Vitamin A deficiency (VAD) is a public health problem in many low- and middle-income countries. A lack of vitamin A weakens the immune system, putting a child at greater risk of disease and early death, and is also the leading cause of preventable child blindness.

Maternal VAD is also a problem in many countries, resulting in night blindness during pregnancy and babies born vitamin A-deficient.

Increasing access and intake of vitamin A-rich foods among vulnerable populations is necessary to reduce VAD, including through fortified foods. While efforts are made to improve the diet, vitamin A supplementation (VAS) has been proven effective in reducing the impact of VAD, particularly among children six months to five years of age.

Evidence in the late 1980s demonstrated clear links between VAD and increased risk of mortality, and studies that delivered high dose VAS to deficient children reported an associated reduction in deaths of children under five. VAS quickly became a cornerstone of strategies designed to improve child survival and is an intervention recommended by the World Health Organization in settings where VAD is a public health problem.

For 30 years, Nutrition International, with significant investment from the Government of Canada, launched and sustained a global VAS program, making gains in child survival and helping bring together key international stakeholders to:

• Recommend and guide new policy
• Develop industry production standards for high-dose vitamin A capsules
• Support annual procurement of vitamin A capsules for more than 70 high-burden countries
• Support vitamin A capsule distribution as part of an integrated packages of child survival interventions

We assure the availability of high-quality vitamin A capsules globally and provide delivery support in our core countries. Our approach includes:

• Improving the manufacturing quality standard of vitamin A capsules
• Organizing and coordinating global procurement and distribution of donated capsules
• Improving local health system capacity to deliver vitamin A to children under five
• Innovating to improve coverage for hard-to-reach children

We are committed to supporting VAS programs for children six months to five years of age, which is one of the most cost-effective ways to improve child survival. One vitamin A capsule costs only two cents to manufacture and is delivered through existing child health and nutrition programs, such as immunization or other routine preventive health and nutrition services.

Leaders in vitamin A supplementation

In countries where vitamin A deficiency remains a public health problem, supplementing children between the ages of six months and five years of age with two doses of vitamin A per year:

• Reduces morbidity and mortality in children affected by VAD:
  • Mortality:
    • 12-24% reduction in overall risk of death
    • 12% reduction in death due to diarrhoea
  • Morbidities:
    • 15% reduced incidence of diarrhoea
    • 50% reduced incidence of measles

• Reduces the chance of children under five dying by up to 12%
• Reduces the incidence of diarrhoea by 15%
• Reduces the odds of child stunting

Leveraging and adapting existing delivery platforms to achieve high coverage

Since the early 1990s, together with our partners, we have helped governments leverage existing delivery platforms, including National Polio Immunization Day campaigns, to cost-effectively achieve high coverage of all eligible children.

Where polio programs have been scaled back, biannual Child Health Days were established to deliver an integrated package of essential preventive child survival services with VAS as its cornerstone. Child Health Days, often delivered as a twice-yearly campaign, regularly achieve high two-dose coverage in countries where routine health systems are not currently reaching large numbers of children six to 59 months of age.

Where local conditions permit, we support governments in integrating VAS into their routine health contacts, and extend the lifesaving preventive services to older children, the ones often not reached past the age of completing their immunizations.