World Disasters Report: saving lives with vitamin A
This year’s World Disasters Report by the International Federation of Red Cross and Red Crescent highlighted the rise of hunger and malnutrition, its causes, and what can be done to help. “Every year some 9 million children across the world die before they reach their fifth birthday, and about one-third of these untimely deaths is attributed to undernutrition (Black et al., 2008).” According to the report, up to 90 percent of these deaths do not occur during food crises or famines but are attributed to long-term chronic hunger that leaves a child with a weak immune system and therefore vulnerable to diseases. “A child suffering from mild undernutrition, for example, is twice as likely to die from malaria as a well-nourished child – and the risk of death is ninefold for a child who is severely undernourished (WHO and UNICEF, 2007).”
In the report, Alfred Sommer, professor of ophthalmology at the Johns Hopkins University School of Medicine points out “if we could get adequate vitamin A to all the children who need it in the world, we could prevent 1 to 2 million children from dying or going permanently blind every single year.” For children in need, vitamin A supplementation can help provide proper nutrition, which is especially critical during the first 1,000 days of life when damage can become irreversible. This time window includes the nine months in the womb, making it equally important for pregnant women to receive adequate nutrition. For example, pregnant women in India and Vietnam who received a multiple micronutrient supplement, in addition to iron and folic acid, had babies with higher birth weights and less stunting and illness compared with a placebo group. “Investing in vitamins and minerals is probably the most cost-effective development intervention that we have in the world today,” says VenkateshMannar, president of The Micronutrient Initiative. We couldn’t agree more.
I thought you would enjoy seeing this photo. I took it Friday when we visited this family and delivered a few blankets, baby clothes, & fortified rice.
Mom is 21, father is 20. They live in a small village in rural Guatemala in an adobe hut, dirt floors, and corn stalk walls. The father works in the corn fields. They live with his mother.
Mom came to our medical clinic in September, 8 months pregnant and, unfortunately, had no prenatal care. During the clinic visit she was examined but the nurse could not hear the baby's heart beat. We sent her to a hospital in a nearby town for an ultrasound. That's when they discovered there were twins. The babies were born October 5, one weighed 4 lbs, 13 oz and the other weighed 4 lbs, 3 ounces, both boys. The babies are healthy but mom is having trouble nursing both babies. They are supplementing by having to buy powdered milk (they don't have a refrigerator) which is very expensive. We are supplying mom with Pre/Postnatal vitamins from Vitamin Angels.
During her visit to our clinic in September, our nurse instructed mom about the benefits of the vitamins. One of our nurses who lives nearby will visit this family every week to monitor the health of mom and babies and take her the vitamins every month.
We truly appreciate Vitamin Angels and all you do for better health around the world.
Promoting nutrition in the Sacred Valley of the Incas
Vitamin Angels recently received an update from DESEA Perú, our in-field partner in southern Peru. Through Thrive to Five, together we are reaching 385 pregnant and lactating women with prenatal vitamins.
Vitamin distribution is well underway in the DESEA Perú project, in the Sacred Valley of the Incas. DESEA’s rural nurse, VilmaFlorezHuayllapuma, has been distributing vitamins coupled with prenatal and postnatal home visits and health care provision. Prenatal women are reporting no side effects from the vitamins, and are consistently taking their supplements. This constitutes a change, as Ministry of Health staff report that the Peruvian supplements of iron and folic acid are not consistently used due to negative side effects. Prenatal women are being encouraged to use the Vitamin Angel supplement and to continue with their dose of iron as Peruvian recommendations for indigenous women in the Andes is a minimum of 300 mg/day.
Lactating women are unanimously reporting increased energy and more milk production, and are delighted to have the vitamin supplements, as lactating women in Peru do not receive any vitamin or micronutrient supplements.
DESEA has also partnered with the Ministry of Health in the District of Lamay to distribute vitamins to pregnant and lactating women throughout the District. A total of four health posts have received vitamins and documentation to help staff monitor and record health information about each patient. Furthermore, DESEA Perú will be meeting this week with the American NGO ‘The Becky Fund’ to establish a vitamin distribution program in the District of Lares, where The Becky Fund is working with women and communities in health and nutrition focused programs.
