Vitamin A Supplementation

Rationale

Giving a high dose of vitamin A twice a year to children 6-59 months old in vitamin A deficient areas will reduce under-five mortality by 23 percent. Vitamin A deficiency impairs immune system function, increases the risk of death associated with diarrhea and measles, and accounts for approximately 600,000 child deaths each year (Black et al., 2008). For newborns, vitamin A supplementation is a promising new intervention with evidence from three field trials in South Asia of a 15 percent or more reduction in mortality in the first six months of life.

Challenge

In recent years some countries have made impressive gains in vitamin A distribution, yet millions of children remain unprotected. One of the greatest challenges for vitamin A supplementation programs is finding sustainable delivery mechanisms. The primary delivery mechanism is six-monthly outreach accompanied by community mobilization. The bi-annual events are called Child Health Days and deliver a package of services such as deworming and immunizations. These events require a significant amount of planning, logistical support, and coordination but enable health systems to reach marginalized communities at least twice a year with a basic package of services. 

A2Z Response

A2Z is supporting vitamin A supplementation for children 6–59 months old in Cambodia, India (UP and Jharkhand states), the Philippines, Tanzania, and Uganda; and for newborns in Nepal and Bangladesh.

Vitamin A supplementation of children. A2Z supports coverage at scale and sustaining programs that have achieved high coverage through institutionalizing six-monthly outreaches as an integral strategy for improving child health, improved district health budgeting for Child Health Days, strengthening vitamin A supplies, better use of monitoring data, mobilization of non-health community workers to help with distribution, and improved outreach to marginalized communities.

A2Z and collaborating partners:

  • Integrate bi-annual vitamin A distribution events within annual district and state health plans
  • Support costing and assured financial resources for bi-annual vitamin A distribution events at the district and national levels in Tanzania, Uganda, and India
  • Assist departments of health to diagnose supply constraints and strengthen capacity in accurate forecasting of supply needs, distribution and storage mechanisms, and appropriate use and recording of supplies in Uganda, India, and Cambodia
  • Facilitate modifications in policies and guidelines to encourage use of community-based non-medical personnel to help with distribution in underserved areas in Cambodia and Uganda
  • Build capacity to improve the use of coverage data to detect low performing areas and help target resources to fill in gaps in Uganda, Tanzania, India, and Cambodia
  • Support microplanning and advocacy to maintain bi-annual distributions for vitamin A combined with other services as core district-level child health strategies
  • Capture lessons learned and document effective processes, tools, and frameworks for adaptation and dissemination globally

Vitamin A supplementation of newborns. A2Z supports the development, implementation, and evaluation of strategies for delivering newborn vitamin A supplementation. A2Z is working with local and international partners to determine feasible and effective approaches of incorporating newborn vitamin A into existing newborn care packages in South Asia.

Visit the Resources section of the website for more information on vitamin A supplementation for newborns, children 6-59 months old, and postpartum women.

 


Reference: Black RE, Allen LH, Bhutta AZ, Caulfield LE, de Onis M, Ezzati Majid E, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371(9608):243-260.