Vitamin a Deficiency in Populations at Risk

7/31/2019 Vitamin a Deficiency in Populations at Risk

1/68


2/68

Global prevalence

o vitamin A defciencyin populations at risk19952005

WHO Global Database

on Vitamin A Defciency


3/68

WHO Library Cataloguing-in-Publication Data

Global prevalence o vitamin A defciency in populations at risk 19952005: WHO global database on

vitamin A defciency.

1.Vitamin A defciency epidemiology. 2.Vitamin A defciency etiology. 3.Vitamin A defciency complications.

4.Child. 5.Eye maniestations. 6.Databases as topic. I.World Health Organization.

ISBN 978 92 4 159801 9 (NLM classifcation: WD 110)

World Health Organization 2009

All rights reserved. Publications o the World Health Organization can be obtained rom WHO Press, World Health Organization, 20 Avenue Appia,

1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; ax : +41 22 791 4857; e-mail: [email protected]). Requests or permission to reproduce or t ranslate

WHO publ ications whether or sale or or noncommercia l di stribution should be addressed to WHO Press, at the above address (ax: +41 22 7914806; e-mail: [email protected]).

Te designations employed and the presentation o the material in this publication do not imply the expression o any opinion whatsoever on the part o

the World Health Organization concerning the legal status o any country, territory, city or area or o its authorities, or concerning the delimitation o its

rontiers or boundaries. Dotted lines on maps represent approximate border lines or which there may not yet be ull agreement.

Te mention o specifc companies or o certain manuacturers products does not imply that they are endorsed or recommended by the World Health

Organization in preerence to others o a similar nature that are not mentioned. Errors and omissions excepted, the names o proprietary products are

distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to veriy the inormation contained in this publication. However, the

published material is being distributed without warranty o any kind, either expressed or implied. Te responsibility or the interpretation and use o the

material lies with the reader. In no event shall the World Health Organization be liable or damages a rising rom its use.

Cover photographs by WHO/P. Virot, L. Rogers, and . Stanley

Designed by minimum graphicsPrinted in France

Suggested citation: WHO. Global prevalence o vitamin A defciency in populations at risk 19952005. WHO Global Database

on Vitamin A Defciency. Geneva, World Health Organization, 2009.


4/68

iii

Contents

Preace vii

Acknowledgements ix

Abbreviations x

1. Introduction 1

1.1 Vitamin A deciency: a public health problem 1

1.1.1 Etiology 11.1.2 Health consequences 1

1.1.3 Assessing vitamin A status and deciency 2

1.2 Control o vitamin A deciency 2

2. Methods 4

2.1 Data sources Te WHO Global Database on Vitamin A Deciency 4

2.2 Selection o survey data 4

2.2.1 Administrative level 4

2.2.2 Population groups 5

2.3 Dening vitamin A deciency 5

2.3.1 Serum or plasma retinol threshold 5

2.3.2 Estimated prevalence o night blindness and biochemical vitamin A deciency or countrieswith no survey data 6

2.3.3 Uncertainty o estimates 6

2.3.4 Combining national estimates 7

2.3.5 Global prevalence o vitamin A deciency in populations at risk 7

2.3.6 Classication o vitamin A deciency as a problem o public health signicance 7

2.4 Population covered by survey data, proportion o population, and the number o individuals with

vitamin A deciency in populations at risk 8

2.4.1 Population covered 8

2.4.2 Proportion o population and the number o individuals afected in countries at risk or

vitamin A deciency 8

3. Results and Discussion 9

3.1 Results 9


3.1.2 Proportion o population and number o individuals with vitamin A deciency in populations at risk 10

3.1.3 Public health signicance o vitamin A deciency 11

3.2 Discussion 16


3.2.2 Strengths o estimates 16

3.2.3 Proportion o population and the number o individuals with vitamin A deciency in populations at risk 16

3.2.4 Classication o countries by degree o public health signicance o vitamin A deciency 16

3.2.5 Comparison to previous estimates 16

3.2.6 Limitations o estimates 17

3.3 Conclusions 18

COntents


5/68

GlObAl preVAlenCe Of VitAmin A DefiCienCy in pOpulAtiOns At risk 19952005iv

References 19

Annexes

Annex 1 WHO Member States grouped by WHO region and UN region as o 2007 21

Table A1.1 WHO Member States grouped by WHO region 21

Table A1.2 WHO Member States grouped by UN region and subregion 22

Annex 2 Results by UN region 24

Table A2.1 Percentage o population at risk o vitamin A deciency covered by night blindness

and serum retinol prevalence surveys (national or subnational) conducted between

1995 and 2005, by UN region 24

Table A2.2 Prevalence o night blindness and numbers o afected preschool-age children and

pregnant women in countries at risk o vitamin A deciency in each UN region 24

Table A2.3 Prevalence o serum retinol


6/68

v

Figures

Figure 1 Night blindness as a public health problem by country 19952005: Preschool-age children 12

Figure 2 Biochemical vitamin A defciency (retinol) as a public health problem by country 19952005:

Preschool-age children 13

Figure 3 Night blindness as a public health problem by country 19952005: Pregnant women 14


Pregnant women 15

COntents


7/68


8/68

vii

Preface

Part o the World Health Organizations mandate is to pro-

vide inormation on the health status o the population at

the global level. In this respect, since 1991, the Department

o Nutrition or Health and Development (NHD) has been

maintaining the Vitamin and Mineral Nutrition Inor-

mation System (VMNIS), which includes three databasesrelated to three micronutrient disorders o public health

signicance globally: iodine deciency, iron deciency

and anaemia, and vitamin A deciency. Te objectives o

VMNIS are to assess the status o the population at the

global level in order to increase the awareness o the public

health community and policy makers, evaluate the impact

o interventions and measure progress towards the goals en-

dorsed by the international community, to compare data

between countries, track changes over time, and increase

the capacity o countries to manage health data related to

micronutrients.

WHO estimates o the global prevalence o vitamin A

deciency were rst published through its Micronutrient

Deciency Inormation System in 1995. Since then, large

programmes on vitamin A deciency control have been

implemented in several countries where vitamin A de-

ciency was a public health problem many o these pro-

grammes involved vitamin A supplementation and were

strengthened by being combined with polio eradication

campaigns. Additionally, vitamin A status indicators, espe-

cially symptomatic reporting o night blindness and serum

retinol concentrations, have been assessed in many more

national surveys than reported or previous estimates. As aresult, most data collected in the present report are based

on reported histories o night blindness and serum retinol

concentrations.

Vitamin A deciency is one o the most important causes

o preventable childhood blindness and is a major contribu-

tor to morbidity and mortality rom inections, especially

in children and pregnant women, aecting the poorest seg-

ments o populations, particularly those in low and middle

income countries. Te primary cause o vitamin A decien-

cy is lack o an adequate intake o vitamin A, and may be

exacerbated by high rates o inection, especially diarrhoeaand measles. Its consequence is most apparent during stag-

es o lie o high nutritional demand (e.g. early childhood,

pregnancy and lactation). A variety o interventions are be-

ing used to improve the vitamin A status o populations:

dietary diversication, vitamin A supplementation and or-

tication.

In 1987, WHO estimated that vitamin A deciency wasendemic in 39 countries based on the ocular maniestations

o xerophthalmia or decient serum (plasma) retinol con-

centrations (


9/68

GlObAl preVAlenCe Of VitAmin A DefiCienCy in pOpulAtiOns At risk 19952005viii

Tis document is divided into three chapters. Te rst

provides an overview o vitamin A deciency, the second

describes the criteria used to identiy, revise, select, and in-

terpret the ndings o the surveys, and the methodology

developed to generate national, regional, and global esti-

mates, while the third discusses the results.

Tis report is written or public health ofcials, nutri-

tionists, and researchers. We hope that readers nd it useul

and eel ree to share any comments with us (micronutri-

[email protected]). We also hope that this inormation will

contribute to our common goal to eliminate vitamin A de-

ciency as a public health problem.


10/68

ix

Acknowledgements

Tis report utilized data rom the WHO Global Database

on Vitamin A Deciency, which is part o the WHO Vita-

min and Mineral Nutrition Inormation System (VMNIS),

developed by the Reduction o Micronutrient Malnutrition

Unit in the Department o Nutrition or Health and De-

velopment.

Tis report is the result o the hard work and collaboration

o several individuals. We would especially like to thank

Lisa M. Rogers, who took the lead on the development o

this report, Daniel Wojdyla o the Universidad Nacional de

Rosario, Argentina or perorming the statistical analyses,

Keith P. West Jr o Johns Hopkins Bloomberg School o

Public Health or his extremely valuable scientic input on

vitamin A, and Bruno de Benoist or his technical expertise

in this area. Grace Rob and Ann-Beth Moller also provid-

ACknOWleDGements

ed valuable assistance in data management. Additionally,

WHO wishes to thank the numerous individuals, institu-

tions, governments, nongovernmental, and international

organizations or providing data or the database. Without

continual international collaboration in keeping the data-

base up-to-date, this compilation on the global situationand trends in the prevalence o vitamin A deciency would

not have been possible. Special thanks are due to ministries

o health o the WHO Member States, WHO regional o-

ces, and WHO country ofces.

Tis report was made possible by the nancial support o

the Micronutrient Initiative, the Government o Luxem-

bourg, the Centers or Disease Control and Prevention, and

Sight and Lie.


11/68

x GlObAl preVAlenCe Of VitAmin A DefiCienCy in pOpulAtiOns At risk 19952005

Abbreviations

GDP Gross domestic product

HDI Human Development Index: a composite indicator o wealth, lie expectancy and education developed by

the United Nations Development Programme.