SantusaCcoyaSutta, who has a high risk pregnancy, receiving vitamins and education.
TuribiaMamaniTapara and her 5 month old daughter receiving vitamins in the campo.
SantusaMamaniSuma, who has a high risk pregnancy, receiving her first supply of vitamins.
Sarah Gasca, Vitamin Angels Web Marketing Manager, describes her recent visit to Haiti where she met children and women benefiting from the vitamin A, children’s multivitamins and women’s prenatal vitamins distributed through Vitamin Angels’ Operation 20/20 and Thrive to Five programs:
Next February will be the fourth anniversary of when I began working for Vitamin Angels. Over the last four years, I've been fortunate enough to watch Vitamin Angels grow and our work and our mission has become a tremendous part of my life. As the Web Marketing Manager, I'm constantly sorting through photos, videos and stories (amongst other things), so I was thrilled to get the opportunity to visit Haiti and understand through first-hand experience how the vitamins we provide are impacting the lives of mothers and children.
Last month, we set off on a week-long journey around Haiti. From clinics, to schools, to malnutrition centers throughout southern Haiti, I was so delighted to see our vitamins on the shelves or being delivered to sick and malnourished women and children. Working with the nurses, I was even able to hand prenatal vitamins directly to several pregnant women and multivitamins to moms with young children. Many of those we talked to can only afford to eat once a day and those meals are often comprised of staple, stomach-filling foods like rice, beans, or cornmeal. The mothers smiled, thanked me, and were genuinely grateful to have something that would improve the health of their children.
While traveling near Les Cayes with our distribution partners, Hope for Haiti, one of the most impactful experiences for me was going to Ravine Sable, a primary and secondary school about an hour and a half away by bumpy car ride. The children were simply gorgeous in their pristine uniforms, many of the girls with matching ribbons in their hair; they sat in simple classroom, in their little red chairs and sang along with their teachers. But when it was time for break, only a handful of the students were able to go eat their lunch. For most of them, their families cannot afford to send them to school with a lunch each day. The director of the school told me that he believes the greatest need at Ravine Sable is a school food program since most of the children will go the entire school day without a meal. I felt my heart sink. But I was thankful that they had vitamins to keep them healthy and help them focus in school.
It is impossible not to fall in love with the children in Haiti. Whether I was at a school, a clinic, or a tent camp, the children would come up to me and grab my hand or play with my hair. It was amazing to feel the love and joy that is captured in the photos that we share with our supporters every day. All I could think was that each and every one of them deserves the opportunity to be healthy, grow and live a happy life.
The second to last day of the trip was the most challenging for me. Having returned to Port au Prince from Les Cayes, we went with Gina Deck, one of medical directors at Partners in Development, to Damier, one of the tent refugee camps for around 6,000 families displaced by the earthquake. Although I have seen these "camps" in pictures and on the news before, being there and experiencing the conditions with all my senses employed was completely different and far more provoking than I could have imagined. Many of the tents are not tents, but pieces of tarp, hanging over dirt and mud floors. Damier was built over a working pig farm. The smell of sewage is in the air while clothes hang out to dry and dinners are cooked inside the tents with unclean and untreated water.
For anyone I have ever met up until now, the conditions would be "unlivable." But living in Damier, there are mothers, fathers, grandmothers, and children who are making a life after losing most or all of their belongings in the earthquake almost 2 years ago. And what is beyond my understanding is the hope and light they have in them when we talked to them about their lives and their stories. We met women who were pregnant with their first children. They were so joyful and had a pregnancy glow like any other mom would have in the US. I was so happy to find that many of them had been to the PID clinics to see the doctors or nurses, were taking prenatal vitamins daily and were in good health.
A lot of people have said to me that it "it must be so rewarding to see the result of your hard work." I hesitate to say the trip was rewarding because although it was an amazing feeling to see that Vitamin Angels’ work really is making a difference in the lives of women and children in Haiti, being there only reemphasized my belief that the work that we do is not about me. It's about the mothers and children who deserve good health. Really, it has been an honor to get to play some part in the health and lives of such strong, hopeful and deserving women and children.
