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India

Vitamin A

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EPIDEMIOLOGICAL DATA
     
Clinical Vitamin A Deficiency
Most Recent Clinical VAD Surveys -- UNICEF MICS
Date: 2000
Other surveys: National Family Health Survey [NFHS2] conducted in 1998-9 by International Institute of Population Sciences and ORC Macro International (DHS)
Groups Surveyed: 0-4 yrs
Sample Size: 65,741
Sampling Method: Sratified two-stage design where the states were divided into rural and urban strata.  In each stratum, sampling was done independently, and the design was self-weighting.  In the first stage, villages/uran blocks wer selected; in the second stage, housefolds were selected from each sampled village/urban blocks systematically, after listing all the households and selecting the first household randomly.
Estimated Prevalence of VAD:

Area

Sample Size

Indicator/Prevalence (%)

Est. Pop. Affected
India MICS  2000  prevalence of Night Blindness 0-4 yrs 65,741 0.6%

5,049,139

(Total Pop.841,523,272 as reported)
ICMR ,District Nutrition Project Survey 2001 XN 6633 2.8%

 
NINWHO/UNICEF Orissa &AP study using serum retinol <0.70umg/l as a cutoff  12-36 months base line and post VA

2,134 Orissa

AP 2,120

 

Orissa 63.8%

AP      52. 3%

 

Orissa 31,659,736

Andhra Pradesh 66,508,008

 

ICMR 16 district study Night blindness in pregnant women in  India  (2001)

Night blindness among children 24-71 months

6,633

 

113,202

2.7%

 

1.03 %

  
 
 
Sub-clinical Vitamin A Deficiency
Most Recent Sub-Clinical VAD Survey -- Serum retinol studies on the National level are not available, however there are a few studies carried out for sub-clinical vitamin A, as reported by Vijayaraghwan of NIN in vitamin A deficiency of India, and the NIN serum retinol level estimation in Orrissa and Andhra Pradesh study.
Estimated Prevalence of VAD:  Serum retinol < 0.7 mmol/Liter

Region/Group

Sample size

Age group

Indicator(s) specify cutoff and/or median

Prevalence in sample %
Madurai Tamil Nadu

130

Age 3-5 yrs

serum retinol <0.70/L

70.8
Bombay

196

1-12 yrs

 same

77.0

Hyderabad

100

0-6 wk.

 same

30

Hyderabad

123

1-5Yrs

 same

31

Trichy

280

<5 yrs

 same

37.5

South Tamil Nadu

366

<3 yrs

 same

16.9

Hyderabad

126

1-5 yrs

 same

80.1

New Delhi

80

1-5 yrs

 same

26.3
         

NIN Orissa/  study

2134-Orissa

12-36 months

 same

 Baseline 63.8
        First follow up 46.1
        Second follow up 86.4

NIN Orissa

same

same

<0.35 U gms

Base line  20.4

First follow  up 5.0

 
 
     
 

POLICY AND LEGISLATION
 

Legislation on VAD
     There is no VAD legislation in India, nor is it being developed.
     There is no specific legislation for VAD, however the Policy for Management of  Vitamin A Deficiency has been in force since 1976. The National Reproductive and Child Health  Program, the National Blindness Control Program, The Integrated Child Development Services Program and the National Nutrition Policy all include interventions for VAD elimination.  This policy focuses on both fortification and supplementation.
     The government published document stating the national policy is the National Nutrition Policy & Policy for Management of VAD and MOHFW Expert Committee report- April 2002.
 

Government Agency to Address VAD

      Reproductive and Child Health  Section in the Ministry of Health and Family Welfare Government of India.  This agencies function is both monitoring and coordination.

    

Assistant Commissioner  MCH, Ministry of Health And Family welfare ,GOI, Nirman Bhawan , New Delhi
     

PROGRAM DATA
Supplementation
Program Description
     The Government of India has adopted a national policy of the elimination of blindness due to VAD in the country.  The policy has been in force since 1976 and has been reviewed and updated. Under this, the GOI supplies the sub-centers  looking after a population group of approx. 5000  people with  drug kits in which 6 bottles of  VA  in 100 ml bottles are supplied bi-annually. The target for the first dose is 25,117,000, against which the coverage reported in 1998-9 is 15,895,826. The target for the second dose is 23,659,000. The coverage of one dose of Vitamin A reported in the NFHS 2 is 29.7 %. The Principal section looking after the VA is the Reproductive and Child Health section of the Ministry of Health and Family Welfare . VAD elimination is part of the National Nutrition Policy and is also a focused activity of the ICDS project of the Department of Women & Child Development, and The National Blindness Control  Program of the Ministry of Health and Family Welfare.
Targeting

