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Special report on environmental endocrine disruption: An effects assessment and analysis. Environmental Protection Agency, National Center of Environmental Assessment, Office of Research and Development. Developmental neurotoxicology in the neonate-effects of pesticides and polychlorinated organic substances. Developmental neurotoxicity of four ortho-substituted polychlorinated biphenyls in the neonatal mouse. Effect of lead, polychlorinated biphenyls, and cyclophosphamide on rat natural killer cells, interleukin 2, and antibody synthesis. Interoretive review of the potential adverse effects of chlorinated organic chemicals on human health and the environment. Polychlorinated biphenyl congeners in adipose tissue lipid and serum of past and present transformer repair workers and a comparison group. Polychlorinated biphenyl concentrations in cod-liver oil: Evidence of a steady-state condition of these compounds in the Baltic area oils and levels noted in Atlantic oils. Pesticides and polychlorinated biphenyl residues in human breast lipids and their relation to breast cancer. Vapor pressures and predicted particle/gas distributions of polychlorinated biphenyl congeners as functions of temperature and ortho-chlorine substitution. Preferential sorption of non- and mono-ortho-polychlorinated biphenyls to urban aerosols. Aerobic mineralization of chlorobenzoates by a natural polychlorinated biphenyl-degrading mixed bacterial culture. Action levels for poisonous or deleterious substances in human food and animal feed. Unavoidable contaminants in food for human consumption and food-packaging material. Dietary and tissue residue analysis and contaminant intake estimations in rats consuming diet composed of Great Lakes salmon: A multigeneration study. The Health Canada Great Lakes multigeneration studysummary and regulatory considerations. Prenatal exposure to polychlorinated biphenyls: Effects on birth size and gestational age. Polychlorinated biphenyl residues in human plasma expose a major urban pollution problem. Sport fish consumption and body burden levels of chlorinated hydrocarbons: A study of Wisconsin anglers. Health effects three years after potential exposure to the toxic contaminants of an electrical transformer fire. An experimental system for investigating vapor-particle partitioning of trace organic pollutants. Pesticide use in 11 agricultural watersheds and presence in stream water, 1975-1977. Cytochrome P450 induction, uroporphyrinogen decarboxylase depression, porphyin accumulation and excretion, and gender influence in a 3-week rat model of porphyria cutanea tarda. Snow scavenging of polychlorinated biphenyls and polycyclic aromatic hydrocarbons in Minnesota. Dry deposition of particulate polychlorinated biphenyls and polycylic aromatic hydrocarbons to Lake Michigan. An assessment of neurotoxicity of Aroclors 1016, 1242, 1254, and 1260 administered in diet to Sprague-Dawley rats for one year. An assessment of Aroclors 1016, 1242, 1254, and 1260 administered in diet to Sprague-Dawley rats for one year. Evidence of excess cancer mortality in a cohort of workers exposed to polychlorinated biphenyls. Multielement and chlorinated hydrocarbon analysis of municipal sewage sludges of American cities. Studies on the relative degradability of polychlorinated biphenyl components by alkaligenes sp. Effect of chlorine substitution on the biodegradability of polychlorinated biphenyls. The influence of molecular structure on the retention and excretion of polychlorinated biphenyls by the mouse.

Reducing the incidence of low birth weight in low-income countries has substantial economic benefits. Worms: identifying impacts on health and education in the presence of treatment externalities. Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. Effect of iron-fortified drinking water of daycare facilities the economics of adressing nutritional anemia 35 on the hemoglobin status of young children. Breeding strategies for biofortified staple plant foods to reduce micronutrient malnutrition globally. Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women. Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomized controlled trial. Initial country-level information about socio-economic differences in health, nutrition and population. Dual fortification of salt with iodine and encapsulated iron: a randomized, double blind, controlled trial in Moroccan schoolchildren. He currently heads the Department of Biological Chemistry and Nutrition at the University of Hohenheim in Stuttgart, Germany. Hans has over 30 years of experience in research on retinoids and their actions on cellular growth and differentiation, vitamin A and human health, and the role of antioxidants and vitamins in human nutrition. He also holds several patents and has founded a biotech company (BioTeSys GmbH) which develops cell and organ culture models to test biological compounds and carries out clinical studies. Besides diseases which lead to losses of blood or impairment of the production of Hb, nutrition plays the most important role. Some vitamins like vitamin B12, folic acid and riboflavin influence the formation of Hb but the most important nutritional factor is iron deficiency, the most frequently occurring micronutrient deficiency in both developed and less developed countries. Since iron deficiency usually responds to iron supplementation or fortification, the assessment of iron status is crucial in the evaluation of nutritional anemia. There are some clinical indicators for iron deficiency, with chronic fatigue the most important, but they are usually unspecific symptoms (1). The evaluation of the iron intake (differentiated in heme and non-heme iron) might also be helpful but the diagnosis relies mainly on biochemical indicators, especially for the early stages of iron deficiency. Usually iron deficiency occurs in three sequentially developing stages: depleted iron stores, iron deficient erythropoiesis and iron deficiency anemia. Therefore part of this chapter will address the problem on how to make this measurement simple and inexpensive, with a focus on developing countries. It is one of the most common and least expensive measurements done in a nutritional laboratory. Inexpensive kits, which are available from several manufactures, include controls which help in getting the correct values. To be able to measure Hb in the field and small offices portable hemoglobinometers are available. Currently used cut off values and factors which influence them are shown in Table 4. Only the third stage of iron deficiency affects the Hb synthesis and there are a number of other conditions and diseases which influence the Hb concentration. To find out if iron deficiency is responsible for the anemia it is usually necessary to include other indicators which are more sensitive and specific for the iron status. If this is not possible, an alternative can be to compare the Hb distribution curve from young children, women in childbearing age and men. If the shift between men and the other groups is bigger than in a standard reference group it indicates that the iron supply is not enough for young children and women, who have a relative higher requirement than men (2).

