STORY

All about Vitamin A Deficiency (VAD) and Vitamin A Supplementation (VAS)

Definition of Vitamin A Deficiency (VAD): insufficient consumption of vitamin A to meet the body’s needs.

The Problem
Children worldwide are getting sick, going blind, and even dying, because their diets lack one essential nutrient – vitamin A.

For babies and young children whose minds and bodies are rapidly growing and developing, vitamin A is essential. Vitamin A deficiency weakens the immune system, meaning children have a harder time fighting off life-threatening illnesses. In severe cases, they can go permanently blind or die from a lack of vitamin A.(i)

Who is at risk?

  • Children 6 to 59 months of age living in (120) countries identified by UNICEF as experiencing moderate to severe vitamin A deficiency.(ii)(iii)
  • Children living in hard-to-reach areas with limited access to healthcare services are at greater risk.(iv)

Scope of problem:

  • About 1/3 (29%) of the world’s children are vitamin A deficient.(v)
  • An estimated 190 million children under the age of five years suffer from vitamin A deficiency, which can lead to weakened immune systems, childhood blindness, and even death.(vi)
  • Approximately 535 million children (6-59 months) are at risk of vitamin A deficiency (eligible for vitamin A supplementation)(vii)
    • Approximately 150 million of those children are not being reached through government health services.(viii)
    • Despite major efforts by governments and NGOs, about 30% of the children who should be receiving vitamin A go unreached because they live in areas considered too difficult to reach, like remote locations or urban slums.
  • In 2011, an estimated 105,700 children died as a result of VAD.(ix)
  • 350,000 children go blind annually due to VAD (x)

Causes:

  • Vitamin A isn’t produced by the body. Children need to regularly consume foods that contain vitamin A like green leafy vegetables and animal products including milk, eggs and liver. When children don’t get enough vitamin A in their daily diets or receive supplementation, they become deficient.
  • To get vitamin A, we have to consume it. In developed countries like the U.S., many of our foods have been fortified with vitamin A and other nutrients for decades. Children in developing countries around the world become vitamin A deficient because their families don’t have access to vitamin A rich foods or can’t afford to buy them regularly.

What happens to a child with Vitamin A Deficiency (VAD)?

  • Vitamin A Deficiency (VAD) can lead to serious illness, and in some cases, death.
  • VAD is the leading cause of preventable childhood blindness.(xi)
  • A weakened immune system makes a child more susceptible to infectious diseases, like diarrhea and measles. Illness, combined with lack of sanitation and other factors, can lead to death.
  • Can lead to blindness (xerophthalmia)(xii)
  • Improper growth leads to stunting (too short for their age). 
  • Thin, brittle, or lightening hair, and/or dry, flaky skin.(xiii)

The Solution

Vitamin A supplementation can help make children stronger and have healthy eyes, and also substantially reduce a child’s risk of illness or death.(xiv)

Vitamin A supplementation is the most immediate and least expensive way to prevent child deaths.[xv] For decades WHO, UNICEF, and the Micronutrient Initiative have been promoting vitamin A supplementation – it is an effective and proven solution that can save lives now.

Why Vitamin A?

  • Vitamin A is one of five recommended nutrients critical for growth and development (iron, folic acid, zinc, iodine and vitamin A).(xvi)-(xvii)
  • Vitamin A is critical for a strong immune system and supports eyesight, bone growth, and healthy skin and hair.(xviii)
  • Vitamin A helps young children boost immunity and fight off illnesses, such as diarrhea and measles.(xix)
  • Vitamin A aids in growth and cognitive development during a child’s early years. (xx)
  • Vitamin A saves lives.
    • Vitamin A supplementation (VAS) can substantially reduce a child’s risk of illness or death. (xxi)
    • This simple intervention can reduce mortality from all causes in at-risk children 6-59 months by up to 24%.(xxii)
  • Vitamin A supplements are one of the least expensive solutions to addressing preventable child deaths.(xxiii)
  • Vitamin A supplementation (VAS) is easy, affordable and scalable.
    • Children ages 6-59 months only need one dose of vitamin A [and albendazole] every 6 months, allowing for an immediate, yet long-lasting benefit.
    • Vitamin A is inexpensive to produce and cost-effective to transport.
    • VAS can be quickly and easily added to existing public health outreach programs. Unlike food aid or fortification, this solution does not require significant new resources or infrastructure to mobilize and deploy.
  • VAS helps reduce common childhood illnesses including post-measles infections and diarrhea, and reduce deaths from diarrhea.(xxiv)
  • Vitamin A supplementation can prevent childhood blindness and boost a child’s immune system.