    

68,105,632 ( in some states the age group is 9-60 months ,some 12-36 months and some 12-36 months)
Capsule Information

    

VA syrup, 100,000 IU/ml

Region/Group

Estimated # of people supplemented, number of times/year

(Twice a year) based on 2001 coverage

Kerala 9-36 months

1,123,400

Tamil Nadu 9-60 months

5,219,058

Orissa 9-60 months

3,339,940
Gujrat 9-36 m 2,137,650
Madhya Pradesh 9-36m 2,137,650
Uttar Pradesh 9-36 m 155,302
West Bengal 12-60 m 1,981,919
Assam 12-60 m

2,730,255
Karnatka 9-36 m 902,050
Andhra Pradesh 1,484,000 1,020,971
Bihar 9-60 m 11,423,990
Maharastra 9-60 m 1,455,000
Rajasthan 12-60 m 5,318,216
   
National Total 40,374,341

Implementation

    

Trough bi-annual Child Health and Nutrition Weeks/Months.

    

The revised program envisages supplementation of VA as a Package of  RCH and /or ICDS services during bi-annual Child Health and Nutrition weeks/months and through the routine Immunization services.
Fortification

 
    

Which foods are now fortified?

Yes

No

Status of program (e.g. legislated, piloted, implemented)

 

Level of food fortification

Is food fortification monitored?

YES

NO

Sugar

 x

 

 Pilot of sugar fortification in Kanpur and candy fortification in Kolkata supported by Micronutrient Initiative

 

yes

 

Maize

 

 

 

 

 

 

Oil

 

 

 

 

 

 

Milk

 x

 

 Pilot by MI

 

yes

 

Wheat flour

 x

 

 Pilot

 

yes

 

Margarine

 

 

 

 

 

 

Rice

 

 

 

 

 

 

Other (specify) ICDS FOODS for young children and pregnant/lactating women in few states

 x

 

 Implemented with WFP support

 

yes

  

Other Programs
     There are  large-scale or national programs (including mass media campaigns) to promote improved vitamin A status through dietary change.
     There are community-based programs to promote improved vitamin A status through dietary change.
     
     
 
MONITORING
 

Clinical and Sub-clinical VAD
     Current monitoring: There are no systematic monitoring activities, but there are ad-hoc baseline and follow up surveys that are carried out in several states.
     Some of the surveys in Section II will be repeated.
     The indicators used are Bitot's spots in children and Night-blindness in children and pregnant women.
     Serum Retinol is used as the indicator for monitoring sub-clinical VAD.
 
Supplementation
     India uses vitamin A syrup produced by local manufacturers.  It is provided through GOI and UNICEF and is monitored by them. The  Drug controller of India is the controlling Authority under law.  UNICEF also sends its VA for testing outside the country.

    

Coverage of the supplementation program is accomplished via routine reporting and some independent coverage surveys.
Fortification
     Impact studies are being planned by the agencies conducting the pilot programs (MI, NIN, Ministry of Food).
     
     
PROGRAM RESOURCES
a
a
Donor Agencies
    

 

Implementing Agency

 

Description of Activities

Expenditure and source of funds in

current year

Supplementation

Fortification

Other (specify)

National/State Governments

 National RCHand  ICDS programs

The GOI figures are   not available

 MI figures NA

 

External Agencies

 UNICEF

 US $ 2.1 million in 2001.

 

 

 

 

MOST, MI, USAID

Figures not available

Figures not available

Figures not available
Total VAD Program Funding History and Forecast for Country – for UNICEF support only

 

Year

VAD Activity

 

Total $(000)

 

Supplementation $(000)

 

Fortification $(000)

Other (specify)

Activity

$(000)

1998

 

 

 

 

 

1999

 

 

 

 

 

2000

 

 

 

 

 

2001

2,200

 NA

Strengthening routine VA distribution

1,000

 

2002

3,000

 

 

 

 

2003

3,000

 

 

 

 

2004

 

 

 

 

 

2005