MDIS Micronutrient Defciency Inormation System

PreSAC Preschool-age children

PW Pregnant womenSD Standard deviation

UN United Nations

VAD Vitamin A defciency

VADD Vitamin A defciency disorders

VMNIS Vitamin and Mineral Nutrition Inormation System

WHO World Health Organization

XN Night blindness


12/68

1

1. Introduction

1. intrODuCtiOn

1.1 Vitamin A defciency: a public healthproblem

Vitamin A deciency (VAD) is a major nutritional concern

in poor societies, especially in lower income countries. Its

presence as a public health problem is assessed by measuring

the prevalence o deciency in a population, represented byspecic biochemical and clinical indicators o status. Te

main underlying cause o VAD as a public health problem

is a diet that is chronically insufcient in vitamin A that can

lead to lower body stores and ail to meet physiologic needs

(e.g. support tissue growth, normal metabolism, resistance

to inection). Deciency o sufcient duration or severity

can lead to disorders that are common in vitamin A de-

cient populations such as xerophthalmia (xeros = dryness;

-ophthalmia = pertaining to the eye), the leading cause o

preventable childhood blindness, anaemia, and weakened

host resistance to inection, which can increase the severityo inectious diseases and risk o death. A poor diet and in-

ection requently coexist and interact in populations where

VAD is widespread. In such settings, VAD can increase the

severity o inection which, in turn, can reduce intake and

accelerate body losses o vitamin A to exacerbate deciency.

Te prevalence and severity o xerophthalmia, anaemia and

the (less-measurable) vicious cycle between VAD and in-

ection in vulnerable groups (notably young children and

pregnant or lactating mothers) represent the most compel-

ling consequences o VAD and underlie its signicance as a

public health problem around the world.

1.1.1 Etiology

Vitamin A is an essential nutrient needed in small amounts

or the normal unctioning o the visual system, and main-

tenance o cell unction or growth, epithelial integrity, red

blood cell production, immunity and reproduction. Essen-

tial nutrients cannot be synthesized by the body and there-

ore must be provided through diet. When dietary intake

is chronically low, there will be insufcient vitamin A to

support vision and cellular processes, leading to impaired

tissue unction. Low vitamin A intake during nutrition-

ally demanding periods in lie, such as inancy, childhood,pregnancy and lactation, greatly raises the risk o health

consequences, or vitamin A deciency disorders (VADD).

Dietary deciency can begin early in lie, with colostrum

being discarded or breasteeding being inadequate, thereby

denying inants o their rst, critical source o vitamin A

(1). Tereater, into adulthood, a diet decient in vitamin

A lacks oods containing either preormed vitamin A esters,such as liver, milk, cheese, eggs or ood products ortied

with vitamin A or lacking its carotenoid precursors (mainly

beta-carotene), such as green leaves, carrots, ripe mangos,

eggs, and other orange-yellow vegetables and ruits. Where

animal source or ortied oods are minimally consumed,

dietary adequacy must rely heavily on oods providing

beta-carotene. However, while nutritious in many ways, a

diet with modest amounts o vegetables and ruits as the

sole source o vitamin A may not deliver adequate amounts,

based on an intestinal carotenoid-to-retinol conversion ra-

tio o 12:1 (2). Tis ratio reects a conversion efciency that

is about hal that previously thought, leading to greater ap-

preciation or why VAD may coexist in cultures that heav-

ily depend on vegetables and ruits as their sole or main

dietary source o vitamin A.

Usually, VAD develops in an environment o ecological,

social and economical deprivation, in which a chronically

decient dietary intake o vitamin A coexists with severe

inections, such as measles, and requent inections caus-

ing diarrhoea and respiratory diseases that can lower intake

through depressed appetite and absorption, and deplete

body stores o vitamin A through excessive metabolism and

excretion (3, 4). Te consequent synergism can result inthe bodys liver stores becoming depleted and peripheral tis-

sue and serum retinol concentrations decreasing to decient

levels, raising the risks o xerophthalmia, urther inection,

other VADD and mortality.

1.1.2 Health consequences

Vitamin A deciency impairs numerous unctions and, as

a result, can lead to many health consequences, to which

inants, young children and pregnant women appear to be

at greatest risk. Xerophthalmia is the most specic VADD,

and is the leading preventable cause o blindness in childrenthroughout the world (5). Night blindness oten appears


13/68

GlObAl preVAlenCe Of VitAmin A DefiCienCy in pOpulAtiOns At risk 199520052

during pregnancy, a likely consequence o preexisting,

marginal maternal vitamin A status superimposed by nu-

tritional demands o pregnancy and intercurrent inections

(6). Anaemia can result rom VAD in children and women,

likely due to multiple apparent roles o vitamin A in sup-

porting iron mobilization and transport, and hematopoiesis

(7). Preexisting VAD appears to worsen inection (8) and

vitamin A supplementation has been shown to reduce the

risk o death in 659 month old children by about 2330%

(911). Tree trials rom southern Asia have reported that

neonatal vitamin A supplementation reduced mortality by

21% in the rst six months o lie (12) while two other stud-

ies conducted in Arica showed no impact o this interven-

tion (13, 14). One study has reported an approximate 40%

reduction in maternal mortality ollowing routine dietary

supplementation with vitamin A during pregnancy (15).

1.1.3 Assessing vitamin A status and defciencyTe main objective o assessing vitamin A status is to deter-

mine the magnitude, severity and distribution o VAD in

a population. Most surveys assess its prevalence in young

children and, with increasing requency, in pregnant or lac-

tating women, as reported here. Although VAD is likely to

be widespread ollowing the preschool years, ew data exist

to reveal the extent o VAD in school-age and young ado-

lescent children (16). Estimating the national prevalence

is to be encouraged as such data aids in targeting regions

or interventions, and provides baseline values or monitor-

ing population trends and intervention programme impact

over time.

wo sets o indicators o VAD are commonly used or

population surveys: clinically assessed eye signs and bio-

chemically determined concentrations o retinol in plasma

or serum. Te term xerophthalmia encompasses the clini-

cal spectrum o ocular maniestations o VAD, rom milder

stages o night blindness and Bitots spots, to potentially

blinding stages o corneal xerosis, ulceration and necro-

sis (keratomalacia) (17), as listed in Table 1. Te stages o

xerophthalmia are regarded both as disorders and clinical

indicators o VAD, and thus can be used to estimate an im-

portant aspect o morbidity and blinding disability as wellas the prevalence o deciency. As corneal disease is rare,

the most commonly assessed stages are night blindness,

obtainable by history, and Bitots spots, observable by han-

dlight examination o the conjunctival surace. Standard

procedures exist or assessing xerophthalmia (17). Although

night blindness and Bitots spots are considered mild stages

o eye disease, both represent moderate-to-severe systemic

VAD, as evidenced by low serum retinol concentrations

(19), and increased severity o inectious morbidity (i.e. di-

arrhoea and respiratory inections) and mortality in chil-

dren (5) and pregnant women (6, 20).

Measuring serum retinol concentrations in a population

constitutes the second major approach to assessing vitamin

A status in a population, with values below a cut-o o

0.70 mol/l representing VAD (21), and below 0.35 mol/l

representing severe VAD. Although there is not yet interna-

tional consensus, a serum retinol concentration below a cut-

o o 1.05 mol/l has been proposed to refect low vitamin

A status among pregnant and lactating women (22). Whilethe distribution o serum retinol concentrations below ap-

propriate cut-os are considered to refect inadequate states

o vitamin A nutriture, a low biochemical concentration o

retinol in circulation is not considered a VADD. Also, while

an inadequate dietary intake o vitamin A or beta-carotene

likely reveals an important and preventable cause o VAD

in a population, it is not an indicator o vitamin A status.

1.2 Control o vitamin A defciencyTree types o community interventions can reduce VAD

in aected populations. Improving the availability and in-

take o vitamin A through dietary diversication should be

viewed as an activity or all communities in order to en-

hance the overall nutritional status o the population. Tis

requires nutrition education to change dietary habits, as

well as providing better access to vitamin A or provitamin

A-rich oods, such as mangoes, papaya, or dark green leay

vegetables. Encouraging home gardening or local coopera-

tives to grow such oods may be necessary in regions where

they are not locally available or are too expensive.

A second approach to increasing the dietary intake o

vitamin A is through ortication o a staple ood or condi-

ment with vitamin A. Tis has been the primary strategy orreducing VAD in Central and South America, where sugar

began to be ortied with vitamin A three decades ago (23).

Although many ood items such as ats, oils, margarine and

cereal products have long been ortied with vitamin A in

high income countries, ew other vitamin A ortication

programmes with national reach currently exist in lower

income countries. It can be expected that this approach will

gain momentum as increasing numbers o potentially orti-

able oods become centrally produced or processed under

controlled conditions and penetrate markets o the poor in

many countries (24

).Tirdly, the most widely practiced approach to control-

Table 1 Classifcation o xerophthalmia

Xn ngh d

X1A Cojcva xo

X1b bo o

X2 Coa xo

X3A Coa cao/aoaaca (< 1/3 coa ac)

X3b Coa cao/aoaaca (1/3 coa ac)

Xs Coa ca

Xf Xohhac d

soc: c (18)


14/68

31. intrODuCtiOn

ling VAD in most high risk countries is the periodic deliv-

ery o high-potency supplements, containing 200 000 IU

o vitamin A, to preschool-age children (


15/68

4 GlObAl preVAlenCe Of VitAmin A DefiCienCy in pOpulAtiOns At risk 19952005

2. Methods

conducted between 1995 and 2006. Most surveys assessed

nutritional status in women or preschool-age children.

