High dose vitamin A capsules – Rusty bullets?

Abstract

SummaryHigh-dose vitamin A capsules (HDVAC) are distributed to preschool children in low-income countries on the assumption that they reduce mortality and treat vitamin A deficiency. As for other so-called magic bullet approaches, donors and policy makers consider their large-scale distribution highly cost-effective. Consequently, other ways to improve vitamin A status have received less attention; both donors and governments assume HDVAC are doing most of what needs to be done. Yet, the only evidence for an effect on mortality comes from 25-year-old studies and this effect no longer appears to be substantial. Surprisingly, impact evaluations have been absent. The only study that might be considered an effectiveness or impact evaluation found HDVAC had no effect in northern India. It is not widely appreciated that the impact of HDVAC on vitamin A status is limited, temporary and not cumulative over time. Nor can it be given to women except immediately after giving birth, and thus it is an inappropriate intervention for tackling vitamin A deficiency. To ensure that we use limited resources wisely, we need to identity and scale up strategies which combat vitamin A deficiency and reduce mortality.

Combatting Vitamin A deficiency

“…Yet, as reviewed by Mason et al (Mason et al 2015), the impact of supplementation on VAD is small and transient and even its impact on mortality no longer appears to be substantial. Some evidence is emerging that for a given sex of the child, it may be dangerous to provide certain vaccinations at the same time as high-dose vitamin A capsules (Fisker and Greiner 2017).…”