November 26, 2001
UNEXPLAINED ILLNESS, CHILDREN -
Deaths trigger fresh controversy over vitamin A program in India
- NEW DEHLI: Indian doctors have renewed their accusation
that international agencies are needlessly promoting the administration of
vitamin A across India to all children aged under 5 years. Pediatricians and
nutritionists launched a barrage of criticism after 14 children died and
thousands fell ill last week in the north eastern state of Assam following a
vitamin A campaign supported by UNICEF (the United Nations Children's Fund).
Health officials are investigating the deaths and illness amid suspicions
that health workers might have given overdoses to children during the
state-wide campaign to deliver vitamin A to 3 million children aged 1 to 5
UNICEF had replaced the traditional 2 milliliters (mL) spoons with 5 mL cups
to pour out vitamin A for the campaign. Health officials suspect that this
switch in the method of measuring the vitamin and the inadequate training of
health workers might have led to overdoses, but they have not ruled out
contamination or other causes. UNICEF officials in New Delhi said that the
cups had been introduced because they were considered more efficient and
hygienic. They said the cups were now being withdrawn, but they added that
it was unlikely that overdoses had caused the deaths and illness. "Even a
full 5 mL cup of vitamin A would not be lethal," a UNICEF official said.
Some Indian doctors have questioned the benefits and safety of the
administration of vitamin A through the "pulse campaign" promoted by UNICEF.
The campaign involves delivering the supplement to all children aged 1 to 5
years across a state on a single day. The Indian Health Ministry has run a
vitamin A program for more than 3 decades that covers children aged 9 months
to 3 years and is linked to immunization, but less than 30 per cent of
target children in India receive even one dose of vitamin A.
Pediatricians are urging more selective use of vitamin A because child
nutrition has improved and clinical signs of vitamin A deficiency, such as
eye disease, are becoming less common. UNICEF maintains, however, that
symptoms of eye disease are associated with advanced vitamin A deficiency
and that children might be needlessly put at risk of impaired immune
function and fatal infections long before such symptoms appear.
Pediatricians reject that argument. "There is no clinching evidence to show
reduction in mortality through vitamin A among children with sub clinical
vitamin A deficiency," said Dr Harsh Pal Singh Sachdev, professor of
pediatrics and clinical epidemiology at the Maulana Azad Medical College,
New Delhi, and editor of the journal Indian Pediatrics.
A technical consultation initiated by the health ministry last year
concluded that existing data were not sufficiently robust to recommend
vitamin A supplementation to reduce mortality in children aged 1 to 5 years.
"The promotion of the universal distribution of vitamin A is a glaring
example of the commercial exploitation of malnutrition in developing
countries by pharmaceutical companies," said Dr Umesh Kapil, additional
professor of human nutrition, All India Institute of Medical Sciences, New
Delhi. The Nutrition Society of India has warned that the Assam episode will
lead to an erosion of public confidence in government health care programs
and might even hinder the pulse poliomyelitis campaign.