Phasing out of the Universal Mega Dose of Vitamin-A Prophylaxis to Avoid Toxicity

Sudip Bhattacharya; Amarjeet Singh

doi:10.3934/publichealth.2017.1.38

AIMS Public Health , 2017, 4(1): 38-46. doi: 10.3934/publichealth.2017.1.38. Review

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Phasing out of the Universal Mega Dose of Vitamin-A Prophylaxis to Avoid Toxicity

Sudip Bhattacharya, Amarjeet Singh

Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India

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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.

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Keywords: keratomalacia; Vitamin-A toxicity; mortality

Citation: Sudip Bhattacharya, Amarjeet Singh. Phasing out of the Universal Mega Dose of Vitamin-A Prophylaxis to Avoid Toxicity. AIMS Public Health , 2017, 4(1): 38-46. doi: 10.3934/publichealth.2017.1.38

References:

1. WPHNA World Public Health Nutrition Association. [cited 2016 Dec 14]. Available from: http://www.wphna.org/htdocs/2011_may_wn3_michael_latham.htm.
2. Sommer A (2008) Vitamin A Deficiency and Clinical Disease: An Historical Overview. J Nutr 138: 1835-1839.
3. World Nutrition. Volume 1, Number 2, June 2010. Journal of the World Public Health Nutrition Association. [cited 2016 Dec 14]. Available from: http://www.dis.xlibx.info/dd-medicine/427180-1-world-nutrition-volume-number-june-2010-world-nutrition-volume-n.php.
4. Kapil U (2004) Update on vitamin A-related deaths in Assam, India. Am J Clin Nutr 80: 1082-1083.
5. West KP, Pokhrel RP, Katz J, et al. (1991) Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet 338: 67-71.
6. Awasthi S, Peto R, Read S, et al. (2013) Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial. Lancet 381: 1469-1477.
7. Pereira SM, Begum A (1969) Prevention of vitamin A deficiency. Am J Clin Nutr 22: 858-862.
8. Kapil U, Sachdev HPS (2013) Massive dose vitamin A programme in India—Need for a targeted approach. Indian J Med Res 138: 411-417.
9. Nesheim M (2010) Need for long-term benefits. World Nutr 1: 106.
10. Reddy V (2010) Need for food-based programmes. World Nutr 1: 106-107.
11. Lyons G (2010) Need to go and stay local. World Nutr 1: 112-113.
12. Amdekar YA, et al. (2010) Vitamin Controversy. World Nutr 1: 114-116.
13. Rahmathullah L, Underwood BA, Thulasiraj RD, et al. (1990) Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med 323: 929-935.
14. Vijayaraghavan K, Radhaiah G, Prakasam BS, et al. (1990) Effect of massive dose vitamin A on morbidity and mortality in Indian children. Lancet 336: 1342-1345.
15. Indian Pediatrics - Editorial. [cited 2016 Sep 4]. Available from: http://www.indianpediatrics.net/may2003/may-477-479.htm.
16. Ramakrishnan U, Latham MC, Abel R, et al. (1995) Vitamin A supplementation and morbidity among preschool children in south India. Am J Clin Nutr 61: 1295-1303.
17. Vitamin A administration and preschool child mortality. POPLINE.org. [cited 2017 Jan 17]. Available from: http://www.popline.org/node/312592.
18. Bhandari N, Bahl R, Sazawal S, et al. (1997) Breast-Feeding Status Alters the Effect of Vitamin A Treatment During Acute Diarrhea in Children. J Nutr 127: 59-63.
19. A Randomized Controlled Trial of Vitamin a Supplementation in Acute Diarrhea. PubMed Journals. [cited 2017 Jan 17]. Available from: https://ncbi.nlm.nih.gov/labs/articles/8617529/.
20. Original Articles Sept-99. [cited 2017 Jan 17]. Available from: http://indianpediatrics.net/sep2.htm.
21. Coles CL, Rahmathullah L, Kanungo R, et al. (2001) Community and international nutrition. J Nutr 131: 255-261.
22. National Prophylaxis Programme for Prevention of Nutritional Blindness. [cited 2016 Dec 14]. Available from: http://nutrition-health-education.blogspot.com/2013/12/national-prophylaxis-programme-for.html.
23. Singh A, Goel S, Kathiresan J (2013) Health Promotion: Need for Public Health Activism. Saarbrücken: LAP LAMBERT Academic Publishing. p464.
24. Tanumihardjo SA, Palacios N, Pixley KV (2010) Provitamin A Carotenoid Bioavailability: What Really Matters? Int J Vitam Nutr Res 80: 336-350.

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This article has been cited by:

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Copyright Info: 2017, Sudip Bhattacharya, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

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