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2016 Nov; New York, New York, UNICEF, 2016 Nov. 77 p.Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million children each year. This report highlights current pneumonia and diarrhoea related mortality, and illustrates the startling divide between the children being reached and the considerable number of those left behind. By developing key protective, preventative and treatment interventions, collectively we are now equipped with the knowledge and the tools required to preventing child deaths due to these leading childhood killers. The report also provides recommendations to further accelerate progress in effective interventions and bridge the greatest gaps in equity.
Geneva, Switzerland, WHO, 2013.  p.This guideline provides global, evidence-informed recommendations on a number of specific issues related to the management of severe acute malnutrition in infants and children, including in the context of HIV. The guideline will help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions for severely malnourished children. It will also support Member States in their efforts to achieve global targets on the maternal, infant and young child nutrition comprehensive implementation plan, especially global target 1, which entails achieving 40% reduction by 2025 of the global number of children under 5 years who are stunted and global target 6 that aims to reduce and maintain childhood wasting to less than 5%. The guideline is intended for a wide audience, including policy-makers, their expert advisers, and technical and programme staff in organizations involved in the design, implementation and scaling-up of nutrition actions for public health. The guideline will form the basis for a revised manual on the management of severe malnutrition for physicians and other senior health workers, and a training course on the management of severe malnutrition..
American Journal of Clinical Nutrition. 2011 Dec; 94(6):1683S-1689S.To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A, the current recommendation for a single high dose of vitamin A in HIV-infected women within 6 wk of delivery should be reviewed.
New York, New York, UNICEF, 2009.  p.This report sets out a 7-point strategy for comprehensive diarrhoea control that includes a treatment package to reduce child deaths, and a prevention package to reduce the number of diarrhoea cases for years to come. The report looks at treatment options such as low-osmolarity ORS and zinc tablets, as well as prevention measures such as the promotion of breastfeeding, vitamin A supplementation, immunization against rotavirus -- a leading cause of diarrhoea -- and proven methods of improving water, sanitation and hygiene practices. Diarrhoea's status as the second leading killer of children under five is an alarming reminder of the exceptional vulnerability of children in developing countries. Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures. (Excerpt)
Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement.
Geneva, Switzerland, WHO, .  p.Iron deficiency with its attendant anaemia is the most prevalent micronutrient disorder on a worldwide basis. In 2001, the UN General Assembly at the Special Session on Children recommended that the prevalence of iron deficiency and anaemia be reduced by one third in children by the year 2010. If achieved, this would contribute greatly to the realization of the Millenium Development Goals. In most countries, national policies have been implemented to provide iron supplements to pregnant women, and to a lesser extent to young children, as the primary strategy for preventing iron deficiency and anaemia. Although the benefits of iron supplementation have generally been considered to outweigh the putative risks, there is some evidence to suggest that supplementation at levels recommended for otherwise healthy children carries the risk of increased severity of infectious disease in the presence of malaria and/or undernutrition. (excerpt)
Lancet. 2007 Sep 22; 370(9592):1030-1031.Young Kwang Chae and Jeong Hyun Yun query whether data from our randomised controlled trial of early, high-dose vitamin A supplementation (50 000 I given with the three diphtheria-tetanus-pertussis [DPT] vaccinations at 6, 10, and 14 weeks) in Gambian infants can contribute to the ongoing controversy about whether there might be harmful interactions between vitamin A supplementation and killed vaccines, particularly in girls. Several notes of caution are necessary. The observations by Benn and colleagues that have raised the concerns relate to excess mortality. Our trial is greatly underpowered for this endpoint. There were two postneonatal deaths in the high-dose group (n=99) and none in the standard WHO dose group (n=98). One male infant died of pneumonia and septicaemia at 7 months and one female of unknown causes at 3 months. This overall post-neonatal infant mortality rate equates to 10 in 1000, which is exceptionally low for this region and reflects the high level of monitoring and clinical care offered to the study participants. This point reduces the usefulness of our data in contributing to the debate. In response to Chae and Yun's query as to whether the vitamin A might have exacerbated DTP-related side-effects, we have reanalysed our data in an attempt to identify potentially life-threatening illnesses. In our original paper we restricted the analyses to clinic visits that elicited a treatment. Numerous non-critical conditions such as colds and skin rashes remained. We have now excluded these and repeated the analysis of potentially life-threatening events for the time window between the first DPT vaccination and vitamin A dose at 6 weeks and the first live vaccine (measles at 9 months). We analysed four diseases (malaria, diarrhoea, pneumonia, and septicaemia) separately and combined. There were 73 events in the high-dose group and 79 events in the WHO group. Owing to small numbers of events there were wide confidence intervals and no differences were significant. The closest to significance (pneumonia) was, if anything, lower in the high-dose group. In summary, our trial is under powered to contribute to this important debate, but we will be happy to contribute the data to future meta-analyses. (full text)
