MICRONUTRIENT

SUPPLEMENTATION
ALMA MAGDASOC- LOZADA, RND, MAPA, PhD PA
Nutritionist- Dietitian IV
DOH RO V, Legazpi City
3 – pronged strategy in response to
micronutrient malnutrition in the country :

1. food fortification – addition of

nutrients to staples (rice, flour,
cooking oil & sugar), in salt &
processed foods
3 – pronged strategy in response to
micronutrient malnutrition in the country :

2. Diet diversification- promoting

the consumption of a variety of
foods rich in micronutrients
3 – pronged strategy in response to
micronutrient malnutrition in the country:

3. Micronutrient supplementation- a
short term intervention, intended to
prevent &/or correct high levels of
micronutrient deficiencies by
providing large doses of Vitamin A,
iron and iodine.
Micronutrient Supplementation

Garantisadong Pambata
- integrated package of services concerning
health, nutrition & environmental
sanitation
Micronutrient Supplementation
Vitamin A supplementation - protection of
children against measles & malnutrition
which causes decreased resistance against
infection
Iron supplementation – protection for
children against iron – deficiency, paleness
& easy fatigability
Micronutrient Supplementation
for Pregnant Women
• Iron/Folic Supplementation
• Preparation: 60 mg elemental iron with
400mcg folic acid tablets
• Dosage/ Frequency/ Duration: 1 tablet
one a day as soon as pregnancy is
determined.
• Give at least a total of 180 tablets to be
taken for the whole duration of the
pregnancy
Micronutrient Supplementation
for Pregnant Women
• Calcium Supplementation
• Preparation: Calcium carbonate 500mg
tablets
• Dosage/ Frequency/ Duration: 1 tablet 3
times a day starting 20 weeks AOG ( age
of gestation) until the end of pregnancy
Micronutrient Supplementation
for Pregnant Women
• Iodine Supplementation
• Preparation: capsule, 200mg elemental
iodine
• Dosage/ Frequency/ Duration: Give 2
capsules single oral dose once a year
during the 1st trimester
Micronutrient Supplementation
for Pregnant Women
• Iodine Supplementation
• Iodine Deficiency Disorder (IDD) prevalence is
classified as moderate or severe (Urine Iodine
Excretion is <20mcg/L to 49 mcg/L)
• Cretinism and neonatal hypothyroidism are
present
• Areas where <90% of households are using
iodized salt and the median UIE among school
children is <100mcg/L
Micronutrient Supplementation for
Post-Partum/ Lactating Women
• Iron/Folic Acid Supplementation
• Preparation: 60mg elemental iron with
folic acid 2.8mg tablets
• Dosage/ Frequency/ Duration:
• Post-partum Women: Give 1 tablet
once a day for a minimum of 3 months
• Women of Reproductive Age: Give 1
tablet once a week until one gets
pregnant again
Micronutrient Supplementation for
Post-Partum/ Lactating Women
• Vitamin A supplementation
• Preparation: capsule 200,000 IU
• Dosage/ Frequency/ Duration: Give 1
capsule within 1 month after delivery
Micronutrient Supplementation for
Post-Partum/ Lactating Women
• Iodine supplementation
• Preparation: capsule 200mg elemental
iodine
• Dosage/ Frequency/ Duration: Give 2
capsules single oral dose if not given in
the past 12 months
Micronutrient Supplementation for
Pregnant/Post-Partum/Lactating Women
clinically diagnosed with Iron Deficiency Anemia
• Iron Supplementation
• Preparation: 60 mg elemental iron
with 400mcg folic acid tablets
• Dosage/ Frequency/ Duration: Give
2 tablets once a day for 3 months
Micronutrient Supplementation for
Pregnant/Post-Partum/Lactating Women
clinically diagnosed with Iron Deficiency Anemia
• Iron Supplementation
• Evaluate after 1 month. If there is adequate response
to therapy (increase in hemoglobin by 1-2g/dL)
continue supplementation and re-evaluate after 2-3
months. If there is no adequate response to the one
month oral iron therapy, evaluate for other possible
cause of anemia
• After completing the 3 months of therapeutic
supplementation, pregnant women should continue
preventive supplementation regimen
Micronutrient Supplementation for Pregnant
Women clinically diagnosed with Xerophthalmia

