Vitamin A Deficiency

Bangladesh

Iodine

BHUTAN

Vitamin A

Iron




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Country Profile		Policy & Legislation
		Program Data
		Monitoring
		Program Resources

	EPIDEMIOLOGICAL DATA


Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey
	Date:	August 1999
	Groups Surveyed:	Children 1-5 yrs and pregnant women
	Sample Size:	910 children (49.7% male and 50.3% female) and 200 pregnant women
		Note: 1000 children were originally sampled, but those with incomplete records or those who had been supplemented with VitA in the last 6 months were not included.
	Sampling Method:	Purposive sample with minor emphasis on regional distribution.
	Sampling Strategy:	The strategy used to obtain the sample was to divide the country into four regions, east, central, south, and west, which also represent the major ethnic groups. For each region, all of the districts were listed, and one was selected randomly from each region to yield four districts. The surveyors then proceeded to the district to list all of the blocks and then villages in each block. One block from each district was selected randomly and then one village was randomly selected. 250 children and 50 women were surveyed from each of the four villages. If the sample size was not satisfied in the selected village, surveyors moved on to the village closest to the sample village to finish the survey.
	Estimated Prevalence of VAD:	Presence of at least one of the following clinical indicators
		1. Conjunctival xeroxes with bitots spot
		2. Corneal xeroxes/ ulceration/ keratomalacia
		3. Corneal scar

Group

Sample Size

Prevalence in Sample

Estimated Population Affected *

Total of children 1-5 years

910

0% or approaching;

1 child among all children sampled had corneal scarring, but cause of disease was not established


Sub-clinical Vitamin A Deficiency
Most Recent Sub-clinical VAD Survey
	Note: The most recent VAD survey was described above. The survey assessed clinical and sub-clinical signs of VAD.

Estimated Prevalence of VAD: Indicator is serum retinol <0.35mm/L

Group	Sample Size	Prevalence in Sample	Estimated Population Affected *
Children 1-5 years	910	2.6%	7795
Pregnant women	173	0.0%

* Estimates based on US Census Bureau data for Bhutan, 1999, children ages 0-4. (www.census.gov)


	POLICY AND LEGISLATION

Legislation on VAD
	There is no VAD legislation in Bhutan and it is neither being developed or about to be enacted. There are no government documents published by the government to state the national policy towards VAD.


Government Agency to Address VAD
	The Nutrition Unit, which acts as coordinating body, the Public Health Division, Ministry of Health and Education, and the Royal Government of Bhutan.


	PROGRAM DATA


Supplementation
Program Description
	The program targets children 6-59 months, post partum women, and primary school children.
	Women are to be supplemented within 8 weeks of delivery and the infant is to be supplemented at the time of first immunization.
	VA supplementation is recorded on the immunization card.
	Currently, there is no system in place to regularly calculate program coverage.
	The start date of the program was not reported.


Targeting
	Children 6-59 months:	214,128
	Post partum women:	Not provided
	Primary school children:	Not provided


Implementation
	Coverage:

Group	Coverage	# Covered
0-59 months	93%

VA Supply:

Source	Supplementation: Capsules # and Value
	200,000 IU		100,000 IU		50,000 IU		10,000 IU
Imported	301,500	MI Grant, cost NR*	169,000	MI Grant, cost NR*	0	0	0	0
Total	301,500		169,000

*NR = Not Reported


Fortification
	There are no VitA fortification programs


Other Programs
Dietary Change
	There is a nationwide kitchen garden program promoting cultivation and intake of colored and leafy green vegetables.
	A community based nutrition program run by a health center is being expanded and implemented in selected districts.
	- It addresses general malnutrition, including micronutrient deficiency, with an integrated, community- based, multi-sectoral approach.


Education Campaigns
	There are national programs that include mass media campaigns to promote improved vitamin A status through dietary change.
	- Note: No description has been provided.



	MONITORING

Clinical and Sub-clinical VAD
	The surveys described in the epidemiology section are being repeated, but there is not routine monitoring of clinical or sub-clinical vitamin A deficiency.

Supplementation
	There are no specific monitoring mechanisms regarding coverage of supplementation programs. However, the numbers of vitamin A capsules imported and/or produced are monitored through biannual reporting of consumption by health facilities.

Fortification
	There are no fortification programs to monitor.



	PROGRAM RESOURCES


Donor Agencies
	External Donor Agencies include MI in Canada, and UNICEF. MI supports the VA program by supplying VA capsules and funding operational expenses. The UNICEF country office provides assistance in implementation of the supplementation and promotional programs.

VAD Program Funding History and Projections

Year	VAD Activity			Total
	Supplementation	Fortification	Other
1998	No record	NR*	NR*	No record
1999	3,000.00			3,000.00
2000	400.00			400.00
2001	7,113.00			7,113.00
2002	7,500.00			7,500.00
2003	8,000.00			8,000.00
2004	9,000.00			9,000.00
2005	10,000.00			10,000.00

* NR = Not Reported

EPIDEMIOLOGICAL DATA

Group

Group

POLICY AND LEGISLATION

PROGRAM DATA

MONITORING

PROGRAM RESOURCES

Year