Lancet. 2007 Sep 22; 370(9592):1030.In their study of the effectiveness of early supplementation with high-dose vitamin A versus standard WHO protocol in Gambian mothers and infants, Momodou Darboe and colleagues report that the proportion of infants attending the clinic was greater in the high-dose vitamin A group than in the WHO protocol group in the first 6 months of life (p=0.018). However, they do not provide any detailed description of the chief complaints responsible for the differences in clinic attendance. It would be worthwhile to learn whether vitamin A supplementation exacerbated side-effects related to diphtheria-tetanuspertussis (DTP) vaccination, since both DTP vaccination and three out of five scheduled supplementations were done in the first 6 months of life. This finding is also interesting because it is consistent with the findings of previous studies that there is a null or detrimental effect of vitamin A supplementation on infant mortality when supplementation is given close to the DTP vaccination. These reportsare of note since the protective effect of vitamin A supplementation is well established when given with the BCG vaccine (at birth) and with the measles vaccine (after 6 months of life). As Darboe and colleagues mention, Benn and colleagues suggested that vitamin A supplementation could amplify the non-specific effects of vaccines, causing differing effects between killed (DTP) and live (BCG and measles) vaccines. We believe that the findings from this study that high-dose vitamin A supplementation around the time of DTP vaccines revealed no advantageous effect and even a negative effect on clinic visits only buttresses the immune modulatory role of vitamin A supplementation with routine vaccines. (full text)
Effectiveness of an early supplementation scheme of high-dose vitamin A versus standard WHO protocol in Gambian mothers and infants: A randomised controlled trial.
Lancet. 2007 Jun 23; 369(9579):2088-2096.Most developing countries have adopted a standard WHO dosing schedule for vitamin A supplementation. However, in 2002 the International Vitamin A Consultative Group (IVACG) Annecy Accord recommended a new high-dose regimen for mothers and infants. Our aim was to test whether the new high-dose regimen of vitamin A supplementation would increase maternal and infant plasma vitamin A, reduce infant Helicobacter pylori infection and nasopharyngeal pneumococcal carriage, and improve infant gut epithelial integrity. In an area of moderate vitamin A deficiency in rural Gambia, 220 mother-infant pairs were enrolled in a randomised double-blind trial between September, 2001, and October, 2004, that compared the IVACG high dose with the WHO dose. The primary endpoints were levels of maternal and infant plasma vitamin A, H pylori infection, pneumococcal carriage, and gut epithelial integrity. The trial is registered as ISRCTN 98554309. 197 infants completed follow-up to 12 months (99 high dose and 98 WHO dose). There were no adverse events at dosing. No differences were found in the primary outcomes for high-dose versus WHO schedule: maternal vitamin A concentration at 2 months plus 0.02 macromol/L (95% CI -0.10 to 0.15); infant vitamin A at 5 months plus 0.01 macromol/L (-0.06 to 0.08); H pylori infection at 12 months -0.3% (-14.7 to 14.2); maternal pneumococcal carriage at 12 months -2.0% (-13.7 to 9.7); infant pneumococcal carriage at 12 months -4.1% (-15.8 to 7.6); infant gut mucosal damage at 12 months 5.2% (-8.7 to 19.2). There were more clinic attendances by the high-dose group in the first 6 months of life (p=0.018). Our results do not lend support to the proposal to increase the existing WHO standard dosing schedule for vitamin A in areas of moderate vitamin A deficiency. Caution is urged for future studies because trials have shown possible adverse effects of higher doses of vitamin A, and potential negative interactions with the expanded programme on immunisation (EPI) vaccines. (author's)
Food and Nutrition Bulletin. 2001; 22(4):352-356.In several Eastern and Southern African countries, between one-third and one-half of the children are vitamin A deficient. Not just one strategy, but a combination of supplementation, fortification, and dietary diversification will provide the solution to the elimination of vitamin A deficiency. Food diversification in general is limited by increasing poverty and household food insecurity. Supplementation coverage rates increased from an average of 22% to 68% during the last four years. This was mainly due to integration of supplementation into national immunization days. Now the challenge is to integrate supplementation into sustainable delivery systems. Several countries have started or are planning maize and/or sugar fortification initiatives, but most of the experience so far has been on a pilot scale, and little is known about the impact of the interventions. There is a need to develop strategies for vitamin A supplementation and fortification of different foods to reach all areas and individuals in a country. (author's)
Report of Working Group 3: Promoting food-based approaches to eliminate vitamin A deficiency in Africa.
