The Missing Ingredient.
Vitamin A deficiency or VAD refers to a lower than normal level of vitamin A in the human body. VAD causes numerous health problems such as nyctalopia (night blindness), xerophthalmia (abnormal dryness of the eyeballs), keratomalacia (corneal ulcer) and visual impairment (blindness in both eyes).
Besides causing eye-related diseases, VAD diminishes the human ability to fight several types of infections (e.g. measles), causes severe complications during pregnancy and lactation periods and also contributes to maternal mortality.
Even a mild deficiency of vitamin A develops many health problems in children, such as diarrheal and respiratory infections, slow bone development, low growth rate and a low chance of survival from serious illness.
In many developing countries, the prevalence of night blindness is high among pregnant women with vitamin A deficiency. As per statistics released by the World Health Organization (WHO), VAD is rare in developed countries and is common in developing and under-developed countries, mostly in Southeast Asia and Africa, affecting about one third of children under the age of five. In these regions, around 250,000 to 500,000 malnourished children under five become blind owing to VAD each year and more than 670,000 children die within a year of becoming blind.
A leading cause of preventable blindness among children, vitamin A deficiency is crucial to achieving the UN Millennium Development Goal 4, which is to reduce child mortality by two-thirds. Held in New York in May 2012, the United Nations Special Session on Children also set a goal to eliminate VAD by 2010, but could not achieve it. In 2013, around 65 percent of children aged 6 to 59 months were given two doses of vitamin A under the UN vaccination program. Living in the least developed countries, 80% of these children were fully protected against VAD during that period.
In Bangladesh, several studies have been carried out to determine the prevalence of vitamin A deficiency among different population groups. The International Centre for Diarrhoeal Disease Research and UNICEF conducted a joint survey there in 2011-2012, which revealed that more than 75 percent of preschool children in the country suffered from some form of VAD.
Based on the prevalence of night blindness in preschool children, some studies have positively shown that the overall rate of deficiency in Bangladesh improved from 3.6% in 1982-83 to 1.78% in 1989 and 0.6% in 1996. However, the National Nutrition Survey in 2012 revealed a high prevalence of subclinical vitamin A deficiency as one of the major public health concerns in Bangladesh.
In a human body, low levels of serum retinol determine subclinical vitamin A deficiency. Based on this medical standard, many reports indicate that the rate of night blindness among adolescents and schoolage children is quite high in rural Bangladesh, whereas night blindness among rural women is nearly 1.5%. In different population groups in the country, dietary intake of vitamin A is found to be below the RDI (Recommended Daily Intake). RDI is the daily intake level of a nutrient which must be taken in adequate amounts by every man and woman to meet the basic requirements.
In 1973, the government of Bangladesh initiated a nationwide 'Nutritional Blindness Programme' to mitigate the growing rate of vitamin A deficiency. Under the programme, children from 6 months to 6 years old were provided with vitamin A capsule (VAC) supplements. Nutrition education was also provided to families and health care providers in order to increase the consumption and production of vitamin A-rich foods. The primary health care workers were also given special training on how to diagnose and treat VAD.
According to the National Vitamin A Campaign of 2013, Bangladesh faces some key challenges to address VAD and other micronutrient deficiencies. For example, weak monitoring system and inappropriate target-setting at sub-district level result in unexpected coverage in some areas. There are gaps between administrative coverage reports and survey coverage reports, while it is difficult to reach those children who live in the most remote and deprived communities, according to campaign results.
Since 1988, the New York-based Helen Keller International Centre has been running a community-based programme in different parts of Bangladesh to produce such foods that are fortified with vitamin A, as a long-term strategy to mitigate vitamin A deficiency, particularly among children and women.
Vitamin A is naturally found in such commonly available foods as tropical fruits, winter squashes, sweet potatoes, dried apricots, dark leafy greens, cabbage, beetroot, cantaloupe, lettuce, bell peppers, carrots, liver, and fish.
Headquartered in Malaysia, WorldFish is a global, non-profit research organization that is working to reduce global poverty and hunger by harnessing the potential of aquaculture and fisheries. Craig Meisner, the Country Director of WorldFish Bangladesh, says, "In Bangladesh, the mola fish represents a low-cost, locally-sourced food that can dramatically improve nutrition and health for a major section of the population. Eating mola, a small indigenous fish, can give substantial health benefits, particularly in preventing diseases caused by vitamin A deficiency."
According to research conducted by the University of Copenhagen and the Bangladesh Agricultural University, the mola fish, also known as the ocean sunfish, can be cultivated in ponds to increase total fish yield manifold as well as the nutritional quality of the yield."
Dr. Shakuntala Haraksingh Thilstead, who is a senior nutrition scientist at the WorldFish Center, says, "The Bangladesh government should promote the culture of mola to increase the frequency and quantity of mola consumption - there is a great potential for this, as Bangladesh has over four million household ponds in which mola can be cultured."
Shamsunnahar Nahid, a senior nutrition consultant at the Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic diseases, says mola is a great source of calcium, protein and vitamin B, and is essential for growth in children. "If mola fish culture is promoted nationwide through proper campaigns, that would be a huge contribution towards ending malnutrition," she says.
Dr. Ahmed is a senior researcher associated with the Institute of Nutrition and Food Science at the University of Dhaka. He says, "Bangladesh needs a more appropriate mix of interventions for the entire population to improve the situation of vitamin A deficiency. More operational research and evaluation are needed if a fully effective programme to alleviate the problem of vitamin A deficiency is to be developed. To achieve the goal of virtual elimination of vitamin A deficiency will require an integrated approach which brings together appropriate actions at every level within and across the many sectors of society."
Besides running short and long-term VAD control and prevention programmes, the government of Bangladesh needs an integrated approach to tackle growing health concerns related to the vitamin A deficiency. To achieve the goal, a mass public awareness programme is necessary which will help the people realise the significance of vitamin A and how to grow vitamin A rich foods on their own.