• Vitamin A Supplementation
• Preparation: capsule 100,000 IU
• Dosage/ Frequency/ Duration: Give 1 capsule
of 100,000 IU once a day for four weeks upon
diagnosis, regardless of age of gestation
• If the pregnant woman is currently taking
multivitamins with Vitamin A do not give
100,000 IU
Micronutrient Supplementation for Post-
Partum/ Lactating Women clinically diagnosed
with Xerophthalmia
• Vitamin A Supplementation
• Preparation: capsule 100,000 IU
• Dosage/ Frequency/ Duration: Give 1
capsule upon diagnosis, regardless of age
of gestation, 1 capsule the next day, and
another capsule 2 weeks after
Micronutrient Supplementation for Female
Adolescents and Non-pregnant/ Non-lactating
WRA
• Iron/Folic acid (routine supplementation)
• Preparation: tablet, 60mg elemental iron
with 2.8mg folic acid
• Dosage/ Frequency/ Duration: Give 1
tablet once a week once menarche starts
and until one gets pregnant
Micronutrient Supplementation for Female
Adolescents and Non-pregnant/ Non-lactating
WRA
• Iron/Folic acid (therapeutic
supplementation)
• Preparation: tablet, 60mg
elemental iron with 400mcg folic
acid
• Dosage/ Frequency/ Duration: Give
2 tablets once a day until
hemoglobin reaches normal level
Micronutrient Supplementation for Female
Adolescents and Non-pregnant/ Non-lactating
WRA
• Iron/Folic acid (therapeutic
supplementation)
• Evaluate after 1 month. If there is adequate
response to therapy (increase in hemoglobin by 1-
2g/dL) continue supplementation and re-evaluate
after 2-3 months. If there is no adequate response
to the one month oral iron therapy, evaluate for
other possible cause of anemia
• After completing the 3 months of therapeutic
supplementation, pregnant women should continue
preventive supplementation regimen
Micronutrient Supplementation for 0-11 months
old Infants (routine supplementation)

• Iron (6-11 months old)

• Preparation: Dropper bottles, 15mg elemental iron/
0.6mL
• Dosage/ Frequency/ Duration: Give 0.6mL once a
day for 3 months

• Preparation: Micronutrient Supplementation,

single serve sachets (15 micronutrient formulation)
• Dosage/ Frequency/ Duration: Give 60 sachets to
continue in 6 months
Micronutrient Supplementation for Low
Birth Weight Infants (less than 2,500g)

• Iron supplementation (LBW)

