Public health programmes for vitamin A deficiency control

Since the early 1980s, when it was first realised that children with the eye signs of vitamin A deficiency (VAD) had a higher mortality rate than children in the same communities who did not have these signs, there have been many large-scale, community-based trials to assess whether improving the vitamin A status of young children improves child health and survival. Many of the trials involved intermittent supplementation with high-dose vitamin A, but food-based interventions such as food fortification have also been assessed. Findings from the large number of randomised controlled trials of supplementation of children aged 6–59 months have been pooled, showing that intermittent supplementation with high-dose vitamin A has a major impact on child mortality in communities of children at risk of VAD. When all the results are combined, the mortality rate of the children given supplements was 24% lower than that of the children not given supplements. Some of these trials also showed a reduction in diarrhoea, measles, night blindness and other signs of xerophthalmia. (The results of trials of children under the age of 6 months, and of newborn infants and mothers, are less clear). Analysis of randomised controlled trials of vitamin A -fortified foods showed significant impacts on serum retinol concentration and haemoglobin levels.1 The results of all these trials have led to global initiatives (see pages 61 and 62) to control VAD in children. There has been progress in many countries, but further action is needed to increase the number of countries implementing programmes to address VAD.