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
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
(a) Source. …