National vitamin A supplementation coverage survey among 6-59 months old children in Guinea (West Africa)

BACKGROUND

Vitamin A deficiency (VAD) is a major contributor to child mortality in sub-Saharan Africa. Sustained control of VAD is essential to meet the Millennium Development Goal (MDG) for reduction of child mortality in Guinea. Since, twice yearly vitamin A supplementation (VAS), either coupled with National Immunization Days or stand-alone has been adopted as a key strategy to combat VAD in 6-59 months old children.

OBJECTIVES

The objectives of this survey were to describe national VAS coverage rates and related factors affecting VAS coverage among 6-59 months old Guinean children.

METHODS

In July 2003, a VAS coverage survey was implemented in Guinea. A cross-sectional random cluster survey was conducted to select Guinean children (n = 1950, 390 mother-child pairs per zone) aged 6-59 months. The country was divided into four agro-ecological zones with 30 clusters chosen per zone. Within each cluster, a random selection of 13 households with at least one child was carried out with random selection of one child per household. Data on characteristics of children, receipt of VAS, caregivers' socio-economic characteristics, vitamin A knowledge and practices of caregivers were collected by questionnaire.

RESULTS

The national coverage rate of 68% is much lower than the official coverage rate of 93%. Middle Guinea, the region most affected by VAD, had the lowest coverage rate (58%).

CONCLUSION

In order to increase overall VAS coverage and reduce regional disparities, it is suggested that mass VAS be organized on a regional level, prioritizing rural regions (Middle and Upper Guinea) and the city of Conakry.

Review: genetically modified plants for the promotion of human health

Plants are attractive biological resources because of their ability to produce a huge variety of chemical compounds, and the familiarity of production in even the most rural settings. Genetic engineering gives plants additional characteristics and value for cultivation and post-harvest. Genetically modified (GM) plants of the "first generation" were conferred with traits beneficial to producers, whereas GM plants in subsequent "generations" are intended to provide beneficial traits for consumers. Golden Rice is a promising example of a GM plant in the second generation, and has overcome a number of obstacles for practical use. Furthermore, consumer-acceptable plants with health-promoting properties that are genetically modified using native genes are being developed. The emerging technology of metabolomics will also support the commercial realization of GM plants by providing comprehensive analyzes of plant biochemical components.

Socioeconomic differentials in supplementation of vitamin A: evidence from the Philippines

The efficacy of supplementation of vitamin A in child survival has been well-demonstrated. However, the effectiveness of a programme of vitamin A supplementation at the population level has been rarely examined. Understanding how programmes reach disadvantaged children can help improve the design of initiatives of vitamin A supplementation. The differentials in receipt of vitamin A by socioeconomic status were assessed using data from the Philippines. Factors associated with receipt of vitamin A during the last six months were examined using the Philippines Demographic and Health Surveys conducted in 1993 and 1998. In total, 6,970 and 6,118 children aged 12-59 months were included in 1993 and 1998 respectively. Logistic regression was used for identifying associations between the outcome and the household socioeconomic variables. The coverage of national-level vitamin A supplementation increased from 27% in 1993 to 79% in 1998. However, children whose mothers did not complete primary education and children living in poor households were less likely to receive supplementation. This disparity increased between the surveys: the adjusted odds of vitamin A intake by poor households compared to middle-class households declined from 0.73 [95% confidence interval (CI) 0.61-0.87) in 1993 to 0.52 (95% CI 0.42-0.63)] in 1998, resulting in an increased health inequity. The vitamin A programme in the Philippines was not uniformly successful in reaching the most vulnerable children. Approaches targeting vulnerable households or approaches not requiring mothers to travel to distribution centres may be more promising.

The impact of vitamin A supplementation on mortality inequalities among children in Nepal

OBJECTIVE

This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials.

DESIGN

The study involved secondary analysis of data from a placebo-controlled randomized field trial of vitamin A supplements. The study took place between 1989-1991 in rural Sarlahi District of Nepal, with 30,059 children age 6 to 60 months. The main outcome measures were differences in mortality between boys and girls, between highest Hindu castes and others, and between the poorest quintile and the four other quintiles.

RESULTS

Without vitamin A, girls in rural Nepal experience 26.1 deaths per 1000, which is 8.3 deaths more than the comparison population of boys. With vitamin A the mortality disadvantage of girls is nearly completely attenuated, at only 1.41 additional deaths per 1000 relative to boys. Vitamin A supplementation also narrowed mortality differentials among Hindu castes, but did not lower the concentration of mortality across quintiles of asset ownership. The vitamin A-related attenuation in mortality disadvantage from gender and caste is statistically significant.

CONCLUSIONS

We conclude that universal supplementation with vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.

Mass supplementation of vitamin A linked to National Immunization Day

OBJECTIVE

Main objectives were to assess the feasibility of linking vitamin A delivery with National Immunization Days (NIDs) and to see the impact on xerophthalmia.

METHODS

An Intervention study of mass distribution of vitamin A solution was undertaken to control widespread xerophthalmia prevalent in children living in about 26 slums of Chandigarh in the year 2000. Two rounds of mass distribution of Vitamin A solution covering 27642 and 31762 children in 1-5 years of age in first and second rounds, respectively, were undertaken. The findings of second round and post evaluation after intervention are presented here. An additional team of two persons per pulse polio immunization (PPI) centre delivered age specific doses of vitamin A solution through 98 centres and operational problems were recorded. PPI staff provided the supervision and PPI tally sheets were used.

RESULTS

The programme achieved a vitamin A coverage rate of 99% in first round and 88% in second round. Only two parents refused vitamin A solution. No side effect or cases of toxicity due to vitamin A were reported by health institutions in the area or in a stratified random sample of 101 children. There was a significant decline (13.4%) in xerophthalmia after two rounds of mass distribution (P < .001). The strategy to deliver vitamin A was successfully integrated into NID's and appeared to achieve a significant decline in xerophthalmia.