2.2 Selection o survey data

Te time rame or the current estimates is 19952005 and

survey data or WHOs Member States were extracted romthe database. Available data on both biochemical (serum/

plasma retinol) and clinical (current or history o night

blindness) VAD were selected or each country based on the

administrative level or which the survey was representative

and on the population group surveyed.

All countries with a 2005 gross domestic product (GDP)

US$ 15 000 were assumed to be ree rom VAD o a pub-

lic health signicance and were thereore excluded. None

o these 37 countries had retinol or night blindness data

reported or either preschool-age children or pregnant

women.

2.2.1 Administrative level

Surveys were rst selected according to the administrative

level they represented. Surveys were considered as national

when they were based on a nationally representative sam-

ple o the population surveyed. Subnational surveys were

selected only i a nationally representative survey was not

available or the years 19952005. Subnational surveys are

classied based on the population they represent: regional

(multiple states), state (representative o the rst adminis-

trative level boundary), district (representative o the sec-

ond administrative level boundary), or local surveys.Seven surveys were included as national even though

some areas within the country had been let out or security

or other concerns. In one o these surveys, data available

rom an originally missing area was pooled with the na-

tional data and weighted by the areas general population

estimate to provide a national estimate or that country.

Tis proportion was determined by using the most recent

census data. Tree additional surveys were accepted as na-

tional even though they were only representative o either

the rural (Bangladesh, Cambodia) or urban (Cuba) popula-

tions.For the majority o countries with subnational data,

2.1 Data sources The WHO Global Databaseon Vitamin A Defciency

Te current estimates are based on data available in the

WHO Global Database on Vitamin A Deciency (27); a

part o the Vitamin and Mineral Nutrition Inormation

System (VMNIS), maintained at WHO Headquarters inGeneva, Switzerland. Tis database compiles inormation

on the prevalence o night blindness, other ocular signs o

VAD, and blood retinol concentrations, regularly collect-

ed rom the scientic literature and through collaborators,

including WHO regional and country ofces, United Na-

tions organizations, ministries o health, research and aca-

demic institutions, and nongovernmental organizations.

MEDLINE and WHO regional databases (Arican Index

Medicus, Index Medicus or the WHO Eastern Mediter-

ranean Region, Latin American and Caribbean Center on

Health Sciences Inormation, Index Medicus or South-East Asia Region) were systematically searched. Tese

resources were augmented by manual searching o arti-

cles published in non-indexed medical and proessional

journals. Data were extracted rom reports written in any

language.

For inclusion in the database, a complete and original

survey report providing details o the sampling method

used is necessary. Serum or plasma retinol levels measured

in capillary, venous, or umbilical cord blood using quan-

titative methods are reported, usually together with the

prevalence o VAD. Measures o clinical VAD may have

included the prevalence o current night blindness (XN),history o maternal night blindness during a previous

pregnancy (pXN), conjunctival xerosis (X1A), Bitots spot

(X1B), corneal xerosis (X2), corneal ulceration/keratoma-

lacia aecting


16/68

5

surveys were representative o at least the rst (state) level

boundary. Exceptions to this were second (district) level

boundary surveys used or Sao ome and Principe, and

Ghana. Most countries that used subnational surveys were

represented by at least two states (rst level boundaries).

Exceptions to this principle were the surveys or ajikistan

and Uzbekistan, or which only one state was covered by

the survey. When two or more surveys at the subnational

level were available or the population group and country

concerned within the acceptable time rame, the results

were pooled into a single summary measure and weighted

by the total population that the survey represented. Te

most recent population census data available between 1995

and 2005 was used or this. No local level surveys and most

district level surveys were used in these estimates to reduce

potential bias in the estimates.

In general, surveys with prevalence data based on a

sample size o less than 100 subjects were excluded. Tissample size, along with a condence level o 95%, would

result in an error 10% i the prevalence estimate was 50%

and the design efect was 1.0. I the sample size was less

than 100, a larger error would result. However, a ew excep-

tions were made. National surveys with a sample size o less

than 100, but greater than 50, were considered as nation-

ally representative only when the results were being applied

to a total population o less than 500 000 people (n=1 in

preschool-age children), or to pregnant women (n=3) since

the numbers in this group are requently small, especially

in populations with a lower rate o reproduction. One na-

tional survey (Mexico) o pregnant women was excluded

because the sample size was less than 50. One survey or

retinol in pregnant women (Zimbabwe) and three surveys

or night blindness in preschool-age children (Gambia, In-

dia, Sri Lanka) did not report a sample size. In these cases,

a sample size o 100 was used only to approximate variances

and derive condence intervals.

2.2.2 Population groups

wo population groups were evaluated: preschool-age chil-

dren (


17/68


taken as slightly conservative. For only two o the 71 val-

ues in children, the predicted prevalence overestimated

the observed prevalence o retinol


18/68

7

95% prediction interval were computed by using the logit

transormations in the regression models and then back-

transorming them to the original scale (37, 38).

2.3.4 Combining national estimates

Country estimates or the 156 Member States with a 2005

GDP


19/68

GlObAl preVAlenCe O VitAmin A DeiCienCy in pOpulAtiOns At risk 199520058

2.4 Population covered by survey data,proportion o population, and the numbero individuals with vitamin A defciency in

populations at risk

2.4.1 Population covered

Te population covered by survey data at the regional and

global level was calculated by summing the number o in-

dividuals in the population group in countries with sur-

vey data divided by the total number o individuals in the

population group in the countries identifed at risk o VAD

in the entire region or globally or each population group.

2.4.2 Proportion o population and the number o

individuals aected in countries at risk or

vitamin A defciency

Te number o individuals with VAD was estimated in

both population groups or both indicators (night blind-

ness and retinol) or each country considered to be at risko VAD, each WHO and UN region, and global ly based on

each countrys proportion o the population with VAD. Te

proportion o the population group with VAD was mul-

tiplied by the national population o those considered to

be at risk o VAD to provide the number o subjects with

VAD at the country level, and the 95% confdence inter-

val was used as a measure o uncertainty. Te population

fgures are or the 2006 projection rom the 2006 revision

o the United Nations population estimates (40). Popula-

tion fgures or pregnant women were derived rom the

annual total number o births (time period 20052010).For 14 countries with a small total population (0.01% o

all women), birth data were not provided in tabulations o

the UN population division, and the number o pregnant

women was estimated by applying a WHO regional average

o births per reproductive-age woman (15 to 49 years) to the

total number o reproductive-age women.

Table 4 Prevalence criteria or defning night blindness

o public health signifcance

Public health Night blindness (XN)importance(degree o Childrena Pregnantseverity) (2471 mo o age) womenb

md >0%


20/68

9

3. Results and Discussion

proportion o preschool-age children and pregnant women

covered by night blindness survey data was 54% and 55%,

respectively, and by serum retinol survey data, 76% and

19%, respectively. By WHO region, the coverage varied

drastically depending on the population group assessed

and the indicator used. For night blindness in preschool-age children, data coverage was highest in South-East Asia

(82.4%) and the Western Pacifc (87.3%) and very low in

Europe (1%) and nil in the Americas (0%). Survey cover-

age or night blindness in pregnant women was the high-

est in South-East Asia (96.8%) and the lowest in Europe

3. results AnD DisCussiOn

3.1 Results


Only the 156 Member States which have a 2005 GDP


21/68

GlObAl preVAlenCe O VitAmin A DeiCienCy in pOpul AtiOns At risk 1995200510

(1.3%). Survey coverage or serum retinol was the highest

in the Western Pacic (99.8%) and the lowest in Europe

(17.8%) or preschool-age children; however, or pregnant

women, coverage was the highest in the Eastern Mediter-

ranean (39.8%) and virtually nil or both Europe (0%) and

the Americas (0.6%).

3.1.2 Proportion o population and number o

individuals with vitamin A defciency in

populations at risk

Globally, night blindness afects 5.2 million preschool-

age children (95% CI: 2.08.4 million) and 9.8 million

pregnant women (95% CI: 8.710.8 million), which corre-

sponds to 0.9% and 7.8% o the population at risk o VAD,

respectively (Table 8). Low serum retinol concentration

(


22/68


Table 11 Prevalence o serum retinol


23/68


Figure 1 Night blindness as a public health problem by country 19952005: Preschool-age children

a) Countries and areas with survey data

Category of public healthsignificance (prevalence ofnight blindness)

None

Mild Mild (>0% 0%


24/68

13


Preschool-age children


b) Countries and areas with survey data and regression-based estimates

Category of public healthsignificance (prevalence ofserum retinol


25/68


Figure 3 Night blindness as a public health problem by country 19952005: Pregnant women



Category of public healthsignificance (prevalence ofnight blindness)

No public healthproblem (


26/68

15

Figure 4 Biochemical vitamin A defciency (retinol) as a public health problem by country 19952005: Pregnant women



Category of public healthsignificance (prevalence ofserum retinol


27/68


3.2 Discussion


Preschool-age children and pregnant women are consid-

ered to be populations most at-risk or VAD due to their

increased demands or vitamin A and the potential health

consequences associated with VAD during these lie stages.

Tus, the estimates presented here are specic to children

under 5 years o age and pregnant women. Tis report does

not address VAD as a public health problem in all other

age groups due to lack o adequate data and understanding

o the public health importance o VAD at other ages (a

research priority). We also assume that VAD is not a pub-

lic health problem or preschool-age children and pregnant

women residing in the 37 countries identied as having

a GDP US$ 15 000, who have been excluded rom this

analysis and consideration.

About hal o the global populations o both preschool-

age children and pregnant women considered to be at risko VAD were covered by survey data or this report. Cover-

age was considerably greater (76%) or serum retinol in pre-

school-age children than in pregnant women (19%) where,

however, it remains low.

