Providing High Strength Vitamin A Supplements to Those Who Need them Most

Every year the MI procures and, through UNICEF, supplies about 500 million doses of vitamin A supplements for donation to over 70 countries, meeting approximately three quarters of the global need. The donation, which goes particularly to countries with high under five mortality rates and/or prevalence of vitamin A deficiency among young children, mainly goes to the neediest countries in Sub-Saharan Africa and South Asia . The capsules are used in national programs to protect children under five from the preventable, but life-threatening effects of vitamin A deficiency. Extra doses are also provided for use in clinical settings so that children brought to health centres with conditions such as measles can receive the appropriate treatment doses.

Ensuring the availability of vitamin A supplies is essential, but is not sufficient to ensure delivery to all children who need them. MI therefore invests in providing technical support to selected high mortality countries to improve delivery.

Children under the age of five at-risk of vitamin A deficiency (VAD) in resource-poor countries do not have sufficient access to VA-rich foods to improve their vitamin A status, and therefore supplementation of children in this age group remains the main strategy for VAD control.

Improving the VAS status of deficient children has been proven to reduce all-cause mortality by 23% (Beaton, et al. Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. ACC/SCN State-of-the-Art Series, Nutrition Policy Paper No 13., 1993.), and as such supplementation is recognized as one the most cost-effective interventions for improving child survival.

Vitamin A, even when delivered as a high dose supplement, does not stay in a deficient child's body very long, and so children at-risk between the ages of 6 and 59 months require a high-dose supplement every four to six months. Reaching all young children in so many countries twice a year presents many challenges for ministries of health and their partners. There are no easy solutions. The MI works with national governments to develop and implement the most appropriate, affordable and cost-effective ways of providing sustained high coverage. In practice, this means linking the provision of vitamin A supplements with other essential health services, often provided through both fixed facilities and through outreach and other community-focused events.

In the past, hundreds of millions of children received vitamin A supplements together with oral polio vaccine during polio National Immunization Days (NIDs). Most nations will soon have achieved polio eradication and these special campaigns will no longer be required. With the phasing out of this opportunity to reach over 90% of children in a given country at least once a year, new ways are being found to ensure high coverage of vitamin A through a diversity of delivery strategies such as Child Health Days and other type activities that deliver not just vitamin A but an integrated package of child survival/health interventions.

In 2004, the MI and UNICEF together conducted rapid assessments in some 20 countries to find more about best practices around the world as countries gain experience with what works and what doesn't work in this post-NID era. The findings point to several factors that can be considered critical success factors for vitamin A supplementation programs:

Taken together, all these factors add up to a paradigm in which national Primary Health Care systems lead and manage a routine cycle of twice-yearly Regular Events to Advance Child Health (REACH). In practice, some countries such as Tanzania and Zambia have shown the way in developing this kind of approach in the form of child health weeks, child health days and so on with the active support of many of the agencies mentioned earlier.

Although aimed at achieving near universal coverage, even these approaches cannot ensure that every single child is protected. MI continued to work this year with national governments and other agency partners to find innovative approaches that could extend protection to children in the hardest-to-reach groups.