Routine vitamin A supplementation for the prevention of blindness due to measles infection in children

Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 04/2011; 4(4):CD007719. DOI: 10.1002/14651858.CD007719.pub2
Source: PubMed


Annually 500,000 children become blind worldwide, 75% of them living in low-income countries. The major causes of blindness in children vary widely from region to region and are related to the standard of living of the community. Corneal scarring from measles, vitamin A deficiency, use of harmful traditional eye remedies and ophthalmia neonatorium (newborn conjunctivitis) are the major causes in low-income countries. Vitamin A is an important nutrient in the body and is required for the normal functioning of the eye. Its deficiency results in poor vision. Measles infection in children has been associated with vitamin A deficiency and blindness. The control of blindness in children is considered a high priority within the World Health Organization's VISION 2020 The Right to Sight Program. Studies have reported the beneficial effect of vitamin A in reducing morbidity and mortality in children with measles. This review examined vitamin A use in preventing blindness in children infected with measles without features of vitamin A deficiency. We included two randomised controlled trials of moderate quality, including 260 children with measles comparing vitamin A with placebo. Two doses of vitamin A given on two consecutive days to hospitalised children with measles significantly increased the blood concentration of vitamin A after one week. However, there is a limitation in that neither of the two included studies reported blindness or other ocular morbidities as end points in children infected with measles. The sample size of the included studies was also relatively small which could affect the precision of the estimates given. Also no adverse event was reported in the included studies. We do not have sufficient evidence to demonstrate the benefit or otherwise of vitamin A in the prevention of blindness in children infected with measles. The evidence is current to March 2013.

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    ABSTRACT: Vitamin A deficiency (VAD) is an important public health problem worldwide that contributes significantly to the global burden of disease. Vitamin A deficiency disorders include xerophthalmia and increased risk of infectious diseases, both of which increase risk of mortality. Xerophthalmia is also a leading cause of preventable blindness. Areas with highly prevalent VAD often share common dietary and other environmental exposures, including poverty, infectious diseases, limited development and poor availability of vitamin A containing food. Globally, the prevalence of VAD has been declining, which may be due to widespread vitamin A supplementation in conjunction with measles immunisation in at-risk populations. Recent meta-analyses confirm that provision of vitamin A to children aged between 6 months and 5 years confers a significant mortality benefit. Further preventative measures for VAD comprise improving availability of vitamin A containing food, including foods biofortified with vitamin A. Ensuring vitamin A is available in any form in adequate quantities remains problematic, especially in areas affected by environmental catastrophes and conflict, and other areas where access to vitamin A containing foods and healthcare interventions is limited. Hence, it remains essential that maternal and child health workers remain vigilant for VAD in nutritionally vulnerable populations.
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    ABSTRACT: Vitamin A deficiency (VAD) is an important cause of blindness and premature death. Red palm oil (RPO) is the richest food source of VA‐forming carotenoids. RPO carotenoid concentration and bioavailability were evaluated and this data used to estimate the amount of RPO needed to meet VA requirements. Amounts ranged from 6.7 to 29.2 g/d (1.5 to 6.5 tsp/d), which are easily consumed. The amount of RPO needed to supply recommended dietary intakes of VA for all 208100000 individuals most in danger for VAD worldwide for 1 y is 0.80 million metric tons, a fraction of annual world palm oil production. Despite its abundance, RPO has seldom been used for VAD prevention on a national level. Pareto charts were constructed to highlight the variables that influence the ability of RPO to prevent VAD on the national level. The most important variable by far was refining method. Most refining methods are designed to remove color and flavor from RPO, resulting in a bland product that lacks carotenoids. Thus, the important barriers to the use of RPO as a food‐based intervention to prevent VAD appear to be that: (1) RPO requires refining, limiting its profitability and availability for small farmers. (2) The goal of most refining methods is to create a low‐cost bland, odorless, and colorless fat which requires removal of carotenoids. (3) Cost, since RPO use competes with high‐dose VA supplements, which are heavily subsidized. It appears that RPO could prevent VAD in many food‐deficit countries if carotenoids were conserved during oil refining, and costs were low enough to make it an attractive alternative to nutritional supplements.
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