3.2.2 Strengths o estimates

Tis report utilizes the most up-to-date data published as

o December 31, 2006 or the years 19952005. Tese es-

timates are based on the greatest number o VAD surveys

conducted in preschool-age children and pregnant women

to date. Where probabilistic, representative surveys havenot been conducted in the 10 year inclusion period, survey

estimates are complemented by regression-based estimates.

Use o GDP US$ 15 000 to classiy a country as high

income and assuming that they are not at risk o VAD o

public health signicance is arbitrary. Although there is lit-

tle survey data available in these countries to support this

assumption, the exclusion is supported by a usual tendency

or VAD risk to decline with rising socioeconomic status,

most clearly evident in its association with xerophthalmia

(4144). A second reason or excluding higher income

countries rom analysis was to improve the predictability

o the regression models and to help place ocus on areaswhere VAD is likely to be o public health signicance.

3.2.3 Proportion o population and the number

o individuals with vitamin A defciency in

populations at risk

Approximately one third o the worlds preschool-age popu-

lation is estimated to be vitamin A decient, with just less

than 1% being night blind at a given time. Te WHO re-

gions o Arica and South-East Asia have the highest burden

o VAD, reected by decient concentrations o the vitamin

in circulation, where 4450% o preschool-age children areaected. Most vitamin A decient children live in South-

East Asia, where 91.5 million preschool-age children have

serum retinol concentrations


28/68


West estimated that 127 million preschool-age children are

vitamin A decient, dened as a serum retinol concentra-

tion


29/68


A limitation o using serum (plasma) retinol concentra-

tion as an indicator o vitamin A status is that it is decreased

by acute and underlying chronic inections (8). Te major-

ity o surveys do not utilize an indicator o inection status

at the time in which retinol is assessed. Concurrent data

on inection status would not alter the indicator-based (i.e.

serum retinol) estimates o prevalence but could infuence

the interpretation o survey ndings with respect to cause

o apparent deciency (48).

In some cases, the prevalence o serum retinol concen-

trations


30/68

19

References

1. Haskell MJ, Brown KH. Maternal vitamin A nutritureand the vitamin A content o human milk. Journal o

Mammary Gland Biology and Neoplasia , 1999, 4:243257.

2. US Institute o Medicine, Food and Nutrition Board,Standing Committee on the Scientic Evaluation o

Dietary Reerence Intakes. Dietary reerence intakes orvitamin A, vitamin K, arsenic, boron, chromium, copper,iodine, iron, manganese, molybdenum, nickel, silicon,vanadium, and zinc. Washington DC, National Acad-emy Press, 2000.

3. Alvarez JO et al. Urinary excretion o retinol in chil-dren with acute diarrhea.American Journal o ClinicalNutrition, 1995, 61:12731276.

4. Mitra AK et al. Urinary retinol excretion and kidneyunction in children with shigellosis.American Journalo Clinical Nutrition, 1998, 68:10951103.

5. Sommer A, West KP Jr. Vitamin A deciency: Health,survival, and vision. New York, Oxord UniversityPress, 1996.

6. Christian P et al. Night blindness o pregnancy in ru-ral Nepal nutritional and health risks. International

Journal o Epidemiolog y, 1998, 27:231237.7. West KP Jr, Gernand A, Sommer A. Vitamin A in nu-

tritional anemia. In: Kraemer K, Zimmermann MB,eds. Nutritional anemia. Basel, Sight and Lie Press,2007: 133153.

8. Scrimshaw NS, aylor CE, Gordon JE. Interactions onutrition and inection. Geneva, World Health Organi-zation (WHO Monograph Series No. 57), 1968 (http://whqlibdoc.who.int/monograph/WHO_MONO_57_(part1).pd).

9. Beaton GH et al. Efectiveness o vitamin A supplementa-tion in the control o young child morbidity and mortalityin developing countries. United Nations (UN) Admin-istrative Committee on Coordination, Sub-committeeon Nutrition State-o-the-Art Series: Nutrition PolicyDiscussion Paper No. 13. Geneva, United Nations,1993.

10. Glasziou PP, Mackerras DE. Vitamin A supplemen-tation in inectious diseases: a meta-analysis. British

Medical Journal, 1993, 306:366370.11. Fawzi WW et al. Vitamin A supplementation and

child mortality. A meta-analysis.Journal o the Ameri-can Medical Association, 1993, 269:898903.

12. Bhutta ZA et al. What works? Interventions or ma-ternal and child undernutrition and survival. Lancet,2008, 371:417440.

13. Benn CS et al. Efect o 50000 IU vitamin A givenwith BCG vaccine on mortality in inants in Guinea-Bissau: randomized placebo controlled trial. British

Medical Journal, 2008, 336:14161420.14. Malaba LC et al. Efect o postpartum maternal or

neonatal vitamin A supplementation on inant mor-tality among inants born to HIV-negative mothersin Zimbabwe.American Journal o Clinical Nutrition,2005, 81:454460.

15. West KP Jr et al. Double blind, cluster randomised tri-al o low dose supplementation with vitamin A or betacarotene on mortality related to pregnancy in Nepal.Te NNIPS-2 Study Group. British Medical Journal,1999, 318:5705.

16. Singh V, West KP Jr. Vitamin A deciency and xe-rophthalmia among school-aged children in South-eastern Asia. European Journal o Clinical Nutrition,2004, 58:13421349.

17. Sommer A. Vitamin A deciency and its consequences:a eld guide to detection and control, 3rd ed. Geneva,World Health Organization, 1995.

18. World Health Organization. Control o vitamin A de-ciency and xerophthalmia . Report o a Joint WHO/UNICEF/USAID/Helen Keller International/IVACGMeeting. echnical Report Series 672. Geneva, WorldHealth Organization, 1982.

19. Sommer A et al. History o nightblindness: a simpletool or xerophthalmia screening.American Journal oClinical Nutrition, 1980, 33:887891.

20. Christian P et al. Night blindness during pregnancyand subsequent mortality among women in Nepal: E-ects o vitamin A and beta-carotene supplementation.

American Journal o Epidemiolog y, 2000, 152:542547.

21. Sommer A, Davidson FR. Assessment and control ovitamin A deciency: the Annecy Accords. Journal oNutrition, 2002, 132: 2845S2850S.

22. West KP Jr. Extent o vitamin A deciency among pre-school children and women o reproductive age.Jour-nal o Nutrition, 2002,132:2857S66S.

23. Arroyave G et al. Evaluation o sugar ortication withvitamin A at the nutritional level. Scientic PublicationNo. 384, Washington DC, PAHO, 1979.

referenCes


31/68


24. Dary O, Mora JO, International Vitamin A Consul-tative Group. Food ortication to reduce vitaminA deciency: International Vitamin A ConsultativeGroup recommendations. Journal o Nutrition, 2002,132:2927S2933S.

25. World Health Organization, UNICEF, IVACG ask

Force. Vitamin A supplements: a guide to their use in thetreatment o vitamin A defciency and xerophthalmia , 2nded. Geneva, World Health Organization, 1997 (http://whqlibdoc.who.int/publications/1997/9241545062.pd).

26. Report o the XXII International Vitamin A Consulta-tive Group Meeting. Vitamin A and the common agen-da or micronutrients. Lima, Peru, 1517 November,2004, pp 4959.

27. Vitamin and Mineral Nutrition Inormation System,WHO Global Database on Vitamin A Deciency [on-line database]. Geneva, World Health Organization(http://www.who.int/vmnis/en/, accessed 31 Decem-

ber 2007).28. World Health Organization. Indicators or assessingvitamin A defciency and their application in moni-toring and evaluating intervention programmes. Ge-neva, World Health Organization, 1996 (WHO/NU/96.10) (http://whqlibdoc.who.int/hq/1996/WHO_NU_96.10.pd).

29. UNDP. Human Development Report 2002, Deepeningdemocracy in a ragmented world. New York, UnitedNations Development Programme, Oxord Uni-versity Press, 2002 (http://hdr.undp.org/en/media/HDR_2002_EN_Complete.pd).

30. Human Development Indicators. In: Cait Murphy BR-

L, ed. Human Development Report 2004. New York,United Nations Development Programme, 2004:139250.

31. World Health Organization. Te World Health Report2005. Make every mother and child count. Geneva,World Health Organization, 2005 (http://www.who.int/whr/2005).

32. World Health Organization. World Health Statistics2005. Geneva, World Health Organization, 2005(http://www.who.int/whosis/whostat/whostat2005en.pd).

33. United Nations Population Division. World populationprospects the 2004 revision. New York, United Na-

tions Population Division, 2005.34. World Health Organization. WHO Child Growth Stan-

dards: Length/height-or-age, weight-or-age, weight-or-length, weight-or-height and body mass index-or-age:Methods and development. Geneva, World Health Or-ganization, 2006.

35. Wackerly D, Mendenhall W, Scheafer RL. Math-ematical statistics with applications, 6th ed. PacicGrove, CA, Duxbury Press, 2001.

36. Lohr SL. Sampling: Design and analysis, 1st ed. PacicGrove, CA, Duxbury Press, 1998.

37. Neter J et al. Applied linear statistical models, 4th ed.New York, McGraw-Hill/Irwin, 1996.

38. Allison PD. Logistic regression using the SAS system. In-dianapolis, IN, Wiley-SAS, 2001.

39. Fleiss JL, Levin B, Paik MC. Statistical methods or ratesand proportions, 3rd ed. New Jersey, Wiley, 2003.40. United Nations Population Division. World population

prospects the 2006 revision. New York, United Na-tions Population Division, 2007.

41. Cohen N et al. Landholding, wealth and risk o blind-ing malnutrition in rural Bangladeshi households. So-cial Science & Medicine, 1985, 21:12691272.

