Letters to the Editor

Indian Pediatrics 2002; 39: 114-115  

Deaths in Assam during Vitamin A Pulse Distribution: The Needle of Suspicion is on the New Measuring Cup

The National Prophylaxis Program for Prevention of Blindness due to Vitamin A deficiency is being implemented in India since the 1970s. The program covers all children in the age group of 9 months to less than three years of age. Children between 9 months to less than 12 months receive a single dose of 1 lakh IU and those between one to three years of age receive 2 lakh IU of Vitamin A every six months. Vitamin A is to be distributed by multipurpose health workers during their routine health care delivery to the benefi-ciaries(1).

Fig. 1 The new measuring cup with the Vitamin A solution bottle.	Fig. 2 The old measuring spoon with the Vitamin A solution bottle.

The deaths of more than 15 children during the Vitamin A distribution by campaign mode in Assam on 11 November 2001 have caused anxiety and concern among health care providers and criticism(2,3). According to the Assam state government, 700 children of 3.2 million who were given the vitamin A dose, became ill(4,5). Whether all these cases were a direct consequence of high dose Vitamin A administration is being investigated.

One of the possible reasons which is evident from the different press reports is the overdose of the Vitamin A because of use of new measuring 5 ml cup (Fig. 1), which was used for first time for administering Vitamin A to the beneficiaries instead of the traditional 2 ml spoon (Fig. 2). Some of the health functionaries who were to administer vitamin A reported that they were neither shown the medicine nor the cup during the training session, held three days before the actual program(6). Even young children of seven weeks have been reported to be given Vitamin A dose(7).

Scientists in India have been advocating that the campaign approach should be avoided(1) as it disturbs the routine health care activities of the worker. Also, the emphasis is to achieve the targets of distribution of Vitamin A doses in campaign and no effort is made to provide health education to the mothers of the beneficiaries, which is the major intervention for the sustainable elimination of the Vitamin A deficiency from the area.

There is need for investigating the causes of deaths and ensuring that such tragedies are not repeated. The measuring cup used for Vitamin A administration should be withdrawn immediately from the program till operational feasibility proves that it can be used efficiently by the village level health functionaries.

Umesh Kapil,
Additional Professor,
Public Health Nutrition,
Department of Human Nutrition,
All India Institute of Medical Sciences,
New Delhi 110 029, India.
E-mail: [email protected]

1. National consultation on benefits and safety of administration of Vitamin A to preschool children and pregnant and lactating mothers. Indian Pediatr 2001; 38: 37-42.

2. Deaths trigger fresh controvery over vitamin A programme in India. BMJ 2001; 323: 1206.

3. Sharma DC. UN Vitamin A campaign in India under fire. Lancet 2001; 358.

4. Probe ordered into vitamin A deaths. The Times of India, New Delhi, November 14, 2001.

5. Barman. Vitamin-A overdose likely. Assam Tribune, November 14, 2001.

6. Mystery shrouds Vitamin A deaths. Assam Tribune, November 28, 2001.

7. Experts wonder whether all children need Vitamin A. Assam Tribune, November 19, 2001.