1. Akoto Osei K, PhD Helen Keller International Asia Pacific Regional Office Monitoring Outcomes of Programs for Vitamin A Deficiency

2. Source: WHO. 2009. ~250 million children suffer from Vitamin A deficiency (VAD)

3. VAD and Health Over 250,000 children become blind each year due to VAD VAD increases risk of morbidity and mortality

4. Strategies to address VAD Vitamin A supplementation Twice yearly for children 6-59 months of age (currently in ~80 countries) Dietary diversification Promoting production and consumption of diversified foods Optimal breastfeeding and complementary feeding practices

5. Strategies to address VAD Home fortification (Micronutrient powders, etc.) Large scale food fortification (VA + oil, flour, sugar, etc.) Biofortification Crops with high beta carotene (Orange Flesh Sweet Potato)

6. Monitoring outcomes of vitamin A programs Data to inform whether our activities where implemented successfully Data to inform if we have reached our objectives

7. Lack of field friendly indicators for assessing impact of these programs on vitamin A status How to estimate the relative contribution of the multiple vitamin A interventions to vitamin A intake and status Limited information on coverage of most VAD programs Limited information on underserved populations Inadequate use of the monitoring data to improve program implementation Limited funding for monitoring VAD programs Challenges with monitoring outcomes of Vitamin A programs

8. For how long should universal vitamin A supplementation programs continue, especially in countries with high coverage of this program? Coverage of vitamin A supplementation programs: ~ 72% globally; and >80% in resource poor countries Decisions about VAD programs – the need for more data Palmer et al, Public Health Nutr., 2012

9. Declining under 5 mortality rate; yet ~8 million child deaths per year

10. Palmer et al, Public Health Nutr. 2012; 9:1-15 Shift from vitamin A supplementation programs for children should be made only when there is sufficient and stable evidence that VAD has reduced, and risk of vitamin A deficiency is minimal. – Consecutive surveys shows low prevalence of VAD (< 5%, based on serum retinol) – Data shows dietary vitamin A intake has improved – High coverage is achieved for vitamin A programs Twice yearly vitamin A supplementation of children 6-59 months should continue

11. Implications for monitoring VAD programs Continuous monitoring and evaluation of VAD programs is needed to guide decisions on how to improve and when to scale back programs. More information is needed on: – Coverage of programs to address VAD – Vitamin A intake and status, including the relative contribution from different sources (fortified and non-fortified foods and supplements)

12. Thank You