Is it time for South Africa to end the routine high-dose vitamin A supplementation programme?

Coutsoudis, Anna; Sanders, David; Dhansay, Muhammad A.; Stuijvenberg, Martha E. van; Benn, C S

doi:10.7196/samj.2019.v109i12.14203

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…It is true that the coverage of VAS, even in the recent past, was found to influence the prevalence of VAD-related health problems like childhood blindness in some affected nations 51 52. But there are also concerns (in India and elsewhere) that the routine practice of administrating massive vitamin A doses indiscriminately has outlived its intended usefulness and that its further continuation may actually put children at risk of developing vitamin A toxicity 19 47–50 53–55. It is more so with the concurrent scaling up of various food-based initiatives (eg, fortification of edible oil and milk with retinol) 19 47 50 54–56.…”

Section: Discussionmentioning

confidence: 99%

Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

Bora

2022

BMJ Glob Health

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IntroductionVitamin A supplementation (VAS) is yet to reach all Indian children aged 9-59 months, despite guidelines for universal coverage. This study mapped geospatial patterns underlying VAS coverage across two policy-relevant administrative unit levels (states and districts) in India. The relationship between spatial distribution of VAS coverage and vitamin A deficiency (VAD) prevalence was also investigated.MethodsThe study draws on nationally representative cross-sectional data collected during National Family and Health Survey 4 (NFHS-4) and Comprehensive National Nutritional Survey (CNNS). VAS coverage was estimated using information obtained during NFHS-4 from mothers about whether their children (n=204 645) had received VAS within 6 months of the survey. VAD prevalence estimates were based on serum retinol measurements during CNNS in under-five children (n=9563). State-level and district-level choropleth maps of VAS coverage were constructed. Spatial patterns were probed using Moran’s statistics, scatter plots and local indicators of spatial association (LISA). Relationship between VAS coverage (as an explanatory variable) and VAD prevalence was explored using spatial autoregressive models.ResultsVAS coverage in India (overall 60.5%) ranged from 29.5% (Nagaland) to 89.5% (Goa) across the various states/union territories. Among districts, it ranged from 12.8% (Longleng district, Nagaland) to 94.5% (Kolar district, Karnataka). The coverage exhibited positive spatial autocorrelation, more prominently at the district-level (univariate Moran’s I=0.638, z-value=25.614, pseudo p value=0.001). LISA maps identified spatial clusters of high coverage and low coverage districts. No significant spatial association was observed between VAS coverage and VAD prevalence in the states during spatial error (R2=0.07, λ=0.30, p value=0.14) and spatial lag (R2=0.05, ρ=0.25, p value=0.23) regression.ConclusionTwo out of every five eligible Indian children were not supplemented with vitamin A. The coverage was geographically heterogeneous with discernible spatial patterns. Their consequences on vitamin A status and associated health effects in the community deserve close monitoring.

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Section: Discussionmentioning

confidence: 99%

Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

Bora

2022

BMJ Glob Health

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“…Vitamin A deficiency in children has long been a concern in South Africa [ 44 ], with targeted interventions to address this malnutrition problem including fortification of maize and bread flour with vitamin A and roll out of the national routine vitamin A supplementation of children younger than 6 years at all public health facilities (Vitamin A Supplementation programme) from 2002 onwards [ 44 ]. Vitamin A is essential for many functions including normal vision and eye health, immunity, cellular proliferation, differentiation and apoptosis [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa

