Analysis for policy to overcome barriers to reducing the prevalence of vitamin a deficiency among children (15–23 months) in Iran

Abstract

Background About 30% of children < 5 years old are estimated to experience vitamin A deficiency worldwide. Globally, vitamin A deficiency can be reduced by five major interventions: supplementation, dietary modification, fortification, promotion of both public health, and breastfeeding. This prospective policy analysis (Prospective policy analysis focuses on the future outcomes of a proposed policy. Adapted from Patton, CV, and Sawicki DS. Basic Methods of Policy Analysis and Planning, Prentice-Hall, Inc. New Jersey,1993). (Patton A, Carl V, and David S. Basic methods of policy analysis and planning, prentice-hall, 3th ed. 2012) aimed to identify evidence-based policy options to minimize prevalence (VAD) among 15–23 months-children in Iran. Methods Thirty-eight semi-structured face-to-face interviews were held with experts at high, middle, and low managerial levels in Iran’s health system, as well as at Schools of Nutrition Sciences and dietetics, using purposive and snowball sampling. All interviews were recorded by a digital voice recorder and then transcribed, codified, and eventually analyzed using a mixed approach (inductive-deductive) by MAXQDA software version 10. Results Most policies related to VAD reduction in this age group are supplementation, expansion of education, and awareness. Three main factors affecting VAD reduction policies emerged from the analysis: basic factors (governance, infrastructure, and organization), underlying factors (social factors, economy), and immediate factors (services). Due to its cross-sectoral nature, evaluating the results of the implementation of this policy requires strong and coherent inter-sectoral cooperation. The existing primary healthcare network (PHC) is a crucial means for successful implementation of policies to address VAD in Iran. Conclusions In addition to supplementation and assistance in this age group, other policies should be also planned to reduce VAD in various regions. In addition to the Ministry of Health & Medical Education (MoHME), other actors need to be involved, we advocate, throughout the entire policymaking process of policy-making to reduce VAD in Iran.

Untitled

“…13 Este porcentaje se encuentra dentro de lo reportado por otros estudios llevados a cabo en niños durante la pandemia (17 a 85%). [48][49][50][51][52][53] La terapia con oxígeno fue necesaria en 11 niños (15.9%), mientras que la ventilación asistida o mecánica se utilizó en 7 pacientes (9.7%).…”

“…Similares resultados se han registrado en otros estudios en los que la terapia con oxígeno se ha utilizada en 0 a 41% de los pacientes y la ventilación mecánica en 0 a 38% de los casos. [48][49][50][51][52][53] Algunos datos no pudieron recuperarse por su falta de registro en los expedientes clínicos. Durante los primeros seis meses de pandemia no se contó en el hospital con pruebas serológicas para la detección del SARS-CoV-2 y la disponibilidad de la reacción en cadena de polimerasa-transcriptasa reversa (RT-PCR) fue limitada.…”

“…Se han informado tendencias similares en Australia, India, África, América del Sur, Turquía y Líbano. [46][47][48][49] En mujeres embarazadas se informa una deficiencia, insuficiencia y suficiencia de vitamina D del 83.28, 15.36 y 1.36%, respectivamente 50. Prevalencia en MéxicoEn 2011, Flores y sus colaboradores reportaron concentraciones séricas en la población mexicana y señalaron las prevalencias de insuficiencia o deficiencia de vitamina D (25-OH-D3 > 75 nmol/L), según las características sociodemográficas.…”

Omega-3/omega-6 fatty acids: Effects on growth and neurodevelopment of the fetus and preterm infant. A narrative review

“…Se estima que 190 millones de niños de edad preescolar y 19 millones de mujeres embarazadas tienen deficiencia de vitamina A en todo el mundo [33][34][35][36] El 30% de los niños menores de 5 años experimenta deficiencia de vitamina A en todo el mundo. 37,38 Prevalencia en México En 2012, la ENSANUT reportó una prevalencia de deficiencia subclínica de vitamina A en el 25% de los niños de 1 a 8 años de edad. 11 Aunque las mujeres embarazadas son susceptibles de padecer deficiencia de vitamina A durante el embarazo, el riesgo aumenta en el tercer trimestre, debido al desarrollo fetal acelerado y al aumento fisiológico del volumen sanguíneo durante este período.…”

Global Burden of Vitamin A Deficiency in 204 Countries and Territories from 1990–2019

“…Although the WHO has made great efforts in reducing the epidemic of VAD, due to major differences in the economy, medical care, food carrier, and availability of other nutrients [ 8 ], the burden of VAD is unbalanced among population in different regions and is more prevalent in areas with lower socio-economic levels [ 9 , 10 ]. Therefore, an assessment of VAD burden at the regional and national levels and identification of high-risk groups could help to identify the highly endemic areas and populations, which could in turn beneficial to guide effective decision making and resource allocation [ 11 ].…”