Vitamin A supplement:a key strategy to prevent vitamin A deficiency among young children in Afghanistan

Ahmad Mujtaba Barekzai ,Abdullah Sahar ,Naseer Ahmad Shinwari

1Rseach Director,Department of Public Health Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.2Vice-chancellor of students’ affairs,Faculty Member,Department of Microbiology,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.3Faculty Member,Department of Biotechnology and Microbial technology,Spinghar Institute of Higher Education,Kabul Campus,Afghanistan.4Technical Manager of Food Safety,KIC,WFP,Afghanistan.

Abstract Background:Vitamin A deficiency is the main problem of public health worldwide demonstrated that 190 million population of preschool children and 122 countries(in Africa and South-East Asia) have vitamin A deficiency,according to recent estimated research.In Afghanistan,vitamin A supplementation is a key strategy to prevent vitamin A deficiency among young children.Children receive vitamin A supplements as part of National Immunization Days (NID) campaigns.Methods:In this case study,the data was collected from June 15/2015 to February 23/2016,and the final report of the Afghanistan Demographic Health Survey (AfDHS) 2015 was released on February 15/2017.All 27,209 children aged 6-59 months who are living with their mothers were included in this study.Who consumed foods rich in vitamin A was not included in this study.Results:The percentages who were given vitamin A supplements in the last 6 months among all children 6-59 months aged.A total of 1,572 children aged among 6-8 months were given vitamin A supplements 670 (42.6%) children and comparison with the total community of the study(27,209) children (2.46%).A total of 1,148 children aged among 9-11 months were given vitamin A supplements to 465 (40.5%) children and comparison with the total community of the study (27,209) children (1.70%).Conclusion:After following up on more studies,we found that vitamin A deficiency is a public problem,thus it is better to use wheat flour fortification,vitamin A capsule (VAC) supplementation,nutrition education,source of vitamin A,and training of primary healthcare workers on the clinical to prevent and treat the vitamin A deficiency among children.Therefore,we aimed to determine the given vitamin A supplementation among children aged 6-59 months in 33 provinces in Afghanistan,in 2015.

Keywords:vitamin A deficiency;supplement;children age 6-59 months;key strategy

Introduction

Vitamin A is retinoic acid,retinol,and retinal,which helped regulate the immune system,visual system function,growth the cells function,production of red blood cells,eye problems,and decreases infectious diseases [1-3].Vitamin A deficiency is the main problem of public health worldwide demonstrated that 190 million population of preschool children and 122 countries (in Africa and South-East Asia)have vitamin A deficiency,according to recent estimated research [4,5].Cross-sectional studies revealed that 30% of children have vitamin A deficiency and 2% of deaths among those aged <5 years [6].Additionally,vitamin A deficiency is a major cause of preventable childhood might sightlessness and raises the risk of illness and death from childhood infections,with measles and those causing diarrhea[7].Vitamin A can be safe as long for children in a largesse,rather than more frequent smaller doses,as it can be stored by the body and released over time as needed [5].There are several problems,which can affect children in Afghanistan.For instance,malnutrition [8],cancers [9,10],anemia,stunting,dietary intake,and deficiency of micronutrients [11-13].As well,vitamin A deficiency is a major problem among Afghan children.Recent history of diarrheal disease,reported night blindness,maternal education less than 9 years,and infrequent consumption of eggs,mangoes,and liver were associated with increased risk of vitamin A deficiency.

To avoid vitamin deficiency among children,the Expanded Program on Immunization (EPI) has strategies focused on supplements and food fortification in the Middle East [14].In addition,when the countries facing emergencies related to vitamin A deficiency,the Expanded Program on Immunization (EPI) has provided the measles vaccine and oils fortified with vitamin A and D as a part of the food to assist reduce the risk of deficiency[15,16].

In Afghanistan,vitamin A supplementation is a key strategy to prevent vitamin A deficiency among young children.Children receive vitamin A supplements as part of National Immunization Days (NID)campaigns (MoPH 2010).The 2015 Afghanistan Demographic health Survey (AfDHS) included questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the six months before the survey [17].Therefore,we aimed to determine the given vitamin A supplementation among children aged 6-59 months in 33 provinces in Afghanistan,in 2015.

Methods

Ethical code

The study was ethically approved by the SU Ethics Committee (code:1386-1403).

Availability of data and materials

The data are not publicly available due to containing information that could compromise the privacy of research participants.

Study design

This is a cross-sectional study.

Study participants

In this case study,the data was collected from June 15/2015 to February 23/2016,and the final report of the AfDHS 2015 was released on February 15/2017.All 27,209 children aged 6-59 months who are living with their mothers were included in this study.Who consumed foods rich in vitamin A was not included in this study.The study was ethically approved by the SIHE Ethics Committee (code:1386-1403).

Sampling

The AfDHS followed a stratified two-stage sample design in urban and rural areas.The first stage involved selecting sample points (clusters)consisting of Enumeration Areas (EAs),that a total of 950 clusters were selected,260 in urban areas and 690 in rural areas.The second stage involved systematic sampling of households,that the household listing operation was undertaken in all of the selected clusters,and a fixed number of 27 households per cluster were selected through an equal probability systematic selection process,for a total sample size of 25,650 households.The Household Questionnaire record all household member and guests,the data was about age,sex,education,marital status,and for children under age 18 parents’ survival status.