Food and Nutrition Bulletin. 2001; 22(4):469.Although malnutrition is a problem in Africa, South Africa and some other African countries are exporters of food. Why, then, is there a problem with malnutrition in general, and vitamin A deficiency in particular, in Africa? The causes of malnutrition can often be traced to limitations in food availability and accessibility and limited behavioral choices. Food-based approaches offer the opportunity to address all three limitations. Well-designed programs have not only improved accessibility, but through empowering communities, and women in particular, have increased the availability of food to vulnerable groups. It has also been argued that increasing the choice of foods is an important part of development. Therefore food-based approaches are essential. The holistic nature of the life cycle is an advantage in using it as the basis for promoting a food-based approach to eliminate vitamin A deficiency in Africa. Multigenerational households are common in Africa. The life-cycle approach allows for broader assessment and analysis of possible vitamin A deficiency and allows for linkages to other sectors. This enables integration among programs. (excerpt)
Report of Working Group 2: Production, conservation, and distribution of foods with vitamin A activity.
Food and Nutrition Bulletin. 2001; 22(4):467-468.Within the medical and health communities, the promotion of foods that are naturally rich in ß-carotene and other sources of vitamin A has a relatively low profile. Many professionals are more comfortable with periodic distribution of high-dose supplements. This lack of interest has limited investment in creative and innovative food-based approaches. In turn this has meant that there are relatively few success stories that have been empirically evaluated and can be used to enhance the profile of this approach. This meeting has been an excellent catalyst for the promotion of a food-based approach, which we believe is a sustainable way to include vitamin A within broader strategies to improve the nutrition and health of those Africans most at risk. There is an urgent need to build partnerships and both informal and formal networks to share experiences on community-level, food-based actions. This is needed as the basis for advocacy at several levels: within the health and nutrition community, with policy makers in governments and international agencies, and with grassroots organizations, including community-based organizations, women's groups, schools, youth organizations, etc. (excerpt)
Global HealthLink. 2005 Mar-Apr; (132):8-9.HELEN KELLER INTERNATIONAL (HKI), a 90-year old organization with established programs worldwide that combat the causes and consequences of blindness and malnutrition, is focusing its tsunami disaster relief efforts on assisting survivors in Indonesia through two assistance activities with both immediate and long-term implications. These disaster response efforts are based on strategies and techniques that the agency already implements, capitalizing on its skills, expertise and experience. The most immediate threat facing the survivors of the earthquake and tsunami is the spread of water-borne and infectious diseases. Many of the survivors are displaced and living in accommodations with poor sanitation and hygiene, making them even more vulnerable to disease. Children are particularly vulnerable to disease and death in the aftermath of disasters, and diarrhea, pneumonia and malaria can become life-threatening problems. Yet, vitamin A and zinc &given to children under five years of age reduce mortality from diarrhea, measles and other causes by 23 percent to 50 percent, and lessen the severity and likelihood of contracting diarrhea, pneumonia and malaria by 30 to 40 percent. (excerpt)
Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality. [Étude randomisée sur l'effet de différentes doses de vitamine A sur la morbidité et la mortalité infantiles]
BMJ. British Medical Journal. 2005 Dec 17; 331(7530):1428-1432.The objectives were to determine whether the dose of vitamin A currently recommended by the World Health Organization or half this dose gives better protection against childhood morbidity and mortality. Design: Randomised study. Setting: A combined oral polio vaccine and vitamin A supplementation campaign in Guinea-Bissau, Africa. Participants: 4983 children aged 6 months to 5 years. Interventions: One of two doses of vitamin A (recommended and half); oral polio vaccine. Main outcome measures: Mortality and morbidity at six and nine months. Mortality was lower in the children who took half the recommended dose of vitamin A compared with the full dose at both six months (mortality rate ratio 0.69, 95% confidence interval 0.36 to 1.35) and nine months (0.62, 0.36 to 1.06) of follow-up. There was a significant interaction between sex and dose, the lower dose being associated with significantly reduced mortality in girls (0.19, 0.06 to 0.66) but not in boys (1.98, 0.74 to 5.29). The lower dose of vitamin A was consistently associated with lower hospital case fatality in girls (0.19, 0.02 to 1.45). Paradoxically, in children aged 6-18 months, the low dose was associated with slightly higher morbidity. Half the dose of vitamin A currently recommended by WHO may provide equally good or better protection against mortality but not against morbidity. (author's)
