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Mass distribution of vitamin A and the prevention of keratomalacia
Insights
Biannual vitamin A supplementation in El Salvador did not reduce keratomalacia rates in children aged 1-4 years. Many eligible children did not receive the vitamin, and ineligible infants were excluded.
Area of Science:
- Public Health
- Ophthalmology
- Pediatrics
Background:
- Vitamin A deficiency is a leading cause of preventable childhood blindness.
- Keratomalacia, a severe manifestation of vitamin A deficiency, poses a significant threat to pediatric populations.
- Effective interventions are crucial for preventing vitamin A deficiency-related eye conditions.
Purpose of the Study:
- To evaluate the efficacy of biannual high-dose vitamin A supplementation in preventing keratomalacia.
- To assess the impact of a public health program on vitamin A deficiency outcomes in young children.
- To identify factors influencing program effectiveness and child health outcomes.
Main Methods:
- Retrospective review of 3,490 pediatric admissions in El Salvador.
- Analysis of keratomalacia incidence before and after program initiation.
- Examination of vitamin A supplementation coverage and child eligibility.
Main Results:
- No significant reduction in vitamin A-related corneal destruction was observed.
- Similar rates of keratomalacia persisted post-program implementation.
- High ineligibility rates (48%) and suboptimal vitamin A uptake (80%) limited program reach.
- Corneal destruction was associated with severe malnutrition; mortality was higher in girls.
Conclusions:
- Biannual high-dose vitamin A supplementation was ineffective in preventing keratomalacia in the studied population.
- Programmatic challenges, including eligibility criteria and adherence, hindered effectiveness.
- Severe malnutrition remains a critical factor in pediatric eye disease and mortality.
Abstract:
A retrospective review of 3,490 adminissions to the major pediatric facility in El Salvador was undertaken to determine whether biannual administration of massive doses of vitamin A (200,000 international units) to all availabel 1- to 4-year-old children was effective in preventing keratomalacia. During the 12 months preceding and following initiation of the program, the number of children admitted with presumed vitamin-A-related corneal destruction (33 vs. 31) and proportion of all malnourished admissions with such destruction (26 vs. 25 per 1,000) were similar. The seasonal distribution of these cases remained unchanged, the usual summer peak closely following the first distribution. Unexpectedly, 48% of the children had been ineligible for participation in the program, the vast majority being under 1 year of age. Only 80% of eligible children had actually received the vitamin. Corneal destruction was invariably accompanied by severe, generalized malnutition. Mortality among girls with corneal destruction (28 per 1,000) was almost three times that of boys, or malnourished patients as a whole.