Effectiveness of vitamin A supplementation among children under 5 years old in Kazakhstan
DOI:
https://doi.org/10.5219/1946Keywords:
children, awareness, vitamin A, deficiency, prevalence, prevention, supplementationAbstract
Micronutrient sufficiency leads to high rates of morbidity and mortality among children in Kazakhstan. Kazakhstan does not have a program for mandatory vitamin A supplementation of children under 5 years of age. Thus, the aim of this study was to assess the effectiveness of a pilot vitamin A supplementation program among children in Kazakhstan with the ultimate goal of informing future vitamin supplementation efforts. In Akmola and Kostanay regions of Kazakhstan, 529 children (aged 6-59 months) were randomly selected in each region through the local policlinics. In the first step of the study, mothers of the children were surveyed about the health status of their children using a standard data collection tool. Children were supplemented with Vitamin A using oral at a dose of 100,000 IU for children aged 6-11 months and 200,000 IU for children aged 12-59 months. Blood serum samples were collected for determining Vitamin A status. In the second step of the study, mothers were interviewed again about the health status of their children 6 months after the intervention and blood serum samples were collected to assess the efficacy of Vitamin A supplementation program. The number of self reported diarrhea cases and other intestinal infections significantly decreased after the vitamin A supplementation. The number of children with normal level of Vitamin A signficantly increased from before to after the intervention. Data from all participants (n = 529; pre VAS and 501 post VAS) showed that mean serum retinol levels increased significantly post VAS from 30.01 ±0.5 µg/dL to 61.06 ±1.2 µg/dL (p <0.001) Likewise, a significant change was observed in the cases of reported diarrhea between pre-test and post-test assessments (30 vs. 95; p <0.01). The health status of the examined children in the Akmola and Kostanay regions had significantly improved after the vitamin A supplementation and it points to the necessity of implementing Vitamin A supplementation program on the national level. This study has important policy implications for recommending the supplementation program on the national scale.
Downloads
Metrics
References
Lowe, N. M. (2021). The global challenge of hidden hunger: perspectives from the field. In Proceedings of the Nutrition Society (Vol. 80, Issue 3, pp. 283–289). Cambridge University Press (CUP). https://doi.org/10.1017/s0029665121000902 DOI: https://doi.org/10.1017/S0029665121000902
Friesen, V. M., Jungjohann, S., Mbuya, M. N. N., Harb, J., Visram, A., Hug, J., Garrett, G. S., & Neufeld, L. M. (2019). Fortification Assessment Coverage Toolkit (FACT) Manual. Global Alliance for Improved Nutrition (Geneva) and Oxford Policy Management (Oxford). Retrieved from https://www.gainhealth.org/sites/default/files/publications/documents/fact-manual.pdf. DOI: https://doi.org/10.36072/bp.1
Hashizume, M., Chiba, M., Shinohara, A., Iwabuchi, S., Sasaki, S., Shimoda, T., Kunii, O., Caypil, W., Dauletbaev, D., & Alnazarova, A. (2005). Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan. In Public Health Nutrition (Vol. 8, Issue 6, pp. 564–571). Cambridge University Press (CUP). https://doi.org/10.1079/phn2004717 DOI: https://doi.org/10.1079/PHN2004717
WHO. (2011). Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. Retrieved from https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.3.