Vitamin A Supplementation

Through National Immunization Days (NID) campaigns the children receive vitamin A supplements to reduce vitamin A deficiency (VAD)(MoPH 2010).The 2015 AfDHS set questions designed to determine whether young children had received vitamin A supplements or deworming medication in the six months before the survey.Nearly half of the children (48%) under age 2 consumed vitamin A-rich foods 24 hours before the interview in Afghanistan.

Statistical

The processing of the 2015 AfDHS data began simultaneously with the fieldwork;thesecompleted questionnaires were edited and entered by 23 data processing personnel specially trained for this task.Data gathering was carried out by 33 field teams,each consisting of one team supervisor,one field editor,three female interviewers,and three male interviewers.All data were entered twice for 100% verification.Data were entered using the CSPro computer package,and some data was completed in the first week of March 2016.The final cleaning of the data set was carried out by the DHS program data processing specialist and was completed by mid-April 2016.

Results

The percentages who were given vitamin A supplements in the last 6 months among all children 6-59 months aged.A total of 1,572 children aged among 6-8 months were given vitamin A supplements 670(42.6%) children and comparison with the total community of the study (27,209) children (2.46%).A total of 1,148 children aged among 9-11 months were given vitamin A supplements to 465(40.5%) children and comparison with the total community of the study (27,209) children (1.70%).A total of 3,723 children aged among 12-17 months were given vitamin A supplements to 1,887(50.7%) children and comparison with the total community of the study (27,209) children (6.93%).A total of 1,985 children aged among 18-23 months were given vitamin A supplements 967 (48.7%)children and comparison with the total community of the study(27,209) children (3.55%).A total of 6,598 children aged among 24-35 months were given vitamin A supplements 3,114 (47.2%)children and comparison with the total community of the study(27,209) children (11.44%).A total of 6,282 children aged 36-47 months were given vitamin A supplements 3,091(49.2%) children and a comparison with the total community of the study (27,209) children(11.36%).And the last total of 5,902 children aged among 48-59 months was given vitamin A supplements 2,727 (46.2%) children and comparison with the total community of the study (27,209) children(10.02%) (Table 1).

Furthermore,a total of 13,961,were given vitamin A supplements 6,603 (47.3%) boys and compared with the total community of the study (27,209) children (24.26%) boys.And the total of 13,248,were given vitamin A supplements were 6,319 (47.7%),and a comparison with the total community of the study (27,209) children (23.22%)girls (Table 1).

As well,the total of 7,810 breast-feedings,given vitamin A supplements 3,655 (46.8%) children and comparison with the total community of the study (27,209) children (13.43%).A total of 19,208 not breastfeeding,given vitamin A supplements 9,200 (47.9%)children and comparison with the total community of the study(27,209) children (33.81%).Given vitamin A supplements in 62(32.5%) children and comparison with the total community of the study (27,209) children (0.22%).A total of 739 mothers edge at birth in 15-19 years,given vitamin A supplements 324 (43.9%),and compared with the total community of the study (27,209) children.A total of 15,407 mothers birth in 20-29 years,given vitamin A supplements 7,287 (47.3%) and a comparison with the total community of the study (27,209) children (26.78%).A total of 8,945 aged at birth 30-39 years,were given vitamin A supplements 4,294(48.0%) and compared with the total community of the study(27,209) children (15.78%).And the last total of 2,118 mothers aged birth in 40-49 years,were given vitamin A supplements 1019 (48.1%)and compared with the total community of the study (27,209)children (3.74%) (Table 1).

Additionally,the total residence in urban 6,271 children,given vitamin A supplements 2,985 (47.6%) children and comparison with the total community of the study (27,209) children (10.97%).The total residents in rural 20,938,were given vitamin A supplements 9,945 (47.5%) children and comparison with the total community of the study (27,209) children (36.55%).In an addition,the highest percentage of given vitamin A supplements in Ghor province (91.7%)among 761 children and the Lowest percentage of given vitamin A supplements is in Urozgan province (8.6%) among 354 children(Table 1).

Finally,the total of mothers with no education was 22,774,given vitamin A supplements 10,384 (45.6%) and in comparison with the total community of study (27,209) is (38.1%).The total of mothers’primary education is 2,154,given vitamin A supplements 1,190(55.3%) and comparison with the total community of study (27,209)is (4.37%).The total of mother’s Secondary education in 1854,given vitamin A supplements 1,114 (60.1%) and comparison with the total community of study (27,209) is (4.09%).And the last total of mothers with more than secondary education was 428,given vitamin A supplements 242 (56.6%) and comparison with the total community of study (27,209) is (0.89%).The percentage of given vitamin A supplements in the lowest wealth quintile is 2,600(49.4%)from 5,265 children and the percentage of given vitamin A supplements in the highest wealth quintile is 2,557 (51.0%) from 5,014 children (Table 1).

