High-dose supplementation with this essential vitamin improves a child’s chance of survival by 12 to 24 per cent in some parts of the world; it bolsters the immune system, helps protect against life-threatening infections like measles and diarrheal disease, and is needed for vision and bone growth.
Ideally, children should get enough vitamin A from a balanced, healthy diet that includes milk, cheese, eggs, fruits and vegetables like mangoes, papaya, carrots, yams and squash or foods fortified with vitamin A. However, in low-income countries, young children often do not eat a well-balanced diet rich in the appropriate vitamins needed for growth, development and survival. These children are especially vulnerable to vitamin A deficiency and its devastating consequences.
Vitamin A deficiency is a public health problem affecting over 250 million children in more than half of countries worldwide. As of 2013, 29 per cent of children – or nearly one in three – ages 6 to 59 months were vitamin A deficient. About half of these affected children lived in sub-Saharan Africa and South Asia.
Protection with two doses
In areas where under-five mortality is high or deficiency is a public health issue, two high-dose vitamin A supplements per year can save lives. Supplementation is safe, only costs 2 cents per dose, and when delivered through platforms like Child Health Events, can be an equitable way of reaching the most vulnerable.
There have been dramatic improvements since 2000, when only five countries in sub-Saharan Africa reached at least 80 per cent of target children with the two required doses. According to recent data, this number had more than tripled in 2014, to 17 countries in the region. Despite these gains, there is an urgent need to make further progress to reach the hardest hit boys and girls who continue to lack vitamin A that is essential for them to survive and thrive.
In 2014, UNICEF supported vitamin A supplementation programmes focusing on sub-Saharan Africa and South Asia where the needs are greatest. These critical child survival interventions protected 92 million children living in the least developed countries. Nevertheless, 46 million of the world’s most vulnerable children were left behind, putting them at an increased risk of disease and death. Future efforts need to focus on the marginalized, the poorest and the least educated, who are disproportionately affected by child mortality and vitamin A deficiency.
Child health events: equitable and effective
Vitamin A supplements are often delivered during Child Health Events alongside other high-impact health interventions such as vaccination, mosquito net provision and deworming. Child Health Events are one of the most equitable delivery strategies because they extend the reach of health systems, bringing vitamin A supplements directly to communities in need. This helps ensure that every child is fully protected. The events are especially successful at reaching vulnerable children in hard-to-reach communities and in fragile settings with weak health services. Particularly in sub-Saharan Africa, countries that have adopted this approach have effectively reached boys and girls with the required two doses each year.
Since twice-yearly events were introduced in 2001, the United Republic of Tanzania has maintained high coverage of vitamin A supplementation among children ages 6 to 59 months. The country holds community-based Child Health Days to address malaria, hookworm, vitamin A deficiency and growth monitoring. The vitamin A component has been highly successful: between 2005 and 2011, national two-dose coverage exceeded 90 per cent, coinciding with the country’s declining rate of child mortality, from 126 deaths per 1,000 live births in 2000 to 68 per 1,000 in 2011.
Currently, Child Health Events are the best way to reach all boys and girls in sub-Saharan Africa with the two doses per year that are needed to improve their chances early on in life. The events succeed because they target and reach vulnerable communities, where routine health systems are weak and under-five mortality rates are high. Since health needs and service delivery vary greatly from country to country, Child Health Events must be tailored specifically to each context in order to ensure that no child is forgotten.
Over the long-term, other strategies for addressing vitamin A deficiency – such as food fortification and education in nutrition and the importance of a diverse diet – are critical to ending vitamin A deficiency. Until such programmes are sustained at scale, however, vitamin A supplementation through Child Health Events remains essential to ensuring child survival today.
For more information, please see Vitamin A Supplementation: A Statistical Snapshot