Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 11:13:04084.
doi: 10.7189/jogh.13.04084.

The prevalence of vitamin A deficiency and its public health significance in children in low- and middle-income countries: A systematic review and modelling analysis

Peige Song #  1 , Davies Adeloye #  2 , Shuting Li  3 , Dong Zhao  4 , Xinxin Ye  5 , Qing Pan  3 , Yiwen Qiu  3 , Ronghua Zhang  4 , Igor Rudan  2   6 ; Global Health Epidemiology Research Group (GHERG)
Affiliations

The prevalence of vitamin A deficiency and its public health significance in children in low- and middle-income countries: A systematic review and modelling analysis

Peige Song et al. J Glob Health. .

Abstract

Background: Vitamin A deficiency (VAD) is widely recognised as a major public health concern in low- and middle-income countries (LMICs). Despite various interventions implemented in many countries, a lack of reliable data is hindering progress. We aimed to consolidate available data and quantify estimates of the prevalence of VAD among children ≤18 years in LMICs.

Methods: We searched PubMed, Medline and Embase for studies reported the prevalence of VAD or marginal (m)VAD among children. A multilevel mixed-effects meta-regression approach was applied to establish the regression models for VAD and mVAD prevalence. The total numbers of children affected by VAD and mVAD in LMICs in 2019 were separately calculated from the estimated age- and socio-demographic index (SDI)-specific prevalence with their corresponding United Nations Population Division populations projections. We estimated areas of significant public health concern in 165 LMICs using the lower confidence interval (CI) of VAD prevalence.

Results: A total of 116 articles from 40 LMICs were retained. In 2019, VAD and mVAD affected 333.95 million (95% CI = 253.00-433.74) and 556.13 million (95% CI = 388.83-767.94) children and adolescents in 165 LMICs, respectively, corresponding to a prevalence of 14.73% (95% CI = 11.16-19.14) and 24.54% (95% CI = 17.15-33.88). The prevalence of both VAD and mVAD was the highest in children aged 0-5 years at 19.53% (95% CI = 15.03-24.91) and 28.22% (95% CI = 20.00-38.24), respectively, with both steadily decreasing to 10.09% (95% CI = 7.44-13.50) and 20.76% (95% CI = 14.16-29.50) in adolescents aged 13-18 years. The prevalence of VAD was significantly higher in the low SDI region at 29.67% (95% CI = 22.67-37.53) compared to 5.17% (95% CI = 3.14-8.43) estimated in the high-middle SDI region. 68 of the 165 LMICs (41.21%) were classified as areas of moderate to severe VAD public health significance.

Conclusions: VAD continues to pose a significant public health concern in many low-income settings. Development in LMICs is a crucial factor for VAD, with a disproportionately higher burden in low SDI regions.

Registration: This study protocol was registered with PROSPERO, CRD42020220654.

PubMed Disclaimer

Conflict of interest statement

Disclosure of interest: The author completed the ICMJE Disclosure of Interest Form (available on request from the corresponding author) and declare the following activities and relationships: Igor Rudan is co-Editor-in-Chief of the Journal of Global Health. To ensure that any possible conflict of interest relevant to the journal has been addressed, this article was reviewed according to best practice guidelines of international editorial organisations.

Figures

Figure 1
Figure 1
Flowchart of study selection. VAD – vitamin A deficiency, mVAD – marginal vitamin A deficiency
Figure 2
Figure 2
Classification of regions by degree of public health significance of vitamin A deficiency. SDI – socio-demographic index, AFR – African Region, AMR – Region of the Americas, EMR – Eastern Mediterranean Region, EUR – European Region, VAD – vitamin A deficiency, mVAD – marginal vitamin A deficiency
Figure 3
Figure 3
Classification of countries by degree of public health significance of vitamin A deficiency (VAD). High- socio-demographic index (H-SDI), including countries with SDI ≥0.805; a lower confidence interval of VAD prevalence of ≥2% but <10% as mild; ≥10% but <20% as moderate; and ≥20% as severe areas of public health significance.
See this image and copyright information in PMC

References

    1. Stevens GA, Bennett JE, Hennocq Q, Lu Y, De-Regil LM, Rogers L, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health. 2015;3:e528-36. 10.1016/S2214-109X(15)00039-X - DOI - PubMed
    1. Wirth JP, Petry N, Tanumihardjo SA, Rogers LM, McLean E, Greig A, et al. Vitamin A supplementation programs and country-level evidence of vitamin A deficiency. Nutrients. 2017;9:190. 10.3390/nu9030190 - DOI - PMC - PubMed
    1. Bailey RL, West KP, Jr, Black RE.The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66:22-33. 10.1159/000371618 - DOI - PubMed
    1. World Health Organization. Global prevalence of vitamin A deficiency in populations at risk 1995-2005: WHO global database on vitamin A deficiency. Geneva: World Health Organization; 2009.
    1. Fawzi WW, Wang D.When should universal distribution of periodic high-dose vitamin A to children cease? Am J Clin Nutr. 2021;113:769-71. 10.1093/ajcn/nqaa428 - DOI - PubMed

Publication types