As supplementation is currently the primary vitamin A-deficiency control strategy and a key strategy for child survival, discussions of progress focus largely on coverage with that intervention. It should be noted that a number of countries, particularly in Latin America and the Caribbean and South Asia, are successfully fortifying staple foods such as sugar and oils with vitamin A. Coverage of fortification programmes has not been systematically assessed, however, and therefore will not be addressed in this section.
Vitamin A supplementation coverage
By the mid-1990s, limited efforts had been undertaken in the area of vitamin A-deficiency control, primarily concentrated in areas affected by severe and clinically apparent deficiency and targeted to children less than 2 years of age through routine immunization contacts. To expedite progress, various concerned organizations, donors and leading technical experts met in an informal consultation in December 1997. The group stressed the importance of vitamin A supplementation as a reliable and effective way to combat vitamin A deficiency and to achieve rapid progress for child survival. The informal consultation also advised all countries with under-five mortality of 70 deaths per 1,000 live births or higher to begin the distribution of vitamin A supplements immediately, regardless of whether the nation's vitamin A problem had been assessed, thus removing a constraint to progress.
Based on 2011 programme data (the latest reporting year for which data is available), 75 per cent of all children in developing countries were fully protected by the requisite two annual doses of vitamin A. Service provided through integrated child health events has helped ensure high coverage in a large number of least developed countries, where weak health systems would otherwise not have reached children. Integrated child health events have proved to be an effective platform for delivery of vitamin A supplements.
Least developed countries lead the way on two-dose coverage
Percentage of children 6–59 months old reached with two doses of vitamin A in 2011
Note: : Data are insufficient to estimate regional averages for Middle East and North Africa, Latin America and Caribbean and Central and Eastern Europe/Commonwealth of Independent States.
Source: UNICEF global database 2011 and additional analysis by Statistics and Monitoring Section, Division of Policy and Practice, UNICEF.
The number of priority countries that reported on having achieved at least 80 per cent coverage with two doses totalled 31 in 2011. More than half of all countries reaching at least 80 per cent of children with two doses were in sub-Saharan Africa, and more than one fifth were in East Asia and the Pacific. Future efforts need to focus on addressing the programmatic bottlenecks so that coverage could improve to protect more children.
Fivefold increase in full coverage in Africa between 2000 and 20081
Overall, significant progress has taken place: The proportion of children receiving vitamin A supplementation between 2000 (41 per cent) and 2008 (88 per cent) more than doubled in the least developing countries. In Africa, full coverage increased fivefold in the same time period. Trends can only be estimated from 2002 for Asia, where full coverage increased from 51 per cent to 70 per cent.
Progress in vitamin A supplementation coverage
Percentage of children 6–59 months old reached with two doses of vitamin A, 2000–2008
Note: Vitamin A supplementation two-dose (full coverage) trends are based on a subset of 16 African countries and 18 least developed countries with data in even years between 2000 and 2008 and on a subset of 11 Asian countries with data in even years between 2002 and 2008.The trend line for Asia begins in 2002 because of a lack of data for trend analysis prior to that.
Source: UNICEF, Tracking Progress on Child and Maternal Nutrition: A survival and development priority, UNICEF, New York, 2009.
This rapid increase in vitamin A supplementation coverage is attributable to the advent of biannual child health days, the main platform for vitamin A distribution in many African countries. In 2008, close to three quarters of all vitamin A supplements were delivered via integrated child health events, therefore making effective use of human and other resources, and by increasing convenience for parents, contributing to higher coverage.
1Countries are routinely combining the delivery of vitamin A with deworming, childhood immunizations, insecticide-treated nets and health promotion messages on hand-washing, iodized salt and breastfeeding.
UNICEF Eastern and Southern Africa, ‘Multi-country Evaluation of Child Health Days in Eastern and Southern Africa’, 2008, pp v-vi.
UNICEF, Tracking Progress on Child and Maternal Nutrition: A survival and development priority, UNICEF, New York, 2009.
1 We are in the process of retrospectively adjusting coverage estimates in the past so that they are fully comparable over the years. Full trend analysis up to 2010 is not available at the moment. The trend analysis presented here is based on a subset of countries with comparable estimates from 2000 to 2008. The trend estimates may be revised once the adjustment is complete.