scholarly journals Refocusing vitamin A supplementation programmes to reach the most vulnerable

2020 ◽  
Vol 5 (7) ◽  
pp. e001997
Author(s):  
Erin McLean ◽  
Rolf Klemm ◽  
Hamsa Subramaniam ◽  
Alison Greig
Keyword(s):  
Vitamin A ◽  
Child Mortality ◽  
Vitamin A Deficiency ◽  
Child Survival ◽  
Public Health Problem ◽  
Mortality Rates ◽  
Vitamin A Supplementation ◽  
Use Of Resources ◽  
Year 2000 ◽  
Programme Coverage

WHO recommends vitamin A supplementation (VAS) programmes for children 6–59 months where vitamin A deficiency is a public health problem. However, resources for VAS are falling short of current needs and programme coverage is suffering. The authors present the case for considering the options for shifting efforts and resources from a generalised approach, to prioritising resources to reach populations with continued high child mortality rates and high vitamin A deficiency prevalence to maximise child survival benefits . This includes evaluating where child mortality and/or vitamin A deficiency has dropped, as well as using under 5 mortality rates as a proxy for vitamin A deficiency, in the absence of recent data. The analysis supports that fewer countries may now need to prioritise VAS than in the year 2000, but that there are still a large number of countries that do. The authors also outline next steps for analysing options for improved targeting and cost-effectiveness of programmes. Focusing VAS resources to reach the most vulnerable is an efficient use of resources and will continue to promote young child survival.

Vitamin A deficiency among children younger than 5 y in India: an analysis of national data sets to reflect on the need for vitamin A supplementation

2020 ◽  
Author(s):  
G Bhanuprakash Reddy ◽  
Raghu Pullakhandam ◽  
Santu Ghosh ◽  
Naveen K Boiroju ◽  
Shalini Tattari ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Sample Survey ◽  
Dietary Vitamin ◽  
High Dose ◽  
Serum Retinol ◽  
Indian Children ◽  
Vitamin A Supplementation ◽  
National Prevalence

ABSTRACT Background Biochemical vitamin A deficiency (VAD) is believed to be a serious public health problem (low serum retinol prevalence >20%) in Indian children, justifying universal high-dose vitamin A supplementation (VAS). Objective To evaluate in Indian children younger than 5 y the risk of biochemical VAD from the Comprehensive National Nutrition Survey, as well as dietary vitamin A inadequacy and excess over the tolerable upper limit of intake (TUL) from national and subnational surveys, factoring in fortification and VAS. Methods Child serum retinol data, corrected for inflammation, were examined to evaluate national- and state-level prevalence of VAD. Simultaneously, dietary intakes from the National Sample Survey Office and the National Nutrition Monitoring Bureau were examined for risk of dietary vitamin A deficiency against its average requirement (AR) derived for Indian children. Theoretical estimates of risk reduction with oil and milk vitamin A fortification were evaluated along with the risk of exceeding the TUL, as well as when combined with intake from VAS. Results The national prevalence of biochemical VAD measured in 9563 children was 15.7% (95% CI: 15.2%, 16.3%), and only 3 states had prevalence significantly >20%. The AR of vitamin A was 198 and 191 µg/d for boys and girls; the risk of dietary inadequacy was ∼70%, which reduced to 25% with oil and milk fortification. Then, the risk of exceeding the TUL was 2% and 1% in 1- to 3-y-old and 4- to 5-y-old children, respectively, but when the VAS dose was added to this intake in a cumulative 6-mo framework, the risk of exceeding the TUL rose to 30% and 8%, respectively. Conclusion The national prevalence of VAD risk is below 20% in Indian children. Because there is risk of excess intake with food fortification and VAS, serious consideration should be given to a targeted approach in place of the universal VAS program in India.

scholarly journals Utilization of vitamin A supplementation services in high priority districts of Bihar