42. Mele L et al. Nutritional and household risk actorsor xerophthalmia in Aceh, Indonesia: a case-controlstudy. Te Aceh Study Group. American Journal oClinical Nutrition, 1991, 53:14601465.

43. Khatry SK et al. Epidemiology o xerophthalmia in

Nepal. A pattern o household poverty, childhood ill-ness, and mortality. Te Sarlahi Study Group.Archiveso Ophthalmology, 1995, 113:425429.

44. World Health Organization. Te global prevalence ovitamin A defciency. Micronutrient Defciency Inorma-tion System (MDIS) Working Paper 2. Geneva, WorldHealth Organization, 1995 (WHO/NU/95.3).(http://www.who.int/nutrition/publications/vad_global_prevalence/en/index.html).

45. Micronutrient Initiative, UNICEF, ulane University.Progress in controlling vitamin A defciency. Ottawa,Micronutrient Initiative, 1998.

46. Micronutrient Initiative, United Nations Childrens

Fund. Vitamin and mineral defciency: a global prog-ress report. Ottawa, Micronutrient Initiative and NewYork, UNICEF, 2004 (http://www.micronutrient.org/pds/VMD.pd).

47. Mason J et al. Recent trends in malnutrition in devel-oping regions: vitamin A deciency, anemia, iodinedeciency, and child underweight. Food and NutritionBulletin, 2005, 26:59108.

48. Turnham DI et al. Efects o subclinical inection onplasma retinol concentrations and assessment o preva-lence o vitamin A deciency: meta-analysis. Lancet,2003, 362:20522058.

49. West KP Jr, Rice A, Sugimoto JD. ables on the global

burden o vitamin A defciency and xerophthalmia amongpreschool aged children and low vitamin A status, vita-min A defciency, and night blindness among pregnantwomen by WHO region (http://www.jhsph.edu/CHN/GlobalVAD.pd; updated August 2002).


32/68

21

AnneX 1

WHO Member States grouped by WHO

region and UN region as of 2007

AnneX 1

Table A1.1 WHO Member States grouped by WHO region

AfricaAlgeria

Angola

BeninBotswana

Burkina Faso

Burundi

Cameroon

Cape Verde

Central African Republic

Chad

Comoros

Congo

Cte dIvoire

Democratic Republic of

the Congo

Equatorial Guinea

Eritrea

Ethiopia

Gabon

Gambia

Ghana

Guinea

Guinea-Bissau

Kenya

Lesotho

LiberiaMadagascar

Malawi

Mali

Mauritania

Mauritius

Mozambique

Namibia

Niger

Nigeria

Rwanda

Sao ome and Principe

Senegal

Seychelles

Sierra Leone

South Africa

Swazilandogo

Uganda

United Republic of

anzania

Zambia

Zimbabwe

AmericasAntigua and Barbuda

Argentina

Bahamas

BarbadosBelize

Bolivia (Plurinational State

of)

Brazil

Canada

Chile

Colombia

Costa Rica

Cuba

Dominica

Dominican RepublicEcuador

El Salvador

Grenada

Guatemala

Guyana

Haiti

Honduras

Jamaica

Mexico

Nicaragua

Panama

Paraguay

Peru

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and theGrenadines

Suriname

rinidad and obago

United States of America

Uruguay

Venezuela (Bolivarian

Republic of)

South-East Asia

Bangladesh

Bhutan

Democratic PeoplesRepublic of Korea

India

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

Tailand

imor-Leste

EuropeAlbaniaAndorra

Armenia

Austria

Azerbaijan

Belarus

Belgium

Bosnia and Herzegovina

Bulgaria

Croatia

Cyprus

Czech Republic

Denmark

Estonia

Finland

FranceGeorgia

Germany

Greece

Hungary

Iceland

Ireland

Israel

Italy

Kazakhstan

Kyrgyzstan

Latvia

LithuaniaLuxembourg

Malta

Monaco

Montenegro

Netherlands

Norway

Poland

Portugal

Republic of Moldova

Romania

Russian FederationSan Marino

Serbia

Slovakia

Slovenia

Spain

Sweden

Switzerland

ajikistan

Te former Yugoslav

Republic of Macedonia

urkey

urkmenistan


33/68


Ukraine

United Kingdom of Great

Britain and Northern

Ireland

Uzbekistan

Eastern Mediterranean

Afghanistan

Bahrain

Djibouti

Egypt

Iran (Islamic Republic of)

Iraq

Jordan

Kuwait

Lebanon

Libyan Arab Jamahiriya

Morocco

Oman

Pakistan

Qatar

Saudi Arabia

Somalia

Sudan

Syrian Arab Republic

unisia

United Arab Emirates

Yemen

Western Pacifc

Austra lia

Brunei Darussalam

Cambodia

China

Cook Islands

Fiji

Japan

Kiribati

Lao Peoples Democratic

Republic

Malaysia

Marshall Islands

Micronesia (Federated

States of)

Mongolia

Nauru

New Zealand

Niue

Palau

Papua New Guinea

Philippines

Republic of Korea

Samoa

Singapore

Solomon Islands

onga

uvalu

Vanuatu

Viet Nam

Table A1.2 WHO Member States grouped by UN region and subregion1

Arica

Eastern Africa

Burundi

Comoros

Djibouti

Eritrea

Ethiopia

Kenya

Madagascar

Malawi

Mauritius

Mozambique

Rwanda

Seychelles

Somalia

Uganda

United Republic of

anzania

Zambia

Zimbabwe

Middle AfricaAngola

Cameroon


Chad

Congo

Democratic Republic of

the Congo

Equatorial Guinea

Gabon

Sao ome and Principe

Northern Africa

Algeria

Egypt

Libyan Arab Jamahiriya

Morocco

Sudan

unisia

Southern Africa

Botswana

Lesotho

Namibia

South Africa

Swaziland

Western Africa

Benin

Burkina Faso

Cape Verde

Cte dIvoire

Gambia

GhanaGuinea

Guinea-Bissau

Liberia

Mali

Mauritania

Niger

Nigeria

Senegal

Sierra Leone

ogo

Asia

Central Asia

Kazakhstan

Kyrgyzstan

ajikistan

urkmenistan

Uzbekistan

Eastern Asia

China

Democratic Peoples

Republic of Korea

Japan

Mongolia

Republic of Korea

Southern Asia

Afghanistan

Bangladesh

Bhutan

India

Iran (IslamicRepublic of )Maldives

Nepal

Pakistan

Sri Lanka

South-eastern Asia

Brunei Darussalam

Cambodia

Indonesia

Lao Peoples Democratic

Republic

Malaysia

Myanmar

Philippines

Singapore

Tailand

imor-Leste

Viet Nam

Western Asia

Armenia

AzerbaijanBahrain

Cyprus

Georgia

Iraq

Israel

Jordan

Kuwait

Lebanon

Oman

Qatar

Saudi ArabiaSyrian Arab Republic

urkey

United Arab Emirates

Yemen

1 http://unstats.un.org/unsd/

methods/m49/m49regin/htm,as of 31 January 2008.


34/68

23

Europe

Eastern Europe

Belarus

Bulgaria

Czech Republic

Hungary

Poland

Republic of Moldova

Romania

Russian Federation

Slovakia

Ukraine

Northern Europe

Denmark

Estonia

Finland

IcelandIreland

Latvia

Lithuania

Norway

Sweden

United Kingdom of Great

Britain and Northern

Ireland

Southern Europe

AlbaniaAndorra

Bosnia and Herzegovina

Croatia

Greece

Italy

Malta

Montenegro

Portugal

San Marino

Serbia

Slovenia

Spain

Te former Yugoslav

Republic of Macedonia

Western Europe

Austria

Belgium

France

Germany

Luxembourg

MonacoNetherlands

Switzerland

Americas

Latin America and

the Caribbean

Caribbean

Antigua and Barbuda

Bahamas

Barbados

Cuba

Dominica

Dominican Republic

Grenada

Haiti

Jamaica

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

rinidad and obago

Central America

Belize

Costa Rica

El Salvador

Guatemala

Honduras

Mexico

Nicaragua

Panama

South AmericaArgentina

Bolivia (Plurinational State

of)

Brazil

Chile

Colombia

Ecuador

Guyana

Paraguay

Peru

Suriname

Uruguay

Venezuela (Bolivarian

Republic of)

Northern America

Canada

United States of America

Oceania

AustraliaNew Zealand

Austra lia

New Zealand

Melanesia

Fiji

Papua New Guinea

Solomon Islands

Vanuatu

Micronesia

Kiribati

Marshall IslandsMicronesia (Federated

States of)

Nauru

Palau

Polynesia

Cook Islands

Niue

Samoa

onga

uvalu

AnneX 1


35/68

24 GlObAl preVAlenCe O VitAmin A DeiCienCy in pOpul AtiOns At risk 19952005

AnneX 2

Results by UN region

Table A2.1 Percentage o populationa at risk o vitamin A defciency covered by night blindness and serum retinol prevalence

surveys (national or subnational) conducted between 1995 and 2005, by UN region

UN region Preschool-age childrenb Pregnant women

Night blindness Retinol Night blindness Retinol

Aca (53)c 37.8 (17)d 75.9 (26) 62.9 (25) 27.0 (8)

Aa (37) 71.7 (12) 83.2 (21) 60.0 (13) 18.8 (7)eo (20) 0.7 (1) 0.7 (1) 1.3 (1) 0 (0)

la Aca ad

h Caa (32) 0 (0) 49.8 (16) 14.9 (6) 0.6 (4)

noh Aca (0) 0 (0) 0 (0) 0 (0) 0 (0)

Ocaa (14) 77.8 (2) 79.1 (3) 0 (0) 0 (0)

