and adolescent girls. Preparations and funding for such a meeting should be sought in the coming few months in order to organize this in time for that event.

Specific actions suggested by experts:

Mother's nutrition
"all women to be replete in Vit D before they conceive 6,000 IU vit D every day"

Infants nutrition explore options to supplement the infant vit D 400 IU per day or Periodic  300.000 vat D to be administered twice per year and given during the immunization activities in the first year of life. 

Such a Program should not be in isolation but integrated to other major programs such as the EPI which in Jordan is highly successful.  In addition  vit D fortification of nutrients should be widened to include dairy products and possible fruit juices manufactured in Jordan.

Najwa Khuri-Bulos MD, FIDSA
Ricardo Uauy MD, PhD
Manfred Eggersdorfer. PhD