Vitamin A deficiency and child survival in sub-Saharan Africa: a reappraisal of challenges and opportunities.
BACKGROUND
Children with vitamin A deficiency have higher risk of morbidity and mortality than vitamin A-sufficient children. Estimates on the potential child survival benefits of vitamin A deficiency control are needed for policy and program advocacy.


OBJECTIVE
To determine the current prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa in order to estimate the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region.


METHODS
Estimates of the prevalence of vitamin A deficiency generated in 1998, data from 11 nationally representative vitamin A deficiency surveys conducted in sub-Saharan Africa between 1997 and 2003, and the measured effects of vitamin A deficiency on child mortality were combined to estimate the prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa and the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region.


RESULTS
Our analysis shows that in the absence of effective and sustained policies and programs for the control of vitamin A deficiency, an estimated 42.4% of children 0 to 59 months of age in sub-Saharan Africa (43.2 million children) are at risk for vitamin A deficiency. Such effective and sustained policy and program action for the control of vitamin A deficiency can bring about a potential 25% reduction in mortality in children 0 to 59 months with respect to 1995 mortality levels (i.e., before the onset of large-scale vitamin A supplementation programs in sub-Saharan Africa).


CONCLUSIONS
Effective and sustained control of vitamin A deficiency has the potential to be among the most cost-effective and high-impact child-survival interventions in sub-Saharan Africa. A stronger political commitment and a more appropriate level of investment in the effective control of vitamin A deficiency could make a large contribution toward the attainment of the Millennium Development Goal for the reduction of child mortality rates by two-thirds between 1990 and 2015. Among the many challenges that Africa will need to face in the coming years, vitamin A deficiency is one that can be overcome. The need is urgent, and the solutions are known, effective, and affordable.
Aguayo
Victor M
VM
UNICEF Regional Office for West and Central Africa, Dakar, Senegal. vaguayo@unicef.org
Baker
Shawn K
SK
D017954:Africa South of the Sahara / Q000453:epidemiology; D002423:Cause of Death; D002662:Child Health Services; D046688:Child Mortality; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D018673:Nutrition Policy; D016019:Survival Analysis; D014802:Vitamin A Deficiency / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*