Assessment and control of vitamin A deficiency disorders

The XX International Vitamin A Consultative Group (IVACG) meeting in Hanoi, Vietnam, in February 2001 celebrated 25 y of progress in prevention and control of vitamin A deficiency disorders (VADD). Programmatic themes included the following: 1) intervention innovations, 2) integration of vitamin A interventions, 3) the increased risk to health of women who are deficient, 4) measurement of progress and impact and 5) programmatic sustainability. The history of IVACG was remembered and the growth of the group from a meeting of 30 to 40 persons in 1975 to nearly 600 delegates from 63 countries was described. Successful adaptation to new challenges and scientific advances, in moving science to practice, was noted. Guidelines for indicators and interventions were reviewed. A set of revised recommendations were made, including the following indicators for assessment (and, for some, outcome evaluation) of VADD: 1) under-five mortality rate >50 as a surrogate indicator to trigger action, 2) maternal night blindness >5%, 3) rapid dark adaptation worse than -1.11 log cd/m(2) and 4) serum retinol <0.7 micro mol/L (>15%) in young children (<6 y). Key recommendations for specific interventions were to double the existing dose of prophylactic vitamin A supplementation to 50,000 international units (IU) at the three Expanded Programme on Immunization contacts for young infants (<6 mo) and to two doses of 200,000 IU each for women within 6 wk after delivery; to support fortification as a valid and necessary strategy to combat VADD; and to recognize that food-based approaches should include promoting breast-feeding and consuming animal products, because promoting plant-based foods alone will not eliminate VADD in young children due to the low bioefficacy of dietary beta-carotene. This meeting clearly set the agenda for the twenty-first century and called for successful implementation of integrated approaches that will eliminate VADD.