Check out these amazing photos from our grantee Bodhi Tree Foundation. Together, through Thrive to Five, we are reaching 651 pregnant and lactating women with multivitamins (donated by ProCaps). The multivitamins are distributed in cooperation with Nepal’s Ministry of Health through district hospitals, village health posts, and Safe Motherhood training classes.
All photos were taken in Humla, Nepal courtesy Bodhi Tree Foundation.
We recently received these beautiful photos from UmuAro USA, one of our in-field partners in Nigeria. Together we are reaching 4,500 children in need with vitamin A through Operation 20/20 and 1,302 pregnant women with multivitamins through Thrive to Five.
Check out these inspiring letters from one of our domestic field partners, Food Bank of Northwest Louisiana. Together, through Thrive to Five, we are reaching 1,381 children and 1,302 pregnant and lactating women with multivitamins. The Food Bank distributes the multivitamins to a host of secondary agencies, including the Ark-La-Tex Crisis Pregnancy Center.
“Vitamin Angels sent The Northwest Louisiana Food Bank the children’s chewable vitamins, which we distributed to 34 of our agencies that we provide for. The agencies we spoke with about the vitamins were very appreciative of them.
The children in the communities that they serve are not always lucky enough to eat a balanced diet and therefore are not receiving all the vitamins and minerals they need. This can have a negative effect on all areas of a child’s life, especially in school. This is where the parents see the most improvement in the children since taking the vitamins, in their schooling. The vitamins improve the children’s learning ability by enabling them to think more clearly and efficiently. Their minds and bodies feel good and have the energy necessary to excel in school.
The NWLA Food Bank and our agencies are thrilled to be able to give children the opportunity to receive the complete nourishment that their bodies need in order to maintain their health. We are hopeful that Vitamin Angels will continue to send us the children’s vitamins. Thank you Vitamin Angels!”
-Kendall Smith, Food Bank of Northwest Louisiana
“Thank you for the donation of prenatal vitamins. Almost all of our clients come from a low economic background with very little funds for any type of medical care. Your donation has made it possible for our non-profit organization to offer a 6 month supply of vitamins at no cost to these new mothers, thus providing a great start for the little ones growing inside!
We see about 50-70 women each month who have a positive pregnancy test and the vast majority of these women accept the vitamins that are offered. This donation has made a huge difference in many, many lives!
Again, thank you for your donation.”
-Karen Cowley, R.N., Ark-La-Tex Crisis Pregnancy Center
Santa Barbara Marathon winner, Moninda Marube races for the children of Kenya
Congratulations to MonindaMarube for winning the Santa Barbara Marathon last weekend! Moninda, originally from Kenya, not only broke the course record but dedicated his race to the children of Kenyan. This is the second year, Moninda has won the SB Marathon, and we couldn’t be happier about his involvement with Vitamin Angels.
Thanks Moninda and to the many other Team Vitamin Angels athletes who participated in the SB marathon raising funds and awareness for children all over the world!
The Vitamin Angels Programs team recently went to Uganda and Mozambique for two weeks to meet with two of our partners who are distributing vitamin A supplements to children 6-59 months of age. Vitamin Angels is reaching 2,000,000 beneficiaries in Uganda and 1,292,750 beneficiaries in Mozambique through our projects this year. Amy Steets, Vitamin Angels’ Program Manager joined our Monitoring and Evaluation (M&E) consultant, Christine Hotz, to learn more about the operations used for delivering vitamin A capsules to beneficiaries. Read what Amy said about the trip:
“Child Days Plus” in Uganda
We spent one week in Uganda observing their national biannual "child days plus" campaigns to better understand how vitamin A is being distributed there. Every April and October, health centers are mobilized to deliver vitamin A and deworming tablets to all Ugandan children under 5. This was the first time that Vitamin Angels has provided vitamin A capsules for the campaign, so it was a great opportunity to see it in action!
