Article Text

Download PDFPDF

Refocusing vitamin A supplementation programmes to reach the most vulnerable
  1. Erin McLean1,
  2. Rolf Klemm2,3,
  3. Hamsa Subramaniam4,
  4. Alison Greig5
  1. 1Nutrition, UNICEF, New York City, New York, USA
  2. 2Helen Keller International, New York City, New York, USA
  3. 3Johns Hopkins University, Baltimore, Maryland, USA
  4. 4UNICEF, New York City, New York, USA
  5. 5Nutrition International, Ottawa, Ontario, Canada
  1. Correspondence to Dr Erin McLean; edmclean_75{at}


WHO recommends vitamin A supplementation (VAS) programmes for children 6–59 months where vitamin A deficiency is a public health problem. However, resources for VAS are falling short of current needs and programme coverage is suffering. The authors present the case for considering the options for shifting efforts and resources from a generalised approach, to prioritising resources to reach populations with continued high child mortality rates and high vitamin A deficiency prevalence to maximise child survival benefits . This includes evaluating where child mortality and/or vitamin A deficiency has dropped, as well as using under 5 mortality rates as a proxy for vitamin A deficiency, in the absence of recent data. The analysis supports that fewer countries may now need to prioritise VAS than in the year 2000, but that there are still a large number of countries that do. The authors also outline next steps for analysing options for improved targeting and cost-effectiveness of programmes. Focusing VAS resources to reach the most vulnerable is an efficient use of resources and will continue to promote young child survival.

  • nutrition
  • public health
  • child health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Handling editor Seye Abimbola

  • Contributors EM conceptualised the approach to revising the list of countries tracked for needing national programmes and worked on a first draft of this paper. RK provided input into the approach and drafts of the paper. HS conducted the analysis to use U5MR as a proxy indicator and provided input into the drafts of the paper. AG provided input into the approach and drafts of the paper.

  • Funding We are grateful to Global Affairs Canada and Proctor and Gamble for funding for vitamin A supplementation, which supported some staff and consultancy time to undertake this analysis and write this paper.

  • Competing interests The authors work for organisations that support vitamin A supplementation programmes.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.