Evaluating Data to Determine when Biotherapeutic Vitamin A Supplementation can be Scaled Back in Children <5 Years Old

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The World Health Organization recommends that high dose vitamin A supplements be administered to children under the age of 5 years to be used as a biotherapeutic to prevent morbidity and mortality. Vitamin A is essential for vision, immunity, reproduction, and growth. In addition to high dose supplements, many countries add preformed vitamin A to staple foods during processing. The Global Alliance for Vitamin A (GAVA) has set up a decision framework to follow to determine if a country can scale back high dose vitamin A supplements in preschool children. The objective of this work was to evaluate data available in African countries to determine if vitamin A supplements can be scaled back. The framework includes evaluating demographic information, dietary intake data, and biomarkers of vitamin A status. All of these data were available for one province in South Africa, one district in Zambia, and a subgroup of children enrolled in a demographic health survey in Ghana. In South Africa, it was determined that there is enough evidence to scale back high dose supplements in one province, but not enough data to scale back supplementation in the whole country. A similar finding was determined in one area of Zambia where dietary intake is adequate. In Ghana, the evidence is mounting that status has improved, but there are still pockets of vitamin A deficiency that likely benefit from high dose supplementation. In conclusion, overlapping interventions in some countries likely leads to adequate vitamin A intakes and in some cases excess. Vitamin A supplementation is used as a therapy to save children’s lives, but in some areas it may no longer be necessary. The repercussions of vitamin A deficiency are devastating and the world has the means to eradicate it; however, vitamin A excess to the point of toxicity also has health concerns. Therefore, balancing needs with intakes is important for overall health. The GAVA framework can be used in any country that has all of the needed data to evaluate their situation or to determine where more data may be needed.Support or Funding InformationSupport for these studies was obtained from the International Atomic Energy Agency (South Africa), HarvestPlus (Zambia), and GroundWork (Ghana). Evaluation of the data was done independently from the funding agencies on published data.