Preventive vitamin A gets missed by two in five eligible children in India

According to a new study of representative survey data, two out of every five eligible children in India are missing out on preventative vitamin A supplementation aimed to avoid health issues linked with vitamin A insufficiency.

BMJ Global Health, an open access publication, published the findings. The data demonstrate that there are several ‘cold spots’ in coverage across the country, as well as substantial differences in coverage within and across states.

Adequate vitamin A intake can only be received from diet, but poor nutrition combined with illnesses prevalent in children under the age of five in developing nations means that an estimated 190 million young children—one in every three—are vitamin A deficient.

Vitamin A is essential for numerous biological activities in the human body, including vision, growth and development, wound healing, reproduction, and immunity.

Childhood vitamin A insufficiency has long been recognised in India as a significant but manageable public health issue.

Since 2006, the government has advised all children aged 9 to 59 months to take high-dose vitamin A supplements.

The researchers used nationally representative cross-sectional data acquired during wave 4 of the National Family and Health Survey 4 (NFHS-4) and the Comprehensive National Nutritional Survey to map coverage by all 640 districts, spanning each of the 29 states and 7 Union Territories (CNNS).

Coverage was calculated by asking mothers if their children (204,645) had received vitamin A supplementation within 6 months of the NFHS-4 survey.

Serum retinol values among the under 5s (9563) during the CNNS were used to determine the prevalence of vitamin A insufficiency.

Data analysis revealed that 2 out of every 5 eligible Indian youngsters had not received vitamin A supplements: 123,836 out of 204,645.

According to the study, overall coverage was 60.5 percent, which is poor when compared to most other South Asian nations. And it varied greatly throughout the states/union territories, ranging from 29.5 percent (Nagaland) to 89.5 percent (Goa).

Among districts, coverage ranged from just under 13% (Longleng district, Nagaland) to 94.5% (Kolar district, Karnataka). There were distinct geographical hotspots and coldspots.

Seventy-one out of the 640 districts (11%) achieved coverage above 80%. But in 13 districts coverage was 20% or below: 4 from Nagaland (Longleng, Mon, Phek, and Zunheboto); 3 from Manipur (Ukhrul, Chandel, and Senapati); 3 from Uttar Pradesh (Muzaffarnagar, Bareilly, and Bahraich); 2 from Rajasthan (Dungarpur and Rajsamand); and 1 from Arunachal Pradesh (East Kameng).

No significant association, however, was observed between supplement coverage and the prevalence of vitamin A deficiency.

Because this is an observational research based on survey data, causation cannot be established. Moreover, while being recognised as an essential public health intervention, the researchers observe that the value of universal vitamin A supplementation is increasingly being questioned, with demands for more nuanced and sustainable alternatives.

However, they point out that low coverage was mostly in areas plagued by infrastructure and logistical issues, high levels of disease, and inequitable health service provision, whereas high coverage was mostly in prosperous areas that rank high in health, demographic, socioeconomic, and developmental indicators.

They conclude that evidence-based techniques are necessary to assess the effect of these disparities and ensure that appropriate vitamin A therapies are administered to those in greatest need.