We visited several different sites ranging from a school distribution carried out under a tree, to rural clinics with extremely limited resources, to an outreach clinic that saw over 200 patients on the day we visited.
One highlight was spending an hour with a group of Village Heath Team workers (VHTs). These are volunteers that get elected or appointed as the village health advocate by their communities. They are given a kit of supplies that enables them to treat specific illnesses like malaria and are trained to refer more serious cases to the health centers. Many times, because of the long distances they must travel to the health centers, the VHTs are the only access villagers have to health care. The VHTs are the people that are reaching the children no one else is reaching and it was a privilege to interact with them and support their work!
Giving vitamin A to children at a preschool.
Vitamin Angels vitamin A in the Hoima District Medical Storage.
Vitamin A and albendazole ready to be given to infants in a clinic.
Finding Vitamin Angels Vitamin A in Mozambique
We spent a week in Mozambique meeting with our field partner and the national Ministry of Health to identify the successes and challenges of their vitamin A supplementation program. Not only did we learn a lot about the program, all along the way we found Vitamin Angels vitamin A on the shelves of government warehouses and in clinics ready for distribution. We spent two days in Gaza province where we visited a provincial warehouse and three district clinics. The district clinics are responsible for getting the vitamin A from the provincial warehouses and they do so by walking, biking, or occasionally driving. At the district level, the supply chain is largely dependent on the motivation of the health workers to obtain the supplies they need based on the needs of the population they are serving. It was so interesting to see the work they are doing and their dedication to the services they are providing.
The entire process of soliciting, coordinating the manufacture, receiving, managing the logistics of export and transport of our vitamins in order to ultimately provide an organized health service is challenging. It was good for me to see where the process picks up when the vitamins are received by our grantees and implementation partners because it gives a new and more meaningful dimension to the spreadsheets I manage and the emails I send every day. It puts the challenges faced and the commitment it takes all the way from our donors, through the Vitamin Angels team, to each single health worker reaching one child with a dose of vitamin A into a new perspective. In a country, like Mozambique, where infrastructure is weak, it is an uphill struggle but by and large I was impressed by their successes and encouraged that most children are receiving the vitamin A they need – in the end, that is why we are all doing this work.
Vitamin A dosing station.
Finding vitamin A in the Mozambique National Medical Stores.
Maternal health, child mortality, and population growth
A recent article from CNN focuses on maternal health and highlights the long-time friend of Vitamin Angels, Robin Lim. Lim, who is a midwife and one of the Top 10 CNN Heroes of 2011, founded health clinics in her native country of Indonesia which offer free prenatal care, birthing services and medical care.
According to the World Health Organization, “Pregnancy and childbirth complications are among the leading causes of death among women living in developing countries.” The article points out that in countries like Uganda, Mali and Somalia, a woman gives birth to an average of six to seven children. In Nigeria this number is close to eight. Some experts believe that having pregnancies too close together prevents women from being able to recover from loss of nutrients, which increases risks for complications. This may explain why there is a connection between countries that have high fertility and high maternal mortality rates.
The article points out that while multiple pregnancies may lead to higher maternal mortality rates, high child mortality rates may also lead to multiple pregnancies. This could be because women in developing countries (in addition to having little control over their reproductive health, including the use of contraceptives) may feel compelled to have multiple pregnancies because many of their children do not survive. In the video below, Hans Rosling, a medical doctor and statistician who teaches global health at the Karolinska Institute in Sweden, further explains this phenomenon of high child mortality and population growth:
Latest controversy: dietary supplements for individuals without deficiencies
A recent article in the Wall Street Journal, citing two recent studies, questions the health benefits of multivitamins and other dietary supplements. The argument however, involves individuals who do not have a specific nutrient deficiencies or chronic illnesses. The Wall Street Journal states that “Researchers and nutritionists are still recommending dietary supplements for the malnourished or people with certain nutrient deficiencies or medical conditions. For instance folic acid—the supplement form of folate——reduces the likelihood of a common birth defect if taken by pregnant women.”
