Vitamin A deficiency control measures: importance of vitamin A supplementation as a public health policy in the Indian context.

Recently prominent nutrition scientists across the world have opposed continuation of vitamin A supplementation (VAS) programmes and recommended gradual phasing out VAS for pre-school children. A few eminent nutrition scientists in India have echoed this view, arguing that vitamin deficiency (VAD) is no longer a public health problem in India. We review the evidence, highlighting the high rates of VAD among pre-school children in India, (clinical, subclinical, and dietary deficiency) and argue that in India VAD remains an immensely important public health problem and it is crucial to strengthen and continue the existing VAS programme in India, and in other developing countries until such time as their children's dietary consumption of vitamin A is improved adequately and blood vitamin A levels reach optimal levels.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.

Prevalence of ocular signs and subclinical vitamin A deficiency and its determinants among rural pre-school children in India.

OBJECTIVE: To assess the magnitude and determinants of vitamin A deficiency (VAD) and coverage of vitamin A supplementation (VAS) among pre-school children. DESIGN: A community-based cross-sectional study was carried out by adopting a multistage, stratified, random sampling procedure. SETTING: Rural areas of eight states in India. SUBJECTS: Pre-school children and their mothers were covered. RESULTS: A total of 71,591 pre-school children were clinically examined for ocular signs of VAD. Serum retinol concentrations in dried blood spots were assessed in a sub-sample of 3954 children using HPLC. The prevalence of Bitot spots was 0·8%. The total ocular signs were significantly higher (P < 0·001) among boys (2·6%) compared with girls (1·9%) and in older children (3-4 years) compared (P < 0·001) with younger (1-2 years), and were also high in children of labourers, scheduled castes and illiterate mothers. The odds of having Bitot spots was highest in children of scheduled caste (OR = 3·8; 95% CI 2·9, 5·0), labourers (OR = 2·9; 95% CI 2·1, 3·9), illiterate mothers (OR = 2·7; 95% CI 2·2, 2·3) and households without a sanitary latrine (OR = 5·9; 95% CI 4·0, 8·7). Subclinical VAD (serum retinol level <20 µg/dl) was observed in 62% of children. This was also relatively high among scheduled caste and scheduled tribe children. The rate of coverage of VAS was 58%. CONCLUSIONS: The study revealed that VAD is a major nutritional problem and coverage of VAS was poor. The important determinants of VAD were illiteracy, low socio-economic status, occupation and poor sanitation. Strengthening the existing VAS programme and focused attention on dietary diversification are essential for prevention of VAD.