Akoto Osei K, PhDHelen Keller InternationalAsia Pacific Regional Office

Monitoring Outcomes of Programs for

Vitamin A Deficiency

Source: WHO. 2009 .

~250 million children suffer from Vitamin A deficiency (VAD)

VAD and Health

Over 250,000 children become blind each year due to VAD

VAD increases risk of morbidity and mortality

Strategies to address VADVitamin A supplementation

• Twice yearly for children 6-59 months of age (currently in ~80 countries)

Dietary diversification• Promoting production and

consumption of diversified foods

• Optimal breastfeeding and complementary feeding practices

Strategies to address VADHome fortification (Micronutrient powders, etc.)

Large scale food fortification

(VA + oil, flour, sugar, etc.)

Biofortification

Crops with high beta carotene (Orange Flesh Sweet Potato)

Monitoring outcomes of vitamin A programs

Data to inform whether our activities where

implemented successfully

Data to inform if we have reached our

objectives

•Lack of field friendly indicators for assessing impact of these programs on vitamin A status•How to estimate the relative contribution of the multiple vitamin A interventions to vitamin A intake and status •Limited information on coverage of most VAD programs•Limited information on underserved populations•Inadequate use of the monitoring data to improve program implementation•Limited funding for monitoring VAD programs

Challenges with monitoring outcomes of Vitamin A programs

For how long should universal vitamin A supplementation programs continue, especially in

countries with high coverage of this program?

Coverage of vitamin A supplementation programs: ~ 72% globally; and >80% in resource poor countries

Decisions about VAD programs – the need for more data

Palmer et al, Public Health Nutr., 2012

Declining under 5 mortality rate; yet ~8 million child deaths per year

Palmer et al, Public Health Nutr. 2012; 9:1-15• Shift from vitamin A supplementation programs for

children should be made only when there is sufficient and stable evidence that VAD has reduced, and risk of vitamin A deficiency is minimal. – Consecutive surveys shows low prevalence of VAD (<

5%, based on serum retinol) – Data shows dietary vitamin A intake has improved– High coverage is achieved for vitamin A programs

• Twice yearly vitamin A supplementation of children 6-59 months should continue

Implications for monitoring VAD programs• Continuous monitoring and evaluation of VAD

programs is needed to guide decisions on how to improve and when to scale back programs.

• More information is needed on: – Coverage of programs to address VAD– Vitamin A intake and status, including the relative

contribution from different sources (fortified and non-fortified foods and supplements)

Thank You