Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T13:09:20.812Z Has data issue: false hasContentIssue false
  • English
  • Français

Vitamin A deficiency in Bangladesh: a review and recommendations for improvement

Published online by Cambridge University Press:  02 January 2007

Faruk Ahmed
Faruk Ahmed*
Affiliation:
Institute of Nutrition and Food Science, University of Dhaka, Dhaka-1000, Bangladesh
*
*Corresponding author: Email duregstr@bangla.net
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

This article provides a comprehensive review of the change in vitamin A status and the extent of vitamin A deficiency among different population groups in Bangladesh up to the present time. The result of experience with different strategies and interventions designed to improve vitamin A status are then reviewed, leading to a discussion of key options for action, as well as important areas for research and evaluation.

Design and setting:

All the available data have been examined in detail, including data from nationally representative samples and nationwide surveys, as well as small studies in different population groups. Reports on the effectiveness of different intervention programmes have been used.

Results:

Over the past three decades a number of studies, which include national nutrition surveys, have been carried out to investigate the prevalence of vitamin A deficiency among different population groups in Bangladesh, and they have demonstrated a significant public health problem. Studies have shown that the prevalence of severe deficiency, based on the prevalence of night blindness in preschool children, decreased from 3.6% in 1982–83 to 1.78% in 1989 and 0.6% in 1996. However, there is still a high prevalence of subclinical vitamin A deficiency, based on the biochemical assessment of serum retinol levels in preschool children, estimated mainly from hospital-based groups. Night blindness and Bitot's spot are also found to exist among school-age children and adolescents. Recent reports indicate that night blindness among rural mothers is as high as 1.4%. Only a limited number of studies, with small sample sizes, are available where serum retinol has been reported for school-age children, adolescents and pregnant women. Nevertheless, these studies confirm the presence of low levels of serum retinol and hence, the existence of subclinical vitamin A deficiency. Furthermore, the dietary intake of vitamin A in each population group has been found to be less than the Recommended Daily Allowance (RDA), indicating a significant risk of deficient intakes of vitamin A.

To address the problem of vitamin A deficiency, the government of Bangladesh started the Nutritional Blindness Programme in 1973. The main activities of the programme include vitamin A capsule (VAC) supplementation to children of 6 months to 6 years old, nutrition education to increase the production and consumption of vitamin A rich foods, and training of primary health-care workers on the clinical diagnosis and treatment of vitamin A deficiency, VAC distribution and nutrition education. Since 1988, as a long-term strategy, Helen Keller International has been implementing community home gardening promotion projects. To date, the possibility that foods may be fortified with vitamin A, has not been explored as a possible approach in Bangladesh.

Conclusion:

Although short- to long-term prevention and control programmes are to some extent in place, to improve the situation of vitamin A deficiency, Bangladesh needs a more appropriate mix of interventions for the entire population. More operational research and evaluation are needed if a fully effective programme to alleviate the problem of vitamin A deficiency is to be developed. Finally, 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.

Keywords

Vitamin ABangladeshProgrammesReviewInterventions
Type
Research Article
Information
Public Health Nutrition , Volume 2 , Issue 1 , January 1999 , pp. 1 - 14
Copyright
Copyright © CABI Publishing 1999

