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Vitamin A Deficiency By Caroline Delori and Shira Lipsky Malnutrition Millions of mothers and children die each day from malnutrition. 83% of children die due to mild or moderate malnourishment. 1/3 rd of world’s population is micronutrient deficient

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Vitamin A Deficiency

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Vitamin a deficiency l.jpg

Vitamin A Deficiency

By Caroline Delori

and Shira Lipsky

Malnutrition l.jpg


  • Millions of mothers and children die each day from malnutrition.

  • 83% of children die due to mild or moderate malnourishment.

  • 1/3rd of world’s population is micronutrient deficient

  • The global economy produces enough food to feed the entire world population.

  • Result of several factors combined.

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What is Vitamin A?

  • Organic compounds that are present in small amounts in foods that are not digested, but absorbed through small intestine.

  • VA Functions; metabolic, photosensitive pigments of retinal cells, differentiation of epithelia.

  • Fat soluble and any excess cannot be excreted in the urine.

  • Most common preformed vitamin found in food is retinol.

    • Found in animal products, such as fish oils, milk, and butter.

  • Carotenoids are converted by the body into retinol.

    • Found in dark leafy vegetables, such as sweet potatoes and yellow fruits and palm oil, and in red chili. It is the red pigment present in carrots.

    • Half of biological activity of VA because of low conversion rate.

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The VAD Story!

  • 230 million children are at risk for VAD.

  • Over one million VAD childhood associated deaths in one year.

  • VAD is prevalent in over 75 countries distributed in S.E. Asia and Africa

  • VAD leads to

    • Infant and child mortality

    • Keratinization- dry skin and cracking of mucous membranes

    • Xerophthalmia- dryness of the eye, blindness

    • Diarrheal disease and respiratory infections

  • Strong link between VAD and infection.

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VA is most beneficial for infants, young children, pregnant and lactating mothers.

VA programs have shown to impact



Child Survival


Other infections

What is VA good for?

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Estimated Numbers of People At-risk and Affected by VAD

RegionVA At RiskVA Affected (Xerophthalmia)



South East Asia1251.5

Eastern Mediterranean160.1

Western Pacific420.1

Total (millions)2512.8

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A Little History

  • 1904- First epidemic of xerophthalmia in Japan

  • 1947- Industrial VA synthesis

  • 1964- First global survey of VAD

  • 1980’s- Importance of VA in child survival was shown

  • 1990- Summit for children

  • 1991- Ending Hidden Hunger Conference

  • 1992- International Conference on Nutrition


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How to Combat VAD

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  • Short-term solution

  • Therapeutic, targeted, or universal

  • Liquid filled gelatin capsules

  • Given orally or intravenously

  • .02 cents each capsule

  • $1.64- 2.20 per child for VA program

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VA Distribution Schedule

AgeRecommended DosageSchedule

0-6 mo.25, 000 IUevery 4 weeks

6-11 mo.100, 000 IUevery 3-6 mo.

1-6 yrs.200, 000 IUevery 3-6 mo.

Pregnant women10, 000 IUevery day during gestation

Lactating mothers200, 000 IUonce

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Food Fortification

  • Medium-term solution

  • Increase nutrients in specific foods

    • Margarine, milk, sugar

  • Identify food vehicle & fortificant

  • Requires commitment from government, food industries, legislation, consumers, and research facilitation.

  • .36 cents per person

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Selecting a VA Food Vehicle

  • Must be consumed by a large proportion of the population.

  • “Little day to day and inter-individual variation occurs in the amount of the food vehicle consumed” which will ensure VA intake remains within a safe range.

  • Food vehicle must go through a process in which VA can be added under controlled conditions and at a minimum cost.

  • Must be able to track the delivery of fortified food.

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Selecting a VA Fortificant

  • Miscible in the food vehicle

  • Must not change the smell, color or taste of the food

  • No chemical interaction with the food resulting in damage of the original food

  • Stable

  • No significant increase in cost of food to the consumer.

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Process of Food Fortification

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Diet Diversification

  • Long-term solution

  • Should run parallel with other short-term solutions

  • Increases the variety and frequency of micronutrient rich food sources

  • Modifies food production, consumption and distribution

    • Red palm oil

    • Sweet potatoes, 1998

  • Cost effective and won’t lead to hypervitaminosis.

  • Through nutritional education, home gardens and improved methods of food preparations, preservation and cooking.

  • No medicalization of food

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Nutrition Education

  • Long-term commitment from the participants.

  • Education of mother and children on how to eat a more well balanced diet filled nutrients

  • Improved local access to VA-rich foods

  • Economic and social payoffs are as high as 84 times the program costs

  • Requires economic, political, operational, behavioral sustainability.

