Polio as a Platform: Using National Immunization Days to Deliver Vitamin A Supplements

By Goodman, Tracey; Dalmiya, Nita et al. | Bulletin of the World Health Organization, March 2000 | Go to article overview

Polio as a Platform: Using National Immunization Days to Deliver Vitamin A Supplements


Goodman, Tracey, Dalmiya, Nita, de Benoist, Bruno, Schultink, Werner, Bulletin of the World Health Organization


Introduction

In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 in ways "which strengthen national immunization programmes and health infrastructure"(1). It is believed that efforts to achieve polio eradication can be a platform for the delivery of other health interventions and for strengthening health systems overall. The successful use of national immunization days (NIDs) to deliver vitamin A clearly shows how this can be done.

The present article reviews the disease burden caused by vitamin A deficiency (VAD), explains how polio NIDs have been used to accelerate progress towards the goal of eliminating VAD, and highlights the critical factors for success, the benefits obtained and the constraints encountered. The platform components provided by NIDs for other preventive child health interventions, and future prospects are outlined.

Disease burden attributable to vitamin A deficiency

The disease burden associated with micronutrient deficiency, or hidden hunger as it is sometimes called, is widely recognized. The World Summit for Children in 1990 and the International Nutrition Conference in 1992 laid down goals and timelines for protecting the world's children from such deficiency. Among the goals was the elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000 (2, 3).

It is considered that VAD exists as a problem of public health significance in varying degrees in 118 countries (Table 1) (4). The highest prevalence of clinical VAD occurs in Africa, while South-East Asia has the highest number of children affected. Clinical VAD, involving signs and symptoms of eye damage and xerophthalmia, affects 3 million children globally. However, the full magnitude of VAD often remains hidden: it is estimated that 140-250 million children under 5 years of age are at risk of subclinical VAD (4, 5); they show none of the ocular signs or symptoms, but have a markedly increased risk of illness and death, particularly from measles and diarrhoea. Annually, VAD causes blindness in 250 000-500 000 children (6) and is a major factor contributing to 1-3 million child deaths (7).

Table 1. Countries and territories categorized according to degree of public

health importance of vitamin A deficiency, by WHO region (information available to WHO in January 2000)

WHO Region     Clinical                 Subclinical

                                 Severe          Moderate

African        Angola            Burundi         Botswana
Region         Benin             Cape Verde      Eritrea
               Burkina Faso      Congo           Namibia
               Cameroon          Cote d'Ivoire   Sierra Leone
               Chad              Gambia
               Comoros           Lesotho
               Ethiopia          Senegal
               Ghana
               Kenya
               Malawi
               Mali
               Mauritania
               Mozambique
               Niger
               Nigeria
               Rwanda
               South Africa
               Togo
               Uganda
               United Republic
                 of Tanzania
               Zambia
               Zimbabwe

Region of      Dominican         Brazil          Belize
the Americas     Republic        Colombia        Bolivia
               Haiti             El Salvador     Ecuador
                                 Mexico          Guatemala
                                 Nicaragua       Honduras
                                 Peru

South-         Bangladesh        Indonesia
East Asia      Bhutan            Myanmar
Region         India
               Nepal
               Sri Lanka

European       Israel
Region         Romania
               Turkey
               Uzbekistan

Eastern        Iraq              Afghanistan
Mediter-       Somalia           Pakistan
ranean         Sudan
Region         Yemen

Western        Cambodia          Lao People's
Pacific        Kiribati            Democratic
Region         Marshall            Republic
                 Islands
               Micronesia
               Papua New
               Guinea
               Philippines
               Solomon
                 Islands
               Vanuatu
               Viet Nam

WHO Region   Subclinical    No data available     No known problem
                 Mild

African      Madagascar     Algeria(b)
Region                      Central African
                              Republic(b)
                            Democratic Republic
                              of the Congo(b)
                            Equatorial
                            Guinea(b)
                            Gabon(b)
                            Guinea(b)
                            Guinea-Bissau(b)
                            Liberia(b)
                            Mauritius
                            Sao Tome and
                              Principe(b)
                            Seychelles
                            Swaziland(b)

Region of    Guyana         Argentina(b)          Antigua and
the          Panama         Cuba                    Barbuda
Americas                    Dominica(b)           Bahamas
                            Paraguay(b)           Barbados
                            Puerto Rico           Canada
                            Suriname              Chile
                            Uruguay(b)            Costa Rica
                            Venezuela(b)          Grenada
                                                  Jamaica
                                                  Saint Kitts and
                                                    Nevis
                                                  Saint Lucia
                                                  Saint Vincent and
                                                    the Grenadines
                                                  Trinidad and
                                                    Tobago
                                                  USA

South-       Thailand       Maldives(b)
East Asia                   Democratic
Region                        People's
                              Republic of
                              Korea(b)

European                    Albania(b)            Austria
Region                      Armenia(b)            Belgium
                            Azerbaijan(b)         Denmark
                            Belarus               Finland
                            Bosnia and            France
                              Herzegovina         Germany
                            Bulgaria(b)           Greece
                            Croatia(b)            Iceland
                            Czech Republic        Ireland
                            Estonia               Italy
                            Georgia               Luxembourg
                            Hungary               Monaco
                            Kazakhstan(b)         Netherlands
                            Kyrgyzstan(b)         Norway
                            Latvia                Poland
                            Lithuania             Portugal
                            Malta                 Russian
                            Republic of           Federation
                              Moldova             Spain
                            San Marino            Sweden
                            Slovakia              Switzerland
                            Slovenia              United Kingdom
                            Tajikistan(b)
                            The former
                              Yugoslav
                              Republic of
                              Macedonia(b)
                            Turkmenistan(b)
                            Ukraine
                            Yugoslavia

Eastern      Jordan         Kuwait                Bahrain
Mediter-     Lebanon        Morocco(b)            Cyprus
ranean       Libyan Arab    Qatar
Region         Jamahiriya
             Saudi Arabia
             Syrian Arab
               Republic
             Tunisia
             United Arab
               Emirates

Western      China          Cook Islands          Australia
Pacific      Malaysia       Mongolia              Brunei
Region                      Nauru                   Darussalam
                            New Zealand           Fiji
                            Niue                  Japan
                            Palau                 Republic of
                            Tokelau                 Korea
                            Tonga                 Samoa
                            Tuvalu                Singapore

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