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].

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.

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.