08 Nov Reassessing the role of Vitamin A supplementation in preventing child mortality
Vitamin A supplementation has saved hundreds of thousands of young lives since its large-scale introduction in many countries in the 1990s. Now experts are asking if the programmes should continue, or if the last two decades of declining mortality rates means the supplementation programmes have done their work.
Vitamin A supplementation (VAS) was introduced in the 1990s in more than 82 countries as a short-term intervention in reducing child mortality.
Vitamin A is an essential micronutrient found in liver, fish, eggs, dairy products, and various vegetables, and is most widely known for its roles in vision and foetal development. Alternative Vitamin A interventions such as biofortification and fortification of foods, along with the increased uptake of immunisations, have made VAS programmes appear less essential than they used to be in some African countries. Most sub-Saharan African countries have been scaling back supplementation since 2008.
In a recent study, published in the American Journal of Clinical Nutrition, researchers set out to provide guidance on the future of VAS programmes. Data from 45 sub-Saharan African countries were analysed with the Lives Saved Tool (LiST).
The study found that an estimated 140,000 child deaths were averted due to the levels of Vitamin A supplementation in 2019. They also estimated the change in child mortality rates should supplementation levels remain the same, be scaled back or be scaled up.
Although a reduction in child mortality in some countries pointed to clear evidence that Vitamin A deficiency was no longer a public health concern could be scaled back, this was certainly not the case for all countries. Most countries analysed would experience significant child mortality rate acceleration should supplementation programmes reduce, and should instead consider scaling up their programmes.
The analysis highlighted critical gaps of much-needed data to inform effective implementation and targeted resource allocation for VAS programmes, such as geographically disaggregated sub-national surveys on food consumption and Vitamin A status, and alternative Vitamin A programmes, such as food fortification.