Global (156) 54.0 (32) 75.7 (67) 55.0 (45) 18.9 (19)

a excd co wh a 2005 GDp us$ 15 000. poao go: pchoo-ag chd (


36/68

25

Table A2.3 Prevalence o serum retinol


37/68


38/68


39/68


40/68


41/68


42/68


43/68


44/68


45/68


46/68


47/68


TableA3.2

Countryestimatesoftheprevalen

ceofnightblindnessinpregnantwomen

19952005

MemberState

Popu

lation2006a

Su

rve

yInformation

Proportionofthepopu

lation

Popu

lationw

ith

VAD

withnightbindness

(nu

mberofindividua

ls)(000)

Pregnantw

omen

General

Dateofsu

rvey

Lev

elof

Agerange

Sample

Pu

blichealth

(000)

(000)

(y

ears)

su

rvey

b

(y

ears)

Size

Referencec

Notes

Estimate

95%

CI

Estimate

9

5%

CI

problem

Veez

ea

598

27191

r

4.7

1.415.2

28

891

no

Vietn

am

1650

86206

r

4.1

1.213.2

67

19218

no

yeme

872

21732

r

9.8

3.027.8

85

26242

ye

Zamb

ia

473

11696

2003

n

15.0049.99

527

5098

5.7

1.717.5

27

883

ye

Zimba

bwe

374

13228

1999

n

15.0049.99

27704680,3331

4.6

3.46.1

17

1323

no

a

po

atiofgeaebaedothe2006ojectioomt

he2007eviioomt

heuitednatiopoatioDi

viio.

b

lev

eove:n=atioaeeetative,=veat

theftadmiitativeeveboda,s=veattheecodadmiitativeeveboda,r=egeiobaedetimate.

c

CoeodtothemeicaeeeceavaiabeitheWH

OGobaDatabaeoVitamiADefciec(htt://www.who.it/vmi/e/).

d

ns

=otecifed


48/68


49/68


50/68


51/68


52/68


53/68


54/68


55/68


56/68


57/68


58/68


59/68


60/68

49

AnneX 4

Country references

Afghanistan

Aghanistan MICS2 Steering Committee et al. 2000Aghanistan Multiple Indicator Cluster Survey (MICS2), Vol.1: Situation Analysis o Children and Women in the East o

Aghanistan. United Nations Childrens Fund, 2001. Re

3302.

Angola

Ministry o Health et al. Assessing vitamin A and iron de-fciency anaemia, nutritional anaemia among children aged060 months in the Republic o Angola [technical report].Ministry o Health, 2000. Re 2839.

Antigua and Barbuda

Micronutrient Working Group. Iron and vitamin A statusin fve Caribbean countries. Cajanus, 2002, 35 (1): 434.Re 3758.

Argentina

Ministerio de Salud, Plan Federal de Salud. Encuesta Na-cional de Nutricin y Salud (ENNyS) [Nacional Nutritionand Health Survey]. Ministerio de Salud, Argentina, 2007.Re 5837.

Armenia

Branca F, Napoletano A, Coclite D, Rossi L. Te healthand nutritional status o children and women in Armenia.Rome, National Institute o Nutrition, 1988. Re 3329.

National Statistical Service, et al. Armenia Demographicand Health Survey 2005. Calverton, MD, ORC Macro,2006. Re 5804.

Bangladesh

Institute o Public Health Nutrition. Vitamin A statusthroughout the liecycle in rural Bangladesh: National Vita-min A Survey 199798. Dhaka, Helen Keller International,1999. Re 3900.

Institute o Public Health. Bangladesh in Facts and Figures:2005 Annual Report o the Nutritional Surveillance Project.

Dhaka, Helen Keller International, 2006. Re 5473.

AnneX 4

National Institute o Population Research and raining(NIPOR), et al. Bangladesh Demographic and Health Sur-vey 2004. Calverton, MD, ORC Macro, 2005. Re 5206.

Benin

Institut National de la Statistique et de lAnalyseconomique et al. Enqute Dmographique et de Sant auBnin, 2001. Calverton, MD, Institut National de la Sta-tistique et de lAnalyse conomique et ORC Macro, 2002.Re 3461.

Rpublique du Benin, Ministre de la Sante Publique, Di-rection de la Sante Familiale, UNICEF, USAID. EnquteNationale sur la Carence en Vitamine A et la Disponibiliten Sel Iode dans les Mnages. Rapport de lEnqute Familiale.

2000. Re 5797.

BhutanPem N, Gyeltshen K, enzin N. Report o a survey or vita-min A defciency in children under Five and pregnant womenin Bhutan. Bhutan Ministry o Health, 2000. Re 2715.

Bolivia (Plurinational State of)

Gutirrez Sardn M et al. Bolivia Encuesta Nacional de De-mograa y Salud 2003 [Bolivia National Demographic andHealth Survey 2003]. La Paz, Ministerio de Salud y De-portes, Instituto Nacional de Estadstica, 2004. Re 5095.

Burkina Faso

Institut National de la Statistique et de la Dmographie[Burkina Faso] et al. Burkina Faso Enqute Dmographique etde Sant 2003 [Burkina Faso Demographic and Health Survey

2003]. Calverton, MD, ORC Macro, 2004. Re 4948.

Projet de Dveloppement Sant et Nutrition. Enqutepidmiologique sur les Carences en Micronutriments dans 15Provinces. Centre National Pour la Nutrition, Ministre dela Sant, Burkina Faso, 1997. Re 5801.

Burundi

Rapport de lEnqute Nationale de Nutrition de la Popula-

tion, 2005. Ministre de la Sant Publique, Rpublique duBurundi, 2006. Re 5748.


61/68


Cambodia

Hix J, Rasca P, Morgan J, Denna S, Panagides D, Tam M,Shankar AH. Validation o a rapid enzyme immunoassayor the quantitation o retinol-binding protein to assessvitamin A status within populations. European Journal oClinical Nutrition, 2006, 60(1):12991303. Re 5761.

Semba RD, de Pee S, Panagides D, Poly O, Bloem MW.Risk actors or xerophthalmia among mothers and theirchildren and or motherchild pairs with xerophthalmia inCambodia. Archives o Ophthalmology, 2004, 122(4):517523. Re 5021.

National Institute o Public Health, National Institute oStatistics, MEASURE DHS ORC Macro. Cambodia De-mographic and Health Survey 2005. Calverton, MD, ORCMacro, 2006. Re 5646.

CameroonInstitut National de la Statistique et al. Enqute Dmo-graphique et de Sant: Cameroon 2004. [Demographic

Health Survey: Cameroon 2004]. Calverton, MD, ORCMacro, 2005. Re 5214.

Ministre de la Sant Publique, UNICEF-Cameroun. En-qute Nationale sur la Carence en Vitamine A et IAnmie au

Cameroun, 2000. 2001. Re 3470.

Cape Verde

Ministrio da Sade e Promoo Social, Fundo das Naes

Unidas para a Inncia. Caracterizao Defcincia de Vi-tamina A e da Anemia em Crianas Pr-escolares de CaboVerde, 1997. Re 5630.


Ministere Delegue a lEconomie au Plan et a la Coopera-tion Internationale et al. Enqute nationale sur lavitaminose

A, la carence en er et la consommation du sel iode. Repub-lique Centraricaine, 2000. Re 1722.

Chad

Mildon A. Vitamin A Add-On Program Final Survey and

Program Report, December 2005. World Vision Canada,2005. Re 5102.

China

Jingxiong J, Toschke AM, von Kries R, Koletzko B, Liang-ming L. Vitamin A status among children in China. PublicHealth Nutrition, 2006, 9(8):955960. Re 5788.

Colombia

National Survey on the Nutritional Situation (ENSIN), Co-

lombia 2005, Protocol Executive Summary. Bogota, Insti-tuto Colombia de Bienestar Familiar, 2005. Re 5773.

Congo (The)

Samba C, Tchibindat F, Houze P, Gourmel B, Malvy D.Prevalence o inant Vitamin A defciency and undernutri-tion in the Republic o Congo.Acta Tropica, 97(3):27083,2006. Re 5631.

Centre National de la Statistique et des tudes conomiques(CNSEE), et al. Enqute Dmographique et de Sant du Con-go. [Demographic Health Survey o Congo, 2005]. Calverton,MD, ORC Macro, 2006. Re 5733.

Costa Rica

Carvajal Fernandez D, Alaro Calvo T, Monge-Rojas R.Defciencia de vitamina A en nios preescolares: un prob-lema re-emergente en Costa Rica? [Vitamin A defciencyamong preschool children: a re-emerging problem in Cos-ta Rica?]. Archivos Latinoamericanos de Nutricin, 2003,53(3):267270. Re 4227.

Cte dIvoire

Asobayire FS. Development o a ood ortifcation strategyto combat iron defciency in the Ivory Coast [dissertation].Zurich, Swiss Federal Institute o Technology, 2000. Re1986.

Cuba

Matos CM, Rodrguez GP, Gutirrez PM, Jimnez EA,Ramos Mesa MA. Estado nutricional de la vitamina A ennios Cubanos de 6 a 24 meses de edad. Revista Cubana de

Alimentacin y Nutricin, 2002, 16(2):95104. Re 3224.Democratic Republic of the Congo

Ministre de la Sant Publique. Importance de la carence envitamine A en Republique Democratique du Congo, 2000.Re 5800.

Dominica

Micronutrient Working Group. Iron and vitamin A statusin fve Caribbean countries. Cajanus, 2002, 35 (1):434.Re 3758.

Dominican RepublicAchcar MM, Ramrez N, Polanco JJ, Ochoa LH, Lere-bours G, Garcia B. Repblica Dominicana; Encuesta de-mogrfca y de salud (ENDESA 2002). Calverton, MD,ORC Macro, 2002. Re 4739.