Trumbo, P., Yates, A. A., Schlicker, S., & Poos, M. (2001). Dietary Reference Intakes. In Journal of the American Dietetic Association (Vol. 101, Issue 3, pp. 294–301). Elsevier BV. https://doi.org/10.1016/s0002-8223(01)00078-5 DOI: https://doi.org/10.1016/S0002-8223(01)00078-5
Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. In Cochrane Database of Systematic Reviews (Vol. 2022, Issue 3). Wiley. https://doi.org/10.1002/14651858.cd008524.pub4 DOI: https://doi.org/10.1002/14651858.CD008524.pub4
Stevens, G. A., Bennett, J. E., Hennocq, Q., Lu, Y., De-Regil, L. M., Rogers, L., Danaei, G., Li, G., White, R. A., Flaxman, S. R., Oehrle, S.-P., Finucane, M. M., Guerrero, R., Bhutta, Z. A., Then-Paulino, A., Fawzi, W., Black, R. E., & Ezzati, M. (2015). Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. In The Lancet Global Health (Vol. 3, Issue 9, pp. e528–e536). Elsevier BV. https://doi.org/10.1016/s2214-109x(15)00039-x
Fund, U. N. C. s. (2020). Estimates of Vitamin A Supplementation Coverage in Preschool-age Children: Methods and processes for the UNICEF global database. Retrieved from https://data.unicef.org/wp-content/uploads/2020/03/Vitamin-a-methods-paper.pdf.
Wirth, J., Petry, N., Tanumihardjo, S., Rogers, L., McLean, E., Greig, A., Garrett, G., Klemm, R., & Rohner, F. (2017). Vitamin A Supplementation Programs and Country-Level Evidence of Vitamin A Deficiency. In Nutrients (Vol. 9, Issue 3, p. 190). MDPI AG. https://doi.org/10.3390/nu9030190 DOI: https://doi.org/10.3390/nu9030190
Doreen Bartlett, L. C., Palisano, R., McCoy, S. W. (2012). Ed. Wong, C, Bartlett, D. J., & Chiarello, L. A. C. H., & Stoskopf, B. The Health Conditions Questionnaire. In Child Care Health and Development (Vol. 38, Issue 1, pp. 128–138). Canadian Institutes of Health Research and US Department of Education.
Craft, N. E., Haitema, T., Brindle, L. K., Yamini, S., Humphrey, J. H., & West, K. P., Jr. (2000). Retinol Analysis in Dried Blood Spots by HPLC. In The Journal of Nutrition (Vol. 130, Issue 4, pp. 882–885). Elsevier BV. https://doi.org/10.1093/jn/130.4.882 DOI: https://doi.org/10.1093/jn/130.4.882
WHO. (1996). Indicators for assessing Vitamin A deficiency and their application in monitoring and evaluating intervention programmes. In WHO (66 p). Retrieved from https://www.who.int/publications/i/item/WHO-NUT-96.10.
de Pee, S., & Dary, O. (2002). Biochemical Indicators of Vitamin A Deficiency: Serum Retinol and Serum Retinol Binding Protein. In The Journal of Nutrition (Vol. 132, Issue 9, pp. 2895S–2901S). Elsevier BV. https://doi.org/10.1093/jn/132.9.2895s DOI: https://doi.org/10.1093/jn/132.9.2895S
Ballew, C., Bowman, B. A., Sowell, A. L., & Gillespie, C. (2001). Serum retinol distributions in residents of the United States: third National Health and Nutrition Examination Survey, 1988–1994. In The American Journal of Clinical Nutrition (Vol. 73, Issue 3, pp. 586–593). Elsevier BV. https://doi.org/10.1093/ajcn/73.3.586 DOI: https://doi.org/10.1093/ajcn/73.3.586
Olmedilla, B., Granado, F., Southon, S., Wright, A. J. A., Blanco, I., Gil-Martinez, E., Berg, H. van den, Corridan, B., Roussel, A.-M., Chopra, M., & Thurnham, D. I. (2001). Serum concentrations of carotenoids and vitamins A, E, and C in control subjects from five European countries. In British Journal of Nutrition (Vol. 85, Issue 2, pp. 227–238). Cambridge University Press (CUP). https://doi.org/10.1079/bjn2000248 DOI: https://doi.org/10.1079/BJN2000248
WHO. (1996). Indicators for assessing Vitamin A deficiency and their application in monitoring and evaluating intervention programmes. In WHO (77 p). Retrieved from https://www.who.int/publications/i/item/WHO-NUT-96.10.
