The Miss­ing In­gre­di­ent

An in­te­grated ap­proach can mit­i­gate wide­spread vi­ta­min A de­fi­ciency in Bangladesh.

Southasia - - CONTENTS - By Faizan Us­mani

Bet­ter health plan­ning


Vi­ta­min A de­fi­ciency or VAD refers to a lower than nor­mal level of vi­ta­min A in the hu­man body. VAD causes nu­mer­ous health prob­lems such as nyc­talopia (night blind­ness), xe­roph­thalmia (ab­nor­mal dryness of the eye­balls), ker­atoma­la­cia (corneal ul­cer) and vis­ual im­pair­ment (blind­ness in both eyes).

Be­sides caus­ing eye-re­lated dis­eases, VAD di­min­ishes the hu­man abil­ity to fight sev­eral types of in­fec­tions (e.g. measles), causes se­vere com­pli­ca­tions dur­ing preg­nancy and lac­ta­tion pe­ri­ods and also con­trib­utes to ma­ter­nal mor­tal­ity.

Even a mild de­fi­ciency of vi­ta­min A de­vel­ops many health prob­lems in chil­dren, such as di­ar­rheal and res­pi­ra­tory in­fec­tions, slow bone de­vel­op­ment, low growth rate and a low chance of sur­vival from se­ri­ous ill­ness.

In many de­vel­op­ing coun­tries, the preva­lence of night blind­ness is high among preg­nant women with vi­ta­min A de­fi­ciency. As per sta­tis­tics re­leased by

the World Health Or­ga­ni­za­tion (WHO), VAD is rare in de­vel­oped coun­tries and is com­mon in de­vel­op­ing and un­der­de­vel­oped coun­tries, mostly in South­east Asia and Africa, af­fect­ing about one third of chil­dren un­der the age of five. In th­ese re­gions, around 250,000 to 500,000 mal­nour­ished chil­dren un­der five be­come blind ow­ing to VAD each year and more than 670,000 chil­dren die within a year of be­com­ing blind.

A lead­ing cause of pre­ventable blind­ness among chil­dren, vi­ta­min A de­fi­ciency is cru­cial to achiev­ing the UN Mil­len­nium De­vel­op­ment Goal 4, which is to re­duce child mor­tal­ity by two-thirds. Held in New York in May 2012, the United Na­tions Spe­cial Ses­sion on Chil­dren also set a goal to elim­i­nate VAD by 2010, but could not achieve it. In 2013, around 65 per­cent of chil­dren aged 6 to 59 months were given two doses of vi­ta­min A un­der the UN vac­ci­na­tion pro­gram. Liv­ing in the least de­vel­oped coun­tries, 80% of th­ese chil­dren were fully pro­tected against VAD dur­ing that pe­riod.

In Bangladesh, sev­eral stud­ies have been car­ried out to de­ter­mine the preva­lence of vi­ta­min A de­fi­ciency among dif­fer­ent pop­u­la­tion groups. The In­ter­na­tional Cen­tre for Di­ar­rhoeal Dis­ease Re­search and UNICEF con­ducted a joint sur­vey there in 20112012, which re­vealed that more than 75 per per­cent of preschool chil­dren in the cou coun­try suf­fered from some form of VAD.

Base Based on the preva­lence of night blindne blind­ness in preschool chil­dren, some stud­ies have pos­i­tively shown that the over­all rate of de­fi­ciency in Bangladesh im­prove im­proved from 3.6% in 1982-83 to 1.78% in 1989 and 0.6% in 1996. How­eve How­ever, the Na­tional Nutri­tion Sur­vey in 2012 re­vealed a high preva­lence of sub­clini sub­clin­i­cal vi­ta­min A de­fi­ciency as one of the m ma­jor pub­lic health con­cerns in Banglad Bangladesh.

In a hu­man body, low lev­els of serum retinol de­ter­mine sub­clin­i­cal vi­ta­min A de­fi­ciency. Based on this med­ica med­i­cal stan­dard, many re­ports in­di­cate that the rate of night blind­ness among ado­les­centsdl and schoolage chil­dren is quite high in ru­ral Bangladesh, whereas night blind­ness among ru­ral women is nearly 1.5%. In dif­fer­ent pop­u­la­tion groups in the coun­try, di­etary in­take of vi­ta­min A is found to be below the RDI (Rec­om­mended Daily In­take). RDI is the daily in­take level of a nu­tri­ent which must be taken in ad­e­quate amounts by ev­ery man and woman to meet the ba­sic re­quire­ments.

In 1973, the govern­ment of Bangladesh ini­ti­ated a na­tion­wide ‘Nu­tri­tional Blind­ness Pro­gramme’ to mit­i­gate the grow­ing rate of vi­ta­min A de­fi­ciency. Un­der the pro­gramme, chil­dren from 6 months to 6 years old were pro­vided with vi­ta­min A cap­sule (VAC) sup­ple­ments. Nutri­tion education was also pro­vided to fam­i­lies and health care providers in or­der to in­crease the con­sump­tion and pro­duc­tion of vi­ta­min A-rich foods. The pri­mary health care work­ers were also given spe­cial train­ing on how to di­ag­nose and treat VAD.

