Health and Nutrition


Factors Affecting Health



Future Challenges


Control of Vitamin-A Deficiency

© UNICEF Bangladesh
A nine month old child is given Vitamin-A drop.

Vitamin-A deficiency is a major cause of preventable blindness in children in Bangladesh. It also impairs growth, lowers resistance to infections and increases the risk of dying. In pregnant and postpartum women, Vitamin-A deficiency can have serious consequences for the health and survival of women and for the Vitamin-A status of their children. The project aims to maintain the high coverage of Vitamin-A supplementation in children aged 1–5 and to increase the coverage among children under one and postpartum mothers.

• The integration of Vitamin-A supplementation of children aged 12-59 months with NIDs has continued to maintain high coverage in children, and to maintain the prevalence of night blindness below 1 per cent.
• Vitamin-A Plus Campaign to deliver a package of health and nutrition interventions to children in Bangladesh, including Vitamin-A supplements to children aged 12-59 months. The Vitamin-A Plus Campaigns replace supplementation through the NIDs, which became annual events in 2003 and will be discontinued after 2005.
• The integration of Vitamin-A supplementation of infants aged 9-11 months when they receive the measles vaccine.
• Mechanisms for vitamin A supplementation of postpartum women: in the Chittagong Hill Tracts (CHT), para workers of Integrated Community Development Project (ICDP) and Health and Family Planning workers provide supplements to postpartum women within six weeks of delivery, and coverage data is collected within the existing EPI reporting system. This effective strategy is being replicated throughout the country.

Impact of the vitamin A project
Since 1973, the government has implemented a national programme for the control of Vitamin-A deficiency among children. This has had financial and technical support from UNICEF and financial support from CIDA, using a community-based supplementation approach with active participation of those communities.

Bangladesh has distributed Vitamin-A capsules to children aged 12-59 months twice a year since the start of the national programme. Until the mid-1990s, the distribution system relied on door-to-door distribution of Vitamin-A capsules by health workers. From 1995, the distribution of vitamin A capsules was linked with the National Immunization Day (NID) for polio at over 120,000 fixed sites in the country. This change in strategy resulted in an increase in coverage from around 45 per cent to over 80 per cent, a remarkable achievement. These impressive results led the government to implement National Vitamin-A Weeks, to distribute the other biannual Vitamin-A dose in years when only one NID was conducted. 

From 2003, a new strategy was developed, which became biannual in 2003 and will be discontinued after 2005. The Government of Bangladesh recognized that distributing multiple nutrition and health interventions would be more cost-effective than Vitamin-A supplements alone, and implemented a package of health and nutrition services for children through a national Vitamin-A Plus Campaign.

In the first campaign, in October 2003, Vitamin-A supplements were distributed to children aged 12-59 months, albendazole to children aged 24-59 months. Children in primary and secondary schools tested salt for iodine. Future Vitamin-A Plus campaigns will always include vitamin A supplementation and albendazole treatment and may include other health and nutrition interventions such as measles vaccination and dissemination of health and nutrition messages

The high coverage of Vitamin-A supplementation to children has resulted in a reduction in the prevalence of vitamin A deficiency. Since 1997, the prevalence of night blindness, an early indicator of vitamin A deficiency, has been maintained below the 1 per cent threshold that indicates a public health problem. However, it must be emphasized that vitamin A deficiency is being controlled by the Vitamin-A supplementation programme rather than being eliminated, because infants and young children still consume diets that are lacking in Vitamin-A. For this reason, the vitamin A supplementation programme must continue until production and consumption of Vitamin-A rich foods are increased. 



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