A Quarter of a Century of Progress to Prevent Vitamin A Deficiency Through Supplementation

A quarter of century has passed since FRI published its first comprehensive review on vitamin A deficiency (VAD) and its prevention. At the time, the major impetus to prevent VAD was to reduce xerophthalmia in preschool children. Today, we have a broader understanding of the public health implications of VAD, with disorders including xerophthalmia, mortality, severe infection, and anemia in preschool children and pregnant women. While deficiency affects most developing countries, nearly half of all deficient children and women live in Southern Asia. Prevention has made substantial strides. High potency vitamin A supplementation (with 200,000 IU) remains a prophylactic mainstay, delivered through fixed facilities, enhanced outreach activities, and national child health day campaigns twice annually. Surprisingly, the costs of semi-annual delivery of vitamin A have changed little over the years, with new cost estimates remaining comparable to earlier figures of US $0.50 per child per year. Emerging is the potential to reduce infant mortality by 20% in Southern Asia by giving a single, oral, 50,000 IU dose of vitamin A to newborns. While 500 million vitamin A capsules are routinely distributed worldwide each year to achieve effective control, progress has been slower with efforts to improve diet on a purposeful global public health scale. Future advances through effective dietary diversification and various means of food fortification will be required before periodic supplementation can be phased down as a major population strategy for controlling vitamin A deficiency.