The document outlines the importance of Vitamin A training for paramedics, detailing its two forms, dietary sources, daily requirements, and the consequences of deficiency, including vision problems and increased mortality rates. It provides statistics on the prevalence of Vitamin A deficiency in India and prevention strategies, such as dietary improvements and regular supplementation. Additionally, it discusses the scheduling and workload requirements for administering Vitamin A doses to children to combat deficiency effectively.

1. For Para-medics Vitamin A Training Dr. SIRAJ VOHRA Block Health Officer, Anklav, Di. Anand, (Gujarat) INDIA (M) 0091-94284 90284, 94284 90384

2. Vitamin A Retinol Beta -carotine Vit. A Measured in - International Unit (IU) 1 IU of Vit. A = 0.3 microgram of Retinol 2 forms Pre-formed Pro-vitamins

3. Role of Vitamin A in Body Normal Vision Maintain normal function of Epithelial & glandular function Supports skeletal growth Power up Immune system & prevents Infection It protects against some cancers i.e. Broncheal.. ??

4. Availability of Vitamin A A. Animal foods Liver Egg Butter Cheese Milk Fish Meat Available as Natural Retinol & easily absorbed from Intestine

5. Availability of Vitamin A (cont..) B. Plant foods Available as Beta-Carotine, converts to Retinol in Intestine Some roots Carrots Green leafy Vegetable Highest source -------  Spinach, Amaranth Yellow fruits Papaya, Mango, Pumpkins

6. Vanaspati Ghee Milk Availability of Vitamin A (cont..) C. Fortified foods ??

10. Daily Requirement of Retinol (Pure Vit A) in Mcgm Requrement of Beta carotine is 4 times higher than Retinol Vit. A is stored in liver & sufficient for body need of 6-9 months Infant 350 1-6 Yrs. 400 7-12 Yrs. 600 Adolescents 600 Adult 600 Pregnant 600 Lactating 950

11. Result of Vitamin A Deficiency Hyperkeratosis Anorexia Growth retardation Chances of frequent Respiratory & Intestinal Infection ..Results in Increase in morbidity & Mortality Occular Complications (Xerophthelmia)

12. Progress of Occular complication (xerophthelmia) Keratomalasia Night Blindness Conjunctival Xerosis Bitot’s Spot Corneal Ulcer

13. 1 st sign of Vit A Deficiency Presented with symptoms only (Not a sign..) Complaint of inability to see in dim light Mother is reliable person to identify this problem ( Not a child !!) Reversible condition Simple Vit A administration can cure the patient Night Blindness

14. First clinical sign, A medical person can identify Conjunctiva becomes dry & not wettable It looks Muddy & wrinkled ( Instead of smooth & Shiny) Conjunctival Xerosis

15. It is Triangular, pearly-white (Or yellowish) foamy spot seen on bulbar conjunctiva on either side of cornea frequently bilateral In young children, It’s a confirmed sign of Vit. A deficiency Bitot’s Spot

16. It is a serious stage Cornea becomes dry & not wettable It looks Opaque ( Instead of smooth & Shiny) This is ir-reversible condition If it’s treated, then also it heals with a scar & affect vision Corneal Xerosis & Ulcer

17. It means liquification of cornea It is a grave medical emergency Cornea becomes soft & may burst open (..& it’s rapid process) If eye collapse, Vision is permanently lost This is major cause of blindness in INDIA Keratomalasia

18. Prevalence in age group of 6 months – 6 Years) Night Blindness - > 1 % ( 100 / 10000 ) Bitot’s Spot - > 0.01 % ( 1 / 10000 ) Keratomalasia - > 5 % ( 500 / 10000 ) Corneal Ulcer - > 0.05 % ( 5 / 10000 ) Conjunctival Xerosis - > 0.5 % ( 50 / 10000 )

19. < 1% Kerala, Meghalaya, Sikkim 1-3% Andhra Pradesh, Karnataka, Manipur, Punjab, Chandigarh 3-6% Haryana, Himachal, J&K, Maharashtra, Tamilnadu, Delhi, Goa, > 6% Assam, Madhya Pradesh, Rajasthan, Uttar pradesh, Bihar, Gujarat

20. Prevention Improve diet of people by dietory Advise Reduce contributory factors i.e. PEM, RTI, Diarroea, Measels Immunisation against Vit. A deficiency… ..That’s 6 monthly administration of Vit. A doses in children (Study proved that decrease in Xerophthalmia incidence by 80% than previous)

21. Toxicity Nausea, Vomiting, Anorexia Sleep disorders Enlarged Liver, Papillar oedema Colouring of plasma & Skin

23. 1 st Dose must be given with Measels at complited 9 months of age Only 2 nd to 9 th Dose (Total 8 Doses) in Biannual round

24. What is Biannual round of Vitamin A ? Twice in a year Only during month of February & August 2 nd to 9 th doses (8 Doses only ) Each dose of 2,00,000 IU (2 ml)

25. Vitamin A Annual workload calculation Workload for 1 st dose = workload for Measels Workload for 2nd dose = workload for Measels Workload for 3rd dose = workload for Measels Workload for 4th dose = workload for Measels Workload for 5th dose = workload for Measels Workload for 6th dose = workload for Measels Workload for 7th dose = workload for Measels Workload for 8th dose = workload for Measels Workload for 9th dose = workload for Measels

26. Vitamin A Annual workload calculation Workload for 2nd to 9 th dose = workload for Measels X 8 (Annual)

27. Vitamin A Biannual workload calculation Workload for 2nd to 9 th dose = workload for Measels X 4 (For round of February) Workload for 2nd to 9 th dose = workload for Measels X 4 (For round of August)

28. Vitamin A Annual requirement calculation Workload for 1st dose (Requirement in ml.) X 1 ml. Workload for 2nd to 9 th dose X 2 ml. +

29. Vitamin A Annual requirement calculation Workload for 1st dose X 1 ml. Workload for 2nd to 9 th dose X 2 ml. + = Workload of measels. = Workload of measels X 8 = Workload of measels X 1 = Workload of measels X 16 + = Workload of measels X 17 (in ml.) (in ml.)

30. = Workload of measels X 17 (in ml.) = Workload of measels X 0.17 (in Bottles) Requirement of Vit A Solution Workload of Vit A 1 st dose = Workload of measels Workload of Vit A - 2 to 9 dose = Workload of measels X 8 All are Annual For Each Biannual round >> Devide it by TWO

31. End of the Vitamin A Training THE BIGGINING.. of your work