NATIONAL VITAMIN A DEFICIENCY PROPHYLAXIS PROGRAMMES

this presentation is about the governmental organised national vitamin A prophylaxis programme which aims to reduce or to prevent the prevalence of vitamin A deficiency.

1. NATIONAL VITAMIN A DEFICIENCY PROPHYLAXIS PROGRAMMES ISABELLA THOBURN COLLEGE PREPARED BY- KANIKA RASTOGI MSC. 3 RD SEM. 180380755031 SUBMITTED TO- SARIKA SHUKLA

2. VITAMIN A Vitamin A is one of a group of fat soluble vitamins that are essential for life and health. Three active forms: retinol, retinal and retinoic. Vitamin A plays a critical role in: Vision (A is part of rhodopsin , the visual pigment) Epithelial tissues need to protect integrity. Growth Reproduction Pattern formation during embryogenesis Bone development Brain development Immune system function Deficiency Diseases: Keratinization , xerosis , Xerophthalmia , Infections, Weak bones, poor teeth.

3. SOUR C ES ANIMAL FOODS: Liver, eggs, butter, cheese, whole milk, fish and meat Fish liver oil - richest natural source of retinol PLANT FOODS: green leafy , most green and vegetables yellow fruits and vegetables , roots (carrot) FORTIFIED FOODS: food fortified with Vit. A such as vanaspati, margarine, milk .

4. VITAMIN A DEFICIENCY Vitamin A deficiency is a preventable cause of blindness. It is a well-known cause of blindness and is associated with elevated mortality among infants and children. People most at risk are children between six months to six years, pregnant women, and lactating women . One of the main causes of Xerophthalmia is the poor intake of vitamin A, this disease is also associated with: Faulty feeding habits Mal absorption syndromes (cystic fibrosis, Whipple's disease, Crohn's disease, ulcerative colitis, short bowel syndrome, gastroenteritis, measles) Pancreatic disease Chronic liver disease Weight Loss Surgery Poverty Ignorance and some other conditions among the entire population, but mainly in developing countries and in young children all over the world in particular.

5. CAUSES Primary Vitamin A Deficiency is usually caused by prolonged dietary deprivation. Secondary Vitamin A Deficiency may be due to Decreased bioavailability of provitamin A carotenoids . Interference with absorption , storage or transport of vitamin A. Fat malabsortion , cholestasis , inflammatory bowel disease, cystic fibrosis, pancreatic insufficiency . Vegan diet Alcoholism Toddlers and preschool children living below the poverty line. In pregrant women,vitamin A deficiency occurs especially in the last trimester due to higher demands by foetus and mother. In children with complicated measles.

6. A) NIGHT BLINDNESS Lack of Vit. A FIRST causes Night blindness. It is the inability to see in DIM LIGHT. It occurs due to impairment in dark adaptation. The condition may get worse if Vit. A is not taken , especially if they suffer from diarrhoea and other infections. B) CONJUNCTIVAL XEROSIS It is the FIRST SIGN of Vit.A deficiency. The conjuctiva becomes dry and non- wettable . It appears muddy and wrinkled (instead of smooth and shiny) C) BITOT’S SPOTS They are triangular , pearly white or yellowish , foamy spots on the BULBAR CONJUCTIVA on either side of the CORNEA. Usually bilateral. In YOUNG children, it indicates Vit.A deficiency. In OLDER individuals, it is often an inactive sequelae of earlier disease. SYMPTOMS

7. D) CORNEAL XEROSIS The cornea appears dull , dry and non-wettable and eventually opaque . This stage is VERY SERIOUS. In more SEVERE DEFICIENCY, there maybe corneal ulceration The ulcer may heal leaving a corneal scar which may affect vision . It is the liquefaction of the cornea. This is an MEDICAL EMERGENCY. The cornea(a part or the whole) may become soft and may burst open . This process is rapid and if the eye collapses , vision is lost . E) KERATOMALACIA F) XEROPTHALMIA (dry eye) It refers to ALL the ocular manifestations of Vit.A deficiency. It is a serious nutritional disorder leading to blindness particularly in South-East Asia . It is MOST COMMON in children aged 1-3yrs , and often related to weaning. It is associated with PEM.

8. PREVENTION Distribution of massive dose capsules (with polio vaccine) Food Fortification (to improve nutrition by enriching commonly-used food products with important vitamins and minerals) »Cooking Oil »Wheat Flour Horticulture and agriculture Green leafy vegetables Orange colored fruits & vegetables Mothers will need advice about: Breast feeding Weaning in general How to prepare them, E.g. giving fried egg to the child Liver, egg, cheese, butter, fish liver oil etc are good sources of vitamin A. Immunization----Measles Avoid traditional healers Herbs Tooth paste etc

9. TRE A TMENT Vit. A deficiency should be treated urgently Nearly ALL the early stages of Xeropthalmia can be REVERSED by: Administration of MASSIVE DOSE of 200,000 IU (or 110mg) of retinol palmitate ORALLY on 2 successive days. ALL children with corneal ulcers are given Vit . A whether or not a deficiency is suspected . Timing Vitamin A dosage Immediately on diagnosis <6months of age 50,000 IU 6-12 months of age 1 lakh IU >12months of age 2 lakh IU Next day Same age specific dose At least 2 weeks later Same age specific dose

10. NATIONAL V ITAMIN A PROPHYLAXIS PROGRAMME

11. Vitamin A prophylaxis programme The National Prophylaxis Programe against Nutritional Blindness due to vitamin A deficiency (NPPNB due to VAD) was started in 1970. In 2006, the age group of eligible children was revised as 9 months to 5 yr. of age (oral prophylactic dose): One dose, 1,00, 000 IU along with measles immunization (operational feasibility). 8 doses at six – monthly intervals of 2.00, 000 IU. The specific aim of preventing nutritional blindness due to keratomalacia . Objectives : Promoting consumption of vitamin A rich food:- Promotion of regular dietary intake of vitamin A rich foods by all pregnant and lactating mother and by children under 5 years of age by increasing local production and consumption of green leafy vegetable and other foods those are rich sources of carotenoids . Creating awareness about the importance of preventing Vitamin A Deficiency:- Among the women’s attending Antenatal clinics, immunization sessions, as well as women and children registered under ICDS programme . Prophylactic Vitamin A as per the following dosage schedule :- 100,000 IU at 9 months with measles immunization. 200,000 IU at 16-18 months with DPT booster. 200,000 IU every 6 months up to the age of 5 years.

12. National Vitamin A Prophylaxis Programme – Current Scenario (2016) Clinical VAD has declined drastically during the last 40 years. – There has been virtual disappearance of keratomalacia . – A sharp decline in the prevalence of Bitot spots • Vitamin A supplementation (VAS) is implemented through the PHCs and sub- centres . – The services of ICDS functionaries are also utilized for Programme implementation. • Universal supplementation of vitamin A to Indian children is being undertaken irrespective of their family background and nutritional status • Recently it has been suggested that India is currently at a stage when universal vitamin A supplementation should transit to -: – A targeted supplementation programme . – The primary focus should now be on sustainable food based approaches to combat vitamin A deficiency . • To increase local production and consumption of green leafy vegetables and other plant foods those are rich sources of carotenoids . • Green leafy vegetables, many fruits and other plant foods are also good sources of folate , vitamin C, Fe, Ca and many other micronutrients

13. THANK YOU