Egypt

Nutrition Institute. National Survey or Assessment o Vita-min A Status in Egypt. United Nations Childrens Fund,Cairo, Egypt, 1995. Re 103.


62/68

51

Eritrea

National Statistics and Evaluation Ofce, et al. Demo-

graphic and Health Survey, Eritrea 2002. Calverton, MD,

ORC Macro, 2003. Re 4639.

Ethiopia

Haidar J, Demissie . Malnutrition and xerophthalmia in

rural communities o Ethiopia. East Arican Medical Jour-

nal, 1999, 76(10):590593. Re 1910.

MacDonald C. World Vision Ethiopia MICAH Program

Final Evaluation Report. World Vision Canada, 2006. Re

5639c.

Central Statistical Agency, et al. Ethiopia Demographic and

Health Survey, 2005. Calverton, MD, ORC Macro, 2006.

Re 5694.

Gabon

Ministre de la Planication de la Programmation duDveloppement et de lAmnagement du erritoire, et al.

Enqute Dmographique de Sant Gabon 2000 [Demo-

graphic and Health Survey Gabon 2000]. Calverton, MD,


Gambia

Bah A et al. Nationwide survey on the prevalence o vitamin

A and iron defciency in women and children in the Gambia.

Banjul, National Nutrition Agency, 2001. Re 2806.

Ghana

Ghana Statistical Service (GSS) et al. Ghana Demographic

and Health Survey 2003. Calverton, MD, ORC Macro,

2004. Re 4943.

Quarshie K, Amoaul E. Proceedings o the workshop on dis-

semination o fndings o vitamin A and anaemia prevalence

surveys. Accra, Ghana, 1998. Re 3004.

David P. Evaluating the Vitamin A Supplementation Pro-

gramme in Northern Ghana: Has it Contributed to Improved

Child Survival? Te Micronutrient Initiative, 2003. Re

5099.

MICAH Ghana Follow-Up Survey Report. World Vision

Ghana, 2000. Re 5104b.

Guatemala

Encuesta Nacional de Micronutrientes. Guatemala City,

Ministerio de Salud Publica y Asistencia Social, 1996. Re

3091.

Guinea

Direction Nationale de la Statistique (DNS) (Guine).

Enqute Dmographique et de Sant Guine 2005 [Demo-

graphic and Health Survey Guinea 2005]. Calverton, MD,ORC Macro, 2006. Re 5726.

Guyana

Micronutrient Working Group. Iron and vitamin A status

in ve Caribbean countries. Cajanus, 2002, 35 (1): 434.

Re 3758.

Haiti

Rpublique dHati et al. Enqute Mortalit, Morbidit et

Utilisation des Services EMMUS-III Hati 2000. Rpub-

lique dHati, 2001. Re 3264.

Ministre de la Sante Publique et de la Population et al. En-

qute sur la prvalence de la carence en vitamine A et de la d-

fcience end iode end Hati. Linstitut Haitien de lEnance,

2005. Re 5353.

Honduras

Ministerio de Salud Pblica et al. Encuesta Nacional de

Micronutrientes Honduras, 1996. egucigalpa, Secretaria de

Salud, Ministerio de Salud Pblica, 1997. Re 3095.

Secretara de Salud [Honduras], Instituto Nacional de Es-

tadstica (INE), Macro International. Encuesta Nacional

de Salud y Demograa 20052006. Calverton, MD, ORC

Macro, 2006. Re 5799.

India

Department o Women & Child Development, UNICEF.

Multiple Indicator Survey 2000 (MICS 2000) India

[summary report]. UNICEF, 2001. Re 4534.

International Institute or Population Sciences et al. Na-

tional Family Health Survey (NFHS-2), 19981999: India.

Mumbai, International Institute or Population Sciences,

2000. Re 2972.

International Institute or Population Sciences et al. Na-

tional Family Health Survey (NFHS-2), India, 19981999,

Northeastern States: Arunachal Pradesh, Manipur, Megha-

laya, Mizoram, Nagaland and Tripura. Mumbai, Interna-

tional Institute or Population Sciences, 2002. Re 3780a.

National Nutrition Monitoring Bureau. NNMB Techni-

cal Report No. 22: Prevalence o Micronutrient Defciencies.

Hyderabad, National Institute o Nutrition, Indian Coun-cil o Medical Research, 2003. Re 5839.

National Institute o Nutrition et al.Annual Report 2005

2006. Hyderabad, Indian Council o Medical Research,

2006. Re 5840.

Indonesia

Statistics [Indonesia], National Family Planning Coordi-

nating Board, Ministry o Health, ORC Marco. Indonesia

Demographic and Health Survey 20022003. Calverton,

MD, ORC Macro, 2003. Re 4538.

AnneX 3


63/68


Iran (Islamic Republic of)

Medical University et al.An Investigation o Under-nutrition

in Iran Year 1380 (2001). Islamic Republic o Iran, Minis-

try o Health and Medical Education, 2006. Re 5379.

Jamaica

WHO/PAHO et al. Micronutrient study report: an assess-

ment o the vitamin A, E, beta-carotene, and iron status in

Jamaica. Kingston, WHO, Pan American Health Or-

ganization, Caribbean Food and Nutrition Institute, 1998

(PAHO/CFNI/98.J1). Re 3093.

Jordan

Ministry o Health Jordan et al. National baseline survey on

iron defciency anemia and vitamin A defciency. Amman,

Ministry o Health, 2002. Re 4382.

Kazakhstan

Kazakh Academy o Nutrition, et al. Estimation o vitamin

A defciency prevalence in Kazakhstan . UNICEF [Central

Asian Republics and Kazakhstan], 2002. Re 5675.

Kenya

Mwaniki DL et al. Anaemia and status o iron, vitamin A

and zinc in Kenya. Te 1999 National Survey. Nairobi, Min-

istry o Health, 2002. Re 3442.

Lao Peoples Democratic Republic

Ministry o Health, Lao Peoples Democratic Republic. Re-

port on national health survey: health status o the People oLAO PDR. Vientiane, Ministry o Health, 2001. Re 770.

Lesotho

Ministry o Health and Social Welare et al. Lesotho De-

mographic and Health Survey 2004. Calverton, MD, ORC

Macro, 2005. Re 5356.

Liberia

Mulder-Sibanda M et al. National Micronutrient Survey. A

national prevalence study on vitamin A defciency, iron de-

fciency anemia, iodine defciency. Monrovia, Ministry o

Health and Social Welare, Family Health Division, Unit-ed Nations Childrens Fund, 1999. Re 1242.

Madagascar

Institut National de la Statistique et al. Enqute Dmo-

graphique et de Sant de Madagascar 20032004. Calver-

ton, MD, ORC Macro, 2005. Re 5190.

Berthine R. Enqute sur la Carence en Vitamine A Chez

les Femmes et les Enants et Enqute sur lAnemie Chez les

Ecoliers de 6 14 Ans, Madagascar 2000. Most Project,

USAID, 2001. Re 5090.

Malawi

National Statistical Ofce et al.Malawi Demographic and

Health Survey 2004. Calverton, MD, ORC Macro, 2005.

Re 5201.

Ministry o Health, UNICEF.Malawi Micronutrient Sur-

vey 2001. Ministry o Health, Lilongwe, Malawi, 2003. Re5602.

Malaysia

Ministry o Health. A study o malnutrition in under fve

children in Malaysia. Kuala Lumpur, Ministry o Health,

1999. Re 4394.

Maldives

Minister o Health, Republic o Maldives.Multiple Indica-

tor Cluster Survey (MICS 2), Maldives. Mal, Ministry o

Health, 2001. Re 2987.

Mali

Schemann J, Malvy D, Sacko D, Traore L. Trachoma and vi-

tamin A deciency. Lancet, 2001, 357(9269):1676. Re 4195.

Cellule de Planication et de Statistique du Ministre de

la Sant (CPS/MS), Direction Nationale de la Statistique

et de lInormatique (DNSI). Enqute Dmographique et de

Sant au Mali 2001. [Mali: Demographic and Health Sur-

vey 2001]. Calverton, MD, ORC Macro, 2002. Re 3446.

Marshall Islands

Palaox NA, Gamble MV, Dancheck B, Ricks MO, BriandK, Semba RD. Vitamin A deciency, iron deciency, and

anemia among preschool children in the Republic o the Mar-

shall Islands. Nutrition, 2003, 19(5):405408. Re 3886.

Mauritius

Ministry o Health Mauritius.A survey o nutrition in Mau-

ritius and Rodrigues (1995). Port Louis, Ministry o Health,

1995. Re 395.

Mexico

Encuesta Nacional de Nutricin 1999. Mexico City, Insti-

tuto Nacional de Salud Publica, 1999. Re 2997.

Micronesia (Federated States of)

Kim D, Sowell A. Vitamin A defciency among children and

caregivers in Chuuk State, Federated States o Micronesia.

Atlanta, Centers or Disease Control and Prevention, 2002.

Re 5672.

Socorro P, Gonzaga C. Results o vitamin A, anemia and

blood lead survey among 24 year old children and reproduc-

tive-aged women in Yap proper and Kosrae State, Federated

States o Micronesia. Atlanta, Centers or Disease Control

and Prevention, 2000. Re 2548.


64/68

53

Mongolia

Erdenechimeg E. Physiologic and hygienic assessment o vi-

tamin A defciency in children, Mongolia. Mongolia. Public

Health Institute, 2000. Re 5767.

Amardulam N, Erdenechimeg E, Burmaa B, Batdelger SH,

Zina P. Vitamin A defciency in Mongolia and results o Avitaminization . Moscow, First International Congress on

School Hygine, May 12, 2004. Re 5768.