Table 1 The percentage is given vitamin A supplements in the last six months,and based on the mother's recall

Table 1 The percentage is given vitamin A supplements in the last six months,and based on the mother's recall(continued)

Discussion

The percentage of given Vitamin A supplements in the lowest wealth quintile is 2,600 (49.4%) from 5,265 children and the percentage of given vitamin A supplements in the highest wealth quintile is 2,557(51.0%) from 5,014 children.Additionally,the percentages who were given Vitamin A supplements in the last 6 months among all children 6-59 months aged.A total of 1,572 children aged among 6-8 months were given vitamin A supplements 670 (42.6%) children and comparison with the total community of the study (27,209) children(2.46%).A total of 1,148 children aged among 9-11 months were given vitamin A supplements to 465 (40.5%) children and comparison with the total community of the study (27,209) children (1.70%).There is not study to provide vitamin A deficiency among young children in Afghanistan.Therefore,we aimed to examine the vitamin A supplement to prevent vitamin A deficiency among children in Afghanistan(Table 1).

The assessment of vitamin A status determines the magnitude,severity,and distribution of vitamin A deficiency (VAD) in a population [18].Cross-sectional studies demonstrated that given vitamin A supplements increase the risk of deficiency,mortality,or the incidence of hospitalization among children and infants [19,20].as well,a cross-sectional study revealed that vitamin A supplement has not impacted the health of children and infants [21].On the other hand,vitamin A supplementation can reduce the morbidity and mortality of infants and children,according to recent studies[22,23].

Several factors may contribute the risk of vitamin A.For instance,widespread maternal under-nutrition,poor dietary quality,losses during diarrhea,and poor to get supplements [24].Therefore,vitamin A deficiency is very common during childhood in many low and middle-income countries even among the populations whose diets rely heavily on vegetables and fruits,and those countries do have not any strategies to prevent or reduce the risk of vitamin A deficiency among children [25].Lower intakes or do not take the vitamin A at this age may lead to vitamin A deficiency which,when severe,can cause visual impairment (night blindness),anemia,weakened resistance to infections,and can also increase the risk of illness and death from childhood infections such as measles and those causing diarrhea [26].Additionally,in countries that have vitamin A deficiency,the increases vulnerability to a range of illnesses including diarrhea,measles,and respiratory infection,so,for this reason,the programs providing high-dose vitamin A supplements to children 6-59 months of age are being implemented as part of their child survival strategy,reaching 71% of this population in developing countries [27,28].The lasting solution in long term is good nutrition requires reliable access to various fresh foods,fortification food of vitamins and minerals,food distribution programs,and horticultural developments might provide [29].The wheat flour fortification and foods guideline in developing countries is may provide a growing opportunity to improve vitamin A intake of the poor,and it is a major public health problem in developing countries,according to recent research [26,30].A cross-sectional study in Bangladesh demonstrated that there is no available rural data on vitamin A status among children 5-15 years of age,and the risk of night blindness and Bitot's spot are also found to exist among school-age children and adolescents [31].The main activities of the program include vitamin A capsule (VAC)supplementation for 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 healthcare workers on the clinical diagnosis and treatment of vitamin A deficiency in schools,medical care clinic,districts,for from provinces,according to world health organization [32].There are several Randomized Control Trials(RCT) studies that revealed that giving vitamin A supplementation to children aged 6-59 months can decrease 28% mortality from diarrhea,including night blindness and exophthalmia [20].However,three Randomized Control Trials (RCT) studies demonstrated that giving vitamin A supplementation to children can be increased the risk of vomiting within the first 48 hours [3,33].The World HealthOrganization (WHO) revealed the most at risk of vitamin A deficiency (VAD) are preschool-age children and pregnant women.Therefore,the recommended dose for children 6-11 months is 100 000 International Units (IU),and for children 12-59 months,it is 200 000 IU to reduce morbidity and mortality among children [34].A case-control study demonstrated that vitamin A can be safely provided to children in a large dose,rather than more frequent smaller doses,as it can be stored by the body and released over time as needed [35].Many countries have successfully integrated strategies to deliver vitamin A supplements to infants and children in their national health policies,including delivery during routine health visits and immunizations.Our study had two strengths.This is the first investigation on vitamin A supplementation among children aged 6-59 months:A Report of Afghanistan Demographic and Health Survey(AfDHS)2015 in Afghanistan and it was a community-based study.On the other hand,the limitation of our study is that most provinces have a very small part of the urban and two of them,Nooristan and Panjsher,have no urban areas at all.For collecting the data,there were unrest place and insecure provinces,for instance,Kunduz,Helmand,Fryab,Badghis,and Ghazni.

Conclusion

After following up,we found that the vitamin A supplement is a key strategy and the most important supplement to prevent vitamin A deficiency among young children in Afghanistan,2015.We suggest preventing vitamin A deficiency among children by 2022.It is better to use wheat flour fortification,vitamin A capsule (VAC)supplementation,nutrition education,and training of primary healthcare workers in the clinical to prevent and treat the vitamin A deficiency among children in Afghanistan.