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Related Experiment Videos

Vitamin A policies need rethinking.

John Mason1, Ted Greiner2, Roger Shrimpton2

  • 1School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA, Department of Nutrition, Hanyang University, Seoul, South Korea and School of Public Health, University of the Western Cape, Cape Town, South Africa masonj@tulane.edu.

International Journal of Epidemiology
|October 13, 2014
PubMed
Summary

High-dose vitamin A (VA) capsules have not reduced child mortality or deficiency rates. Frequent, lower doses of VA through food fortification and regular supplementation are more effective. A policy shift is recommended.

Keywords:
Child malnutritionchild mortalityvitamin A

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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).