Washington, D.C., IVACG, 2004 Apr.  p. (USAID Cooperative Agreement No. HRN-A-00-98-00027-00)As evidence has grown about the potential health benefits of reducing deficiencies of other micronutrients in addition to vitamin A, particularly iron, folate, and zinc, health officials have increasingly considered administering vitamin A in combination with other micronutrients, either as supplements or as fortified dietary products. But little is known about the potential interaction, physical and physiologic, of simultaneously administered multiple micronutrients in chronically malnourished populations at varying risk of micronutrient deficiency and serious, recurrent infections (including HIV, tuberculosis, and malaria). Since programs to address other micronutrient deficiencies will inevitably be combined with vitamin A control efforts, it is critically important that relevant policies and decisions be based on sound science concerning the effect of administering multiple micronutrients simultaneously. Therefore, developing an adequate scientific basis for these policies and decisions will increasingly engage IVACG’s attention. (excerpt)
Geneva, Switzerland, WHO, Department of Immunization, Vaccines and Biologicals, 2004.  p. (WHO/EPI/TRAM/93.5 (updated 2004); WHO/PBL/93.31)This teaching aid is about measles, and its potentially harmful effects on the eyes of children.1 Understanding the risks of damage to the eye from measles is the first step before learning what action to take to save sight. Measles causes a great amount of unnecessary death and blindness in children, especially in Africa and parts of Asia. Death and loss of sight due to measles are health care disasters that simply should not occur. Measles is a highly infectious disease preventable by immunization. Reducing deaths due to measles is a global health priority. Immunized children rarely get measles and the cost of immunization is low. The road to good health is also the road to good vision. Since the eye problems due to measles are especially dangerous in children who eat less well, this teaching aid also presents good feeding habits and how to improve the diet for the malnourished child. Protein-energy malnutrition is the most widespread form of malnutrition. It is not easily preventable in poor communities or where there is serious shortage of food as in famine situations and civil strife. (excerpt)
Geneva, Switzerland, WHO, 1999 May. 56 p. (WHO/CDS/CSR/ISR/99.1)These technical guidelines are part of a series developed by the Communicable Diseases Cluster (CDS) at the World Health Organization. The purpose of this series is to update current knowledge on diseases with epidemic potential, to help health officials detect and control outbreaks, and to strengthen the capacity for emergency response to an epidemic situation. These guidelines have been prepared jointly with the Health Technology and Pharmaceuticals Cluster (HTP). The contribution of the Government of Ireland to the production of this document is gratefully acknowledged. (excerpt)
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
New York Times on the Web. 2002 Mar 4;  p..In India, the death of a 2-year old boy named Wahidur and some 30 other children has halted the vitamin A campaign supported by UN International Children's Emergency Fund. Rumors spread that the vitamin A supplementation has caused the death, causing fear among the people. However, investigation by public health officials revealed that it was not vitamin A that killed many of the children but rather by common sickness like diarrhea and pneumonia. In addition, laboratory tests determined that the vitamin syrup met all the standards. Studies have shown that vitamin A sharply reduces the chances of death of many malnourished youngsters in developing countries due to diarrhea, measles and other diseases. It also helps prevent blindness. According to Dr. Alfred Sommer, an epidemiologist and dean of the Bloomberg School of Public Health at John Hopkins University, an estimated tens of thousands of Indian children would die needlessly if the vitamin A campaign is not restored.
