Vitamin a prophylaxis

Vitamin A prophylaxis programme

1. Vitamin A Prophylaxis Mrs.Nagamani.T Dept of Community Health Nursing Quality Health Care College of Nursing

2. Introduction Vitamin A is a micronutrient belonging to group of fat soluble vitamins Vitamin A is necessary for the regulation of various bodily functions such as growth, vision, reproduction,  immunity etc . The  vitamin A  deficiency may lead to various health issues such as susceptibility to various infections, stunting, eye health, and vision issues. VAD also affects the systematic immunity and results in various infections with increased severity. Vitamin A plays a major role in various  biological phenomenon  and it can't be produced naturally in human body, hence it must be consumed via diet resources. Vitamin A deficiency is a major controllable nutritional problem in developing countries.

3. Incidence According to UNICEF, around one third of the children are not receiving the supplementation of Vitamin A they need . According to WHO, an estimated 250 000–500 000 children who are vitamin A-deficient become blind every year, and half of them die within 12 months of losing their sight. Vitamin A Deficiency in newborn, infants and children is responsible for – 6% of under-5 deaths - 5%of under-5 DALYs – 1.7% of total DALYs lost

4. Incidence in India It is estimated that 30-40,000 children in India, may lose their eye-sight because of vitamin A deficiency . India has the highest prevalence of clinical and subclinical VAD among South Asian countries;  62% of preschool children were reported to be deficient  in vitamin A. These dramatic results suggested high mortality rate, leading to an annual 330,000 child deaths . Women of childbearing age excessively suffered from night blindness, with 5% pregnant women manifesting subclinical VAD. Among these 5%, about 12% were severely affected with night blindness during pregnancy 

5. Functions of Vitamin A in Human Body System Function Vision Light and Dark adaptation Cellular differentiation morphogenesis Gene transcription Immune response Non-specific, cell metabolism ( anti infection vitamin and is vital for survival ) Hemopoeisis Iron metabolism Growth Skeletal Thyroid metabolism Regulation of Thyroid Stimulating Hormone(TSH) secretion Anti-oxidant Scavenger of free radicals

6. Effects of Vitamin A Deficiency Vitamin A deficiency results from a dietary intake of vitamin A that is inadequate to satisfy physiological needs. 

7. Night Blindness Often the first symptom – indicative of retinal dysfunction • Leads to subjective impairment of vision in night Conjunctival Xerosis Range of dryness to keratinization of conjunctiva in form of thickening, wrinkling and pigmentation • Changes in the proteins proteins and secretory cells • Can lead to infections in the eye Bitot’s Spots Dryness and foamy/Cheesy accumulations on the inner eyelids Corneal Xerosis Dullness or cloudy cornea Texture of the cornea dry and rough Keratomalacia Softening, ulceration on the cornea • Perforation of the cornea • A medical emergency • Leads to blindness Corneal Scar Healed sequelae of prior corneal disease related to Vitamin A Deficiency – Opacities or scars of varying density (nebula, macula, leukoma ) – Weakening and out pouching of the remaining corneal layers. Not specific for xerophthalmia , also caused by trauma and infection

8. Deficiency of vitamin A is associated with significant morbidity and mortality from common childhood infections, and is the world’s leading preventable cause of childhood blindness. Vitamin A deficiency also contributes to maternal mortality and other poor outcomes of pregnancy and lactation. It also diminishes the ability to fight infections. Even mild, subclinical deficiency can be a problem, because it may increase children's risk for respiratory and diarrheal infections, decrease growth rates, slow bone development and decrease the likelihood of survival from serious illness . Diet surveys have shown that the intake of Vitamin A is significantly lower than the recommended daily allowance in young children , adolescent girls and pregnant women.

