Information, resources and references provided by Sight and Life, Vitamin Angels and Prof. Clare Gilbert. Photo credit: © Matt Dayka/Vitamin Angels IN12
Vitamin A deficiency (VAD) remains a significant a cause of preventable childhood blindness and increased risk of mortality among children under five years of age, although improvements have been made due to VAD programmes and increase coverage with measles immunization. Despite this, VAD is a major public health problem in the developing world affecting 190 million children under five particularly in Africa and South East Asia with India contributing to 85% of cases in South East Asia (WHO, 2009). Biochemical VAD is of public health significance in 122 countries and clinical VAD is of concern in 45 countries (WHO, 2009).
Prevention means to stop something from happening. Vitamin A supplementation completely “stops”/prevents childhood blindness from vitamin A deficiency. Invest in prevention and preventive interventions! Just 2 doses of vitamin A given annually to all children 6-59 months of age prevents their developing vitamin A deficiency blindness. Because vitamin A deficiency can have a range of consequences, including an increased risk of child mortality, the term now used is “vitamin A deficiency disorders” (VADD). The reason why there are global programmes for control of vitamin A deficiency in children is because it also significantly increases under 5 mortality rates in countries where it is a public health problem. Indeed, under 5 mortality rates are now used to indicate the likelihood that whether a country has significant vitamin A deficiency in its population of children.
Improving a child’s vitamin A status enhances resistance to infections and reduces the overall risk of mortality by 24% (COCHRANE, 2011). A minimum coverage of 70% of children 6-59 months of age is required to observe reductions in childhood mortality (UNICEF, 2007). The dosage recommended is one dose of vitamin A for children 6-11 months and two doses annually thereafter to the age of 59 months. The World Health Organization (WHO) recommends that all infants and children 6 – 59 months of age should receive vitamin A supplementation (VAS) if they reside in a country in which VAD is classified as being of either “moderate” or “severe” public health significance—this is known as Universal Supplementation. Universal Supplementation is currently recommended for 122 countries—73 countries with severe VAD and 49 countries with moderate VAD (WHO, 2009).
Significant progress has been seen globally with an overall rise in VAS coverage among children under 5 years of age with one dose from 50% to 66% (UNICEF, 2012). Some of the greatest successes have emerged from the least developed countries where the coverage rate has been maintained above 70% from 1999-2004 (UNICEF, 2007). Successful interventions also exist in countries like Democratic People’s Republic of Korea, Indonesia, Kyrgyzstan, the Occupied Palestinian Territory, Thailand, Uzbekistan, and Vietnam where, despite not being listed by UNICEF as a priority country for vitamin A supplementation, VADD was recognized as a public health problem and each of these countries committed to a robust VAS program. In several countries, including Bangladesh, where universal coverage has been achieved, VAS has contributed to a significant reduction in under five mortality (UNICEF, 2007, UNICEF, 2012). However, only 41 of the 122 priority countries have achieved effective coverage for VAS (UNICEF, 2012).
The Road Ahead
The full child survival benefits of VAS need to be realized especially in countries with high under 5 mortality rates (i.e. more than 50 per 1000 live births) U5MR. Adding VAS to child health and immunization days has contributed to increased coverage using a proven, innovative delivery mechanism. Further effort is necessary to accelerate the gains achieved. Advocacy is required to sustain efforts in VAD prevention and control through poverty reduction strategies. Efforts to control VADD are an integral part of reducing childhood mortality and achieving the Millennium Development Goals (UNICEF, 2007).
Imdad, A., Herzer, K., Mayo-Wilson, E., Yakoob, M. Y., Bhutta, Z. A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age (Review), Cochrane Library, Issue 1, 2011. Internet http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008524.pub2/pdf (Accessed 01 September 2011)
UNICEF (2007) Vitamin A Supplementation: A Decade of Progress. Available from: http://www.unicef.org/publications/files/Vitamin_A_Supplementation.pdf (Accessed 09 May 2011)
UNICEF (2012). The State of the World’s Children: Children in an urban world. Internet http://www.unicef.org/sowc2012/statistics.php (Accessed 07 April 2012)WHO (2009) Global prevalence of vitamin A deficiency in populations at risk 1995–2005: WHO global database on vitamin A deficiency. Available from http://whqlibdoc.who.int/publications/2009/9789241598019_eng.pdf (Accessed 09 May 2011)
Do vitamin A deficiency and undernutrition still matter? Comm Eye Health Vol. 26 No. 84 2013. Published online 20 December, 2013
Access below additional resources thanks to Dr. Shilpa Vinod Bhatte and Senior Technical Advisor Dr. Clayton Ajello from Vitamin Angels (Vitamin A Supplementation Eye Health Messages) and Vitamin Angels Programs Division (List of References).