CONCLUSION

Linking of vitamin A distribution with PPI could be a basis for launching similar initiatives in other areas of India and other countries where xerophthalmia is a public health problem.

Rapid assessment and delivery of Vitamin A to slum children by using National Immunization Day in Chandigarh

This study was done with the objective to see the feasibility of using National Immunization Days (NIDs) for rapid assessment, and delivery of Vitamin A solution to about 27,600 children dwelling in 26 slums in Union Territory of Chandigarh. The assessment of Vitamin A deficiency (VAD) was done in a stratified random sample of 1304 children during third round of Intensified Pulse Polio Immunization (IPPI) and delivery of Vitamin A solution was done during fourth round of IPPI in 1999-2000 covering 27,642 children in the age group of 1-5 years. An additional team of two persons per centre delivered age specific doses of Vitamin A solution through 72 centres and operational problems were recorded. IPPI staff provided supervision and same tally sheets as of IPPI were used. The prevalence rate of VAD was 24.6%, with conjunctival xerosis, bitot's spot and corneal xerosis as 23.7%, 0.6% and 0.2% respectively. 27,275 (98.7%) children out of 27,642 were administered Vitamin A solution, with no major operational problem. Only five parents (0.01%) refused Vitamin A solution. No case of side effect or toxicity due to Vitamin-A was reported. The strategy to assess and deliver Vitamin A during NID's was found to be feasible and successful and could be a basis for launching similar initiatives in other areas of India and other countries where VAD is a public health problem.

Evaluation of vitamin A supplementation in Gulshan-e-Sikandarabad

INTRODUCTION

Vitamin A deficiency (VAD) causes blindness of 250,000 to 500,000 children annually, around the world. It also increases the risk of morbidity and mortality due to other diseases. Pakistan is categorized in the 'Severe Sub-Clinical Deficiency' group. A mass supplementation program has been started in 1999.

AIM

To determine the coverage of vitamin A supplements in children under five years of age, and to assess the incidence of symptoms related to hypervitaminosis A.

SETTING

Block I-A of Gulshan-e-Sikanderabad.

METHODOLOGY

A survey was conducted, using the fourth year MBBS students of Ziauddin Medical University (ZMU), under faculty supervision. A pre-tested structured questionnaire was used to assess coverage and symptoms of toxicity.

RESULTS

Data was obtained on 489 children. The coverage of polio and vitamin A supplementation was 88% and 74.8%, respectively. In all 15 children (4.4%) experienced symptoms of toxicity related to vitamin A supplementation.

CONCLUSION

Although vitamin A supplementation can save lives, it is only a short term measure. What is needed is a multi-strategy approach including short and long term strategies.

The role of universal distribution of vitamin A capsules in combatting vitamin A deficiency in Bangladesh

Vitamin A deficiency is a major public health problem among preschool-aged children in many developing countries. In Bangladesh, a national nutritional surveillance system was initiated in 1990 to monitor 1) the occurrence of vitamin A deficiency by history of night blindness and 2) the routine coverage of national twice-yearly prophylactic vitamin A capsule (VAC) distribution. This study comprised data collected from June 1990 to August 1994. The VAC distribution had a mean coverage rate of 48.7% (95% confidence interval (CI) 48.4-49.0) in the rural areas; the coverage rate in the urban slums was 93.7% (95% CI 93.4-94.0). In the rural areas, the mean prevalence of night blindness was 0.86% (95% CI 0.81-0.91) and the bimonthly prevalence of night blindness ranged from 0.50% (95% CI 0.32-0.77) to 1.48% (95% CI 1.19-1.85), while in the urban slums the mean prevalence was 0.22% (95% CI 0.18-0.28) and the bimonthly prevalence ranged from zero to 0.62% (95% CI 0.27-1.37). The efficiency of VAC distribution was 27% (95% CI 17.6-35.3) in the rural areas and 77.8% (95% CI 61.8-87.1) in the urban slums. After adjustment for multiple potentially confounding factors, VAC receipt by individual children reduced the risk of night blindness in both rural and urban areas (rural areas: odds ratio (OR) = 0.74, 95% CI 0.63-0.87; urban slums: OR = 0.39, 95% CI 0.19-0.82). Breastfeeding was a protective factor for night blindness in both rural (OR = 0.53, 95% CI 0.42-0.67) and urban (OR = 0.32, 95% CI 0.15-0.66) areas. Night blindness was inversely related to the level of routinely attained coverage, and the degree of protection was associated with the time interval between the moment of VAC receipt and the moment of data collection. Although the prevalence of vitamin A deficiency in Bangladesh has been considerably lower in the 1990s than it was in the 1980s, it is still prevalent at all socioeconomic levels. Supplementation with high-dose VACs is an effective strategy for reducing night blindness, but the efficiency of the program will improve when coverage in the rural areas increases.

[Consumption of vitamin A in Ribeira, São Paulo (Brazil)]

Foi evidenciado o problema da baixa adequação de vitamina A, em localidade considerada grande produtora de alimento rico nesse nutriente, a cidade de Ribeira (S. Paulo, Brasil ), produtora de mamão (Carica Papaya L.). A análise dos dados evidencia que esse alimento, que poderia contribuir para cobrir as necessidades recomendadas de vitamina A, foi consumido em quantidades ínfimas. Atribuiu-se esse fato, à falta de conhecimento por parte da população local, do valor nutritivo dos alimentos ricos em vitamina A. Recomenda-se o desenvolvimento de campanhas de educação alimentar.