References

1McLaren, DS, Frigg, M. Sight and Life Manual on Vitamin A Deficiency Disorders (VADD). Basel, Switzerland: Task Force Sight and Life, 1997.Google Scholar
2Blomhoff, R, Green, MH, Norum, KR. Vitamin A metabolism: new perspectives on absorption, transport, and storage. Physiol. Rev. 1991; 71: 951–90.CrossRefGoogle ScholarPubMed
3Sommer, A, West, KP Jr. Vitamin A Deficiency: Health, Survival and Vision. New York: Oxford University Press, 1996.Google Scholar
4WHO Expert Group. Vitamin A Deficiency and Xerophthalmia. Tech. Rep. Ser. No. 590. Geneva: WHO, 1982.Google Scholar
5WHO. Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring and Evaluating Intervention Programmes. Geneva: WHO, 1996.Google Scholar
6WHO. Global Prevalence of Vitamin A Deficiency. WHO, Micronutrient Deficiency Information System (MDIS) Working Paper No. 2. WHO/UNICEF. Doc. WHO/NUT/95. 3. Geneva: WHO, 1995.Google Scholar
7Udomkesmalee, E. Vitamin A deficiency in Asia. Vital News 1992; 3(3): 1–5.Google Scholar
8Upadhyay, MP, Gurung, BJ, Pillai, KK, Nepal, BP. Xerophthalmia among Nepalese Children. Am. J. Epidemiol. 1985; 121: 71–7.Google Scholar
9Gopaldas, T. Vitamin A deficiency beyond the preschool years. In: West, KP Jr, ed. Rapporteur. Bellagio Meeting on Vitamin A Deficiency and Childhood Mortality. New York: Helen Keller International, 1992.Google Scholar
10Mandal, GS, Nanda, KN, Bose, J. Night blindness in pregnancy. J. Obstet Gynecol. India 1969; 19: 453–8.Google Scholar
11Katz, J, Khatry, SK, West, KP Jr et al. Night blindness during pregnancy and lactation in rural Nepal. J. Nutr. 1995; 125: 2122–7.CrossRefGoogle ScholarPubMed
12UNDP. The Dancing Horizon. Human Development Prospects for Bangladesh. UNDP, 1997.Google Scholar
13UNICEF. The State of the World's Children 1997. Oxford: Oxford University Press, 1997.Google Scholar
14 US-DHEW. Nutrition Survey of East Pakistan, March 1962–January 1964. United States Department of Health, Education and Welfare, Public Health Service, 1966.Google Scholar
15Kamel, WWAssignment Report on Blindness Prevention Programme, Bangladesh. New Delhi: WHO, 1972.Google Scholar
16INFS. Nutrition Survey of Rural Bangladesh, 1975–76. Dhaka, Bangladesh; Institute of Nutrition and Food Science, University of Dhaka, 1977.Google Scholar
17INFS. Nutrition Survey of Rural Bangladesh, 1981–82. Dhaka, Bangladesh: Institute of Nutrition and Food Science, University of Dhaka, 1983.Google Scholar
18HKI/IPHN. Bangladesh Nutritional Blindness Study, 1982–83. Dhaka, Bangladesh: Helen Keller International and Institute of Public Health Nutrition, 1985.Google Scholar
19IPHN/UNICEF. Nutritional Blindness Prevention Programme Evaluation Report, 1989. Dhaka, Bangladesh: Institute of Public Health Nutrition and UNICEF, 1989.Google Scholar
20Khan, MU, Haque, E, Khan, MR. Nutritional occular diseases and their association with diarrhoea in Matlab, Bangladesh. Br. J. Nutr. 1984: 52: 1–9.CrossRefGoogle Scholar
21Islam, MN, Yusuf, HKM. Incidence of nightblindness in preschool children of rural Bangladesh: new risk factors Envisaged. Bangladesh J. Nutr. 1990; 3: 21–7.Google Scholar
22Saha, AR, Ahmed, K, Hossain, A. Clinical symptoms of micronutrients deficiency in two rural Bangladesh communities with and without the supply of safe drinking water. Bangladesh. J. Nutr. 1991; 4(2): 1–7.Google Scholar
