Vitamin A policies need rethinking.

Area of Science:

• Public Health Nutrition
• Global Health
• Micronutrient Deficiency

Background:

• Vitamin A (VA) deficiency affects one-third of children in developing countries, with slow progress in reduction.
• Extensive periodic high-dose VA capsule distribution programs have been implemented for 20 years, reaching 80% of children.
• These programs were based on early findings suggesting a reduction in child mortality, which have not been consistently confirmed by later efficacy trials.

Purpose of the Study:

• To evaluate the continued relevance and effectiveness of periodic high-dose vitamin A (VA) supplementation programs.
• To assess the impact of VA interventions on child mortality and deficiency prevalence.
• To propose a policy shift towards more effective strategies for vitamin A delivery.

Main Methods:

• Review of efficacy trials and large-scale program evaluations of vitamin A supplementation.
• Analysis of the impact of periodic high-dose VA capsules on child mortality and serum retinol levels.
• Consideration of changing disease patterns and their influence on the effectiveness of VA interventions.

Main Results:

• Efficacy trials since 1994 have largely failed to confirm a mortality impact of high-dose VA capsules.
• A major program evaluation (DEVTA trial) showed no impact on mortality in 1-6-year-old children.
• Periodic high-dose VA supplementation does not effectively reduce vitamin A deficiency, as measured by low serum retinol.

Conclusions:

• There is limited evidence that current intermittent high-dose vitamin A programs significantly impact child mortality, possibly due to evolving disease patterns.
• Frequent intake of physiological doses of vitamin A, through food-based approaches (fortification) and regular low-dose supplementation, effectively increases serum retinol and reduces deficiency.
• A policy shift is urgently needed to transition from high-dose periodic capsule distribution to strategies promoting frequent, regular, physiological intakes of vitamin A (daily or weekly).