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Vitamin A Deficiency

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Title: Vitamin A Deficiency


1
Vitamin A Deficiency
  • By Caroline Delori
  • and Shira Lipsky

2
Malnutrition
  • Millions of mothers and children die each day
    from malnutrition.
  • 83 of children die due to mild or moderate
    malnourishment.
  • 1/3rd of worlds population is micronutrient
    deficient
  • The global economy produces enough food to feed
    the entire world population.
  • Result of several factors combined.
  • www.info.usaid.gov/pop_health/nmh

3
What is Vitamin A?
  • Organic compounds that are present in small
    amounts in foods that are not digested, but
    absorbed through small intestine.
  • VA Functions metabolic, photosensitive pigments
    of retinal cells, differentiation of epithelia.
  • Fat soluble and any excess cannot be excreted in
    the urine.
  • Most common preformed vitamin found in food is
    retinol.
  • Found in animal products, such as fish oils,
    milk, and butter.
  • Carotenoids are converted by the body into
    retinol.
  • Found in dark leafy vegetables, such as sweet
    potatoes and yellow fruits and palm oil, and in
    red chili. It is the red pigment present in
    carrots.
  • Half of biological activity of VA because of low
    conversion rate.

4
The VAD Story!
  • 230 million children are at risk for VAD.
  • Over one million VAD childhood associated deaths
    in one year.
  • VAD is prevalent in over 75 countries distributed
    in S.E. Asia and Africa
  • VAD leads to
  • Infant and child mortality
  • Keratinization- dry skin and cracking of mucous
    membranes
  • Xerophthalmia- dryness of the eye, blindness
  • Diarrheal disease and respiratory infections
  • Strong link between VAD and infection.

5
What is VA good for?
  • VA is most beneficial for infants, young
    children, pregnant and lactating mothers.
  • VA programs have shown to impact
  • Xerophthalmia
  • Measles
  • Child Survival
  • Growth
  • Other infections

6
(No Transcript)
7
Estimated Numbers of People At-risk and Affected
by VAD
  • Region VA At Risk VA Affected (Xerophthalmia)
  • Africa 52 1.0
  • Americas 16 0.1
  • South East Asia 125 1.5
  • Eastern Mediterranean 16 0.1
  • Western Pacific 42 0.1
  • Total (millions) 251 2.8
  • http//www.sph.emory.edu/PAMM/Ih552/Jan28fortifica
    tion/

8
A Little History
  • 1904- First epidemic of xerophthalmia in Japan
  • 1947- Industrial VA synthesis
  • 1964- First global survey of VAD
  • 1980s- Importance of VA in child survival was
    shown
  • 1990- Summit for children
  • 1991- Ending Hidden Hunger Conference
  • 1992- International Conference on Nutrition
  • www.sightandlife.or/info/slides/slidesp16-30.pdf
  • www.worldbank.org/html/extdr/hnp/nutrition

9
How to Combat VAD

10
Supplementation
  • Short-term solution
  • Therapeutic, targeted, or universal
  • Liquid filled gelatin capsules
  • Given orally or intravenously
  • .02 cents each capsule
  • 1.64- 2.20 per child for VA program

11
VA Distribution Schedule
  • Age Recommended Dosage Schedule
  • 0-6 mo. 25, 000 IU every 4 weeks
  • 6-11 mo. 100, 000 IU every 3-6 mo.
  • 1-6 yrs. 200, 000 IU every 3-6 mo.
  • Pregnant women 10, 000 IU every day during
    gestation
  • Lactating mothers200, 000 IU once
  • www.sightandlife.org/info/manual/salManchap10.pdf

12
Food Fortification
  • Medium-term solution
  • Increase nutrients in specific foods
  • Margarine, milk, sugar
  • Identify food vehicle fortificant
  • Requires commitment from government, food
    industries, legislation, consumers, and research
    facilitation.
  • .36 cents per person
  • http//www.jsi.com/intl/omni/sugr_pt1.htm

13
Selecting a VA Food Vehicle
  • Must be consumed by a large proportion of the
    population.
  • Little day to day and inter-individual variation
    occurs in the amount of the food vehicle
    consumed which will ensure VA intake remains
    within a safe range.
  • Food vehicle must go through a process in which
    VA can be added under controlled conditions and
    at a minimum cost.
  • Must be able to track the delivery of fortified
    food.
  • www.jsi.com/intl/omni/sugr_pt1.htm

14
Selecting a VA Fortificant
  • Miscible in the food vehicle
  • Must not change the smell, color or taste of the
    food
  • No chemical interaction with the food resulting
    in damage of the original food
  • Stable
  • No significant increase in cost of food to the
    consumer.
  • www.jsi.com/intl/omni/sugr_pt1.htm

15
Process of Food Fortification

16
  • www.jsi.com/intl/omni/sugr_pt1/htm

17
Diet Diversification
  • Long-term solution
  • Should run parallel with other short-term
    solutions
  • Increases the variety and frequency of
    micronutrient rich food sources
  • Modifies food production, consumption and
    distribution
  • Red palm oil
  • Sweet potatoes, 1998
  • Cost effective and wont lead to
    hypervitaminosis.
  • Through nutritional education, home gardens and
    improved methods of food preparations,
    preservation and cooking.
  • No medicalization of food
  • www.jsi.com/intl/omni/sugr_pt1.htm

18
Nutrition Education
  • Long-term commitment from the participants.
  • Education of mother and children on how to eat a
    more well balanced diet filled nutrients
  • Improved local access to VA-rich foods
  • Economic and social payoffs are as high as 84
    times the program costs
  • Requires economic, political, operational,
    behavioral sustainability.

