Vitamin A Deficiency

Bolivia

Brazil

Vitamin A

Iron

Chile




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	EPIDEMIOLOGICAL DATA

Clinical Vitamin A Deficiency

Most Recent Clinical VAD Survey:

Date:

1992

Groups Surveyed:

Children 0-5 years of age.

Sample Size:

13,711

Sampling Method:

Representative sample of children in Northeast Region of Paraíba.

Estimated Prevalence of VAD:

Region/Group	Sample size	Prevalence in sample %
Clinical Ophthalmologic	13,711	XN- 0.04 X1B-0.0122222222222222222333 XS-0.032222222
National Total:


Sub-clinical Vitamin A Deficiency
Most Recent Sub-Clinical VAD Survey: Estimated Prevelance of Low Serum Retinol, and/or Median Serum Retinol
	Estimated Prevalence of VAD:

Region/Group*	Sample Size	Population in Region/Group (if available)	Indicator (s) Specify cutoff and/ or median serum retinol	Prevalence in Sample %
Northeastern Region – The State of Sergipe. Survey realized in 1998 with representative samples of children of 6 till 59 months through the HPLC method	722	Not available	<0.70mmol/l	32.1
Northeastern Region – The State of Pernambuco. Survey realized in 1997 with representative samples of children with less then 5 years of age through the Bessy Lowry method.	699	Not available	<0.70mmol/l	19.3
3) Northeastern Region – The State of Paraíba. Survey realized in 1992 with representative samples of children with less then 5 years of age through the Bessy Lowry method.	1032	Not available	<0.70mmol/l	16.0
4) Northern Region – Survey realized in nursery schools and kindergartens in the States Roraima (Boa Vista), Amazonas (Manaus) and Rondônia (Porto Velho) with not representative samples of children between 3 and 7 years of age through the Bessey method.	Roraima (Boa Vista) – 90 Amazonas (Manaus) – 476 Rondônia (Porto Velho) - 145	Not available	<0.70mmol/l	15.5 19.6 32.4
5) Southeastern Region – The State of Rio de Janeiro (Rio de Janeiro). Survey realized in 2 public kindergartens with newly born from 1995 until 1996 through the Bessey Lowry method	253	Not available	<0.70mmol/l	26.5

6) Southeastern Region – The State of São Paulo (Campinas). Survey realized in 4 hospitals with new-born from 1991 until 1992 through the Bessey Lowry method.

356 (Low weight at delivery).

356 (Adequate weight at delivery.)

Not available

<0.70mmol/l

33.1

14.6

More groups

National Total:

Not applicable (The surveys cited do not include all the regions of Brazil) Currently a Survey about micronutrients (Vitamin A and Iron) is being planned which will be developed on a national scale with the participation of the Micronutrient Initiative.


	POLICY AND LEGISLATION

Legislation on VAD
	There is VAD legislation in Brazil that was created in 1994 and revised in 2002 during a technical meeting held to evaluate the governmental decree.
	Legislation created primarily through the National Program of Control of Vitamin A Deficiencies with additional help from the National Policy of Alimentation.
	Legislation focuses on both supplementation and fortification.
	There have been government documents published stating the national policy regarding VAD called the Food and Nutrition National Policy.

Government Agency to Address VAD
	Unit of Food and Nutrition Policy-The Ministry of Health. Their function is coordination
	Contact Information: Denise Costa Coitinho



	PROGRAM DATA


Supplementation
Program Description
	Vitamin A supplementation was conducted through the National Program which was implemented in 1994.
	There is a policy to address vitamin A supplementation for mothers within 8 weeks of delivery. Currently it is a pilot program in the Northeastern region for women leaving the hospital.


Targeting
	Children 6-59 months all over the country and Children 12-59 months in the Northeastern Region.

1999: 2,479,743

2000: 2,190,995

2001: 1,854,271

Capsule Information

6 million 200,000 IU capsules are locally produced at a cost of $327,230.76

800,000 100,000 IU capsules are locally produced at a cost of $29,876.92

2001

600,000 capsules (100,000 IUs)

4,605,200 capsules (200,000 IUs)

2002

800,000 capsules (100,000 IUs)

6,000,000 capsules (200,000 IUs)

Implementation

Vitamin A supplementation is given through vaccination campaigns and other public mobilization campaigns during routine systematic of public health units.

Vitamin A supplementation also given through National Immunization Day/Week, Market Days, other mass campaigns, and through clinics (hospital discharge).

Estimated Number of People Supplemented 2002

Region/Group	Estimated # of people supplemented, number of times/year
Alagoas State	153,536
Bahia State	414,496
Ceará State	636,955
Maranhão State	243,665
Paraíba State	269,593
Pernambuco State	272,400
Piauí State	37,593
Sergipe State	43,737
North Rio Grande State	56,452
Jequitinhonha Valley	62,403
National Total	2,190,830

Fortification There are no current programs to fortify food

Fortification There are no current programs to fortify food, but a program for rice fortification is being discussed.

Other Programs
Dietary Programs
	There is a large-scale/national program to promote improved Vitamin A status through dietary change called the Food and Nutrition National Policy.
	National program deals with the prevention and control of nutritional disturbances and illnesses associated with alimentation and nutrition. The program gives special attention to hipovitaminose A
	There are community-based programs to promote improved Vitamin A status with the transmission of information about the importance of prevention and treatment of Vitamin A deficiency. Program also deals with the incentives regarding the consumption of aliments containing Vitamin A
	Community-based programs are conducted in the health centers and by health officials.
Mass Media Campains.
	Radio program currently being developed to transmit information to the people regarding nutritional deficiencies including Vitamin A deficiency.


	MONITORING

Clinical and Sub-clinical VAD
	Not Reported.

Supplementation
	Imported capsules are tested by the quality control program of the Official Laboratory.
	Coverage of the supplementation program is accomplished via trained public health officials who take care of the distribution and the quantitative data is checked by the States (regional level) and by the Ministry of Public Health (national level).

Fortification
	Not Reported

	PROGRAM RESOURCES

Donor Agencies

Implementing Agency	Description of Activities	Expenditure and source of funds in current year
Implementing Agency	Description of Activities	Suppl.	Fortif.	Other (specify)
National/State Govenrments	Secretaries of Public Health of Municipals and States lllllllllllllllllllllllllll llllAid for distribution and control of the llllproduction
External Agencies	1. Pan-American Health Organization- Technical Consultancy 2. UNICEF- support in education material

Total VAD Program Funding History and Forecast for Country

Year	VAD Activity				Total $(000)
	Supplementation $(000)	Fortification $(000)	Other (specify)
	Supplementation $(000)	Fortification $(000)	Activity	$(000)
1998	Donation (IM/OPS)		Meeting with the State Commission of Alimentation and Nutrition to check the distribution of supplements
1999	Donation (IM/OPS)		Meeting with the State Commission of Alimentation and Nutrition to check the distribution of supplements
2000	Donation (IM/OPS)		Meeting with the State Commission of Alimentation and Nutrition to check the distribution of supplements
2001	Ministry of Health		Meeting with the State Commission of Alimentation and Nutrition to check the distribution of supplements		US $273,000.00
2002	Ministry of Health		Meeting with the State Commission of Alimentation and Nutrition to check the distribution of supplements		US $327,230.76

EPIDEMIOLOGICAL DATA

POLICY AND LEGISLATION

PROGRAM DATA

MONITORING

PROGRAM RESOURCES

VAD Activity