2018 ◽  
Vol 5 (2) ◽  
pp. 667
Author(s):  
Nivedita Sinha ◽  
Rajesh R. Sinha ◽  
Ajay Krishna ◽  
Rashmi Singh
Keyword(s):  
Public Health ◽  
Vitamin A ◽  
Observational Study ◽  
Health Problem ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Short Term ◽  
Cross Sectional ◽  
Vitamin A Supplementation ◽  
Ultimate Outcome

Background: Vitamin A deficiency (VAD) is a major preventable public health problem. Prevalence of VAD in preschool children was 5.7% (India), and 4.5% (Bihar). India is implementing biannual Vitamin A Supplementation (VAS) since 2007 along with 80 other countries. VAS was originally proposed as a short term measure, followed by dietary improvement. Since vulnerability to VAD is more in high priority districts (HPDs), it was deemed worthwhile to study the extent to which VAS programme is utilized in the 10 HPDs of Bihar with respect to the processes involved and the ultimate outcome of empowering the community with knowledge and capacity to combat VAD on their own.Methods: Cross sectional observational study conducted in 6 randomly selected blocks and 5 session sites per block of the 10 HPDs. 300 sites sampled for processes and 893 caregivers interviewed for their knowledge.Results: Out of 300 sites, 269 sites found functional, 30.85% sites had due lists and 30.11% had MCP cards; 20.44% had adequate VA. IEC displayed at 52.78% and 71.3% sessions conducted in shade. In 79.55% sites efforts made to determine age of child before administration. Correct use of recommended spoon known to 80.66%, benefits of VA to 76.57% and diseases due to VAD to 81.7% of FLWs. Knowledge regarding VA good in 33.4% of caregivers, average in 35.5%, and poor in 30.9%.Conclusions: Crucial gaps found in necessary inputs and conduct of VAS. Community knowledge found lacking for sustainable programme withdrawal. Better programme management will improve utilization. 

scholarly journals Vitamin A Supplementation Coverage and Ocular Signs among Children Aged 6–59 Months in Aleta Chuko Woreda, Sidama Zone, Southern Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Temesgen Nigusse ◽  
Achamyelesh Gebretsadik
Keyword(s):  
Health Education ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Clinical Signs ◽  
Public Health Problem ◽  
Southern Ethiopia ◽  
Wealth Status ◽  
Health Development ◽  
Vitamin A Supplementation ◽  
Ocular Signs

Background. Periodic vitamin A supplementation to children is a cost-effective strategy to avert vitamin A deficiency. However, few pieces of evidence are available about the coverage of vitamin A supplementation at the community level in the study area. Therefore, the aim of this study was to assess vitamin A supplementation coverage and prevalence of ocular signs of vitamin A deficiency among children aged 6–59 months. Methods. Community-based cross-sectional study design was conducted using a two-stage stratified random sampling method. Data were collected from mothers with children aged 6–59 months using a structured pretested questionnaire. A total of 665 children aged 6 to 59 months were examined for clinical signs and symptoms of vitamin A deficiency by trained clinical health professionals. Descriptive statistics and logistic regression were done. Result. Vitamin A supplementation coverage in the study area was 36.2% (95% CI: 32.6–39.9). Overall, the prevalence of xerophthalmia was 2.7%. Age group 6–23 months (AOR: 2.1, 95% CI: 1.4–2.9), good maternal knowledge (AOR: 1.5, 95% CI: 1.2–2.1), children with high wealth status (AOR: 2.3, 95% CI: 1.4–3.8), precampaign health education on vitamin A (AOR: 3.4,95% CI: 2.1–5.6), member of Health Development Army (AOR: 2.7, 95% CI: 1.7–4.2), and access to health facility within <30 minutes (AOR: 2.5, 95% CI: 1.6–3.8) were significantly associated with the receipt of vitamin A capsule. Conclusion. Vitamin A supplementation coverage of the study area was low as compared to the UNICEF threshold of 70%. Vitamin A deficiency is a public health problem in the study area. Increasing maternal level of knowledge, precampaign health education on vitamin A supplementation, and strengthening Health Development Army are recommended to increase the vitamin A supplementation coverage.

