Swaziland Iodine

Tanzania

Vitamin A

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EPIDEMIOLOGICAL DATA
     
Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey - 1988
Date: October to November 1988
Groups Surveyed: Survey done in two drought-prone divisions, namely Kishapu and Negezi of Shinyanga Rural district located in the Western zone of Tanzania.
Sample Size: 3,518 children 6mos - 6 yrs.
Sampling Method: National probability sample with disproportionate stratification by province
Sampling Strategy: 22 villages of the 2 divisions under the Child Survival Protection and Development (CSPD) programme supported by UNICEF were covered. 3,518 children between ages of 6 to 72 months were selected by a systematic random sampling from a list of 17,495 eligible children in village registers. The sample was determined by assuming a prevalence of as high as 2% with a marginal error of 0.005 in the dry areas., and fitted in the formula: n = Z2  x pq/d2,  where number of children to be screened, p= prevalence of corneal ulcer (0.02), q = the probability of no corneal ulcer, Z = standard normal deviate (1.96 at 95% confidence interval), d = marginal error ( 0.005). Therefore, n = 3012. A sample size of about 3500 was agreed to take care of non-attendance.
Estimated Prevalence of VAD:  

Age Group

Sample Size

Prevalence ( %)

6 month - 6 years

(Shinyanga rural study, 1988)

3,518

XN         =  5    (0.14%)

XN + 1B = 6    (0.17%)

X3A        = 1    (0.03%)

XS          =  8    (0.23%)

                    XN= Night Blindness, X1B = Bitot's spots, X3A = Corneal ulceration, XS = Corneal scar
 
Sub-clinical Vitamin A Deficiency
Most Recent Sub-Clinical VAD Survey
  Date: September - October 1997
  Groups Surveyed: The survey covered 10 sentinel districts representing distinct agro-ecological zone of Tanzania Mainland.  Survey groups were children 6 months - 6 years old and lactating women.
  Sample Size: 900 children, 229 lactating women
  Sampling Method: The 20 regions of Mainland Tanzania were categorized into 20 agro-ecological zones each comprising 2 regions.  In each zone random selection of one region, one district and eventually one village was done.  Each selected village contributed to the total sample size based on equal proportion of targeted children 6 months to 6 years old). 
   
Estimated Prevalence of VAD: 

 

Age Group

Sample Size

Indicator(s)

Prevalence ( %) or median value

6 months - 6 years (6 - 71 months)

853

Serum Retinol below 20 mcg/dL

Serum Retinol below 10 mcg/dl (severe VAD)

24.2

 4.3

Lactating women

229

Breasmilk retinol < 30 mcg/dL

69.0

 
 
     
 

POLICY AND LEGISLATION
 

Legislation on VAD
     There is VAD legislation in Tanzania.  It was passed in 1992 and 1997 and has not been significantly revised since.

Government Agency to Address VAD

      Tanzania Food and Nutrition Centre.

    

Contact Information:  Box 977 Dar es Salaam

    

Email:  fsn@ud.co.tz
   
     

PROGRAM DATA
Supplementation
Program Description
     1)  Disease - targeted vitamin a supplementation through primary health care facilities (government owned dispensaries and health centres).  Coverage unknown as there is no universal information system to capture the data, target: children under the age of 5 year and the general population presenting at the facilities with xerophthalmia or VAD-precipitating diseases (i.e Acute or persistent diarrhoea, moderate and severe protein-energy undernutrition, measles and lower respiratory tract infections).  The programme started in 1987 under the Essential Drugs Programme (EDP) supported by DANIDA and distributed through the Medical Stores Department (MSD).  Drug supply for this programme has stopped, as there is adequate supply through MI/UNICEF support.
    

2)  Universal supplementation through the Expanded Programme on Immunization (EPI) to:   (a) Children under the age of 24 months at six monthly intervals starting from the timing of    routine measles immunization (i.e. at 9 completed months of age, then at 15 and 21 months of age).  The coverage of children was 69%, 25% and 15% at 9, 15 and 21 months of age, respectively, in the year 2000 (TFNC 2001). (b) Lactating women within one month post-partum. 49% coverage in 2000.  The supplementation through EPI started in 1997.
     3)  Universal supplementation to children aged 6 - 60 mos.  a) Social Mobilization campaigns for the Day of African Child (DAC) which climaxes on 16th June. 80% coverage of targeted Tanzanian children (5,842,953) and 100% of children in Tanzanian refugee camps (50.265) in June 2001.  b) Social mobilization campaigns for the World AIDs Day (WAD) which climaxes on 1st December.  91% coverage of targeted Tanzanian children (5,867,671) and 98% of children in refugee camps (i.e. data for 27, 277 from one camp in Kagera region is available) data from another camp in Kigoma not yet secured supplementation through DAC and WAD started in 2001.
     4)  Supplementation through sub-national measles immunization campaigns was practiced in 30 and 52 districts in 1999 and 2000, respectively.  The coverages were 94% and 99% of 1,550,000 and 2,434, 771 targeted children aged 6 months to 5 years in the respective years.  This programme was stopped and gave way to supplementation through social mobilization campaigns (DAC and WAD) which have advantages of a national coverage.
 
