THE ROLE OF UNIVERSAL DISTRIBUTION OF VITAMIN-A CAPSULES IN COMBATINGVITAMIN-A-DEFICIENCY IN BANGLADESH

Vitamin A deficiency is a major public health problem among preschool- aged children in many developing countries. In Bangladesh, a national nutritional surveillance system was initiated in 1990 to monitor 1) th e occurrence of vitamin A deficiency by history of night blindness and 2) the routine coverage of national twice-yearly prophylactic vitamin A capsule (VAC) distribution. This study comprised data collected fro m June 1990 to August 1994. The VAC distribution had a mean coverage r ate of 48.7% (95% confidence interval (CI) 48.4-49.0) in the rural are as; the coverage rate in the urban slums was 93.7% (95% CI 93.4-94.0). In the rural areas, the mean prevalence of night blindness was 0.86% (95% CI 0.81-0.91) and the bimonthly prevalence of night blindness ran ged from 0.50% (95% CI 0.32-0.77) to 1.48% (95% CI 1.19-1.85), while i n the urban slums the mean prevalence was 0.22% (95% CI 0.18-0.28) and the bimonthly prevalence ranged from zero to 0.62% (95% CI 0.27-1.37) , The efficiency of VAC distribution was 27% (95% CI 17.6-35.3) in the rural areas and 77.8% (95% CI 61.8-87.1) in the urban slums. After ad justment for multiple potentially confounding factors, VAC receipt by individual children reduced the risk of night blindness in both rural and urban areas (rural areas: odds ratio (OR) = 0.74, 95% CI 0.63-0.87 ; urban slums: OR = 0.39, 95% CI 0.19-0.82). Breastfeeding was a prote ctive factor for night blindness In both rural (OR = 0.53, 95% CI 0.42 -0.67) and urban (OR = 0.32, 95% CI 0.15-0.66) areas. Night blindness was inversely related to the level of routinely attained coverage, and the degree of protection was associated with the time interval betwee n the moment of VAC receipt and the moment of data collection. Althoug h the prevalence of vitamin A deficiency in Bangladesh has been consid erably lower in the 1990s than it was in the 1980s, it is still preval ent at all socioeconomic levels. Supplementation with high-dose VACs i s an effective strategy for reducing night blindness, but the efficien cy of the program will improve when coverage in the rural areas increa ses.