Date Published: January 20, 2017
Publisher: AIMS Press
Author(s): Sudip Bhattacharya, Amarjeet Singh.
Childhood blindness due to corneal ulceration was prevalent among poor Indian children. To tackle this situation, the National Institute of Nutrition (NIN), Hyderabad, India, Vitamin-A (Vit-A) prophylaxis programme was launched nationally in 1970 after field testing. Research of Indian Council for Medical Research (ICMR) documented that prevalence of Vit-A deficiency signs such as Bitot’s spot decreased among children, over a period of time. However, this decrease cannot be ascertained is due to mass Vit-A prophylaxis programme. This is because coverage was low and patchy. Improved nutrition status, wider vaccination coverage, increased rate in breast feeding and improvement of healthcare services played a crucial role. Rather many studies revealed that (mass prophylaxis to the child who is having adequate Vit-A level) it may be harmful to certain group of children as a result of acute toxic symptoms. High dose of Vit-A is capable of loss of bone density-hence retarded growth may be observed in susceptible individuals. To tackle this issue food based approach should be promoted (which includes breast feeding) along with timely measles vaccination. The children who have signs of Vit-A deficiency (e.g. night blindness, xeropthalmia, Bitot’s spot) or post measles children should receive Vit-A in age specific daily doses for two weeks along with Vit-A rich food, like green leafy vegetables, red palm oil, liver etc. Public spirited citizens, together with scientific community in India, should discourage this “one size fit to all” approach. It will not only avoid the ill effects of high dose of Vit-A but also it will help us optimal utilization of health resources in a resource poor country like India.
International public health policy makers recommend mega dose of Vitamin-A (Vit-A) to all children aged between 6–60 months irrespective of nutritional status. According them it is a major public health problem in 1950s–60s. In many countries the mega dose of Vit-A was given over enthusiastically to the children. Even today it is still continuing as a part of routine supplementation irrespective of areas where Vit-A deficiency signs are rare .
The previous claim by 30% reduction of child hood mortality by mega dose administration was questionable . The study of John Hopkins group in Indonesia claimed reducing mortality by administration of mega dose of Vit-A, suffered from many methodological issues. There were issues like non randomization of baseline samples, control group had disease (malnutrition along with signs of Vit-A deficiency), cause of death was not mentioned and randomization done at village level and children data was presented .
Current government health policy (Indian) advocates mega dose of Vit-A, according to policy a child (9th to 36th month ) have to receive 1,700,000 IU of Vit-A, it is massive ,. Massive dose can cause acute and chronic toxicity to certain group of children. Ranging from bulging of anterior fontanelle (sign of increased intracranial tension) to mental retardation, even death incidence . Thus it can do more harm than good.
Study revealed that Vit-A can accelerate loss in bone density by the process of demineralization, followed by growth retardation. This issue can be further complexed by other sub issues like poor family, malnourished mother, underweight child, poor availability of sunlight in slum areas etc.
A balanced diet is the ultimate way to prevent micronutrient deficiency. Government of India should promote production and consumption of locally available seasonal fruits and vegetables. Green leafy vegetables, animal liver, red palm oil are the best sources of for Vit-A. Promotion of kitchen, school and community gardening are very important, but it is usually ignored. We as Indians have tremendous opportunity to encash our natural resources, because most of our people are resending in villages where fresh vegetables and fruits are easily available. Another important aspect is that, garden foods and animal foods are natural, they are fresh and it cannot be substituted by any synthetic capsules (“magic bullets”). Gardening (by exercise) prevents us from chronic diseases also. So single health promotive approach may results in multiple health benefits.
Public spirited citizens, together with scientific community in India, must ensure the phasing out of the universal mega-dose Vit-A prophylaxis approach.