Targeting

Programme

People targeted in 2002

Through routine EPI to children < 2 years old

2,789,910

Through routine EPI women within 4 weeks of deliery

1,394,955

Children 6 months - 5 years old through DAC and WAD campaigns

6,277,297

                        Note: the populations are not additive as some people are targeted for both routine and campaign supplementations
Capsule Information

Source

100,000 I.U

200,000 I.U

MI

1,991,000

13,485,500

Procured by MSD for EDP supply (Jan-April 2001).  3600 dispensaries and 260 Health Centres owned by government

1,648,000

-

Total

3,639,000

13,485,500

                      Note: Under the EDP system, each government received one tin of 100 vitamin A capsules per month, whereas health cenres received 2 tins (200 capsules per months) of 100,000 I.U.

 

Vitamin A Supply for year 2001

 

Source

Supplementation: Number of Capsules (000)

 

200,000 IU

100,000 IU

50,000 IU

10,000 IU

 

 

 

 

 

Imported into country

12,198,500

3,637,000

-

-

Locally produced

 

 

 

 

Totals

 12,198,500

 3,637,000

 

 

 
Implementation

    

Routine EPI services for children aged 9-24 months and women within 4 weeks of delivery.

    

Through Health facilities for young children suffering from xerophthalmia or VAD - precipitating diseases.  Also for adults suffering from xerophthalmia.

    

National social mobilization campaigns i.e. Day of African Child (DAC) and World AIDs day.
Fortification

Program Description
     Fortification of maize is currently in the pilot phase.
Other Programs
Dietary Change
     Every district development program has a component addressing food and nutrition problems-including VAD. The most popular programme which covers about half of the districts (55) of mainland Tanzania is the Child Survival, Protection and Development Programme (CSPD) supported by UNICEF.  All the other districts have similar programmes conducted in partnership with other donors (e.g. Plan International, World Vision, Care International, Africare).  For vitamin a, the focus is mainly on preschool children and women of child bearing age.  The programmes are run by village, ward and district governments in partnership with extension workers in health, agriculture, Community Development, Education and Planning.
     
     
 
MONITORING
 

Clinical and Sub-clinical VAD
     The National xerophthalmia surveillance programme .
     The National sentinel surveillance on vitamin A supplementation.
     The national Health Management Information system which incorporates indicators on performance vitamin A supplementation through EPI.
     The national task force on vitamin A supplementation campaigns evaluates performance of the campaigns and formulates improvements actions.
     The indicators used for monitoring clinical VAD are Night blindness, Bitot's spots, Corneal ucleration and Corneal Scar among eye patients.
     The indicators used for monitoring sub-clinical VAD are Serum Retinol level below 20 mcg/dL or below 10 mcg/dL, among preschool children, and Breastmilk retinol below 30 mcg/dL.  Judgement of Public health significance of VAD as per WHO criteria.
 
Supplementation
     Capsules are monitored.  Stock received at Central Medical Stores Department (MSD) is related to requested amounts and requirements for national supplementation programs.

    

Coverage of supplementation is done by monitoring forms completed by health clinics and is summarized as follow:         a) through EPI, the Health Management Information EPI and Reproductive and Child Health (RCH) meeting reports,        b) for supplementation through social mobilization campaigns, district summary reports are compiled at national level by TFNC.  The national report is discussed in the national task force on the campaigns and feedback given to regions (provinces).  Districts and regions discuss campaigns results in Health Management and Development Committee meetings
Fortification
     Content and distribution of vitamin A fortified commodities is monitored via the national Food Control Commission for compliance to regulations.
.    
     
PROGRAM RESOURCES
   

Donor Agencies
   
  Ministry of health through TFNC, EPI, IMCI, Health Education Unit and National AIDS Control Programmes; Ministry of Agriculture and Food Security, Ministry of Education, Ministry of Community Development Women Affairs and Children, President's Office - Regional Administration and Local governments, Tanzania AIDS Control commission (TACAIDS) Muhimbili University College of Health Science and Medical Stores Department. (MSD)  External Agencies MI, UNICEF, USAID, Plan International GDS, International Centre for Research on women, International programme for Chemical Sciences  (IPICS). Rotary  International, JICA.
   
 

 Implementing Agency

 Description of Activities
National/State Governments COORDINATION: Ministry of Health and TFNC. EPI, IMCI  - supervision of supplementation activities.  MSD - distribution of the supplements to districts.  Government  and external partners are members of either National Task force or consultative group meetings.

MI, UNICEF, USAID and Plan International

Financial support.