National Vitamin A Prophylaxis Programme: need for change in current age strategy.

Child survival and Safe Motherhood Programme emphasises on giving vitamin A prophylaxis upto three years of age only, contrary to earlier practice of its administration upto six years of age, based on the assumption of reduction of serious manifestations of vitamin A deficiency three years of age onwards. A cross-sectional study enrolling 1094 children was done to investigate vitamin A deficiency in under six children in urban slums of Nagpur city in Central India in post CSSM scenario. Clinical as well as subclinical (detected by abnormal conjunctival impression cytology) assessment of vitamin A status was performed according to standard procedures, as per WHO recommendations. The overall prevalence of xerophthalmia was 8.7%. Only milder manifestations of xerophthalmia were observed. Significantly higher prevalence of xerophthalmia was observed in more than three years of age. Although nonsignificant, higher prevalence of subclinical vitamin A deficiency was observed in above three years of age group. In view of current age strategy for vitamin A supplementation (< or = 3 years) and observed higher prevalence of clinical and subclinical vitamin A deficiency above three years of age in this study (also endorsed by earlier studies) a call for review of current age strategy for vitamin A supplementation is warranted.

Subclinical vitamin A deficiency in undersix children in Nagpur, India.

The present cross sectional study was carried out to estimate prevalence of subclinical vitamin A deficiency among undersix children by using conjunctival impression cytology in urban slums of Nagpur city in central India. The study population included 308 non-xerophthalmic undersix children selected randomly. Conjunctival impression cytology was performed by standard procedure. Out of 308 children 110 (35.7%) had subclinical vitamin A deficiency. Increasing prevalence of subclinical vitamin A deficiency was non-significantly associated with advancing age. Higher prevalence of subclinical vitamin A deficiency was observed in severely malnourished children. The prevalence of subclinical vitamin A deficiency observed in this study (35.7%) is much more than the criteria laid down by WHO, which warrants community wide intervention. This problem assumes more significance because they are apparently healthy and if timely vitamin A supplementation is not given, any intercurrent infection is likely to worsen the vitamin A status and result in known consequences of xerophthalmia.