• Preparation: Dropper bottles,
15mg elemental iron/ 0.6mL
• Dosage/ Frequency/ Duration:
Give 0.3mL once a day starting
at 2 months up to 6 months of
age
Micronutrient Supplementation for
6-11 months old clinically diagnosed
to have Iron Deficiency Anemia
• Iron supplementation
• Preparation: Dropper bottles, 15mg
elemental iron/ 0.6mL
• Dosage/ Frequency/ Duration: Give
3-6mg/kg/day elemental iron in 3
divided doses every day for 3 months
• After completing 3 months therapeutic supplementation,
infants should continue preventive supplementation
regimen
Micronutrient Supplementation for
6-11 months old clinically diagnosed
with Measles
• Vitamin A supplementation
• Preparation: 100,000 IU per capsule
• Dosage/ Frequency/ Duration: Give 1 capsule
upon diagnosis regardless when the last dose
of Vitamin A capsule was given.
• Give another capsule after 24 hours
Micronutrient Supplementation for
6-11 months old with Persistent
Diarrhea/ Severe Pneumonia/
Severely Underweight
• Vitamin A supplementation
• Preparation: 100,000 IU per capsule
• Dosage/ Frequency/ Duration: Give 1
capsule upon diagnosis except when
child was given VAC less than 4 weeks
before diagnosis
Micronutrient Supplementation for
6-11 months old clinically diagnosed
with xerophthalmia
• Vitamin A supplementation
• Preparation: 100,000 IU per capsule
• Dosage/ Frequency/ Duration: Give
immediately 1 capsule upon diagnosis, 1
capsule the next day, and another
capsule 2 weeks later
Micronutrient Supplementation for
less than 6 months old with diarrhea
• Zinc supplementation
• Preparation: Dropper bottles,
27.5mg/mL (equivalent to 10mg
elemental zinc), 15mL drops
• Dosage/ Frequency/ Duration: Give 1mL
once a day for not less than 10 days
• Preparation: tablet, 20mg elemental zinc
• Dosage/ Frequency/ Duration: Give ½
tablet once a day for not less than 10
days
Micronutrient Supplementation for
6-11 months old with diarrhea
• Zinc supplementation
• Preparation: Syrup bottles, 55mg/5mL
(equivalent to 20mg elemental zinc), 60mL
syrup
• Dosage/ Frequency/ Duration: Give 5mL once a
day for not less than 10 days
• Preparation: tablet, 20mg elemental zinc
• Dosage/ Frequency/ Duration: Give 1 tablet
once a day for not less than 10 days
Micronutrient Supplementation for
12-59 months old with diarrhea
• Zinc supplementation
• Preparation: Syrup bottles, 55mg/5mL
(equivalent to 20mg elemental zinc), 60mL
syrup
• Dosage/ Frequency/ Duration: Give 5mL once a
day for not less than 10 days
• Preparation: tablet, 20mg elemental zinc
• Dosage/ Frequency/ Duration: Give 1 tablet
once a day for not less than 10 days
Vitamin A
Dosage
Req’rmt
per/year,
Commodity Target Eligible (cap/tabs/b
population ot/sachet)

100,000 IU Infants 6-11 months (GP) Pop x 0.171% 1 cap

(capsule)
200,000 IU Children 12-59 months Pop x 8.658% 2 caps
(capsule) (GP)
100,000 IU *High Risk Infants 6-11 Pop x 0.171% X 1 cap
(capsule) months 20%
200,000 IU *high Risk Children 12-59 Pop x 10.8% X 1 cap
(capsule) months 20%
200,000 IU Post Partum Women (PP) Pop x 2.056% 1 cap
(capsule)
Iron supplementation
Iron Dosage
Req’rmt
per/year,
Target Eligible (cap/tabs/bot/s
population achet)
El 60mg with Pregnant Pop x 270 tabs
400 mcg folic Women (AP) 2.056% x
acid anemic 42.5%
El 60mg with Pregnant Pop 180 tabs
400 mcg folic Women (AP) x2.056% x
acid non anemic 57.5%
El 60mg with Post partum Pop 180 tabs
400 mcg folic Women (PP) x2.056% x
acid anemic 31.4%
 Iron
Iron
supplementation Dosage
Req’rmt
per/year,
Target Eligible
population
cap/tabs/bo
t/sachet
El 60mg w/ Post partum Pop x2.056% 52 tabs
2.8mg Folic acid Women(PP) non x 68.6%
anemic
El 60mg w/ Women 10-49 years Pop 180 tabs
2.8mg Folic acid old (anemic) x20.484% x
22.7%
El 60mg w/ Women 10-49 years Pop 52 tabs
2.8mg Folic acid old (non anemic) x20.484% x
77.3%
El 60mg w/ Women 10-49 years Pop 60 tabs
2.8mg Folic acid old with malaria x20.484% x
0.08%
 Iron supplementation
Iron Dosage
Req’rmt
Target Eligible per/year,
population cap/tabs/b
ot/sachet
**Drops El LBW infants Pop 2 bottles
15mg/0.6ml x2.056% x
19.6%
**Drops El Infants 6-11 months Pop 2 bottles
15mg/0.6ml (anemic) x0.171% x
55.7%
**Drops El Infants 6-11 months Pop 2 bottles
15mg/0.6ml (non anemic) x0.171% x
44.3%
 Iron supplementation
Iron Dosage
Req’rmt
Target Eligible per/year,
population cap/tabs/bot/
sachet
**syrup El 30mg/5ml Children 12-23 months Pop x2.071% x 8 bots
(anemic) 41%
**syrup El 30mg/5ml Children 12-23 months Pop x2.071% x 8 bots
(non anemic) 59%
**syrup El 30mg/5ml Children 24-59 months Pop x8.658% x 8 bots
(anemic) 20.8%
**syrup El 30mg/5ml Children 5-9 year old 8 bots
Pop x10.738% x
anemic
20.4%
**syrup El 30mg/5ml Children 5-9 year old with Pop x 10.738% x 8 bots
malaria 0.08%
**syrup El 30mg/5ml Children 5-9 year old with Pop x 10.738% x 8 bots
schistomiases 4%
Micro-Nutrient Powder
Dosage
Req’rmt
MNP Target Eligible per/year,
population cap/tabs/
bot/sachet
**micronutrient Infants 6-11 Pop x 0.171% 90
powders months sachets-
every day
** micronutrient Children 12-23 Pop x 2.071% 180
powders months sachets
Iodine supplementation
Dosage
Req’rmt
Iodine Target Eligible per/year,
population cap/tabs/b
ot/sachet
Capsule, 200 mg Pregnant Women Pop x 2 caps
elemental iodine (AP) – 1st 2.056%
trimester
Capsule, 200 mg Post Partum Pop x 2 caps
elemental iodine Women (PP) 2.056%
 Zinc supplementation
Dosage
Req’rmt
Zinc Target per/year,
Eligible cap/tabs/bo
population t/sachet
Zinc Drops 27.5 mg/ ml Infants below 6 *** Pop x 1 bottle
(equiv. to 10 mg elemental months 0.171% x
zinc) 15 ml bottle drops 3.27%
Syrup, 55 mg/ ml (equiv. Children 6-59 *** Pop x 2 bottles
to 20 mg elemental zinc) months 8.658% x
60 ml syrup 3.27%
**** Dispersible zinc tab Children 6-59 *** Pop x 10 tabs
(20mg zinc) months 8.658% x
3.27%
 Calcium supplementation

