Vitamin A Deficiency - Panama

Iodine

Panama

Vitamin A

Iron

Paraguay




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Country Profile		Policy & Legislation
		Program Data
		Monitoring
		Program Resources

	EPIDEMIOLOGICAL DATA


Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey - (Not Reported)


Sub-clinical Vitamin A Deficiency
Most Recent Sub-Clinical VAD Survey

	Date:	1999
	Groups Surveyed:	Children 12 - 59 months
	Sample Size:	924
	Sampling Method:	(being translated)
	Sampling Strategy:	(being translated)
	Estimated Prevalence of VAD: Indicator is serum retinol

Serum Retinol Level (mcg/dL)	Sample Size	Prevalence in Sample %	Est. Pop. Affected
<10 (deficient)	17	1.8
10 – 19.9 (below)	70	7.6
20 – 49.9 (normal)	752	81.4
>= 50 (above)	85	9.2


	POLICY AND LEGISLATION

Legislation on VAD
	VAD legislation exists and it was passed in 1976 and has not since been revised. The legislation specifies that sugar be fortified with vitamin A at a level of 50 mg of retinol, per gram of sugar. The government has published documents that officially state its policy towards VAD.


Government Agency to Address VAD
	The Ministry of Health (Department of Nutrition) addresses VA. The agency’s function is to coordinate and monitor VAD.


	PROGRAM DATA


Supplementation
Program Description
	The supplementation program targets children 0-59 months of age and women within 8 weeks of delivery.


Targeting
	Children 0-59 months:
	Post partum women:


Implementation
	Supplements are given through national immunization days and market days.

	Coverage:

Group	Estimated # Supplemented	# times/year
> 1 Year	8245 (91.6%)
1-4 years	11, 985 (15.8%)
Post partum women	8,715 (50.2%)
Total	28, 945

VA Supply:

Source	Supplementation: Capsules # and Value
	200,000 IU		100,000 IU		50,000 IU		10,000 IU
Imported	32,685	980.00	8,245	247	0	0	0	0
Locally Produced	0	0	0	0	0	0	0	0
Total	32,685	980.00	8,247	247.00	0	0	0	0

Fortification
	Cermix is the most widely fortified product with vitamin A, but milk, margarine, infant cereals and formulas, ketchup, and artificial drinks are also.
	There is no monitoring of the fortification of any of these products and there is no information provided on the levels of fortification, the percent of the commodity fortified, or the status of the program.
	An estimated 52, 466 people consume Ceremix.
	The fortificant used in the pre- mix is panatol, which costs $12.51/kg.


Other Programs
Dietary Change
	There is a national program to promote improved VA status through dietary change. The program includes messages to promote foods rich in VA as well as posters and pamphlets on the prevention and control of VA deficiency.



	MONITORING

Clinical and Sub-clinical VAD
	To monitor clinical VAD, hospitals report all cases of severe VAD annually.
	No indicators are used to monitor sub-clinical VAD.


Supplementation
	A registry of the number of capsules is monitored and updated monthly.
	The coverage of supplementation programs is monitored by maintaining a registry at each regional health facility of all capsules distributed in that region.
	The registry ensures that the right number of capsules have reached the target population.

Fortification
	The content of fortified foods is monitored at the point of production.
	The ceremix is distributed by the MOH to poor populations with quality control tests done every 4 months by INCAP.



	PROGRAM RESOURCES

Donor Agencies

Implementing Agency	Description of Activities	Expenditure for Current Year
Implementing Agency	Description of Activities	Supplementation	Fortification	Other
National/State Governments	MINSA, has implemented projects to distribute VA supplements with funding from BID and the World Bank.	12,000
External Agencies	OPS and UNICEF have offered logistical support for the purchase of VA supplements, and financed surveys, educational materials and training of health professionals.			50,200

VAD Program Funding History and Projections

Year	VAD Activity							Total
	Suppl.		Fort.		Other
	Activity	$	Activity	$	Activity	$
1998
1999					Survey of VAD		72,000
2000	NR		NR		Acceptability and impact assessment of the PAC, the training of the civil employees, and the educational materials.
2001					Reproduction of VA norms, study of SAN		18,500

* NR = Not Reported