Hypovitaminosis A: international programmatic issues

Abstract

The virtual elimination of vitamin A deficiency and all its consequences is high on the political agenda as a solvable public health problem by the end of the decade. Five to six times more children in the developing world are likely to be subclinically than clinically deficient. Subclinical deficiency can be detected by newer methodological approaches. Subclinically deficient children are at increased risk of severe and fatal infections. The problem at a population level is avoidable by the appropriate selection and application of a mix of available interventions. Countries are challenged to assess, analyze and take actions to incorporate nutrition concerns into development planning to attain end-of-decade goals.

PIP: This article is based on a presentation given at a nutritional symposium at the Experimental Biology '93 Conference. The author describes the worldwide problem of vitamin A deficiency. Children of developing countries are particularly affected and may develop keratomalacia. Keratomalacia remains the major cause of preventable childhood blindness in developing countries. In 1987 WHO identified 37 developing countries that exhibited an increased risk for eye disease because of a deficiency of vitamin A. Vitamin A deficient populations may be identified by classic xerophthalmia (clinical symptoms) or by using 1-2 biological measurements. No single biological measurement of a subclinical deficiency was considered best. Subclinical indicators might include: plasma and/or breast milk retinol levels, dose-response testing, and functional tests measuring night blindness and eye conjunctival impression cytology. Treatment is immediate and given in 3 doses of vitamin A at concentrations related to the child's age. Children 1 year old and older are given 200,000 international units (IU), infants aged 6-12 months are given 100,000 IU, and for those aged under 6 months 50,000 IU are recommended. Intervention efforts should be customized to fit the country. WHO recommends that any strategy include the following: public awareness, infectious disease control, improved agricultural and horticultural programs, nutritional and health education programs, breast feeding promotion, vitamin A supplemental programs, and world health leaders' conferences.