Ac­cord­ing to the Na­tional Vi­ta­min A Cam­paign of 2013, Bangladesh faces some key chal­lenges to ad­dress VAD and other mi­cronu­tri­ent de­fi­cien­cies. For ex­am­ple, weak mon­i­tor­ing sys­tem and in­ap­pro­pri­ate tar­get-set­ting at sub-district level re­sult in un­ex­pected cov­er­age in some ar­eas. There are gaps be­tween ad­min­is­tra­tive cov­er­age re­ports and sur­vey cov­er­age re­ports, while it is dif­fi­cult to reach those chil­dren who live in the most re­mote and de­prived com­mu­ni­ties, ac­cord­ing to cam­paign re­sults.

Since 1988, the New York-based He­len Keller In­ter­na­tional Cen­tre has been run­ning a com­mu­nity-based pro­gramme in dif­fer­ent parts of Bangladesh to pro­duce such foods that are for­ti­fied with vi­ta­min A, as a long-term strat­egy to mit­i­gate vi­ta­min A de­fi­ciency, par­tic­u­larly among chil­dren and women.

Vi­ta­min A is nat­u­rally found in such com­monly avail­able foods as trop­i­cal fruits, win­ter squashes, sweet pota­toes, dried apri­cots, dark leafy greens, cab­bage, beetroot, can­taloupe, let­tuce, bell pep­pers, car­rots, liver, and fish.

Head­quar­tered in Malaysia, World­Fish is a global, non-profit re­search or­ga­ni­za­tion that is work­ing to re­duce global poverty and hunger by har­ness­ing the po­ten­tial of aqua­cul­ture and fish­eries. Craig Meisner, the Coun­try Di­rec­tor of World­Fish Bangladesh, says, “In Bangladesh, the mola fish rep­re­sents a low-cost, lo­cally-sourced food that can dra­mat­i­cally im­prove nutri­tion and health for a ma­jor sec­tion of the pop­u­la­tion. Eat­ing mola, a small in­dige­nous fish, can give sub­stan­tial health ben­e­fits, par­tic­u­larly in pre­vent­ing dis­eases caused by vi­ta­min A de­fi­ciency.”

Ac­cord­ing to re­search con­ducted by the Univer­sity of Copen­hagen and the Bangladesh Agri­cul­tural Univer­sity, the mola fish, also known as the ocean sun­fish, can be cul­ti­vated in ponds to in­crease to­tal fish yield man­i­fold as well as the nu­tri­tional qual­ity of the yield.”

Dr. Shakun­tala Haraks­ingh Thilstead, who is a se­nior nutri­tion sci­en­tist at the World­Fish Cen­ter, says, “The Bangladesh govern­ment should pro­mote the cul­ture of mola to in­crease the fre­quency and quan­tity of mola con­sump­tion — there is a great po­ten­tial for this, as Bangladesh has over four mil­lion house­hold ponds in which mola can be cul­tured.”

Sham­sun­na­har Nahid, a se­nior nutri­tion con­sul­tant at the Bangladesh In­sti­tute of Re­search and Re­ha­bil­i­ta­tion for Di­a­betes, En­docrine and Meta­bolic dis­eases, says mola is a great source of cal­cium, pro­tein and vi­ta­min B, and is es­sen­tial for growth in chil­dren. “If mola fish cul­ture is pro­moted na­tion­wide through proper cam­paigns, that would be a huge con­tri­bu­tion to­wards end­ing mal­nu­tri­tion,” she says.

Dr. Ahmed is a se­nior re­searcher as­so­ci­ated with the In­sti­tute of Nutri­tion and Food Sci­ence at the Univer­sity of Dhaka. He says, “Bangladesh needs a more ap­pro­pri­ate mix of in­ter­ven­tions for the en­tire pop­u­la­tion to im­prove the sit­u­a­tion of vi­ta­min A de­fi­ciency. More op­er­a­tional re­search and eval­u­a­tion are needed if a fully ef­fec­tive pro­gramme to al­le­vi­ate the prob­lem of vi­ta­min A de­fi­ciency is to be de­vel­oped. To achieve the goal of vir­tual elim­i­na­tion of vi­ta­min A de­fi­ciency will re­quire an in­te­grated ap­proach which brings to­gether ap­pro­pri­ate ac­tions at ev­ery level within and across the many sec­tors of so­ci­ety.”

Be­sides run­ning short and long-term VAD con­trol and preven­tion pro­grammes, the govern­ment of Bangladesh needs an in­te­grated ap­proach to tackle grow­ing health con­cerns re­lated to the vi­ta­min A de­fi­ciency. To achieve the goal, a mass pub­lic aware­ness pro­gramme is nec­es­sary which will help the peo­ple re­alise the sig­nif­i­cance of vi­ta­min A and how to grow vi­ta­min A rich foods on their own.

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