In fact, Mark Hyman, MD argues in the Huffington Post that individuals who do not have a specific deficiency should not throw out their vitamins. He points out that the latest study from Archives of Internal Medicine which questions the safety of supplements is strictly observational and that these types of studies “are not designed to be used to guide clinical medicine or public health recommendations. All doctors and scientists know that this type of study does not prove cause and effect.”
Hyman goes on to show that the study’s findings are unclear and even unfounded. For example, the study found that the greatest risk of taking supplements is caused by taking iron after menopause. Hyman asserts that iron is rarely found in multivitamins and that no doctor would ever recommend iron supplementation to a post-menopausal woman without anemia. In addition, the report did not consider hormone replacement therapy (which could have had harmful effects on the vitamin user group), patient background, the forms and quality of vitamins, and the fact that the sample only included older white women. Hyman urges people not to be swayed by observational studies like this, and to instead, focus on the “Overwhelming basic science and experimental data [that] supports the use of nutritional supplements for the prevention of disease and the support of optimal health.”
Success stories: improvement of maternal and child health in Uzbekistan
We recently received an update from our grantee Medical Teams International (MTI) in Uzbekistan. Together we are reaching 400,000 children with vitamin A and 10,066 women with multivitamins.
The national program on improvement of maternal health has given the great opportunities to young mothers, living in rural areas to improve the health of their children and build stronger immunity system. Providing this vitamin has enabled more than 9300 women to supplement their daily needs of vitamins and micronutrients such as vitamin A, iron, iodine, zinc and others. Many of these women suffer from anemia and other consequences of malnutrition. Using a multiple vitamin and mineral supplement can help:
•Prevent micronutrient deficiencies, including anemia and zinc deficiency
•Improve the body’s immune system and health
•Reduce early infant mortality
•Reduce the incidence of low birth weight
•Improve physical and cognitive development in children by 2 years of age
Below we would like to present some photos and success stories taken and recorded by MTI staff during the monitoring visits to local clinics in Tashkent and Tashkent region where the multivitamins were donated through the Ministry of Health that was very grateful to donors for this opportunity as sufficient provision with good micronutrients is a critical issue in Uzbekistan.
1) This is a photo of recently married 21-year-old Sabina during her first check up with a gynecologist. The doctor is explaining the importance of taking necessary vitamins during the first trimester of the pregnancy and recommends prenatal vitamins as a balanced supplementation to Sabina’s daily nutrition. Zamira and her husband already have two kids and the income earned in the family is not sufficient for proper nutrition. Zamira’s previous pregnancies were difficult and children were born weak and both later developed anemia. Zamira was happy to receive the daily supplement of vitamins hoping that her third baby would be healthier and stronger.
3) This is a story of Irina, 24, a young mother of a 5 month old boy Alexander.
"I got married 3 years ago and my husband wanted to have a baby right after our marriage. I also wanted to have a baby but for some reason our dream did not come true the first year of our marriage. It neither happened the second year and this started troubling both of us. We went for a full medial examination and the doctors found that one of the reasons for my weak health was anemia and stresses at work. The doctors said I needed additional iron in order to improve my health. At the same time I was allergic to certain synthetically produced vitamins and therefore had to be very careful while taking vitamins and other supplements. Finally after some therapies I felt good and became pregnant. The doctors were watching my pregnancy very carefully and always warned me about proper nutrition and balanced vitamin support. At last my husband and I were blessed to have a wonderful son – Alex. We love him so much and I want to give him the best I can.
After being dismissed from the maternity hospital I was told to watch my nutrition especially in terms of anemia and allergy now that I was responsible for provision for two. But this was the time when hidden problems returned. I tried to take some vitamin supplements during the first weeks after Alex’s birth and most of them caused a bad allergic reaction for both of us. I was shocked to discover the rash all over Alex’s skin one of the mornings after taking some local vitamins the day before. The doctors were puzzled trying to find a balanced vitamin supplement for me and my baby. Finally a few weeks ago I was called by my doctor who said that they received a new vitamin for pregnant and lactating women. I was especially pleased to find out it was given to women free of charge as we had a little tension in the family budget related to baby’s birth and my maternity leave. I started taking the prenatal vitamins and luckily my baby and I didn’t have any allergies or rashes. Moreover I started feeling much better and that annoying feeling of exhaustion and tiredness is gone. I feel much more energetic and full of life that I can now dedicate to my beloved family. I want to thank Medical Teams and my doctors who gave me the opportunity to enjoy my life and be able to raise Alex as a healthy child!"
