Delivering a lifesaving micronutrient to children in Bangladesh

Vitamin A deficiency is a public health concern all around the world, affecting children under five in more than half of all countries. In South Asia, which has one-fifth of the world’s population, 44-50% of pre-school children are affected by severe vitamin A deficiency (VAD). This causes visual impairment and night blindness, and weakens the immune system, putting a child at greater risk of disease and early death.

In 1973, to safeguard the health of children and provide them with this critical micronutrient, the government of Bangladesh initiated the ‘Nutritional Blindness Prevention Programme’, which evolved into the ‘National Vitamin A Plus Campaign’ (NVAC) in 2003. The programme has been a major success in reducing under-five mortality in the country and improving community awareness about VADs, foods rich in vitamin A, and vitamin A supplementation (VAS).

To ensure that no child gets left behind in receiving biannual doses of vitamin A, NVAC has initiated the targeted child-to-child search strategy proposed by Nutrition International. The unique approach tracks children residing in the 240 ‘hard-to-reach’ unions and administers VAS to them through door-to-door visits by healthcare providers.

With such targeted health and nutrition interventions, Bangladesh has made significant strides in improving child health and nutrition. The prevalence of VAD among preschool children of the country remains at 20.5%, much less than the world’s average.

However, with the advent of COVID-19, like many other developing nations, Bangladesh is facing a malnutrition crisis. A study conducted by the Bangladesh National Nutrition Council (BNNC) predicts chronic stunting to rise to 41% – a full ten-point increase over 2017-18 levels – setting back progress by almost a decade.

Addressing nutrition and food insecurity needs to be a key component of the nation’s COVID-19 response. The reinstating of the NVAC in October 2020 is a welcomed step that will provide the lifesaving micronutrient to approximately 20 million children all over the country, including half a million in hard-to-reach areas.

The NVAC has adapted to COVID-19 realities and has reinstated the administration of vitamin A to all children 6-59 months old. Health workers involved in this process have been trained in safety protocols developed by the Global Alliance for Vitamin A (GAVA), which is hosted and chaired by Nutrition International. Considering that VAS has shown to contribute to an all-cause mortality reduction of more than 12% when provided twice yearly to children under five, it is evident that such reliable and safe distribution of vitamin A both during and after this pandemic will have multiple benefits.

Although there is no current evidence on the effectiveness of vitamin A for the treatment of COVID-19 or the reduction in the severity of the specific symptoms it causes, VAS is especially important for vulnerable children in the context of an infectious disease outbreak. Not only does it reduce the incidence of diarrhoea by 15% and the incidence of measles by 50%, but it also contributes to reducing the odds of child stunting, which can have lifelong health benefits.

Vitamin A supplementation remains an essential health and nutrition intervention, and all children aged 6 to 59 months — including those who are suspected or confirmed cases of COVID-19 — should continue to receive vitamin A supplementation.

The frontline of any country’s health system is the immune system of its people, which is fueled by good nutrition. It is crucial to invest in nutrition now so that a generation of children are not robbed of their full potential.