Government of India initiated the National Prophylaxis Programme against
Nutritional Blindness due to vitamin A deficiency (VAD) in 1970 due to
the high prevalence of VAD amongst children in the age group of 9-59
months in the country. The national scenario of VAD has changed
significantly. However, the universal vitamin A supple-mentation is
still being undertaken possibly for two benefits: (i) prevention
of nutritional blindness due to VAD, and (ii) reduction in
under-5 mortality rate (U5MR).
The existing scientific evidence suggests that the
prevalence of Bitot’s spots among preschool children have reduced to
0.3% (range 0-0.7%), and is limited to isolated geographical pockets in
the country [1]. A gradual reduction has been documented in U5MR from 74
(NFHS-3) [2] to 50 (NFHS-4) during 2005 to 2015 [3].
Table I presents NFHS-3 (2005-2006) and
NFHS-4 (2015-2016) data on U5MR, infant mortality rate (IMR) and
coverage of vitamin A supplementation in 35 states of India. The
difference in U5MR and IMR amongst children is 9 (range 0 to 14), and is
in the range of 0-5 in group A states. As 60% of the IMR is in the
neonatal period due to causes such as accidents, genetic disorders,
congenital anomalies and low birth weight, there is no biological
mechanism by which vitamin A supplementation can possibly intervene and
prevent these deaths. Large scale intervention studies and recent
systematic reviews have also suggested that reduction in U5MR by vitamin
A supplementation is negligible (2-3%) [4,5].
TABLE I Current Status on Infant Mortality Rate and Under Five Mortality Rate and Progress of Coverage of
MDVA Supplementation in India Over a Decade
|
|
|
Coverage of MDVA
supplementation |
Region |
Under-five mortality |
Infant Mortality Rate |
NFHS-3 |
NHFS-4 |
|
rate
NHFS-4 (2015-2016) |
NHFS-4(2015-2016) |
(2005-2006) |
(2015-2016) |
India |
50 |
41 |
16.5 |
60.2 |
Group A states |
|
|
|
|
Daman and Diu |
34 |
34 |
* |
68.4 |
Goa
|
13 |
13 |
31 |
89.5 |
Puducherry |
16 |
16 |
* |
75.0 |
Kerala |
7 |
6 |
31.5 |
74.4 |
Andaman & Nicobar |
13 |
10 |
* |
69.3 |
Sikkim |
32 |
29 |
18 |
84.3 |
Himachal Pradesh |
38 |
34 |
26.7 |
64.3 |
Karnataka |
32 |
28 |
13.6 |
78.7 |
Lakshadweep |
23 |
19 |
* |
52.3 |
Manipur |
26 |
22 |
11.2 |
32.1 |
Punjab |
33 |
29 |
14.6 |
70.6 |
Telangana |
32 |
28 |
* |
76.3 |
Maharashtra |
29 |
24 |
23.3 |
70.5 |
West
Bengal |
32 |
27 |
31.7 |
68.4 |
Group B states |
|
|
|
|
Andhra Pradesh |
41 |
35 |
* |
72.1 |
Jammu and Kashmir |
38 |
32 |
12.6 |
64.7 |
Mizoram |
46 |
40 |
40.2 |
68.6 |
Tamil Nadu |
27 |
21 |
33.1 |
68.3 |
Tripura |
33 |
27 |
28.3 |
62.8 |
Uttarakhand |
47 |
40 |
12.8 |
36.9 |
Assam |
56 |
48 |
12.2 |
51.3 |
Haryana |
41 |
33 |
10.5 |
66.7 |
Nagaland |
37 |
29 |
6.6 |
27.1 |
Dadra and Nagar Haveli |
42 |
33 |
* |
59.3 |
Gujarat |
43 |
34 |
12.8 |
71.2 |
Odisha |
49 |
40 |
20.4 |
69.1 |
Arunachal Pradesh |
33 |
23 |
15.8 |
39.4 |
Bihar |
58 |
48 |
25.1 |
62.3 |
Chhattisgarh |
64 |
54 |
8.9 |
70.2 |
Jharkhand |
54 |
44 |
18 |
52.9 |
Meghalaya |
40 |
30 |
14.9 |
54.4 |
Rajasthan |
51 |
41 |
8.6 |
39.6 |
Delhi NCT |
47 |
35 |
12.6 |
54.2 |
Madhya Pradesh |
65 |
51 |
12.5 |
60.4 |
Chandigarh |
* |
* |
* |
56.3 |
MDVA: mega dose of
vitamin A. |
In spite of the strong evidence to discontinue
vitamin A supplementation in the country, there has been a dramatic
increase in the coverage of mega dose of vitamin A supplementation from
16% (NFHS-3) to 60% (NFHS-4) amongst children in the age group of 9-59
months (Table I). The Group A states with difference in
U5MR and IMR in the range of 0-5 even, have a high coverage of vitamin A
supplementation.
Government of India should adopt and implement
evidence-based decisions for vitamin A supplementation as it may lead to
wasteful expenditure of manpower and financial resources. Also, the
toxicity of mega dose of vitamin A supplementation is a cause of great
concern.
References
1. National Nutrition Monitoring Bureau. Diet and
Nutritional Status of Rural Population, Prevalence of Hypertension and
Diabetes Among Adults and Infant and Young Child Feeding
Practices-Report of Third Repeat Survey- Technical report number
26;2012.
2. International Institute for Population Sciences.
National Family Health Survey (NFHS-3): India. Mumbai: IIPS; 2005-2006.
Available from: http://rchiips.org/NFHS/maharashtra_report.shtml.
Accessed July 03, 2017.
3. International Institute for Population Sciences.
National Family Health Survey (NFHS-4): India. Mumbai: IIPS; 2015-2016.
Available from: http://rchiips.org/NFHS/factsheet_NFHS-4.shtml.
Accessed July 03, 2017.
4. Mazumder S, Taneja S, Bhatia K, Yoshida S, Kaur J,
Dube B, et al. Efficacy of early neonatal supplementation with
vitamin A to reduce mortality in infancy in Haryana, India (Neovita): a
randomised, double-blind, placebo-controlled trial.Lancet.
2015;385:1333-42.
5. Mason J, Greiner T, Shrimpton R, Sanders D, Yukich J. Vitamin A
policies need rethinking. Int J Epidemiol. 2015;44:283-92.