19
DEBATE
  • Which program would be most effective in the
    country you selected for your MCH proposal?
    Discuss the issues involved in implementing a
    program solution. Use the list of pros and cons.

20
Different Programs Must Consider…
  • Survey the extent of the problem
  • Severity of the deficiency
  • Distribution of the deficiency
  • based on age, gender, urban, rural,
    agriculture, socioeconomic
  • Identifying target population
  • Screening for VAD
  • www.jsi.com/intl/omni/sugr_pt1.htm

21
Program Issues Supplementation
  • Most common vehicle is EPI
  • What will happen when polio is eradicated?
  • Timing of intervention and cost
  • Scope of population reached
  • Procurement or production VA capsules- UNICEF
  • Monitoring of VA program
  • Requires foreign currency
  • An efficient, sustainable distribution system
  • Shared responsibility by immunization and
    nutrition sectors.
  • National Micronutrient Day in Niger
  • http//dcc2.bumc.bu.edu/IH887/IH887A1.htm

22
Program Issues Food Fortification
  • Identify food vehicle and fortificant the high
    cost of fortificant
  • Field testing of fortificant must be done at many
    locations in one country due to differing
    environmental conditions.
  • There might not be a food vehicle, in which case,
    one must be created.
  • Need technologically developed food industry,
    field testing and appropriate monitoring.
  • Micronutrient losses may occur at each point in
    distribution chain and at household levels during
    storage and preparation.
  • Social marketing of the fortified food
  • Harmonization between different sectors involved
  • Sangkap Pinoy Seal Program in Philippines
  • Zambia, May 1998
  • Swaziland, June 1999

23
Program Issues Diet Diversification
  • Home gardening issues
  • available technology- seeds, assistance
  • cultural acceptability and sensitivity
  • land suitable for gardening
  • time
  • Requires community involvement
  • Requires nutritional education of consumers
  • Challenging to coordinate and requires much
    cooperation
  • Labor intensive operation
  • Costly economically and logistically
  • Results arent readily seen
  • http//dcc2/bumc.bu.edu/IH887/IH887A1.htm

24
Cost Analysis of Programs
  • Summary of cost-effectiveness of three VA
    interventions in Guatemala, 1991.
  • Program Persons reached High-risk person
    reached
  • Fortification 0.287 0.653
  • Capsule Distribution 1.524 1.524
  • Food Production/Education 1.191 2.707
  • (long-term effect)
  • Phillips, M, Sanghvi T, Suarez R, McKingney J,
    and Fiedler J. The Costs and Effectiveness of
    Three Vitamin A Interventions in Guatemala. Soc
    Sci Med.1996.42(12)1661-1668

25
Controversy Issues
  • VA is a known teratogen
  • Difficult to evaluate if maternal mortality rate
    is effected by VAD
  • Side effects of hypervitaminosis
  • Malformation
  • Schizophrenia
  • Head ache and loss of appetite
  • Bulging Fontanelle

26
More Controversies…
  • There are pros and cons to all interventions,
    therefore difficult to assess which one to
    implement.
  • Protection afforded by prophylactic large doses
  • Dosage amount
  • Associated with the increase in severity of the
    infection
  • Ghana Study
  • Selection of target population- high-risk, medium
    risk, and low risk populations
  • Multiple micronutrient fortification
  • Which food vehicles and fortificants to use
  • Reports that dark vegetables and fruits do not
    provide as much carotenoids as was assumed.

27
Biotechnology
  • You provide the idea and theyll make it!
  • Genetically Engineered Rice
  • You can target very precisely the kind of crops
    needed
  • Increase agricultural production time
  • The potential benefits of VA in a grain of rice
    are greater than the possible risks.
  • Requires cooperation among scientists and funding
    institutions
  • Rarely managed correctly
  • Unforeseen negative effects
  • Risks range from human health effects through
    eating the foods to environmental impacts-
    spreading genes through cross pollination to
    other plants
  • Many people opposed to idea because of possible
    issues
  • Need global forum for governments, NGOs and
    industries to discuss risks and benefits of
    biotechnology
  • http//www.cgiar.org/ifpri/media/innews/2052099.ht
    m

28
New Technology
  • CIP (International Potato Center)- sweet potatoes
    varieties increase intake of VA
  • Swiss Federal Institute of Technology-
    genetically engineered rice
  • Plants that fortify themselves and deliver VA
    through their seeds.
  • MI and UNICEF- developing and testing new dropper
    to administer VA
  • WHO and UNICEF-
  • IMCI (Integrated Management of the Sick Child)-
    treat VAD to reduce diseases
  • IMCI- taking advantage of the contact made when a
    sick child comes in for care

29
Conclusions
  • Different countries require various solutions,
    sometimes a combination of two
  • Middle income countries- Philippines, Zambia and
    other Latin Am. countries
  • Food fortification
  • Low income countries- Urban
  • Food fortification and government subsidies
  • Low income countries- Nepal, Bangladesh, and
    rural Indonesia
  • Supplementation used
  • Extreme measures
  • Evaluation of supplementation programs with a
    case control study.
  • Biotechnology is an option, but must look at the
    different environments to see what should be
    implemented
  • Must answer if should implement program even if
    not all at risk or unknown
  • Focus should be on reduction of infections
    improving primary health care, sanitation, water
    supply, and reducing poverty.
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