Vitamin A Prophylaxis Programs in Developing Countries: Past Experiences and Future Prospects

Clinical eye signs are estimated to affect 5–10 million children annually in the developing world. Thus most experience with large‐scale prophylaxis programs has been with periodic distribution of high‐dose vitamin A supplements directed toward preventing ocular problems. However, subclinical vitamin A depletion affects an estimated five‐ to 10‐fold larger population, and evidence is accumulating for a subclinical protective role of vitamin A against risk of mortality, and perhaps morbidity. Current programs aim to integrate prophylaxis with vitamin A supplements into ongoing programs. Decentralization of distribution of supplements and their integration into community‐based programs require careful consideration of dosages and frequency to assure safety and broad coverage. Fortification of foods and condiments has not provided adequate prophylaxis in countries with significant vitamin A deficiency. Other strategies recognized as more sustainable, long‐term solutions have received less attention, and their potential has not been evaluated. Such strategies aim to increase dietary intake of vitamin A and/or decrease physiologic requirements; these strategies include horticulture, public health, socioeconomic improvement, and nutrition and health education measures.