Dosage
Req’rmt
Calcium Carbonate Target Eligible per/year,
population cap/tabs/bo
t/sachet
Calcium Carbonate Pregnant Women Pop x 420 tabs
500 mg elemental (esp. those high 2.056 %
calcium tablet risk for
gestational
hypertension)
 Iodine supplementation
Dosage
Req’rmt
Iodine Target Eligible per/year,
population cap/tabs/bot/s
achet
Iodized oil capsule Pregnant Women Pop x 2 caps
200mg (2 caps in the 1st 2.056%
trimester)
Iodized oil capsule Post-Partum/ Pop x 2 caps
200mg Lactating Women 2.056%
Micronutrient supplementation for
Pregnant Women
• 2nd Trimester- Calcium Carbonate for
prevention of eclampsia & pre-
eclampsia and to reduce developing
hypertensive disorder with 500 mg
elemental calcium given on the 20th week,
taken 3x a day with meals with full
stomach
Micronutrient supplementation for
Pregnant Women
• Along with the usual Iron and Folic
acid- prevent anemia & neural tube
defects
• Iodized oil capsule- prevents goiter,
spontaneous abortions & helps in
brain development of infants
EVERYDAY is GARANTISADONG
PAMBATA (GP DAY): VITAMIN A
and other Micronutrients
• QUARTERLY REPORT: April, July, October of the
current year, January of the next year

APRIL CATCH UP
• 6-11 MONTHS - 100,000 IU
• 12-59 MONTHS - 200,000 IU- 1st dose

OCTOBER CATCH UP
• 12-59 MONTHS - 200,000 IU- 2ND dose
 Philippine Integrated Management of Acute Malnutrition
(PIMAM)
SEVERE ACUTE MALNUTRITION
0-6 MONTHS: IN-PATIENT THERAPEUTIC CARE(ITC)
RUTF – READY TO USE THERAPEUTIC FOOD
Out Patient Care (OTC 6-59 mos.)
•
Thank you