 |
|
Letters to the Editor Indian Pediatrics 2004; 41:864-866 |
|
Cost of Syrup Versus Capsule Form of Vitamin A |
|
We read the article entitled "Cost of syrup versus capsule form of vitamin A supplementation"(1) with great interest and found it informative. The authors have compared the cost of supplementing vitamin A in the form of syrup versus capsules in the research manuscript but in the conclusion authors have interestingly recommended use of applicaps for vitamin A administration. However, the existing scientific evidence indicates that supplementation of vitamin A should be continued in the form of syrup as presently being done in India under the "National Program of Prevention of Nutritional Blindness due to vitamin A Deficiency" because of the following reasons. (i) The present study was descriptive in nature and no mention has been made of total number of Anganwadi workers and AuxilIary Nurse Midwives (ANMs) included in the study. The functionaries interviewed for distribution of vitamin A were from a research project area who may not be true representatives of Anganwadi workers, ANM and Lady Health Visitors (LHVs) involved in supplementation of vitamin A under the existing national program. (ii) Applicaps for administration of vitamin A which have been recommended by the authors have been documented to provide inaccurate dose of vitamin A. Keeping in view of this fact, WHO and UNICEF have recommended the use of multi- dose liquid dispensers(2), The results mentioned in Table II of the article indicate that the wastage of vitamin A was almost similar when vitamin A was administered in syrup form vis-a-vis capsules or applicaps (1.111 vs 1.0204). (iii) The authors have not mentioned any reference for the data presented in Table III on "non-economical issues" related to vitamin A capsules, applicaps and solution. The facts mentioned in the table appear to be based on their personal observations. (iv) To modify the mode of vitamin A supplementation from syrup to capsule form in the existing national program, the following issues also need to be considered. (a) Two types of capsules one with one lakh units (for infants) and the other with two lakh units (for 1-3 years) will be required. (b) Training of the 1,60,000 ANMs, 23,000 LHVs and 5,17,100 Anganwadi workers(3) will have to be undertaken so as to prevent recurrence of overdosing of vitamin A and consequent fatal accidents in young children as happened in Assam. (c) Presently, two types of gelatin capsules are commonly used in pharmaceutical industry, one derived from pork skin by hydrolysis with an acid and the other from bones and skin of other animals by hydrolysis with an alkali(4). Currently, all the gelatin capsules available in India are made from animal bones. According to pharmaceutical industry the capsules of vegetarian origin would increase the price by four to six times(5). (d) In the past, discovery by population that manufacturers were using lard to process vanaspathi in India caused an upheaval. The use of non-vegetarian based vitamin A capsules under the national program could open another Pandora’s box. In conclusion, before adopting administration of vitamin A by capsules or applicaps in India the issues discussed in this communication should be carefully examined. Umesh Kapil,
|
|
References |
|
|