scholarly journals The determinant of National Vitamin A supplementation in Ethiopia: A Multilevel Logistic Regression Analysis

2020 ◽  
Author(s):  
Mohammed M. Oumer ◽  
Zelalem Mengestu ◽  
Sewbesew Yitayih ◽  
Malede Mequanent ◽  
Ayenew Molla
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Vitamin A ◽  
Low Income ◽  
Associated Factors ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Linear Mixed Effect Model ◽  
Mixed Effect ◽  
Vitamin A Supplementation

Abstract Background: Vitamin A deficiency is a public health problem in many low-income countries including Ethiopia. Globally, the prevalence of vitamin A deficiency is estimated to be 190 million among children under-five age causing one up to two million deaths annually.Its periodic supply is a major intervention program to reduce the morbidity, mortality, and blindness among the children in Ethiopia. Objective: The aim of this study was to determine associated factors of national vitamin A supplementationamong children aged 6-59 monthsusing the 2016 Ethiopian Demographic and Health Survey Data. Methods: A population based cross-sectional study design wasperformed to determine factors associated with the vitamin A supplyamong children aged between 6 and 59 monthswithin the last six months before the start of the survey. A univariateanalysis, bivariate analysis, binary logistic regression, and generalized linear mixed effect model were appliedto analyze the data. Results: After adjusting for covariates; the odds of taking vitamin A supply were 1.3 times, 1.7 times, and 1.8 times higher among the women who had two, three, and four and above antenatal care visits, respectively. The mothers’ employment status, health cheek up after their delivery,and theirhealth facility delivery were positively influence the uptake of the vitamin A capsule. In addition,women residing in the communities with high proportion of the media exposure[AOR (Adjusted Odds Ratio) = 1.17 (95%CI: 1.00, 1.37)]were positively associated with the receipt of vitamin A capsule.Random effects indicated that the variation on the uptake of vitamin A supplementation between the communities was statistically significant in all stage of the models. Conclusions: The individual and community level characteristics had a significant influence on the uptake of vitamin A supplementation. Therefore, these factors should be considered in policy formulation and programming in order to improve the coverage of vitamin A supplementation in Ethiopia. Keywords: Vitamin A supply, associated factors, multilevellogistic regression analysis, Ethiopia

scholarly journals Transgenic Pro-Vitamin A Biofortified Crops for Improving Vitamin A Deficiency and Their Challenges

2017 ◽  
Vol 11 (1) ◽  
pp. 11-23 ◽  
Author(s):  
Hyejin Lee
Keyword(s):  
Developing Countries ◽  
Vitamin A ◽  
Nutrition Education ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Current Status ◽  
Vitamin A Supplementation ◽  
Safety Issues ◽  
Crop Development ◽  
Significant Attention

Vitamin A Deficiency (VAD) has been a public health problem among children in developing countries. To alleviate VAD, Vitamin A Supplementation (VAS), food fortification, biofortification and nutrition education have been implemented in various degrees of success with their own merits and limits. While VAS is the most widely utilized intervention in developing countries to ease the burden of VAD, some have raised questions on VAS’ effectiveness. Biofortification, often touted as an effective alternative to VAS, has received significant attention. Among the available biofortification methods, adopting transgenic technology has not only facilitated rapid progress in science for enhanced pro-Vitamin A (pVA) levels in target crops, but drawn considerable skepticism in politics for safety issues. Additionally, VAD-afflicted target regions of transgenic pVA crops widely vary in their national stance on Genetically Modified (GM) products, which further complicates crop development and release. This paper briefly reviews VAS and its controversy which partly demanded shifts to food-based VAD interventions, and updates the current status of transgenic pVA crops. Also, this paper presents a framework to provide potential influencers for transgenic pVA crop development under politically challenging climates with GM products. The framework could be applicable to other transgenic micronutrient biofortification.

