Vitamin A: From Research to Action

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(No Transcript)
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Vitamin A From Research to Action

• Monique Mosolf
• VITA Coordinator
• USAID

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Child Survival Mandate

• Mandate from Congress to address primary causes
  of child survival

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Main Causes of Under-Five Mortality1990 and 2000
HIV
Diarrhea
4
Others
12
28
Others
Diarrhea
29
28
Malaria
Malnutrition(underlying factor)60
8
Malnutrition(underlying factor)gt50
Perinatal
Malaria
7
22
Whooping
ARI
cough
ARI
4
15
Neo-natal
20
tetanus
Measles
Measles
6
11
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1990
2000
Source Protecting the Worlds Children, A Call
for Action, 1990 Evidence and
information for Policy/WHO, Child Adolescent
Health and Development, 2001 WHO,
Child and Adolescent Health and Development. On
line www.who.int/child-adolescent-health/inegr.htm

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Impact of Vitamin A
Percent Mortality Reduction
Average Reduction 23
Sommer and West, 1996
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Consequences of VA Deficiency

• ? all-cause U5 mortality by 23-34
• ? measles U5 mortality by gt50
• ? diarrhea U5 mortality by gt33
• ? malaria U5 morbidity by 30
• ? childhood blindness
• ?? ? maternal mortality (40)

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Cumulative Pregnancy-related Mortality, NNIPS-2,
Nepal
RR 0.60 0.47 0.63 0.56
0.60 0.51
West et al, BMJ, 1999
RR Relative Risk RR excludes 1.0
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Vitamin A Deficiency

• gt150 million U5s VAD
• 4 million children with xerophthalmia
• 1-2.5 million child deaths/year
• 20 million women with low status
• 6 million night blind pregnant women

K. West, in preparation, 2001
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The Magnitude of the Problem
Vitamin A deficiency, children 0-4, 1994
At-risk of iodine deficiency, 1997
Anemia, women, 1997
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What Do We Do??
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Essential Nutrition Actions (ENAs)
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Vitamin A

• Post-partum maternal supplementation
• Breastfeeding
• Semi-annual supplementation 6-59 mo of age
• Vitamin A-rich foods (incl/esp fortified foods)
• Case mgmt supplementation

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VA Supplementation

• Conducted in gt75 countries globally
• Partners
• UNICEF
• CIDA
• WHO
• Micronutrient Initiative
• MOST
• BASICS

• VA distribution since 1980s in Philippines,
  Bangladesh, Indonesia
• Estimated to cost lt1 per child per year

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Operationalizing VA supplementation

• Twice per year distribution to children 6-59
  months
• 100,000 IU to 6-12 months 200,000 IU to 12-59

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Operationalizing VA Supplementation

• National Immunizations Days
• VA/Micronutrient Days
• Child Health Weeks
• EPI/Routine Health Services

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National Immunization Days

• High coverage achieved
• Linked to strong infrastructure

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Child Health Week

• Country Examples
• Zambia
• Nicaragua
• Philippines
• Incorporation of other child health
  interventions bed net re-dripping, IFA,
  immunizations, tetanus, deworming

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VA/Micronutrient Days Nepal

• Female Community Health Volunteers
• National coverage, achieving gt80 coverage

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EPI/Routine Health Services

• VA is distributed through child health visits
  (US - well-child visits)
• Requires strong health seeking behavior
• Typically results in low coverage

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Post-Partum Supplementation

• 200,000 IU capsule should be delivered to women
  within 24 hours of delivery.
• Second dose (200,000 IU) should be given at least
  24 hours after the first dose, but no later than
  6 weeks.

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Food Fortification
In some countries, fortifying food staples like
flour, sugar and margarine can help end vitamin A
deficiency

• Safe, effective, sustainable
• Must ensure women and children have access to
  fortified food

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Impact of Sugar Fortification
IMPACT OF THE SUGAR FORTIFICATION PROGRAMS IN
CENTRAL AMERICA Vitamin A Status of Preschoolers
( plasma retinol lt 20 µg/dL)
1965 1977 1987 1995 1967
1996 1966 1988 1998
GUATEMALA HONDURAS
EL SALVADOR
First Period Second Period
(Efficacy) (Effectiveness)
(Effectiveness)
(Effectiveness)
Source Nutritional National Surveys.
Preliminary data because reliability of method
has not been confirmed.
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Global Alliance for Improved Nutrition

• GAIN
• A alliance of public and private sector
• Seeks to save lives and improve health through
  the elimination of vitamin and mineral
  deficiencies.
• To support developing countries in their efforts
  to implement locally developed food fortification
  strategies
• Alliance Members Foundations, donors,
  multilateral organizations, industry, academic
  institutions, NGOs/PVOs, developing country
  experts.

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Dietary Diversification

• A priority or not?

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Thank you