9. Its time to relax Walk around for a moment and stress out yourself……..

10. Activity Q. Deficiency of vitamin A in children causes : a) Goitre b) Poor cognitive development c) Poor bone growth d)   Increased risk of mortality Answer_________

11. Vitamin A Prophylaxis Programme The National Prophylaxis Programme against Nutritional Blindness due to vitamin A deficiency (NPPNB due to VAD) was started in 1970 with an aim of preventing nutritional blindness due to keratomalacia . The Programme was started as a 100 per cent centrally sponsored programme . To begin with, this Programme was initiated in 11 States of the country . It utilises technology developed by National Institute of Nutrition, Hyderabad It has helped to decrease the preventable blindness in the community

12. Aim:   to decrease the prevalence of Vitamin A deficiency Objective : Prevention of vitamin A deficiency Treatment of Vitamin A deficient children

13. Prevention of vitamin A deficiency Promoting consumption of Vitamin A rich food – promotion of regular dietary intake of Vitamin A rich foods by all pregnant and lactating women and by children under 5 years of age by increasing local production and consumption of green leafy vegetables and other plant 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 session, as well as women and children registered under ICDS programme . Prophylactic Vitamin A as per the following dosage schedule: 100000 IU at 9 months with measles immunization 200000 IU at 16-18 months, with DPT booster 200000 IU every 6 months, up to the age of 5 years. Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years.

14. Treatment of Vitamin A deficient children All children with xerophthalmia are to be treated at health facilities. All children having measles, to be given 1 dose of Vitamin A if they have not received it in the previous month. All cases of severe malnutrition to be given one additional dose of Vitamin A.

15. Determinants of VADD The odds of bitot’s spots higher among children – With family size of more than four – Illiterate mothers – Households without a sanitary latrine – Not received even one dose of Vitamin A supplementation – Be longing to backward communities Source: Laxamaiah A et al. Prevalence of ocular signs and subclinical vitamin A Deficiency and its determinants among rural pre-school children in India. Public health Nutrition 2011;15:568-577

16. Vitamin A supplementation Vitamin A supplementation is – Cost-effective – Safe – Sustainable – Easily implemented on a national scale • Over 6,00,000 lives can be saved each year • 20 million disability adjusted life years can be gained

17. Availability of Vitamin A for supplementation Syrup • Capsules • Tablets • Injectables

18. Vitamin A Syrup Available in concentration of 1,00,000 or 2,00,000 IU • Should be administered using 2ml spoon/dispenser • Must be kept away from direct sunlight • Stored in cold dark room temperature and is stable for minimum one year • Bottle once opened must be utilized within 6-8 weeks

19. Vitamin A Supplementation Schedule for Indian Children Age Dose Frequency 6 months to 11 months 1,00,000 IU Once 12 months to 5 years 2,00,000 IU Every 6 months Source: Vitamin A and IFA Supplementation. Ministry of Health and Family Welfare, 2006.

20. Why every 6 months supplementation is required? Body cannot make Vitamin A on its own – Vitamin A is stored in the liver • Illness, if occurs, depletes stored Vitamin A • Vitamin A stores lasts for 4-6 months only

21. Food fortification with Vitamin A Fortification of staple foods such as – Wheat and rice and other grains – Vegetable oil – Dairy foods – Margarine – Sugar

22. Activity Q. Under vitamin A prophylaxis programme , the amount of oral vitamin A solution administered to children (1 year to 6 years) is____ a)  2 lakh units every 6 months b)  1 lakh units every 6 months c)  2 lakh units every 1 year d)  1.5 lakh units 1 year Ans _________________

23. References WHO. Vitamin A deficiency list of publications. ( http://www.who.int/nutrition/publications/micronutrients/vitamin_a_deficiency/en / http://nhm.gov.in/images/pdf/programmes/child-health/guidelines/goi_vit_a.pdf http://nutritionfoundationofindia.res.in/pdfpublication/Nutrition%20Transition%20in%20india1947-2007/7.11.2%20Vitamin%20A%20Deficiency%20pr%20map.pdf

24. Make sure to administer Vitamin A to all your children and do consume Vitamin A rich foods in your diet and stay Healthy. Thank You For more videos please Subscribe to my Channel.