TY - JOUR
T1 - A Changing Landscape for Vitamin A Programs
T2 - Implications for Optimal Intervention Packages, Program Monitoring, and Safety
AU - Klemm, Rolf D.W.
AU - Palmer, Amanda C.
AU - Greig, Alison
AU - Engle-Stone, Reina
AU - Dalmiya, Nita
N1 - Publisher Copyright:
© The Author(s) 2016.
PY - 2016/6
Y1 - 2016/6
N2 - Background: Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options. Objective: This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs. Methods: We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk. Results: Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supple-ments) will be required to achieve VA adequacy in most settings. Current efforts to measure the coverage of multiple VA interventions, as well as whether and how much VA children are receiving, are few and fragmented. Conclusions: Where intervention overlap exists, further effort is needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level. Vitamin A status data will also be critical for navigating the changing landscape of VA programs. Data from these monitoring efforts will help to guide decisions on the optimal mix, tar-geting, and exposure to VA interventions to maximize public health benefit while minimizing any potential risk.
AB - Background: Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options. Objective: This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs. Methods: We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk. Results: Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supple-ments) will be required to achieve VA adequacy in most settings. Current efforts to measure the coverage of multiple VA interventions, as well as whether and how much VA children are receiving, are few and fragmented. Conclusions: Where intervention overlap exists, further effort is needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level. Vitamin A status data will also be critical for navigating the changing landscape of VA programs. Data from these monitoring efforts will help to guide decisions on the optimal mix, tar-geting, and exposure to VA interventions to maximize public health benefit while minimizing any potential risk.
KW - assessment
KW - fortification
KW - supplementation
KW - toxicity
KW - vitamin A deficiency
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U2 - 10.1177/0379572116630481
DO - 10.1177/0379572116630481
M3 - Article
C2 - 27004480
AN - SCOPUS:85014033015
SN - 0379-5721
VL - 37
SP - S75-S86
JO - Food and nutrition bulletin
JF - Food and nutrition bulletin
IS - 2
ER -