Vitamin A Deficiency - South Africa

Somalia

Iodine

South Africa

Vitamin A

Iron

	EPIDEMIOLOGICAL DATA


Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey
	Date:	July - October 1994, SAVACG survey.
	Groups Surveyed:	National survey in all 9 provinces (rural & urban) among children 6-71 months.
	Sample Size:	11,430
		Note: Children were examined for clinical vitamin A deficiency and sub-clinical deficiency (serum-retinol assessments). Survey can be found at www.sahealthinfo.org
	Sampling Method:	National probability sample with disproportionate stratification by province
	Sampling Strategy:	A total of 360 cluster of households studied, of which 358 were available for analysis. A total of 18 219 households (19 003 families) were selected. Age, gender and rural/urban groups were fairly equally distributed.
	Estimated Prevalence of VAD:

Sub-clinical Vitamin A Deficiency

Most Recent Sub-Clinical VAD Survey

The most recent sub-clinical VAD survey was described above.

Prevalences were obtained for national, provincial, urban/rural, age groups, maternal education and type of housing.

A total of 4788 blood samples were drawn for serum retinol, ferritin and full blood count concentrations.

Analysis was done on 4283 samples.

Estimated Prevalence of VAD:

Legislation on VAD
	There is no VAD legislation in South Africa, however it is being developed.
	Final fortification regulations will be published by the end of 2002.
	The government has published documents that state national policy regarding VAD.
	Enforcement of the fortification regulations will come into effect early in 2000.
	Draft regulations for mandatory fortification to be published within the next two months.


Government Agency to Address VAD
	Department of Health. The agencies function is both coordination and monitroing.
	Contact Information: Director of Nutrition. Department of Health. Private Bag 828. Pretoria, 001 South Africa.


Supplementation
Program Description
	The program targets non-breast-fed infants, children 6-60 months and post partum women.
	The program includes both prophylactic and treatment.
	VA supplementation has started and implementation by all the provinces will be in place from June 2002.


Targeting
	Children 6-60 months:	214,128
	Post partum women:	935,774
	Non-breast-fed infants (at 6 weeks):	192,489 (prophylaxis) plus 19,249 (treatment)


Capsule Information
	Currently high-dose capsules are imported.
	About 920,000 (100 000 IU capsules) and 4,456,000 (200,000 IU) capsules were received as donations last year, the remainder is procured from a local supplier (200,000 IU).

Implementation
	Implementation is planned by provinces to increase coverage of children 24 – 60 mos. of age.
	It is accomplished via clinics and hospitals.

Fortification
Program Description
	Mixture of micronutrients, including; vitamin A, thiamin, riboflavin, niacin, B6, folic acid, iron and zinc
	The fortification of maize meal and wheaten flour will be mandatory for all maize meal and wheaten flour and the program will be monitored
	Sugar is proposed as an additional vehicle for fortification with vitamin A. However, SADC agreement has to be obtained before regulations can be compiled
	The standards for fortification is 6,400 IU vitamin A/kg maize meal, 5,400 kg vitamin A/kg wheaten flour and 50,000 IU vitamin A/kg sugar.

Foods Fortified

Which foods are now fortified?	Yes	No	Status of program (e.g. legislated, piloted, implemented)	Approx. % commodity fortified	Level of fortification/ Vitamin A content
Which foods are now fortified?	Yes	No		Approx. % commodity fortified	Level of fortification/ Vitamin A content
Sugar		N	Proposed vehicle SADC agreement to be obtained	None yet
Maize	Y		Current enrichment voluntary Draft mandatory regulations ready for publication	Few companies enrich voluntary	Varies
Oil		N
Milk	Y		Voluntary	Few companies enrich voluntary	Varies
Wheat flour	Y		Current enrichment voluntary Draft regulations ready for publication	Few companies enrich voluntary	Varies
Margarine	Y		Voluntary	Majority of companies enrich voluntary	Varies
Rice		N
Other (specify)

Micronutrient Premixes
	Food Companies are enriching bread and maize meal and other food commodities on a voluntary basis. Exact figures are therefore not available.
	Approximately 3,179,416 MT maize meal and 1,864,622 MT wheat flour will be fortified with vitamin A.
	Premix specification: 119.04g vitamin A/kg wheaten flour and 138.88g vitamin A/kg maize meal.
	Dosage: 200g premix per ton wheaten flour/maize meal).

Other Programs
Dietary Change
	A nutrition campaign is scheduled for April 2002.
	A booklet for health workers on vitamin A deficiency and focusing on dietary diversification have also been developed
	Community-based organizations can apply for government funding to start projects such as food gardens in the community or at clinic premises.

Health workers serve on the project committees.

Clinical and Sub-clinical VAD
	Impact monitoring of supplementation and fortification programme will be developed in 2002.
	Surveys in Section II will be repeated and will be a part of the monitoring system.
	Xeropthalmia is used as the indicator for monitoring clinical VAD.
	Serum Retinol is used as the indicator for monitoring sub-clinical VAD.

Supplementation
	Capsules are monitored through the stock control systems in provinces.
	Coverage of supplementation to post partum women, children 6 – 11 months, and to children 12 to 60 months will be monitored (as part of the minimum essential data set), through the District Health Information System. Indicators on coverage will also be included in the National Demographic Health Survey which will be conducted in 2003.

Fortification
	A monitoring system for the fortification programme will be developed in 2002, and will be in place in 2003, when enforcement commences.

Donor Agencies

Implementing Agency	Description of Activities	Expenditure/ source of funds in current year
Implementing Agency	Description of Activities	Supplementation	Fortification
UNICEF	Donated capsules, technical support, support for training and capacity-building, IEC materials	Yes
UNICEF and MI	Technical support, support for training and capacity-building and IEC		Yes

EPIDEMIOLOGICAL DATA