23Sikder, ZU, Henry, FJ, Hussain, M, Rahman, M. Xerophthalmia malnutrition and diarrhoea in urban Bangladesh: a clinic based study. Indian Pediatr. 1988; 25: 946–51.Google ScholarPubMed
24Mahalanabis, D. Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case–control study. Br. Med. J. 1991; 303: 493–6.CrossRefGoogle ScholarPubMed
25HKI. Nutrition Surveillance Project, Report of Round 41. Dhaka: Helen Keller International, 1996.Google Scholar
26Brown, KH, Rajan, MM, Chakraborty, J, Aziz, KMA. Failure of a large dose of vitamin A to enhance the antibody response to tetanus toxoid in children. Am. J. Clin. Nutr. 1980; 33: 212–17.Google Scholar
27Stoll, BJ, Banu, H, Kabir, I, Molla, A. Nightblindness and vitamin A deficiency in children attending a diarrhoeal disease hospital in Bangladesh. J. Trop. Pediatr. 1985; 31: 36–9.Google Scholar
28Molla, A, Islam, A, Molla, AM, Jahan, F. Change in serum vitamin A concentration after an oral dose in children with acute diarrhoea. J. Pediatr. 1983; 103(6): 1000–2.Google Scholar
29Henning, B, Stewart, K, Zaman, K, Alam, AN, Brown, KH, Black, RE. Lack of therapeutic efficacy of vitamin A for non-cholera, watery diarrhoea in Bangladeshi children. Eur. J. Clin. Nutr. 1992; 46: 437–43.Google Scholar
30Rahman, MM, Mahalanabis, D, Wahid, MA, Islam, MA, Habte, D. Administration of 25,000 IU vitamin A doses at routine immunization in young infants. Eur. J. Clin. Nutr. 1995; 49: 439–45.Google Scholar
31Wahid, MA, Alvarez, JO, Rahman, MM, Hussain, M, Jahan, F, Habte, D. Subclinical vitamin A deficiency in young infants in Bangladesh. Nutr. Res. 1997; 17: 591–8.Google Scholar
32Brown, KH, Black, RE, Becker, S, Nahar, S, Sawyer, J. Consumptions of foods and nutrients by weanling in rural Bangladesh. Am. J. Clin. Nutr. 1982; 36: 878–89.Google Scholar
33Hussain, A, Kvale, G, Odland, M. Diagnosis of night blindness and serum vitamin A level: a population based study. Bull. WHO 1995; 73: 469–76.Google Scholar
34Ahmed, F, Khan, MR, Mohiduzzaman, M, Shaheen, N, Barua, S, Bhuyan, MAH. Relationship between growth and nutrient status in school children of Urban Bangladesh. In: Said, HM, Rahman, MA, Abdulla, M, Vohora, SB, Athar, M, eds Elements and Liver: Proceedings of the International Symptoms on Trace Elements and Liver Diseases. Karachi, Pakistan: Hamdard Foundation, pp–26–33, 1996.Google Scholar
35Ahmed, F, Khan, MR, Karim, R, et al. Serum retinol and biochemical measures of iron status in adolescent schoolgirls in urban Bangladesh. Eur. J. Clin. Nutr. 1996; 50: 346–51.Google Scholar
36Ahmed, F, Hasan, N, Kabir, Y. Vitamin A deficiency among adolescent female garment factory workers in Bangladesh. Eur. J. Clin. Nutr. 1997; 51: 698–702.Google Scholar
37Ahmed, F, Khan, MR, Kabir, I, Fuch, G. Interrelationship between anthropometric indices, vitamin A and iron status in adolescent girls. Report of the PCC-Collaborative Research Project. Dhaka: ICDDR, B, 1997.Google Scholar
38Hassan, N, Barua, S. Nutrition profile of the orphans: a case study in the Dhammarajika Orphanage of Dhaka city. Bangladesh J. Nutr. 1990; 3: 43–53.Google Scholar
39Sarker, BR, Abdullah, M, Sarker, SK. Dietary intake pattern among Bangladesh female workers in garment factories and their health problem. Bangladesh J. Nutr. 1993; 6: 73–8.Google Scholar
40Huq, SF. Nutritional profile and prevalence of anaemia in female garment workers. M.Sc. thesis. University of Dhaka, Dhaka, Bangladesh, 1994.Google Scholar