This situation has recently occurred in response to the finding of higher mortality among children in a highly malaria endemic area when supplemented with iron in the absence of malaria control measures (22). That the increased risk was small, that those findings were not observed in an area where malaria transmission was controlled using treated bed nets and treatment of suspected cases, and that malaria was very highly endemic in the area (23), did not receive much emphasis in the discussions that followed on the publication of the findings. Semba for a well-balanced diet with sufficient vitamins and minerals, and the development of new strategies for ensuring an adequate intake, such as home fortification, also creates further opportunities and new approaches. The micronutrient report: current progress and trends in the control of vitamin A, iron, and iodine deficiencies. Micronutrient Initiative, International Development Research Centre, Ottawa, Canada. Low compliance with an iron-supplementation program: a study among pregnant women in Jakarta, Indonesia. Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to age 19 years. Only a small proportion in northeast Thai schoolchildren is associated with iron deficiency. Effect of the maternal E-globin gene on hematologic responses to iron supplementation during pregnancy. Iron sta- tus in association with cardiovascular disease risk in 3 controlled feeding studies. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomized, placebo-controlled trial. Semba Micronutrient Sprinkles to control anemia 17 269 Successful approaches: Sprinkles Stanley H. Zlotkin Melody Tondeur Sprinkles Global Health Initiative, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada Contact: stanley. He is the Founder and President of the Sprinkles Global Health Initiative at the Hospital for Sick Children in Toronto, Canada, as well as a Professor in the Department of Pediatrics at the University of Toronto, and Head of the Division of Gastroenterology, Hepatology and Nutrition at the Hospital for Sick Children. Stanley is known internationally for his work on knowledge translation and as a successful social entrepreneur, and was awarded the Order of Canada, the highest civilian honor, for his international work to improve the lives of children globally. Her main professional interest is contributing to improving the health and nutrition of vulnerable populations in underdeveloped countries. Melody is currently working for the Sprinkles Global Health Initiative at the Hospital for Sick Children in Toronto where she is involved in program development, research, field operations management, and partner relationships. The use of commercially fortified food has had limited success in underdeveloped countries, where storebought foods are not widely available or affordable, especially for young children. In areas where the prevalence of anemia is at least 40% or above, it is recommended to continue supplementation until 24 months of age. However, adherence is often limited due to a combination of factors: the syrup has an unpleasant metallic aftertaste, leaves dark stains on teeth, and high doses cause abdominal discomfort (6). Furthermore, there are technical disadvantages associated with the use of liquid iron preparations such as short shelf life, high transportation costs due to the weight of the bottles, and difficulty in accurately dispensing the drops, especially among illiterate populations, as the caregiver is required to measure a decimal volume from a dropper (7, 8). The root cause of the ineffectiveness of many programs has been an inability to develop a sustainable framework to reach the most vulnerable populations with appropriate and costeffective solutions. This article describes each stage in the development of the Sprinkles intervention for the control of anemia and micronutrient deficiencies in infants and young children. The Sprinkles concept was based on the principle that targeted food fortification has been successful in the West and was inspired by a legacy at the Hospital for Sick Children, where Pablum (the first fortified infant cereal) was invented in 1929 to control the epidemic of rickets which was rampant in Canada at that time. In Sprinkles, the iron (ferrous fumarate) is encapsulated within a thin lipid layer to prevent the iron from interacting with food, thereby limiting changes to the taste, color, or texture of the food. Caregivers are instructed to add the entire contents of one sachet daily to any semi-solid food prepared for their infant or young child in the household, immediately before serving. Other essential micronutrients including zinc, iodine, vitamins C, D and A, and folic acid may be added to Sprinkles sachets. The first efficacy study involved only anemic children and demonstrated that Sprinkles achieved a similar cure rate as compared to the reference standard, iron drops (9). Fifty-eight percent of children who received Sprinkles went from an anemic (Hb<100 g/L) to a non-anemic state (Hb 100 g/L) in 2 months. Given that the study took place during the wet season, when malaria transmission is high, the anemia cure rate of close to 60% was considered very successful. Children who were treated for anemia in this study were included in a maintenance phase study for 6 months to determine whether continued intake of Sprinkles was needed to sustain their non-anemic status.

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