WHO. Guideline: Vitamin A supplementation in infants 1–5 months of age. (2011). In WHO. Retrieved from https://iris.who.int/bitstream/handle/10665/44628/9789241501811_eng.pdf?sequence=1.
Jia, M., Zhen, L., & Xiao, Y. (2022). Changing Food Consumption and Nutrition Intake in Kazakhstan. In Nutrients (Vol. 14, Issue 2, p. 326). MDPI AG. https://doi.org/10.3390/nu14020326 DOI: https://doi.org/10.3390/nu14020326
Sadighi, J., Nedjat, S., & Rostami, R. (2019). Systematic review and meta-analysis of the effect of iron-fortified flour on iron status of populations worldwide. In Public Health Nutrition (Vol. 22, Issue 18, pp. 3465–3484). Cambridge University Press (CUP). https://doi.org/10.1017/s1368980019002179 DOI: https://doi.org/10.1017/S1368980019002179
Baizhumanova, A., Nishimura, A., Ito, K., Sakamoto, J., Karsybekova, N., Tsoi, I., & Hamajima, N. (2010). Effectiveness of communication campaign on iron deficiency anemia in Kyzyl-Orda region, Kazakhstan: a pilot study. In BMC Hematology (Vol. 10, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/1471-2326-10-2 DOI: https://doi.org/10.1186/1471-2326-10-2
Tazhibayev, S., Dolmatova, O., Ganiyeva, G., Khairov, K., Ospanova, F., Oyunchimeg, D., Suleimanova, D., & Scrimshaw, N. (2008). Evaluation of the Potential Effectiveness of Wheat Flour and Salt Fortification Programs in Five Central Asian Countries and Mongolia, 2002–2007. In Food and Nutrition Bulletin (Vol. 29, Issue 4, pp. 255–265). SAGE Publications. https://doi.org/10.1177/156482650802900402 DOI: https://doi.org/10.1177/156482650802900402
Beisbekova, A., Raushanova, A., Juszkiewicz, K., Kainarbayeva, M., Chuyenbekova, A., Khassenova, G., Kozhakhmetova, A., & Kenessary, D. (2019). Medico-social effectiveness of biological monitoring of iodine deficiency status (IDS) among women of reproductive age in Kazakhstan. In Annals of Agricultural and Environmental Medicine (Vol. 26, Issue 1, pp. 73–77). Institute of Rural Health. https://doi.org/10.26444/aaem/90718 DOI: https://doi.org/10.26444/aaem/90718
Adinepour, F., Pouramin, S., Rashidinejad, A., & Jafari, S. M. (2022). Fortification/enrichment of milk and dairy products by encapsulated bioactive ingredients. In Food Research International (Vol. 157, p. 111212). Elsevier BV. https://doi.org/10.1016/j.foodres.2022.111212 DOI: https://doi.org/10.1016/j.foodres.2022.111212
Kroupina, M. G., Toemen, L., Aidjanov, M. M., Georgieff, M., Hearst, M. O., Himes, J. H., Johnson, D. E., Miller, B. S., Syzdykova, A. M., & Sharmanov, T. S. (2014). Predictors of Developmental Status in Young Children Living in Institutional Care in Kazakhstan. In Maternal and Child Health Journal (Vol. 19, Issue 6, pp. 1408–1416). Springer Science and Business Media LLC. https://doi.org/10.1007/s10995-014-1647-0 DOI: https://doi.org/10.1007/s10995-014-1647-0
WHO. (2019). Global prevalence of vitamin A deficiency in populations at risk 1995–2005: WHO global database on vitamin A deficiency.
