This document discusses vitamin A deficiency, its causes, effects, and prevention through supplementation programs in India. It notes that vitamin A is essential for vision, immunity, growth and reproduction. Deficiency can lead to increased infections and blindness in children. India has a high prevalence of deficiency, especially in preschoolers and pregnant women. The national prophylaxis program aims to prevent blindness through supplementation of vitamin A to children from 9 months to 5 years at doses of 100,000 IU every 6 months. Food fortification and dietary diversification can also help prevent deficiency. Regular supplementation is important as vitamin A stores deplete within 4-6 months.

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
o 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.
o 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.
o 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

23. 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_________________

24. References
• WHO. Vitamin A deficiency list of publications.
(http://www.who.int/nutrition/publications/micronutrients/vit
amin_a_deficiency/en/
• http://nhm.gov.in/images/pdf/programmes/child-
health/guidelines/goi_vit_a.pdf
• http://nutritionfoundationofindia.res.in/pdfpublication/Nutriti
on%20Transition%20in%20india1947-
2007/7.11.2%20Vitamin%20A%20Deficiency%20pr%20m
ap.pdf

25. Make sure to administer VitaminA to all your children and do
consume VitaminA rich foods in your diet and stay Healthy.
Thank You
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