Senekal

Nel

Malczyk

et al. 2020

IJERPH

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In 1999, the National Food Consumption Survey found serious risk of dietary deficiency for a number of micronutrients in 1- to 9-year-old children in South Africa. To address these shortfalls, fortification with vitamin A, thiamine, riboflavin, niacin, vitamin B6, folic acid, iron and zinc of maize meal and bread flour was made mandatory in 2003. The aim of this study was to examine micronutrient intakes of 1- to <10-year-old children after nearly 20 years of fortification in two of the most urbanized and economically active provinces, Gauteng (GTG) and the Western Cape (WC). A multistage stratified cluster random sampling design and methodology was used. Households were visited by fieldworkers who interviewed caregivers and obtained dietary intake data by means of a multiple-pass 24-h recall. Two additional 24-h recalls were completed among a nested sample of 146 participants to adjust the single 24-h recall data of the total sample using the National Cancer Institute Method. Results show that median intake of all the fortification nutrients were above the estimated average requirement (EAR), with the only concern being folate in the WC. Between a quarter and a third of children in the WC, where maize porridge intake was significantly lower than in GTG, had a folate intake below the EAR. Nutrients that are not included in the fortification mix that remain a serious concern are calcium and vitamin D, with intake of dairy and vitamin D sources being very limited in both provinces. The improvement in micronutrient intakes of children is encouraging, however the outstanding nutrient deficiency risks need attention.

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“…In the SAHANES study at the national level, the prevalence of vitamin A de ciency was 43.6%. South Africa introduced routine periodic high-dose vitamin A supplementation in 2002 to reduce childhood mortality, however, there is no evidence from the past two decades, with changing disease pro les, increased use of vaccines and reduced morbidity from diarrhoea and pneumonia, that a high-dose programme is nearly as effective today as it was in some countries 20-30 years ago (30). Moreover, it has been found that there may also be pockets where, due to unique eating patterns, vitamin A de ciency may not be present at all (31).…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status of Children 24–60 Months Attending Early Child Development Centres in a Semi-Rural Community in South Africa

Makanjana

Naicker

2020

Preprint

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Background: Despite the numerous efforts to improve the nutritional status of children, a high prevalence of malnutrition still exists in South Africa. This study aimed to determine the nutritional status of children attending Early Child Development centres in South Africa.Methods: In this baseline study, we randomly selected two Early Child Development centres comprising of 116 children aged 24–60 months, separated into two cohorts, 24–47 and 48–60 months from the Valley of a Thousand Hills area in the Ethekweni municipality. Dietary intake was measured through the 24hDR and analysed using Food Finder software. The food frequency questionnaire was used to calculate the food variety and food group diversity scores. Anthropometric measurements; weight and height were taken and the WHO Anthro software was used to convert it to nutritional data indices. Vitamin A and haemoglobin levels were collected through dry blood spot cards and assessed using WHO indicators.Results: The findings showed that participants had a low mean energy intake (24–47 months; 4906.2kJ and 4997.9kJ, 48–60 months; 5936.4kJ and 5621.2kJ (p = 0.038), low fruit and vegetable consumption (24–47 months; 63.8g and 69.5g (p = 0.037), 48–60 months; 68.3g and 74.4g (p = 0.038) and the top five foods consumed were carbohydrate rich foods for girls and boys respectively. Stunting was noted in 7% and 20% (48–60 months) (p = 0.012) and overweight in 8% and 17% (24–47 months) and 17% and 13 % (48–60 months) (p = 0.041) in girls and boys respectively. Low serum retinol levels (<0.070µmol/L) were found in 9.1% of boys (24–47 months), 8% and 7.4% of girls and boys (48–60 months). Low haemoglobin levels (<11.0 g/dL) were found in 50.0% and 30.4% (24–47 months) and 8.6% and 39.3% (48–60 months) of girls and boys respectively. Conclusion and recommendation: Malnutrition, despite many national and provincial initiatives, still exists at Early Childhood Development centres in South Africa calling for the application of contextualized nutrition interventions to suite resource-poor settings.

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Is it time for South Africa to end the routine high-dose vitamin A supplementation programme?

Cited by 10 publications

References 26 publications

Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

Provincial Dietary Intake Study (PDIS): Micronutrient Intakes of Children in a Representative/Random Sample of 1- to <10-Year-Old Children in Two Economically Active and Urbanized Provinces in South Africa

Nutritional Status of Children 24–60 Months Attending Early Child Development Centres in a Semi-Rural Community in South Africa

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