Barua, A. B., & Sidell, N. (2004). Retinoyl β-Glucuronide: A Biologically Active Interesting Retinoid. In The Journal of Nutrition (Vol. 134, Issue 1, pp. 286S-289S). Elsevier BV. https://doi.org/10.1093/jn/134.1.286s DOI: https://doi.org/10.1093/jn/134.1.286S
Harrison, E. H. (2012). Mechanisms involved in the intestinal absorption of dietary vitamin A and provitamin A carotenoids. In Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids (Vol. 1821, Issue 1, pp. 70–77). Elsevier BV. https://doi.org/10.1016/j.bbalip.2011.06.002 DOI: https://doi.org/10.1016/j.bbalip.2011.06.002
Smith, E. R., Shankar, A. H., Wu, L. S.-F., Aboud, S., Adu-Afarwuah, S., Ali, H., Agustina, R., Arifeen, S., Ashorn, P., Bhutta, Z. A., Christian, P., Devakumar, D., Dewey, K. G., Friis, H., Gomo, E., Gupta, P., Kæstel, P., Kolsteren, P., Lanou, H., … Sudfeld, C. R. (2017). Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries. In The Lancet Global Health (Vol. 5, Issue 11, pp. e1090–e1100). Elsevier BV. https://doi.org/10.1016/s2214-109x(17)30371-6 DOI: https://doi.org/10.1016/S2214-109X(17)30371-6
Amimo, J. O., Michael, H., Chepngeno, J., Raev, S. A., Saif, L. J., & Vlasova, A. N. (2022). Immune Impairment Associated with Vitamin A Deficiency: Insights from Clinical Studies and Animal Model Research. In Nutrients (Vol. 14, Issue 23, p. 5038). MDPI AG. https://doi.org/10.3390/nu14235038 DOI: https://doi.org/10.3390/nu14235038
Yu, N., Su, X., Wang, Z., Dai, B., & Kang, J. (2015). Association of Dietary Vitamin A and β-Carotene Intake with the Risk of Lung Cancer: A Meta-Analysis of 19 Publications. In Nutrients (Vol. 7, Issue 11, pp. 9309–9324). MDPI AG. https://doi.org/10.3390/nu7115463 DOI: https://doi.org/10.3390/nu7115463
Vijayaraghavan, K. (2018). National control programme against nutritional blindness due to vitamin A deficiency: Current status & future strategy. In Indian Journal of Medical Research (Vol. 148, Issue 5, p. 496). Medknow. https://doi.org/10.4103/ijmr.ijmr_1781_18 DOI: https://doi.org/10.4103/ijmr.IJMR_1781_18
Mayo-Wilson, E., Imdad, A., Herzer, K., Yakoob, M. Y., & Bhutta, Z. A. (2011). Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. In BMJ (Vol. 343, Issue aug25 1, pp. d5094–d5094). BMJ. https://doi.org/10.1136/bmj.d5094 DOI: https://doi.org/10.1136/bmj.d5094
Abdelkader, A., Wahba, A. A., El-tonsy, M., Zewail, A. A., & Shams Eldin, M. (2022). Recurrent respiratory infections and vitamin A levels: a link? It is cross-sectional. In Medicine (Vol. 101, Issue 33, p. e30108). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/md.0000000000030108 DOI: https://doi.org/10.1097/MD.0000000000030108
Long, K. Z., Rosado, J. L., DuPont, H. L., Hertzmark, E., & Santos, J. I. (2007). Supplementation with vitamin A reduces watery diarrhoea and respiratory infections in Mexican children. In British Journal of Nutrition (Vol. 97, Issue 2, pp. 337–343). Cambridge University Press (CUP). https://doi.org/10.1017/s0007114507257757 DOI: https://doi.org/10.1017/S0007114507257757
Prado, E. L., Abbeddou, S., Adu‐Afarwuah, S., Arimond, M., Ashorn, P., Ashorn, U., Bendabenda, J., Brown, K. H., Hess, S. Y., Kortekangas, E., Lartey, A., Maleta, K., Oaks, B. M., Ocansey, E., Okronipa, H., Ouédraogo, J. B., Pulakka, A., Somé, J. W., Stewart, C. P., … Dewey, K. G. (2017). Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso. In Journal of Child Psychology and Psychiatry (Vol. 58, Issue 11, pp. 1264–1275). Wiley. https://doi.org/10.1111/jcpp.12751 DOI: https://doi.org/10.1111/jcpp.12751