Morocco

Nasri I, El Bouhali B, Aguenaou H, Mokhtar N. Vitamin

A deciency among Moroccan women and children. Ari-

can Health Sciences, 2004, 4:38. Re 5496.

Ministre de la Sant, ORC Macro, Projet PAPFAM. En-

qute sur la Population et la Sant Familiale 200304. ORC

Macro, 2005. Re 5191.

Mozambique

Ministrio da Sade et al. Inqurito nacional seovre a de-

fcincia de vitamina A, prevalncia de anemia e malria em

crianas dos 659 meses e respectivas mes. Maputo, Instituto

Nacional de Sade, 2003. Re 589.

Instituto Nacional de Estatstica, Ministrio da Sade.

Moambique: Inqurito Demogrphifco e de Sade 2003

[Mozambique: Demographic and Health Survey 2003].

Calverton, MD, ORC Macro, 2005. Re 5195.

Myanmar

Zin MM. Report on National Survey o Micronutrients,

20042005. Myanmar, Ministry o Health, 2005. Re

5685.

Nepal

Ministry o Health Nepal et al. Nepal Micronutrient Status

Survey 1998. Kathmandu, Ministry o Health, 1999. Re

1083.

Ministry o Health, New ERA, ORC Macro. Nepal De-

mographic and Health Survey 2001. Calverton, MD, ORC

Macro, 2001. Re 3321.

Nicaragua

Gurdin M, Kontorovsky I, Alvarado E, Ramrez SA,

Hernndez R. Sistema integrado de vigilancia de interven-

ciones nutricionales (SIVIN), 2004 [Integrated system o

monitoring nutrition interventions (SIVIN), 2004]. Mana-

gua, Ministerio de Salud, 2005. Re 5730a.

Instituto Nacional de Estadsticas y Censos, Ministerio de

Salud. Encuesta Nicaragense de Demograa y Salud 2001

[Demographic Health Survey Nicaragua 2001]. Calverton,


Niger

Rpublique du Niger, et al. Enqute Indicateurs Multiples

de la Fin de la Dcennie (MICS). United Nations Childrens

Fund, 2000. Re 3392.

Nigeria

International Institute o Tropical Agriculture (IITA), US-

AID, UNICEF, USDA. Nigeria Food Consumption and

Nutrition Survey 20012003 [summary]. International In-

stitute o Tropical Agriculture, 2004. Re 4581.

Ajose OA, Adelekan DA, Ajewole EO. Vitamin A status

o pregnant Nigerian women: relationship to dietary habits

and morbidity. Nutrition and Health, 2004, 17(4):325333.

Re 4764.

Oman

Ministry o Health o the Sultanate o Oman, UNICEF

Muscat, World Health Organization-Eastern Mediterra-nean Regional Ofce. National Micronutrient Status and

Fortifed Food Coverage Survey, Oman, 2004. Department

o Nutrition, Ministry o Health the Sultanate o Oman,

2006. Re 5525.

Pakistan

Pakistan Institute o Development Economics et al. Na-

tional Nutrition Survey 20012002. Islamabad, Govern-

ment o Pakistan, Planning Commission, 2003. Re 4640.

Panama

Ministerio de Salud, et al. Encuesta nacional de vitamina A

y anemia por defciencia de hierro [National survey o vitamin

A and iron defciency anemia]. Panama City, Ministerio de

Salud, 2000. Re 3097.

Papua New Guinea

Friesen H, Verma N, Lagani W, Billson F, Saweri W, Earl J.

Vitamin A status o children in dierent provinces in Papua

New Guinea. In:Abstracts o the 34th Annual Symposium o

the Medical Society o Papua New Guinea; 1998 Sept 711.

Port Moresby, Papua New Guinea Medical Society, 1998.

Re 4140.

Peru

Instituto Nacional de Salud, Centro Nacional de Aliment-

acin y Nutricin, Direccin Ejecutiva de Vigilancia Ali-

mentaria y Nutricional. Inorme nacional de defciencia de

vitamina A en nios menores de 5 aos y mujeres en edad rtil

19972001. Lima, Ministerio de Salud, 2001. Re 5412a.

Cspedes R, Dcila E, Fort A, Ulloa L, Castro Z. Per En-

cuesta Demogrfca y de Salud Familiar ENDES Continua

2004; Inorme principal. Calverton, MD, ORC Macro,

2005. Re 5357.

AnneX 3


65/68


Philippines

Pedro MRA, Cerdena CM, Molano WL, Constantine A,

Perlas LA, Palaox EF, Patalan L, Chavez M, Madriaga J,

Castillo E, Barba CVC. Sixth National Survey 2003. Ma-

nila, Food and Nutrition Research Institute, Department

o Science and echnology, 2006. Re 5452.

National Statistics Ofce, ORC Macro. Philippines: Na-

tional Demographic and Health Survey 2003. Calverton,


Republic of Moldova

Moldova Ministry o Health and Social Protection, et al.

Moldova Demographic and Health Survey 2005: Preliminary

Report. Chisinau, Moldova Ministry o Health and Social

Protection, 2005. Re 5489.

Rwanda

Ministre de la Sant et al. National Nutrition Survey oWomen and Children in Rwanda in 1996 [fnal report]. Ki-

gali, Ministre de la Sant, 1997. Re 2558.

Institut National de la Statistique du Rwanda (INSR), et al.

Rwanda Demographic and Health Survey 2005. Calverton,


St. Vincent and the Grenadines

Micronutrient Working Group. Iron and vitamin A status

in ve Caribbean countries. Cajanus, 2002, 35 (1): 434.

Re 3758.

Sao Tome and Prncipe

Carvalho A, Sousa L, Costa P, Neto O. Relatrio do Estudo

Sobre a Carncia de Micronutrientes. Republica Democrti-

ca de So ome e Prncipe, 2000. Re 5803.

Senegal

Sali N, Ayad M. Enqute Dmographique et de Sant au

Sngal 2005. Calverton, MD, ORC Macro, 2006. Re

5739.

Sri Lanka

Ministry o Health and Indigenous Medicine, MedicalResearch Institute. Vitamin A defciency status o children in

Sri Lanka 1995/1996 [survey report]. Dehiwela, Ministry o

Health and Indigenous Medicine, 1998. Re 2716.

Sudan

Federal Ministry o Health et al. Comprehensive Nutrition

Survey. Khartoum, Federal Ministry o Health, National

Nutrition Department, 1997. Re 1443.

Tajikistan

Avgonov Z, Gaibov AG, azhibaev ShS, Khairov KhS.

[Prevalence o vitamin deciency in ajik children] Voprosy

Pitaniia, 2005, 74(4):1416. Re 5718.

The former Yugoslav Republic of Macedonia

Branca F et al.Multiple indicator cluster survey in FYR Mac-

edonia with micronutrient component. Rome, National In-

stitute o Nutrition, 2000. Re 1609.

Thailand

Nutrition Division, Department o Health, Ministry o

Public Health. Te 5th National Nutrition Survey o Tai-

land, 2003. Tailand, 2003. Re 5848.

Timor-Leste

Ministry o Health imor-Leste et al. imor Leste 2003

Demographic and Health Survey. Newcastle, Australia, Min-istry o Health/University o Newcastle, 2003. Re 5050.

Uganda

Uganda Bureau o Statistics (UBOS) et al. Uganda Demo-

graphic and Health Survey 20002001. Calverton, MD,


United Republic of Tanzania

National Bureau o Statistics (NBS) anzania et al. an-

zania Demographic and Health Survey 200405. Dar es

Salaam, National Bureau o Statistics, ORC Macro, 2005.

Re 5221.

Ballart A, Mugyabyso JKL, Ruhiye DRM, Ndossi GD,

Basheke MM. Te National Vitamin A Defciency Control

Programme. A Preliminary Report on the National Vitamin A

Survey 1997. Dar es Salaam, anzania Food and Nutrition

Centre, 1998 (FNC Report No: 1880). Re 5738.

Uzbekistan

Analytical and Inormation Center et al. Uzbekistan Health

Examination Survey 2002. Calverton, MD, Analytical and

Inormation Center, State Department o Statistics, ORC

Macro, 2004. Re 4950.

Viet Nam

Khan NC, Ninh NX, Nhien NV, Khoi HH, West CE,

Hautvast JGAJ. Sub clinical vitamin A deciency and

anemia among Vietnamese children less than ve years o

age.Asia Pacifc Journal o Clinical Nutrition, 2007, 16(1):

152157. Re 5813.

National Institute o Nutrition General Statistical O-

ce.2000 Vietnam-Child and Mother Nutrition Situation.

Hanoi, Medical Publishing House, 2001. Re 2976.


66/68

55

Zambia

Luo C, Mwela CM. National survey on vitamin A defciency

in Zambia: a random cluster study or children (05 years)

and mothers attending national immunization days in August

1997. Lusaka, National Food and Nutrition Commission,

1997. Re 1325.

Micronutrient Operational Strategies and Technologies

(MOST) et al. Report o the national survey to evaluate

the impact o vitamin A interventions in Zambia, July and

November 2003. Zambia, Micronutrient Operational Strat-

egies and Technologies, United States Agency or Inter-

national Development (USAID) Micronutrient Program,

2003. Re 5098.

Zimbabwe

Ministry o Health and Child Welare, Nutrition Unit.

Zimbabwe National Micronutrient Survey: 1999. Harare,

Ministry o Health and Child Welare, 2001. Re 2641.

Central Statistical Ofce, Macro International Inc.Zimba-

bwe Demographic and Health Survey 1999. Calverton, MD,


Measure DHS+. Micronutrient Update. Calverton, MD,


Vitamin a Deficiency in Populations at Risk

Documents

Transcript of Vitamin a Deficiency in Populations at Risk