scholarly journals Maternal Vitamin A Deficiency during Pregnancy and Its Relation with Maternal and Neonatal Hemoglobin Concentrations among Poor Egyptian Families

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
A. M. Hamdy ◽  
M. M. Abdel Aleem ◽  
A. A. El-Shazly
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Maternal Serum ◽  
Major Public Health Problem ◽  
Serum Retinol ◽  
Cross Sectional ◽  
Vitamin A Supplementation ◽  
Term Newborns

Background. Vitamin A deficiency (VAD) during pregnancy represents a major public health problem in developing countries. Anemia is a common consequence of VAD. We aimed to measure serum retinol concentrations of a sample of poor Egyptian mothers and correlate it with their Hb% and cord Hb%. Methods. This cross-sectional study included 200 healthy mothers and their healthy full term newborns. Maternal and cord blood samples were collected for CBC and measurement of serum retinol concentrations. Results. Forty-seven mothers (23.5%) had VAD and 50% were anemic. Mothers with VAD had a significantly lower mean Hb% and a significantly higher frequency of anemia (95.7%) compared to mothers without VAD (35.9%). The relative risk for anemia among mothers with VAD was 2.7 (CI = 2.12–3.3). Newborns of mothers with VAD had a significantly lower mean cord Hb% compared to newborns of mothers without VAD. Maternal serum retinol concentrations were positively correlated with maternal Hb% and cord Hb%. Conclusion. Maternal VAD during pregnancy among poor mothers is associated with maternal anemia and lower Hb% of newborns at birth. Vitamin A supplementation is highly recommended for this vulnerable group.

scholarly journals Vitamin A Deficiency and Child Survival in Sub-Saharan Africa: A Reappraisal of Challenges and Opportunities

2005 ◽  
Vol 26 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Victor M. Aguayo ◽  
Shawn K. Baker
Keyword(s):  
At Risk ◽  
Vitamin A ◽  
Child Mortality ◽  
Vitamin A Deficiency ◽  
Child Survival ◽  
Sub Saharan Africa ◽  
Children At Risk ◽  
Potential Child ◽  
Sub Saharan ◽  
Policies And Programs

Background Children with vitamin A deficiency have higher risk of morbidity and mortality than vitamin A–sufficient children. Estimates on the potential child survival benefits of vitamin A deficiency control are needed for policy and program advocacy. Objective To determine the current prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa in order to estimate the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. Methods Estimates of the prevalence of vitamin A deficiency generated in 1998, data from 11 nationally representative vitamin A deficiency surveys conducted in sub-Saharan Africa between 1997 and 2003, and the measured effects of vitamin A deficiency on child mortality were combined to estimate the prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa and the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. Results Our analysis shows that in the absence of effective and sustained policies and programs for the control of vitamin A deficiency, an estimated 42.4% of children 0 to 59 months of age in sub-Saharan Africa (43.2 million children) are at risk for vitamin A deficiency. Such effective and sustained policy and program action for the control of vitamin A deficiency can bring about a potential 25% reduction in mortality in children 0 to 59 months with respect to 1995 mortality levels (i.e., before the onset of large-scale vitamin A supplementation programs in sub-Saharan Africa). Conclusions Effective and sustained control of vitamin A deficiency has the potential to be among the most cost-effective and high-impact child-survival interventions in sub-Saharan Africa. A stronger political commitment and a more appropriate level of investment in the effective control of vitamin A deficiency could make a large contribution toward the attainment of the Millennium Development Goal for the reduction of child mortality rates by two-thirds between 1990 and 2015. Among the many challenges that Africa will need to face in the coming years, vitamin A deficiency is one that can be overcome. The need is urgent, and the solutions are known, effective, and affordable.

scholarly journals Vitamin A deficiency and child mortality in Mozambique

2005 ◽  
Vol 8 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Victor M Aguayo ◽  
Sonia Kahn ◽  
Carina Ismael ◽  
Stephan Meershoek
Keyword(s):  
Child Health ◽  
Health Services ◽  
Vitamin A ◽  
Child Mortality ◽  
Vitamin A Deficiency ◽  
Child Survival ◽  
Community Outreach ◽  
Child Health Services ◽  
Potential Contribution ◽  
Risk Of Death

AbstractBackground:In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average.Objectives:To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations.Methods:The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD = 1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births).Results:In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30 000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group.Discussion:Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers’ training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.