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Which program would be most effective in the country you selected for your MCH proposal? Discuss the issues involved in implementing a program solution. Use the list of pros and cons.

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Different Programs Must Consider…

  • Survey the extent of the problem

  • Severity of the deficiency

  • Distribution of the deficiency

    based on; age, gender, urban, rural, agriculture, socioeconomic

  • Identifying target population

  • Screening for VAD

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Program Issues: Supplementation

  • Most common vehicle is EPI

  • What will happen when polio is eradicated?

  • Timing of intervention and cost

  • Scope of population reached

  • Procurement or production VA capsules- UNICEF

  • Monitoring of VA program

  • Requires foreign currency

  • An efficient, sustainable distribution system

  • Shared responsibility by immunization and nutrition sectors.

  • National Micronutrient Day in Niger

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Program Issues: Food Fortification

  • Identify food vehicle and fortificant; the high cost of fortificant

  • Field testing of fortificant must be done at many locations in one country due to differing environmental conditions.

  • There might not be a food vehicle, in which case, one must be created.

  • Need technologically developed food industry, field testing and appropriate monitoring.

  • Micronutrient losses may occur at each point in distribution chain and at household levels during storage and preparation.

  • Social marketing of the fortified food

  • Harmonization between different sectors involved

    • Sangkap Pinoy Seal Program in Philippines

    • Zambia, May 1998

    • Swaziland, June 1999

Program issues diet diversification l.jpg

Program Issues: Diet Diversification

  • Home gardening issues

    • available technology- seeds, assistance

    • cultural acceptability and sensitivity

    • land suitable for gardening

    • time

  • Requires community involvement

  • Requires nutritional education of consumers

    • Challenging to coordinate and requires much cooperation

    • Labor intensive operation

    • Costly economically and logistically

  • Results aren’t readily seen


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Cost Analysis of Programs

Summary of cost-effectiveness of three VA interventions in Guatemala, 1991.

ProgramPersons reachedHigh-risk person reached

Fortification 0.2870.653

Capsule Distribution1.5241.524

Food Production/Education1.1912.707

(long-term effect)

Phillips, M, Sanghvi T, Suarez R, McKingney J, and Fiedler J. The Costs and Effectiveness of Three Vitamin A Interventions in Guatemala. Soc Sci Med.1996.42(12):1661-1668

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Controversy Issues

  • VA is a known teratogen

  • Difficult to evaluate if maternal mortality rate is effected by VAD

  • Side effects of hypervitaminosis:

    • Malformation

    • Schizophrenia

    • Head ache and loss of appetite

    • Bulging Fontanelle

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More Controversies…

  • There are pros and cons to all interventions, therefore difficult to assess which one to implement.

  • Protection afforded by prophylactic large doses

  • Dosage amount

  • Associated with the increase in severity of the infection

  • Ghana Study

  • Selection of target population- high-risk, medium risk, and low risk populations

  • Multiple micronutrient fortification

  • Which food vehicles and fortificants to use

  • Reports that dark vegetables and fruits do not provide as much carotenoids as was assumed.

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  • You provide the idea and they’ll make it!

    • Genetically Engineered Rice

  • You can target very precisely the kind of crops needed

  • Increase agricultural production time

  • The potential benefits of VA in a grain of rice are greater than the possible risks.

  • Requires cooperation among scientists and funding institutions

  • Rarely managed correctly

  • Unforeseen negative effects

  • Risks range from human health effects through eating the foods to environmental impacts- spreading genes through cross pollination to other plants

  • Many people opposed to idea because of possible issues

  • Need global forum for governments, NGO’s and industries to discuss risks and benefits of biotechnology

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New Technology

  • CIP (International Potato Center)- sweet potatoes varieties increase intake of VA

  • Swiss Federal Institute of Technology- genetically engineered rice

  • Plants that fortify themselves and deliver VA through their seeds.

  • MI and UNICEF- developing and testing new dropper to administer VA

  • WHO and UNICEF-

    • IMCI (Integrated Management of the Sick Child)- treat VAD to reduce diseases

    • IMCI- taking advantage of the contact made when a sick child comes in for care

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  • Different countries require various solutions, sometimes a combination of two

  • Middle income countries- Philippines, Zambia and other Latin Am. countries

    • Food fortification

  • Low income countries- Urban

    • Food fortification and government subsidies

  • Low income countries- Nepal, Bangladesh, and rural Indonesia

    • Supplementation used

    • Extreme measures

  • Evaluation of supplementation programs with a case control study.

  • Biotechnology is an option, but must look at the different environments to see what should be implemented

  • Must answer if should implement program even if not all at risk or unknown

  • Focus should be on reduction of infections improving primary health care, sanitation, water supply, and reducing poverty.

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