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Health

How Important is Vitamin A ?

Vitamin A deficiency is one of the major nutritional problems in Bangladesh. Vitamin A is a fat soluble vitamin that has several functions in the body: It plays a crucial role in normal vision; epithelial cell growth and maintenance; immune function; growth and development; haemopoiesis; fertility (male and female) and embryogenesis. The scale of malnutrition and the resulting eye diseases among children is among the worst in the world. Vitamin A does not only prevent nutritional blindness among children. Recent scientific studies reveal that in populations where Vitamin A deficiency is endemic like in our country, a 23-34% reduction in mortality is expected when Vitamin A status is raised to normal values.

Vitamin A plays an important role in the overall development of child and increase resistance of children to infection. It is possible to prevent 400-500 deaths among children below 5 years every day in Bangladesh with regular intake of sufficient Vitamin A in the diet. Infant mortality rate (66/1000 live births) and child mortality rate (88/1000 live births) among 1-5 years are unacceptably high in Bangladesh. Given that diarrhoea and measles are still leading causes of child mortality, Vitamin A supplementation have been included as an effective child survival strategy to reduce the incidence of these diseases.

In infants, Vitamin A deficiency (VAD) can limit growth, impair immunity and increase mortality rates. Infants born with low vitamin A stores increase their susceptibility to infection. Moreover a mother's diet deficient in Vitamin A may result in preterm birth, growth failure or low birth weight. The effect on children can be quite severe, resulting in blindness and death. It is common for children to have vision related complications as VAD develops. In adolescents and adults, VAD results in impaired vision and immune system, although less severe.

To address the grave situation, the Government of Bangladesh instituted the Nutritional Blindness Prevention Programme in 1973. The Institute of Public Health Nutrition (IPHN) as the only mandated govt. institute on nutrition has been playing an effective role in addressing Vitamin A deficiency since its establishment with the active support of The Micronutrient Initiative (MI), CIDA, UNICEF, WHO, NNP and NGOs.

Of late, the Government has embarked upon yet another innovative strategy, 'The National Vitamin A Plus Campaign'. The Campaign has now been designed as a bi- annual event for the delivery of a package of health and nutrition services to children 0-59 months in addition to Vitamin A capsule supplementation. These high potency Vitamin A capsules (200,000 i.u) are not available in the market and are distributed according to govt. guideline only during the semi-annual Campaign

Apart from supplementing children 1-5 years through nationwide campaigns, infants under one are supplemented through routine EPI activities. There is also provision for treating the sick children (measles, diarrhoea and eye lesions) with Vitamin A at the Government health facilities.

There are several determinants for VAD in our country. Poverty is an important factor. Protein energy malnutrition, faulty feeding practices, poor socio-economic status, lack of knowledge, attitude, beliefs and taboos all play important roles in the causation of VAD.

In Bangladesh, more than 80 per cent of the blind comes from landless households. This is due to the limited purchasing power of the households and unavailable land to cultivate.

The presence of infection can greatly decrease Vitamin A levels in the body. During infection, the circulating levels of Vitamin A are reduced. This is particularly true with measles, diarrhoeal diseases and respiratory tract infections.

Vegetables are the primary source of Vitamin A in the diet. However, the total production of vegetables is inadequate. Current production of vegetables is considerably below the domestic requirement. There is therefore, a big gap between the vegetable productions estimated at 1.6 million MT and the national vegetable requirement estimated at 10 million MT (Hortex Foundation).

The Vitamin A consumption has been persistently inadequate. According to National Nutrition Survey 1995-96,percent of population able to meet their nutrient requirements with regard to Vitamin A is as follows: Rural: 42.6,Urban: 49.5 and National: 44.1 percent. Nationally, the consumption of vegetable is reckoned to be 50-70 g/head/day as against the requirement of 200 g/head/day from nutritional point of view (Hortex Foundation).

In the body, beta-carotene from plant sources is converted to Vitamin A.A daily intake of 100gm of leafy vegetables is a simple and cost effective way of meeting the daily requirement of Vitamin A.

In order for the body to effectively absorb the beta-carotene found in vegetables, oil is required in cooking. In Bangladesh, oil is used sparingly in cooking, and total oil and fat intake is low (15gm/capita/day).

Dietary Vitamin A can be obtained from both animal and plant sources. It is found primarily in meat, liver, kidney, eggs, fatty fish liver oil and dairy products. Dietary Vitamin A can also be obtained from beta carotene, which is found in red, yellow and orange coloured fruits and green leafy vegetables. The chief sources of green leafy vegetables include taro black/green arum leaves (kalo/shobuz kochu shak), helencha shak, drumstick leaves (sajina shak), indian spinach (pui shak), bottle gourd leaf (lau shak), jute leaves (pat shak), amaranth red leaf (lal shak) and spinach. Among the vegetables, pumpkin, carrots and sweet potatoes (coloured) are very rich in Vitamin A. Mango, papaya and jackfruits are rich sources of Vitamin A in the fruits.

VAC supplementation is recognized as a measure that is not indefinitely sustainable. It is generally accepted that supplementation of VAC is a short-term measure and that the long-term solution to Vitamin A deficiency is to encourage increased production and consumption of green leafy vegetables and coloured fruits. Efforts to improve consumption through IEC/BCC campaigns and nutrition education usually focus on promoting the increased consumption of beta-carotene sources. Food fortification remains an effective strategy for targeting the entire population in a cost effective sustainable manner. Foods fortified with Vitamin A (sugar, vegetable oils, margarine, milk and tea) can be important sources of dietary Vitamin A.