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Health

A Simple Way to Get Rid of Vitamin A Deficiency

Dr. Shamim Ahmed

Vitamin A deficiency (VAD) is a leading factor that results in the death and ill health of millions of children all over the world. Children in Bangladesh often suffer from infectious, diarrhoeal and respiratory diseases, all of which reduce the body's capacity to absorb the Vitamin A that is consumed. The diseases on the other hand, are caused by poverty, malnutrition, lack of education and lack of access to the foods needed to sustain a healthy diet.

Vitamin A deficiency has become a public health problem in Bangladesh, one that needs immediate intervention. In this regard it has been found that fortification of edible oil with Vitamin A remains the most affordable, cost effective and sustainable method to address the crisis.

After years of dialogue and " brain storming", edible oil fortification with Vitamin A in Bangladesh has become a reality. There was of course much skepticism, even among the medical professionals about the efficacy and also about the possible "toxicity" fear in absence of inadequate and inappropriate quality assurances.

Fortunately the Micronutrient Initiative (MI) has successfully spearheaded the campaign for the fortification drive and facilitated a series of formal and informal sessions for the last several years. The mission has been to stimulate and support national efforts to eliminate vitamin and mineral deficiency by supporting effective and sustainable programmes, assuring universal coverage and sustained impact on the health and well being of people. One of the goals of the Initiative is to increase access of the target population to foods fortified with vitamins and minerals.

Possible foods that can be fortified with Vitamin A include mainly oil, wheat and sugar. Eventually, it was edible oil that was found to be the most appropriate food to be fortified by the researchers of the Initiative. This is because soybean oil is something that is consumed by practically everyone regardless of age or economic status.

There are more reasons why oil was the chosen one. The stability of Vitamin A in oil is greater than other currently used foods such as flour, sugar or corn soy blends and oil facilitates the absorption of Vitamin A by the body. In sealed and opaque containers that protect Vitamin A and oil from light and air, losses of Vitamin A are negligible for upto a year. There is a wide variation in Vitamin A stability during cooking, depending on time and temperature. The common methods of cooking in our country are frying/deep frying and simmering. Vitamin A is quite stable at boiling/simmering even when heated over an extended period of time and losses will range from 5% for boiling or simmering to 20% when the food is fried. However, at very high temperature or deep-frying, Vitamin A losses can be quite significant at over 50%.

The present consumption of 5 litres/person/year i.e. 14 grams per day is considered low by any standard. Over 65 percent of edible oil in Bangladesh is now imported and refined centrally in a limited number of oil refineries, suggesting that efforts to introduce fortification in refineries could result in high coverage of edible oil consumed in Bangladesh. At present, there are about 13 functioning oil refineries in Bangladesh for edible oil.

The advantage of fortifying edible oil starts with the fact that the cost of fortification is minimal and can easily be shared by the public and private sector. The procedure usually requires limited technical skills and equipment in addition to the skills and equipment already possessed by the food processing plants. Soyabean oil was considered for fortification because it is widely consumed, involves simple technology and is cost effective. Flour was not considered because it is not a preferred cereal. Moreover, it would be difficult to ensure quality assurance in hundreds of flourmills across the country. The other vehicle, namely sugar is expensive and is not widely consumed.

A local entrepreneur, M.M Vegetable Oil Products Ltd -- a concern of Mostafa Group has taken initiative to fortify soyabean oil and built fortification equipment complete with dosage system under the technical guidance from the Micronutrient Initiative and financial assistance of Canadian International Development Agency. This is the first such initiative in our country. The Industry has a market share of about 30%.

The Formal Launching Ceremony of the First Edible Oil Fortification with Vitamin A in Bangladesh was inaugurated by Ministry of Law, Justice and Parliamentary Affairs, in November 2005. It is hoped that the fortification of edible oil would open the floodgate to fortification of other food items as well and thus help overcome malnutrition in our country.

Unfortunately almost all the oil refineries are marketing Vitamin A and D enriched labeled oil even though this is far from the truth. Interestingly, these refineries do not have the technology to fortify edible oil, nor did they procure the premix required for the fortification. Increased awareness and strict enforcement of the legislation is the answer to prevent such fraud. People, moreover, must be aware of the fact that such false claims are being made so that they buy and consume only the certified brands of edible oil fortified with Vitamin A. No doubt that a simple intervention such as this could actually save the lives of countless number of children. It can also prevent many avoidable diseases that afflict both adults and children.