Dosing Process: The tip of a high dose vitamin A capsule is cut off by a trained service provider and the contents are dripped into the child’s mouth, without touching the child. This concentrated dose is stored in the liver and slow-released over time into the child’s system.

Quote: “One of the most compelling investments is to get nutrients to the world’s undernourished. The benefits from doing so – in terms of increased health, schooling, and productivity – are tremendous.” Vernon Smith, Nobel laureate economist.

Vitamin Angels’ Impact

Vitamin Angels approach is preventive. We supplement children who are at risk of, or suffering from, vitamin A deficiency, rather treating conditions that arise as a result of VAD.

  • In 2015, Vitamin Angels reached over 41 million children with vitamin A.

Dosing Schedule:  A child suffering from vitamin A deficiency only needs to receive one lifesaving dose twice a year. Ideally, children are given vitamin A every six months from ages 6 months to 5 years old.

Following from internationally recognized guidelines by the WHO and UNICEF, Vitamin Angels calculates that each child 6-11 months of age receives one dose of 100,000 IU vitamin A annually; and each child 12-59 months of age receives two doses of 200,000 IU vitamin A annually.

Additional Info: Wherever possible, we pair deworming treatments with vitamin A to eliminate the presence of intestinal worms which contribute to poor absorption of vitamin A.

Sources:

[i] Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy The Cochrane Collaboration. 2015, Issue 11.

[ii] WHO. Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency. Geneva, World Health Organization, 2009.

[iii] Stevens GA, Bennett JE, Hennocq Q, Lu Y, et al. Trends and mortality effects of vitamin A deficiency in children

in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health 2015; 3: e528–36

[iv] [iv] Lancet Series: Maternal and Child Nutrition 1: Maternal and child undernutrition and overweight in low-income and middle-income countries, p. 29.  2013. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, et. al. and the Maternal and Child Nutrition Study Group.

[v] Stevens GA, Bennett JE, Hennocq Q, Lu Y, et al. Trends and mortality effects of vitamin A deficiency in children

in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health 2015; 3: e528–36

[vi] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[vii] Calculated using: Population of children under 5 by populations (a) combined with populations with mild, moderate, and severe vitamin A deficiency (b).  (a)Population of children under 5: From State of the World’s Children 2013: Every Child Counts. UNICEF. (b) Populations with mild, moderate, and severe VAD: From Global prevalence of vitamin A deficiency in populations at risk 1995–2005: WHO global database on vitamin A deficiency (2009). 

[viii] Population of children under 5 reached with VAS is 70% in countries that need VAS: From State of the World’s Children 2013: Every Child Counts. UNICEF.

[ix] Stevens GA, Bennett JE, Hennocq Q, Lu Y, et al. Trends and mortality effects of vitamin A deficiency in children

in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health 2015; 3: e528–36

[x] Investing in the Future. A United Call to Action on Vitamin and Mineral Deficiencies. Global Report 2009. p. 7 http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf

[xi] WHO (2002). The World Health Report 2002: Reducing risks, promoting healthy life. Geneva: WHO Press, 2002.

[xii] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[xiii] FAO. Food Security Analysis Unit for Somalia. Nutrition: A guide to data collection, analysis, interpretation and use.

[xiv] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[xv] “The 2008 Copenhagen Consensus ranked micronutrient supplements for children (vitamin A and zinc) as the #1 priority for addressing the world’s greatest challenges, based on the costs and benefits of the solution.”  Copenhagen Consensus 2008-Results. http://www.copenhagenconsensus.com/sites/default/files/cc08_results_final_0.pdf

[xvi] Sommer A, West KP Jr. Vitamin A deficiency: Health, survival and vision. New York: Oxford University Press, 1996.

[xvii] UNICEF. Micronutrients. http://www.unicef.org/nutrition/index_iodine.html

[xviii] WHO (2002). The World Health Report 2002: Reducing risks, promoting healthy life. Geneva: WHO Press, 2002.

[xix] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[xx] Sommer A, West KP Jr. Vitamin A deficiency: Health, survival and vision. New York: Oxford University Press, 1996.

[xxi] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[xxii] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.

[xxiii] Copenhagen Consensus 2008-Results http://www.copenhagenconsensus.com/sites/default/files/cc08_results_final_0.pdf

[xxiv] Imdad A., Herzer K., Mayo-Wilson E., Yakoob M.Y, and Bhutta Z.A. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. p. 2. Art. No.: CD008524. DOI: 10.1002/14651858.CD008524.pub2.