Progress to date

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. Summary information on the scale of food fortification efforts in priority countries is included under country data on vitamin A-deficiency control.

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 two 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 at least =70 deaths per 1,000 live births 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.

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 2008, in 54 countries with national programmes for which data were available in July 2009

                                                                                                          Source: UNICEF, 2009

Based on 2008 data (the last reporting year for which data is available) 71 per cent of all children in developing countries were fully protected by the requisite two annual doses of vitamin A. Global and regional coverage for 2008 is illustrated in the figure above, showing the greatest proportion of children covered to be living in least developed countries. In 2008, 22 out of 34 least developed countries with data had surpassed the 80 per cent target of full coverage of vitamin A supplementation. Service provided through integrated child health events has helped to ensure high coverage in a large number of these countries, where weak health systems would otherwise not have reached children. Integrated child health events were the most effective platform for delivery of vitamin A supplements in 2008, resulting in more than 80 per cent coverage on average. In addition, nearly three quarters of the 20 countries with the highest number of deaths among children under 5 years old achieved more than 80 per cent full coverage of vitamin A supplementation in 2008, indicating that this life saving intervention is being implemented at scale in countries where its benefit can be greatest. 

The number of priority countries that reported on having achieved at least 80 per cent coverage with two doses totalled 31 in 2008. Close to half of all countries reaching at least 80 per cent of children with two doses were in sub-Saharan Africa, followed by East Asia and the Pacific, South Asia and then a handful of countries from CEE/CIS such as Azerbaijan, Kyrgyzstan and Tajikistan. A number of countries trail closely behind with two-dose coverage levels in the 70 per cent range including India, Nigeria, Sudan and Uganda. 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 2008

While the current supplementation indicator measures coverage with at least one dose, effective protection from deficiency and its consequences will require supplementation on a four- to six-month schedule. Ideally, coverage achieved in the second half of the year (as reported in UNICEF's The State of the World's Children) would be comparable to that achieved earlier in the year and therefore truly representative of progress. In the past, however, coverage levels have often varied widely from round to round due to changes in distribution mechanisms, or some countries have been unable to deliver a second annual dose at all. There has been great progress in the number of countries achieving at least 80 per cent full coverage, with 31 countries reaching this goal in 2008. Overall, however, significant progress has taken place: the number of children receiving VAS between 2000 (41 per cent) and 2008 (88 per cent) more than doubled in least developing countries. In Africa, full coverage increased five-fold 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.

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. Countries are routinely combining the delivery of vitamin A with de-worming, childhood immunisations, bed nets and health promotion messages on hand-washing, iodised salt, and breastfeeding)¹.

Progress in vitamin A supplementation coverage
Percentage of children 6–59 months old reached with two doses of vitamin A, 2000–2008

1. UNICEF Eastern and Southern Africa. “Multi-country Evaluation of Child Health Days in Eastern and Southern Africa,” 2008, Pp v-vi.