http://bmj.com/cgi/content/full/323/7323/1206
BMJ 2001;323:1206 ( 24 November )
News roundup
Deaths trigger fresh controversy over vitamin A programme in India
Ganapati Mudur New Delhi
Indian doctors have renewed their accusation that international agencies are
needlessly promoting the administration of vitamin A across India to all
children aged below 5 years.
Paediatricians and nutritionists launched a barrage of criticism after 14
children died and thousands fell ill last week in the north eastern state of
Assam following a vitamin A campaign supported by Unicef. Health officials are
investigating the deaths and illness amid suspicions that health workers might
have given overdoses to children during the state-wide campaign to deliver
vitamin A to three million children aged 1 to 5 years.
Unicef had replaced the traditional 2 millilitre spoons with 5 millilitre
cups to pour out vitamin A for the campaign. Health officials suspect that this
switch in the method of measuring the vitamin and the inadequate training of
health workers might have led to overdoses, but they have not ruled out
contamination or other causes. Unicef officials in New Delhi said that the cups
had been introduced because they were considered more efficient and hygienic.
They said the cups were now being withdrawn, but they added that it was
unlikely that overdoses had caused the deaths and illness. "Even a full 5
millilitre cup of vitamin A would not be lethal," a Unicef official said.
Some Indian doctors have questioned the benefits and safety of the administration
of vitamin A through the "pulse campaign" promoted by Unicef. The
campaign involves delivering the supplement to all children aged 1 to 5 years
across a state on a single day. The Indian health ministry has had a vitamin A
programme running for more than three decades that covers children aged 9
months to 3 years and is linked to immunisation. However, less than 30% of
target children in India receive even one dose of vitamin A.
Paediatricians are urging more selective use of vitamin A because child
nutrition has improved and clinical signs of vitamin A deficiency, such as
symptoms of eye disease, are becoming less common. However, Unicef maintains
that symptoms of eye disease are associated with advanced vitamin A deficiency
and that children might be needlessly put at risk of impaired immune function
and fatal infections long before such symptoms appear.
Paediatricians reject that argument. "There is no clinching evidence to
show reduction in mortality through vitamin A among children with subclinical
vitamin A deficiency," said Dr Harsh Pal Singh Sachdev, professor of
paediatrics and clinical epidemiology at the Maulana Azad Medical College, New
Delhi, and editor of the journal Indian Pediatrics.
A technical consultation initiated by the health ministry last year
concluded that existing data were not sufficiently robust to recommend vitamin
A supplementation to reduce mortality in children aged 1 to 5 years. "The
promotion of the universal distribution of vitamin A is a glaring example of the
commercial exploitation of malnutrition in developing countries by
pharmaceutical companies," said Dr Umesh Kapil, additional professor of
human nutrition, All India Institute of Medical Sciences, New Delhi.
The Nutrition Society of India has warned that the Assam episode will lead
to an erosion of public confidence in government healthcare programmes and
might even cause a serious setback to the pulse poliomyelitis campaign.
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Rapid Response responses to
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responses
Over dose of Vitamin A and possible hypercalcemia
Padmanabhan Badrinath, Clinical
Assistant Professor & Hon Consultant in Preventive Medicine , Department
of Community Medicine, UAE University, PO Box 17666, Al-Ain, UAE
bmj.com, 22 Nov 2001 [Response]
Where did it go wrong?
Dr. Lalitha D'Souza, Researcher , National
Perinatal Epidemiology Unit, Institute of Health Sciences, University of
Oxford, Oxford OX3
bmj.com, 23 Nov 2001 [Response]
Administration of Massive dose of Vitamin A and
related deaths in India
Dr. Umesh Kapil, Additional
Professor , All India indsititue of Medical Sciences,New Delhi, India
bmj.com, 23 Nov 2001 [Response]
No short cuts in Public Health!!!
Dinesh Agarwal
bmj.com, 23 Nov 2001 [Response]
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