According to the rules in the WHO Basic documents (45) and the processes recommended in the WHO handbook for guideline development (5), all experts participating in WHO meetings must declare any interest relevant to the meeting prior to their participation. The declarations-of-interest statements for all guideline group members were reviewed by the responsible technical officer and the relevant departments before finalization of the group composition and invitation to attend a guideline group meeting. All guideline group members and participants of the guideline development meetings submitted a declaration-of-interests form, along with their curriculum vitae, before each meeting. Participants of the guideline development group meetings participated in their individual capacity and not as institutional representatives. In addition, they verbally declared potential conflicts of interest at the beginning of each meeting. The procedures for management of conflicts of interests strictly followed WHO Guidelines for declaration of interests (WHO experts) (46). The potential conflicts of interest declared by members of the guideline group are summarized next.1
Dr Mary Chea is employed by the National Maternal and Child Health Centre, Ministry of Health of Cambodia. Dr Chea declared having carried out research and work on projects related to multiple micronutrient powders. First, she has carried out operational research for the Good Food for Children Project, which compared infant and young child feeding (IYCF) education and Sprinkles™ for infants and young children in poor settings in Svay Rieng District, Svay Rieng Province, Cambodia. Second, she has coordinated, managed and implemented the Good Food for Children Study (Sprinkles™ Project) for the whole project period (2007–2010). It was agreed that she could participate fully in the deliberations and decision-making on this recommendation.
Dr Luz Maria De-Regil declared that her present employer is an international nongovernmental organization devoted to the improvement of micronutrient status among infants, children and women. These activities are primarily financed by the government of Canada. The Micronutrient Initiative (MI) is a leading organization working exclusively to eliminate vitamin and mineral deficiencies in the world's most vulnerable populations, including work on and support of multiple micronutrient powders. Dr De-Regil declared that she is a co-author of systematic reviews on: (a) point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school age; (b) multiple micronutrient powders for point-of-use fortification of foods in pregnant women; and (c) point-of-use fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Dr De-Regil also declared that she was involved in the preparation of the guideline on point-of-use fortification with multiple micronutrient powders as a former member of WHO staff. Dr De-Regil was allowed to be a member of the guideline development group and could participate in the deliberations related to recommendations on the use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women, but recused herself from voting on this recommendation.
Dr Rukhsana Haider is employed by the Training and Assistance for Health and Nutrition (TAHN) Foundation, Dhaka, Bangladesh. Dr Haider declared that, at the time of the meeting, she was a member of the Technical Advisory Group for Helen Keller International's Assessment and Research on Child Feeding (ARCH) Project. It was agreed that she could participate fully in the deliberations and decision-making on this recommendation.
Dr Maria Elena del Socorro Jefferds is employed by United States Centers for Disease Control and Prevention (CDC). She declared that she was a co-investigator on a CDC-funded study on the effectiveness of micronutrient powers in Kenya and is lead author and co-author of several publications on this topic, including being co-author and editor of a special Sight and Life supplement on micronutrient powders published in 2013. She also declared that she participated in a United Nations Children's Fund (UNICEF)/CDC workshop on scaling up micronutrient-powder interventions for children aged 6–23 months. She also declared that she was the coordinator and writer of a monitoring manual for home fortification interventions, including micronutrient powders, for the Home Fortification Technical Advisory Group (HF-TAG); that she was an investigator on the first global assessment of home fortification interventions and the lead author of the corresponding report and of a related journal article, both published in 2013; and that she is a co-author of a Cochrane systematic review of micronutrient powders intervention in children aged 6–23 months and 2–12 years. She was allowed to participate in the deliberations on recommendations related to multiple micronutrient powders but she recused herself from decision-making (voting) on the recommendations related to the use of multiple micronutrient powders for point-of-use fortification of foods.
Dr Lynette Neufeld declared that her current employer has received funding in the past 4 years for research and programming related to micronutrient powders, but that she is not leading any of these initiatives. She also declared that, in her previous position with a different employer, she was involved in research studies related to micronutrient powders. She declared her membership on the Steering Committee of HF-TAG. She was allowed to participate in the deliberations on recommendations related to multiple micronutrient powders but she recused herself from decision-making (voting) on the recommendations relating to the use of multiple micronutrient powders for point-of-use fortification of foods.
All other members completed and signed a written declaration of interests before the meeting and made a verbal declaration of their interest during the meeting. It was considered that these interests were not relevant for this guideline on the use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women. External experts also declared their interest but did not participate in the deliberations or decision-making process.
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A conflict-of-interest analysis must be performed whenever WHO relies on the independent advice of an expert in order to take a decision or to provide recommendations to Member States or other stakeholders. The term “conflict of interest” means any interest declared by an expert that may affect or be reasonably perceived to affect the expert's objectivity and independence in providing advice to WHO. WHO's conflict-of-interest rules are designed to avoid potentially compromising situations that could undermine or otherwise affect the work of the expert, the committee or the activity in which the expert is involved, or WHO as a whole. Consequently, the scope of the inquiry is any interest that could reasonably be perceived to affect the functions that the expert is performing.