Vitamin A Supplementation and Measles

1995 ◽  
Vol 16 (9) ◽  
pp. 358-359
Author(s):  
Glenn J. Fennelly
Keyword(s):  
Vitamin A ◽  
Acute Phase ◽  
Vitamin A Deficiency ◽  
Serum Levels ◽  
Morbidity And Mortality ◽  
Serum Retinol ◽  
Vitamin A Supplementation

Vitamin A deficiency resulting from inadequate intake or induced by infection is associated with increased morbidity and mortality. Measles, the major single infectious cause of mortality in children worldwide, is more severe in children who have preexisting vitamin A deficiency. Several recent studies suggest that: 1) measles is associated with depressed serum levels of vitamin A; 2) hyporetinemia, defined as a serum retinol of less than 0.7 µmol/L, is associated with increased mortality from measles, especially in children younger than 2 years of age; and 3) vitamin A will decrease the risk of complications and death when administered during the acute phase of illness (within 5 days of the onset of rash).

scholarly journals Early neonatal vitamin A supplementation and infant mortality: an individual participant data meta-analysis of randomised controlled trials

2018 ◽  
Vol 104 (3) ◽  
pp. 217-226 ◽  
Author(s):  
Keyword(s):  
Infant Mortality ◽  
Vitamin A ◽  
Maternal Education ◽  
Vitamin A Deficiency ◽  
Population Characteristics ◽  
Infant Survival ◽  
Vitamin A Supplementation ◽  
Maternal Vitamin ◽  
Early Infant ◽  
The Impact

BackgroundBiannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.MethodsInvestigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of age using random effects models and meta-regression. One investigator withdrew but allowed use of the data.FindingsOverall there was no effect of NVAS on infant survival through 6 (risk ratio (RR) 0.97; 95% CI 0.89 to 1.06) or 12 months of age (RR 1.00; 95% CI 0.93 to 1.08) but results varied by study population characteristics.NVAS significantly reduced 6-month mortality among the trials conducted in Southern Asia (RR 0.87; 95% CI 0.77 to 0.98), in contexts with moderate or severe vitamin A deficiency (defined as 10% or higher proportion of women with serum retinol <0.7 µmol/L or 5% or more women with night blindness) (RR 0.87; 95% CI 0.80 to 0.94), early infant mortality was 30 or more per 1000 live births (RR 0.91; 95% CI 0.85 to 0.98), 75% or more of infant mortality occurred in the first 6 months of life (RR 0.92; 95% CI 0.84 to 1.01), or where >32% mothers had no schooling (RR 0.88; 95% CI 0.80 to 0.96). NVAS did not reduce mortality in the first 6 months of life in trials conducted in Africa, in contexts characterised by a low prevalence of vitamin A deficiency, lower rates of infant mortality and where maternal education was more prevalent. There was a suggestion of increased infant mortality in trials conducted in Africa (RR 1.07; 95% CI 1.00 to 1.15).Individual-level characteristics such as sex, birth weight, gestational age and size, age at dosing, parity, time of breast feeding initiation, maternal education and maternal vitamin A supplementation did not modify the impact of NVAS.ConclusionNVAS reduced infant mortality in South Asia, in contexts where the prevalence of maternal vitamin A deficiency is moderate to severe and early infant mortality is high; but it had no beneficial effect on infant survival in Africa, in contexts where the prevalence of maternal vitamin A deficiency is lower, early infant mortality is low.

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