principle 9, micronutrient supplementation can be an effective intervention in some situations. Recommendations are summarized below. Vitamin A WHO and UNICEF recommend universal supplementation with vitamin A as a priority in children aged 6–59 months in countries with a high risk of deficiency (Table 2). In these countries, a high dose of vitamin A should also be given to children with measles, diarrhoea, respiratory disease, chickenpox, other severe infections or severe protein-energy malnutrition, or who live in the vicinity of children with vitamin A deficiency (21). Table 2 High-dose universal distribution schedule for prevention of vitamin A deficiency Infants 6–12 months of age 100 000 IU orally, every 4–6 months Children > 12 months of age 200 000 IU orally, every 4–6 months Iron As a rule, fortified foods should be preferred to iron supplements for children during the complementary feeding period. Caution should be exercised with iron supplementation in settings where the prevalence of malaria and other infectious diseases is high. In malaria-endemic areas, universal iron supplementation is not recommended. If iron supplements are used, they should not be given to children who have sufficient iron stores as the risks of severe adverse events appear to be greater in those children. Prevention and management of anaemia in such areas requires a screening system to identify iron-deficient children, and the availability of and accessibility to appropriate anti-malarial and other anti-infective treatments (22,23). Iodine In 1994, WHO and UNICEF recommended universal salt iodization (USI) as a safe, cost-effective and sustainable strategy to ensure sufficient intake of iodine by all individuals. However, in areas with severe iodine deficiency, vulnerable groups – pregnant and lactating women and children less than 2 years – may not be adequately covered when USI is not fully implemented, and iodine supplementation may be necessary. The WHO/UNICEF Joint Statement on reaching optimal iodine nutrition in pregnant and lactating women and young children provides guidance for the categorization of countries and subsequent planning of an adequate response (24). Zinc Zinc supplementation is recommended as adjunct therapy in the management of diarrhoea. Zinc (20 mg/ day) should be given to all children with diarrhoea for 10–14 days. In infants below 6 months of age, the dose of zinc should be 10 mg/day (25). 3.3 Local adaptation of complementary feeding recommendations Table 3 lists types of foods, the principle nutrients they contain, and how they can be fed to children for good complementary feeding. To develop specific feeding recommendations that respond to the Guiding principles and that are locally acceptable and affordable, a process of adaptation is needed. It is useful to involve caregivers and families in the process of adaptation, and of deciding what is culturally appropriate (26). The following steps are usually required: K Review existing national or local feeding guidelines. K Develop a list of locally available foods. K Find out the nutrient content of the local foods from food tables (27). K Calculate the amount of various foods that would provide a child with his or her daily needs of the various nutrients – linear programming techniques can be used for this (28). K Assess which foods and quantities of foods caregivers and families accept as suitable for children, and identify their feeding practices and preferences. K Arrange trials of improved practices, asking mothers or other caregivers to choose new, improved feeding practices and try them out themselves. 3. Complementary feeding 26 Infant and Young Child Feeding – Model Chapter for textbooks Obtain feedback on what works best in their circumstances. Whether or not vitamin-mineral supplements should be included in the recommendations depends on the micronutrient content of locally-available foods, and whether children can eat enough suitable foods. Infants 6–11 months K Continue breastfeeding K Give adequate servings of: — Thick porridge made out of maize, cassava, millet; add milk, soy, ground nuts or sugar — Mixtures of pureed foods made out of matoke, potatoes, cassava, posho (maize or millet) or rice: mix with fish, beans or pounded groundnuts; add green vegetables K Give nutritious snacks: egg, banana, bread, papaya, avocado, mango, other fruits, yogurt, milk and puddings made with milk, biscuits or crackers, bread or chapati with butter, margarine, groundnut paste or honey, bean cakes, cooked potatoes Children 12–23 months K Continue breastfeeding K Give adequate servings of: — Mixtures of mashed or finely cut family foods made out of matoke, potatoes, cassava, posho (maize or millet) or rice; mix with fish or beans or pounded groundnuts; add green vegetables — Thick porridge made out of maize, cassava, millet; add milk, soy, ground nuts or sugar K Give nutritious snacks: egg, banana, bread, papaya, avocado, mango, other fruits, yogurt, milk and puddings made with milk, biscuits or crackers, bread or chapati with butter, margarine, groundnut paste or honey, bean cakes, cooked potatoes Table 3 Appropriate foods for complementary feeding Whatfoodsto give and why Howto give the foods Breast milk: continues to provide energy and high quality nutrients up to 23 months Staple foods: provide energy, some protein (cereals only) and vitamins K Examples: cereals (rice, wheat, maize, millet, quinoa), roots (cassava, yam and potatoes) and starchy fruits (plantain and breadfruit) Animal-source foods: provide high quality protein, haem iron, zinc and vitamins K Examples: liver, red meat, chicken, fish, eggs (not good source of iron) Milk products: provide protein, energy, most vitamins (especially vitamin A and folate), calcium K Examples: milk, cheese, yogurt and curds Green leafy and orange-coloured vegetables: provide vitamins A, C, folate K Examples: spinach, broccoli, chard, carrots, pumpkins, sweet potatoes Pulses: provide protein (of medium quality), energy, iron (not well absorbed) K Examples: chickpeas, lentils, cowpeas, black-eyed peas, kidney beans, lima beans Oils and fats: provide