published a policy paper, referring to the results of the Awasti study and suggesting that VAS programs are “less relevant” because of a decreasing prevalence of measles and diarrhea and the fact that VA supplements do not impact the underlying VAD.
#DEVTA NOVEL PART 52 TRIAL#
reported the results of a randomized controlled trial in Guinea-Bissau, and concluded that “VAS had no overall effect on mortality but was associated with reduced mortality in girls and increased mortality in boys”. published results of a large cluster-randomized effectiveness trial in India (the Deworming and Enhanced Vitamin A (DEVTA) trial) that showed, conversely, that semi-annual VAS did not reduce mortality. In 2013, following the publication of these reviews, Awasti et al. Between 19, more than 40 efficacy studies of VAS in children 6–59 months of age were conducted, and two systematic reviews and meta-analyses have concluded that VA supplements can considerably reduce mortality and morbidity during childhood. VAS programs began in the 1990s in response to evidence demonstrating the association between VAD and increased childhood mortality.
For this reason, while VAS provides a protective dose in the presence of VAD, complementary interventions are needed for VAD control such as VA (bio-) fortification, micronutrient powders, dietary diversity, nutrition education, and prevention and control of infectious disease. A high-dose of VA improves VA status for only up to three months in children who have low dietary intake. Due to VA’s influence on immune function, supplementation with a high-dose of VA is designed to reduce mortality associated with measles, diarrhea, and other illnesses and not to sustainably improve the VA status of populations. At present, more than 80 countries worldwide are implementing universal VA supplementation (VAS) programs targeted to children 6–59 months of age through semi-annual national campaigns. Supplementation with high doses of preformed VA is currently one of the most widely-used interventions delivering VA. The transfer of VA in breast milk from the mother to the child depends on the status of the mother, and thus VAD often develops early in life, particularly in populations that consume diets low in provitamin A carotenoids and/or populations prone to infections, which often lead to reduced intake or depletion of VA stores. VAD is also a major cause of preventable childhood blindness. It is estimated that globally about 30% of children <5 years of age are vitamin A (VA) deficient, and about 2% of all deaths are attributable to VAD in this age group. Vitamin A deficiency (VAD) is considered one of the most prevalent micronutrient deficiencies worldwide, mainly affecting children in developing countries. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.
We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment.
At the same time, the coverage of VA interventions can also be measured. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. Vitamin A supplementation (VAS) programs targeted at children aged 6–59 months are implemented in many countries.
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