Putting the A in South Asia: Sustainable programmes needed to curb vitamin A deficiency
According to the WHO, 44% of South Asian children between six months and five years old are afflicted, making the region second only to sub-Saharan Africa, where 48% of children are affected.
Vitamin A deficiency is a major public health problem worldwide, having become the top cause of preventable childhood blindness, and raising the risk of death from common childhood ailments like diarrhoea.
Studies have found periodic supplementation with large doses of vitamin A (one dose every four to six months) to be an affordable and effective method of lowering all-cause mortality by 12% to 24%. Despite this, only 64% of vitamin A-deficient children managed to access the necessary supplementation in 2016.
According to UNICEF data, 82 countries — including Bangladesh, India, Nepal, Sri Lanka, Cambodia, Indonesia, Laos, Myanmar and the Philippines — are considered priorities for national supplementation programmes.
Two-dose coverage estimates for 2016 were available for 57 of them, among which only 20 countries received coverage of 80% or above. This signifies a downward trend after a marked rise in coverage between 2000 and 2015.
A UNICEF report entitled Coverage at a Crossroads: New directions for vitamin A supplementation programmes stated that only 64% of targeted children in South Asia received two-dose coverage, with wide fluctuations among the different countries. This makes South Asia the region with the second lowest level of coverage, just ahead of West and Central Africa (54%).
In contrast, vitamin A-deficient children in East Asia have been receiving consistent two-dose coverage of above 80% for the last 10 years, thanks to superior healthcare systems and more stable delivery formats.
The main factors influencing the consistency of two-dose coverage were public support, funding stability, and partnership effectiveness between the public and private sectors.
The UNICEF report highlighted the importance of cooperation between governments, international organisations such as the WHO and UNICEF, and local healthcare systems and community workers (including family members and community leaders) in successfully implementing supplementation programmes.
It said: "A government contribution to financing vitamin A supplementation programmes demonstrates political commitment and paves the way for continued implementation. While it is common for countries to finance the salaries of health workers, other programme costs are often covered by donors.
"Donor funding does not necessarily mean the programme is undervalued; however, domestic contributions demonstrate government priorities and mark the programme as worthy of investment. Indeed, in some ways, the budget document is the best reflection of national policy priorities."
Currently, there is a push in India to improve existing supplementation programmes.
The Ministry of Women and Child Development has instructed the use of only fortified food for all programmes under government safety net schemes such as the Integrated Child Development Services, in a bid to eliminate all micronutrient deficiencies, including that of vitamin A.
Programmes in other South Asian countries have also received foreign funding. We recently reported on Bangladesh's rice fortification initiative, which received a hefty donation from the country’s Dutch embassy.
The initiative aims to minimise micronutrient deficiencies across the country by fortifying the staple with a host of vitamins, including vitamins A, B1 and B12, as well as minerals such as iron and zinc.
In Pakistan, the UK's Department for International Development launched a food fortification programme in September 2016 for flour, ghee and edible oils, in order to lower the country's incidence of vitamin A deficiency and iron-deficiency anaemia.