41Ali, SMK, Islam, K, Pramanik, MA, Bhuiyan, NH, Begum, NN. Availability of nutrients for adolescent girls. Bangladesh J. Nutr. 1994; 7: 13–17.Google Scholar
42Ahmed, F, Zareen, M, Khan, MR, Banu, CP, Haq, MN, Jackson, AA. Dietary pattern, nutrient intake and growth of adolescent school girls in urban Bangladesh. Publ. Health. Nutr. 1998; 1(2): 83–92.CrossRefGoogle ScholarPubMed
43Ahmed, F, Khandaker, MAI. Dietary pattern and nutritional status of Bangladeshi manual workers (Rickshaw pullers). Int. J. Food Sci. Nutr. 1997; 48: 285–91.Google Scholar
44Nahar, L, Huq, SF, Barua, S, Islam, MS. Vitamin A and iron status amongst female garment workers. Dhaka Univ. J. Biol. Sci. 1995; 4: 119–24.Google Scholar
45Bloem, MW, Huq, N, Gorstein, J et al. Production of fruits and vegetables at the homestead is an important source of vitamin A among women in rural Bangladesh. Eur. J. Clin. Nutr. 1996; 50 (suppl. 3), S62–7.Google Scholar
46Sultana, S, Nahar, B, Quazi, S. Dietary intake of micronutrients in normal state and during pregnancy. Bangladesh J. Nutr. 1990; 4(1): 19–25.Google Scholar
47Barua, S, Begum, R. Birth weight in relationship with the level of vitamin A and alpha-tocopherol in cord and maternal serum. Bangladesh J. Nutr. 1996; 9: 41–9.Google Scholar
48Hasin, A, Begum, R, Khan, MR, Ahmed, F. Relationship between birth weight and biochemical measures of maternal nutritional status at delivery in Bangladeshi urban poors. Int. J. Food. Sci. Nutr. 1996; 47: 273–9.Google Scholar
49Barua, S, Tarannum, S, Nahar, S, Mohiduzzaman, M. Retinol and alpha-tocopherol content in breast milk of Bangladeshi mothers under low socio-economic status. Int. J. Food. Sci. Nutr. 1997; 48: 13–18.Google Scholar
50Roy, SK, Islam, A, Molla, A, Akramuzzaman, SM, Jahan, F, Fuchs, G. Impact of a single megadose of vitamin A at delivery on breastmilk of mothers and morbidity of their infants. Eur. J. Clin. Nutr. 1997; 51: 302–7.CrossRefGoogle ScholarPubMed
51HKI. Vitamin A capsule distribution; trends in Bangladesh. Dhaka: Nutritional Surveillance Project, Helen Keller International, 1996.Google Scholar
52Bloem, MW, Hye, A, Wijnroks, M, Ralte, A, West, KP Jr, Sommer, A. The role of universal distribution of vitamin A capsules in combating vitamin A deficiency in Bangladesh. Am. J. Epidemiol. 1995; 142: 843–55.Google Scholar
53 BINP. Project Monitoring Report, October 1997. Bangladesh Integrated Nutrition Project, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, 1997.Google Scholar
54Greiner, T. Report to SIDA on Two Different Nutritional Blindness Prevention Programmes in Bangladesh. Uppsala University, Sweden: International Child Health Unit, 1993.Google Scholar
55Levin, HM, Pollitt, E, Galloway, R, McGuire, J. Micronutrient deficiency disorder. In: Jamison, DT, Mosley, WH, eds Disease Control Priorities in Developing Countries. World, Bank, 1991.Google Scholar
56HKI. Gardens for Bangladesh. Dhaka, Bangladesh: Helen Keller International, 1996.Google Scholar
57Hussain, R, Chowdhuri, MA, Quadir, A. ABC Study to Assess the Feasibility of Vitamin A Fortification of Sugar and Edible Oil in Bangladesh for Prevention of Blindness. Dhaka: Assistance for Blind Children.Google Scholar
58Greiner, T, Mitra, SN. Evaluation of the impact of food-based approach to solving vitamin A deficiency in Bangladesh. Food Nutr. Bull. 1995; 16(3): 193–205.Google Scholar