The development and evaluation of an intervention to inform and counsel Zimbabwean women about HIV transmission through breastfeeding. A study by the ZVITAMBO Project, Johns Hopkins University School of Hygiene and Public Health, the Support for Analysis and Research in Africa (SARA) Project and the LINKAGES Project at the Academy for Educational Development.
Washington, D.C., AED, LINKAGES, .  p.In 1998, the policy recommendations of UN organizations regarding breast-feeding shifted, following reports of evidence that HIV can be transmitted from infected mothers to their babies during breast-feeding. From a recommendation in the early 1990s that all babies in developing countries should be breast-fed, the UN recommends that HIV-positive women be fully informed about various feeding options and supported in their individual decisions about how to feed their babies. With a view of this recommendation, the Zimbabwe Vitamin A for Mothers and Babies Project (ZVITAMBO) was developed. This Project is a large clinical trial being conducted in Harare to assess the impact of a large dose of vitamin A provided to mothers and/or newborn babies on infant mortality, new HIV infections among postnatal women, and HIV transmission through breast-feeding. It also explores ways to fully inform pregnant and early postnatal women about the risks and benefit of breast-feeding, mixed feeding, and replacement feeding for infant health and mother-to-child transmission of HIV. Results from the qualitative and quantitative studies conducted by ZVITAMBO will provide guidance to the government of Zimbabwe and other agencies about how best to counsel women about infant feeding in the context of high HIV prevalence.
POLIO NEWS. 1999 Jun; (4):5.An estimated 4.3 million children were vaccinated against polio and given vitamin A supplements during the first round of the National Immunization Days (NIDs) in Afghanistan. In the remote areas, 20,000 health workers and volunteers were trained and deployed to reach children for vaccination. Moreover, the WHO helped in the distribution of supplies and sent supervisors into three villages of the remote district of Badakshan. A strong-mounted, well-coordinated social mobilization campaign through the local radio was made possible by mosques, the BBC, Voice of America, and print media in Afghanistan and Pakistan. NIDs are jointly conducted by the WHO, the UN Children's Fund, the Ministry of Public Health, and nongovernmental organizations. Mass immunization campaigns and NIDs have been conducted in Afghanistan since 1994.
Travel to UNICEF / New York to participate in meeting on integrating vitamin A supplementation into immunization programs, January 12-13, 1998.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 1998. , 6,  p. (Report; USAID Contract No. HRN-C-00-93-00031-00)This report pertains to a consultant meeting in New York City with UNICEF during January 12-13, 1998, to discuss the integration of vitamin A supplementation into immunization programs. One consultant stayed to talk about vitamin A/immunization training materials being developed by BASICS with World Health Organization (WHO) staff and staff from Helen Keller International. The UNICEF meeting included about 35 participants who were mostly WHO and UNICEF headquarters and field staff. There were WHO regional immunization advisers from the Eastern Mediterranean, Southeast Asia, and the Americas. Three staff from USAID and representatives from Canada attended. Several logistics issues arose. Vitamin A supplementation should be introduced at 4-6 months, but the closest immunization contact period is not until after 9 months or before 4 weeks. Second, there is no medical data to ensure that a massive dose of vitamin A would not interfere with DPT effects. It was agreed that the links are helpful but not limited to the Expanded Program of Immunization. The meeting produced a draft paper on background, summary findings, and conclusions and recommendations, which are included in the appendices. It is concluded that many countries already provide vitamin A during immunization contacts. One single recommended strategy does not meet diverse country settings. Additional fieldwork is needed before solidifying strategies. Training should not be delayed. A packaging alternative is to shift to a small squeeze bottle that can be calibrated by size and dose. The mid-level manager's module on vitamin A and EPI continues to be revised.
