Time for a targeted programme?

Scientists question the universal supplementation approach that is prevalent in India, arguing it may not work for all children

Textbook wisdom — that supplementing Indian children with vitamin A is beneficial — is under attack from some scientists at the institution that once recommended it. Rather than being administered universally, as was the norm, vitamin A needs to be selectively given only if required, they argue.

Programme highlights

The National Prophylaxis Programme against Nutritional Blindness due to Vitamin A Deficiency ((NPPNB due to VAD) was launched in 1970. Such blindness is identified by changes to the skin and the eye, including keratinised growth on the conjunctiva known as Bitot’s spots; deficiency also manifests in night blindness.

Today, children aged 6-60 months are administered vitamin A every six months in doses of 200,000 IU or 60 mg, as per World Health Organization (WHO) recommendations. But physicians administer it to children routinely, irrespective of their nutritional status, though WHO recommends vitamin A supplements where prevalence of vitamin A deficiency is 20% or higher in infants and children under 60 months or where night blindness prevalence in children is higher than 1%.

Alternative viewpoint

Scientists at the National Institute of Nutrition (NIN) in Hyderabad, which made the supplementation recommendation in India more than four decades ago, are now divided on the subject. A scientist at the institution, who did not want to be named, says those in favour of the programme cite numbers that are not acceptable.

“Those within the institute who support the programme claim that the incidence of Bitot’s spots is about 0.8%, warranting universal vitamin A supplementation. The actual figure could be much lower,” says the scientist, weighing in favour of a targeted approach. Outside of NIN, a recently published review of scientific studies on the subject also favours doing away with the universal programme. Published in Clinical Nutrition ESPEN by Dr. Sudip Bhattacharya and Dr. Amarjeet Singh of the Postgraduate Institute of Medical Education and Research, Chandigarh, the review also points to studies that recorded vitamin A toxicity in the country. The death of over 30 children in Assam in 2001 reportedly occurred after vitamin A supplementation. The authors cite several other studies that claim improvements in nutritional status in the last 40 years, warranting a targeted approach to the problem — and not universal supplementation — which would also lower the cost burden of the programme.

The vitamin A supplementation programme is often credited for reducing childhood mortality by as much as 23%. Similar effectiveness is claimed in tackling blindness and Bitot’s spots. Noting that the incidence of vitamin A-associated blindness has greatly reduced, Dr. Bhupesh Bagga of Hyderabad’s L.V. Prasad Eye Institute states the continued need for supplementation. “Besides the one or two cases of eye problems in babies post infections like measles, there are populations in rural areas where vitamin A deficiency exists. Though not as severe as before, many children could be on the borderline,” he says.

Critics of the programme cite NIN’s own surveys that established patchy coverage of the programme. They also claim that reduction in mortality, blindness as well as vitamin A deficiency was related to improved nutrition, as pointed by the Clinical Nutrition ESPEN paper.

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Printable version | May 27, 2020 7:04:08 PM |

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