4) This is the story of Oksana, 33 year old mother of 3 children.
"My name is Oksana. I’m 33 years old. I now have 3 lovely children. Unfortunately we are not so rich and due to my weak health and poor material condition in our family we were not able to keep all children we were blessed with. I regret this so badly... I am sure that children are a great gift given by God to make people happy. I already had 2 kids - 14 years old girl and 5 years old boy when I became pregnant again. To be a mother is such happiness! I could not say “no” to my third baby whose heart was already beating and I wanted to go through this again by giving a birth and raising my kid. I had a lot of difficulties during my pregnancy. I became so weak after my previous pregnancies, which caused a big problem with my health. Therefore right after that as I became pregnant I came to see my doctor immediately. After full a examination, I was told that everything was all right but for normal development of my baby it was necessary to take vitamins for pregnant women. I immediately received these vitamins in a polyclinic and started seeing my doctor every month.
My pregnancy passed normally. I took one capsule of my pregnancy vitamins once a day throughout my whole pregnancy period. My doctor was very attentive to me. And there was a miracle - I gave birth to a beautiful daughter. This is because I always followed my doctor’s advice and took vitamins and my health was always kept well. And after delivery I had normal lactation. My doctor told me that I could take vitamins during breastfeeding. I appreciate the great support from all the people who helped me during my pregnancy. I love children very much. I think that the main thing in a family is a mutual understanding and a great love. I wish you happiness!"
The Vitamin Angels Programs team recently went to Haiti for two weeks to meet with five of our partners who are distributing vitamin A supplements to children 6-59 months of age. Vitamin Angels is reaching 272,750 children through our projects in Haiti this year. Ada Lauren, Vitamin Angels’ Manager of Technical Services was in Haiti with our Monitoring and Evaluation (M&E) consultant, Christine Hotz, to learn more about the operations used for delivering vitamin A capsules to beneficiaries. Read what Ada said about the trip:
Some of the locations we visited were very remote—for one partner, we had to take a small plane to Les Cayes, in the South East part of Haiti, then a 4 hour truck ride to the coastal town of Pestel. Once in Pestel, we then took a small boat to an island where our partners are distributing vitamin A to the children as part of an ongoing series of health interventions. Seeing the lengths that our partners go to in trying to reach the children who do not have access to health care was remarkable. The children were so sweet, and the mothers and fathers so grateful for these services. They were continually telling me to say THANK YOU to Vitamin Angels and the donors that supply the vitamin A and albendazole.
The main objective of the monitoring and evaluation exercise that Vitamin Angels is conducting this year is to gain a better understanding of the operations used to distribution of Vitamin A Capsules (VAC) sourced from Vitamin Angels. More specifically, we wish to identify any weaknesses or challenges in the distribution activities that could be improved with additional technical support, identify strengths in these activities that may be useful to implement in other VA programs, and identify potential opportunities for expansion of VAC distribution activities supported by Vitamin Angels. The monitoring and evaluation visit encompassed all aspects of the vitamin A supplementation program, including the (1) Context of the VAC supplementation program in relation to national activities, (2) Planning procedures, (3) Shipping, transportation, and storage of VAC, (4) Training of staff/volunteers for VAC distributions, (5) Communications/social mobilization, (6) Implementation (VAC distribution), (7) Record keeping, and (8) Follow up activities. Our goal is to strengthen our own internal processes so we can provide more relevant and useful support to our field partners. This trip to Haiti was a very positive step for commencing more robust M&E activities for Vitamin Angels’ vitamin A distribution partners.
-Ada Lauren, Vitamin Angels Manager of Technical Services