Geneva, Switzerland, World Health Organization [WHO], Administrative Committee on Coordination, Subcommittee on Nutrition, 1989 Oct. , 136 p. (ACC / SCN State-of-the-Art Series; Nutrition Policy Discussion Paper No. 5)This state-of-the-art UN nutrition policy discussion paper focuses on the interaction of malnutrition and infection in child mortality in developing countries. Given the cyclic nature of the interaction, it is appropriate to define a malnutrition-infection complex. Inadequate dietary intake can cause weight loss or failure of growth in children and lead to low nutritional reserves. This is associated with a lowering of immunity, probably with all nutrient deficiencies. In the case of protein-energy and vitamin A deficiencies, there may be progressive damage to mucosa, lowering resistance to colonization and invasion by pathogens. Under these circumstances, the incidence, severity, and duration of diseases are increased. The disease process itself exacerbates loss of nutrients, inducing malnutrition, which leads, in turn, to further damage to defense mechanisms. The first part of this report reviews present knowledge on malnutrition and infection. The second includes an annotated bibliography of research on the following topics: infection as a risk factor for poor growth, poor growth as a risk factor for infection, vitamin a deficiency as a risk factor for infection, iron deficiency as a risk factor for infection, zinc deficiency as a risk factor for infection, and other vitamins and minerals.
Delivery of oral doses of vitamin A to prevent vitamin A deficiency and nutritional blindness: a state-of-the-art review.
Geneva, Switzerland, World Health Organization [WHO], Administrative Committee on Coordination, Subcommittee on Nutrition, 1987 Jun. , 113 p. (ACC / SCN State-of-the-Art Series; Nutrition Policy Discussion Paper No. 2)This state-of-the-art UN nutrition policy discussion paper focuses on the prevention and control of vitamin A deficiency and nutritional blindness. Although large-dose vitamin A distribution has emerged as a safe, effective means of preventing xerophthalmia, numerous factors have impeded more widespread application of this intervention. The protective period can vary with the frequency and severity of precipitating and contributory factors such as infection and protein-energy malnutrition. Medical, targeted, and universal approaches have been used to distribute vitamin A to communities at risk. Problems arise in ensuring the uninterrupted supply of vitamin A doses, supervising and training personnel, and record keeping. Declining target group coverage is the single most important cause of ineffective xerophthalmia prevention. Preliminary cost-benefit analysis indicates the benefits of preventing xerophthalmia calculated in monetary terms far outweigh program costs, supporting the continued use of periodic vitamin A distribution campaigns. Discussion papers appended to this report cover alternative strategies with emphasis on food fortification, technologies currently available in India to combat vitamin A malnutrition, programmatic issues in vitamin A dose delivery, and delivery of large doses of vitamin A.
INDIAN PEDIATRICS. 1997 Mar; 34(3):263-5.An estimated 6.6 million of the 12.2 million deaths that occur each year among children under 5 years of age in developing countries are associated with malnutrition. The World Health Organization, in collaboration with other United Nations agencies and nongovernmental organizations, has launched campaigns focused on protein-energy malnutrition, iodine deficiency disorders, vitamin A deficiency, and iron deficiency anemia. By January 1996, 96 countries had developed national plans of action for nutrition and an additional 41 had a plan under preparation. Various types of micronutrient malnutrition (especially iron deficiency) not only are important causes of disability in themselves, but also make the body less able to withstand infections and other sources of morbidity. Iron supplementation, salt iodization, and vitamin A supplementation--in addition to the production, distribution, and preparation of healthy foods--are essential to nutritional health.
EARTH TIMES. 1996 Oct 16-31; 9(18):8.Vitamin A, iodine, and iron are widespread, cheap, available, and needed in small quantities by the human body in order to remain healthy. Many people, however, especially women and children, do not consume adequate quantities of these micronutrients. Indeed, vitamin deficiency affects more than 200 million children worldwide, and a lack of vitamin A supplementation could be the cause of 1-3 million child deaths per year. The problem remains particularly serious in 76 countries. Vitamin A affects vision and the immune system such that deficiency can cause blindness, delay recovery from diarrhea, and cause an episode of measles to be more severe. Vitamin A deficiency is more likely to be found in arid regions, among the poor, and in areas without a historical pattern of eating vitamin A-rich foods. Supplementation readily corrects the problem. The author notes that the United Nations Children Fund (UNICEF) has helped make countries aware of the problem of micronutrient deficiencies.