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National immunisation days and vitamin A distribution in Mali: has the vitamin A status of pre-school children improved?

Published online by Cambridge University Press:  02 January 2007

JF Schémann ,
A Banou ,
D Malvy ,
A Guindo ,
L Traore  and
G Momo
JF Schémann*
Affiliation:
Institute of African Tropical Ophthalmology (IOTA), BP 248 Bamako, Mali
A Banou
Affiliation:
Ophthalmic Centre, Segou, Mali
D Malvy
Affiliation:
Centre René Labusquière, University Victor Segalen Bordeaux 2, Bordeaux, France
A Guindo
Affiliation:
Institute of African Tropical Ophthalmology (IOTA), BP 248 Bamako, Mali
L Traore
Affiliation:
Institute of African Tropical Ophthalmology (IOTA), BP 248 Bamako, Mali
G Momo
Affiliation:
Institute of African Tropical Ophthalmology (IOTA), BP 248 Bamako, Mali
*
*Corresponding author: Email jfschemann@wanadoo.fr.
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Abstract

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Objective:

The impact on vitamin A status of the distribution of vitamin A during national immunisation days (NIDs) has not been well established despite strong promotion by international agencies and donors. Using a pre–post design, the change in prevalence of vitamin A deficiency was examined in pre-school children in Mali.

Design:

Two cross-sectional surveys were conducted in Mopti region, the first in March 1997 before this strategy was adopted and the second in March 1999, four-and-a-half months after a mass distribution of vitamin A during NIDs.

Subjects and setting:

We compared the vitamin A status of children aged 12 to 66 months targeted in 1999 by NIDs with the status of children in the same age group in 1997. Infectious events of the previous two weeks were concurrently recorded. Within the 1999 sample, the status of recipient and non-recipient children was also compared.

Results:

In 1997, the prevalence of xerophthalmia (defined by the presence of night blindness and/or Bitot spots) was 6.9% (95% confidence interval (CI) 5.1–9.2) and the modified retinol dose response (MRDR) test proved abnormal in 77.8% of 12–66-month-old children (95% CI 68.27–85.17). In 1999 this picture had improved significantly, both for xerophthalmia prevalence, 3.3% (95% CI 2.1–5.2), and abnormal MRDR test response, 63.1% (95% CI 54.25–71.23). The infectious morbidity rates between 1997 and 1999 tended to decrease. No significant improvement was found among children older than those targeted by NIDs. In 1999, children who received vitamin A had a lower risk for xerophthalmia (3.0% for recipients vs. 8.7% for non-recipients) and experienced fewer infectious events.

Conclusions:

The clinical and biological vitamin A status of pre-school children improved between 1997 and 1999. Mass distribution of vitamin A appears to reduce the occurrence of xerophthalmia and would seem to be associated with a decrease in other related illnesses. Vitamin A supplementation during NIDs should be given a high priority when vitamin A deficiency remains a public health problem.

Keywords

Night blindnessXerophthalmiaModified retinol dose response testNational immunisation daysMali
Type
Research Article
Information
Public Health Nutrition , Volume 6 , Issue 3 , June 2003 , pp. 233 - 240
Copyright
Copyright © CAB International 2003

References

1Goodman, T, Dalmiya, N, de Benoit, B, Schultink, W. Polio as a platform: using national immunization days to deliver vitamin A supplements. Bull. World Health Org. 2000; 78: 305–14.Google ScholarPubMed
2West, KP Jr. Extent of vitamin A deficiency among preschool children and women of reproductive age. J. Nutr. 2002; 132: 2857S–66S.CrossRefGoogle ScholarPubMed
3Beaton, GH, Martorell, R, Aronso, KJ. Vitamin A supplementation and morbidity and mortality in developing countries. Food Nutr. Bull. 1994; 15: 282–9.CrossRefGoogle Scholar
4Humphrey, JH, West, KP, Sommer, A. Vitamin A deficiency and attributable mortality among under-5-year-old. Bull. World Health Org. 1992; 70: 228–32.Google Scholar
5United Nations Children's Fund (UNICEF). Progress of Nations. New York: UNICEF, 1999.Google Scholar
6Traoré, L, Banou, A, Sacko, D, Malvy, D, Schémann, JF. Les stratégies de lutte contre les déficits en vitamine A. Santé 1998; 8: 158–62.Google Scholar
7World Health Organization (WHO). Methods of Assessment of Avoidable Blindness. WHO Offset Publication No. 54. Geneva: WHO, 1980.Google Scholar
8Direction Nationale de la Statistique et de l'Information (DNSI). Recensement général de la population et de l'habitat du Mali (RGPH). Bamako, Mali: DNSI, 1987.Google Scholar
9WHO Working Group. Use and interpretation of anthropometric indicators of nutritional status. Bull. World Health Org. 1986; 64: 929–41.Google Scholar
10Helen Keller International (HKI). How to Use the HKI Frequency Method to Assess Community Risk of Vitamin A Deficiency. New York: HKI, 1994.Google Scholar
11Tanumihardjo, SA, Muhilal, ER, Yuniar, Y, Permaesih, D, Sulaiman, Z, Karyadi, D, et al. Vitamin A status in preschool age Indonesian children as assessed by the MRDR assay. Am. J. Clin. Nutr. 1994; 60: 142–7.CrossRefGoogle Scholar
12Tanumihardjo, SA, Koelner, PG, Olson, JA. The modified relative dose response assay as an indicator of vitamin A status in a population of well-nourished American children. Am. J. Clin. Nutr. 1994; 60: 148–52.Google Scholar
13World Health Organization (WHO). Indicators for Assessing Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes. Micronutrient Series. Geneva: WHO, 1996.Google Scholar
14Sommer, A. Vitamin A Deficiency and Its Consequences, A Field Guide to Detection and Control, 3rd ed. Geneva: World Health Organization, 1995.Google Scholar
15Donnen, P, Brasseur, D, Dramaix, M, Vertongen, F, Ngoy, B, Zihindula, M, et al. Vitamin A deficiency and protein–energy malnutrition in a sample of preschool age children in the Kivu Province in Zaïre. Eur. J. Clin. Nutr. 1996; 50: 456–66.Google Scholar
16Kafwembe, EM, Sakwa, TY, Manyando, O, Mwandu, D, Chipipa, J, Chipaila, P. The vitamin A status of Zambian children attending an under five clinic as evaluated by the Modified Relative Dose Response (MRDR) test. Int. J. Vit. Nutr. Res. 1996; 66: 190–6.Google ScholarPubMed
17Haskell, MJ, Handelman, GJ, Peerson, JM, Jones, AD, Rabbi, MA, Awal, MA, et al. Assessment of vitamin A status by the deuterated-retinol-dilution technique and comparison with hepatic vitamin A concentration in Bangladeshi surgical patients. Am. J. Clin. Nutr. 1997; 66: 67–74.CrossRefGoogle ScholarPubMed
18Tanumihardjo, SA, Permaesih, D, Muherdiyantinindsih, , Rustan, E, Rusmil, K, Fatah, AC, et al. Vitamin A status of Indonesian children infected with Ascaris lumbricoides after dosing with vitamin A supplements and albendazole. J. Nutr. 1996; 126: 451–7.CrossRefGoogle ScholarPubMed
19Tanumihardjo, SA. Can lack of improvement in vitamin A status indicators be explained by little or no overall change in vitamin A status of humans? J. Nutr. 2001; 131: 3316–8.CrossRefGoogle ScholarPubMed
20Ministère de la|Santé. EDS: Enquête Démographique et de Santé. Bamako, Mali: Ministère de la Santé, 1996.Google Scholar