Soares, M. M., Silva, M. A., Garcia, P. P. C., Silva, L. S. da, Costa, G. D. da, Araújo, R. M. A., & Cotta, R. M. M. (2019). Efect of vitamin A suplementation: a systematic review. In Ciência & Saúde Coletiva (Vol. 24, Issue 3, pp. 827–838). FapUNIFESP (SciELO). https://doi.org/10.1590/1413-81232018243.07112017 DOI: https://doi.org/10.1590/1413-81232018243.07112017
Villamor, E., & Fawzi, W. W. (2000). Vitamin A Supplementation: Implications for Morbidity and Mortality in Children. In The Journal of Infectious Diseases (Vol. 182, Issue s1, pp. S122–S133). Oxford University Press (OUP). https://doi.org/10.1086/315921 DOI: https://doi.org/10.1086/315921
Ye, Y., Yang, X., Zhao, J., He, J., Xu, X., Li, J., Shi, J., & Mu, D. (2022). Early Vitamin A Supplementation for Prevention of Short-Term Morbidity and Mortality in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis. In Frontiers in Pediatrics (Vol. 10). Frontiers Media SA. https://doi.org/10.3389/fped.2022.788409 DOI: https://doi.org/10.3389/fped.2022.788409
Wirth, J. P., Woodruff, B. A., Engle-Stone, R., Namaste, S. M., Temple, V. J., Petry, N., Macdonald, B., Suchdev, P. S., Rohner, F., & Aaron, G. J. (2017). Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. The American journal of clinical nutrition, 106(Suppl 1), 416S–427S. https://doi.org/10.3945/ajcn.116.143073 DOI: https://doi.org/10.3945/ajcn.116.142323
McLean, E., Cogswell, M., Egli, I., Wojdyla, D., & de Benoist, B. (2008). Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. In Public Health Nutrition (Vol. 12, Issue 04, p. 444). Cambridge University Press (CUP). https://doi.org/10.1017/s1368980008002401 DOI: https://doi.org/10.1017/S1368980008002401
Shah, D., & Sachdev, H. P. S. (2001). Effect of gestational zinc deficiency on pregnancy outcomes: summary of observation studies and zinc supplementation trials. In British Journal of Nutrition (Vol. 85, Issue S2, pp. S101–S108). Cambridge University Press (CUP). https://doi.org/10.1079/bjn2000301 DOI: https://doi.org/10.1079/BJN2000301
Lyellu, H. Y., Hussein, T. H., Wandel, M., Stray-Pedersen, B., Mgongo, M., & Msuya, S. E. (2020). Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania. In BMC Pregnancy and Childbirth (Vol. 20, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12884-020-02966-0 DOI: https://doi.org/10.1186/s12884-020-02966-0
WHO. (2017). Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation. Retrieved from https://www.who.int/publications/i/item/9789240081765.
Stevens, G. A., Bennett, J. E., Hennocq, Q., Lu, Y., De-Regil, L. M., Rogers, L., Danaei, G., Li, G., White, R. A., Flaxman, S. R., Oehrle, S.-P., Finucane, M. M., Guerrero, R., Bhutta, Z. A., Then-Paulino, A., Fawzi, W., Black, R. E., & Ezzati, M. (2015). Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. In The Lancet Global Health (Vol. 3, Issue 9, pp. e528–e536). Elsevier BV. https://doi.org/10.1016/s2214-109x(15)00039-x DOI: https://doi.org/10.1016/S2214-109X(15)00039-X
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Potravinarstvo Slovak Journal of Food Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This license permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
