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Letters to the Editor Indian Pediatrics 2003; 40:919 |
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Effect of Vitamin A Supplementation on Childhood Morbidity, Mortality |
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Although cut-off level of serum retinal of 20 microgram/dL for marginal, and 10 microgram for definite deficiency have been advocated and extensively used in population based studies, but a level of 10 microgram has been suggested for deficiency in Indian continent in children above 1 month of age(2). The question of supplementing all children with mega dose vitamin A is fraught with danger, when the prevalence of vitamin A deficiency in India is 0.21%(1). The observation of large increase in rate of pneumonia in well nourished children who received 10000 IU of vitamin A weekly(3), and reduced CD+3/CD+4 cells in elderly vitamin A supplemented subjects, the differential effect of VAS in pneumonia and diarrhea, raise the question of enormous public health implications. Even in countries with substantial malnutrition, there are many children who are not vitamin A deficient and who might be harmed by VAS. Mass campaigns to administer vitamin A would have to be altered to include an assessment for vitamin A deficiency(4). The finding from vitamin A trials are not consistent, and authors have rightly concluded that "there is no evidence as yet in favor or against substantive benefit of universal vitamin A supplementation to children in India". It is right time to discuss and review the necessity of continuing with mega dose vitamin A supplementation to all children with vaccination program, which might be more harmful in view of above mentioned facts. A.P. Gupta, |
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