Dodgy doses
a countrywide vitamin a supplementation programme for children has been embroiled in controversy, with accusations that unicef has been pushing it to benefit Roche, the only company that manufactures the vitamin supplement. A public interest petition demanding a better programme, designed to combat night blindness, is pending in the Rajasthan High Court, with the final hearing slated for December 23, 2005. Though it is against the Union ministry of health and family welfare (mohfw) and the state government, unicef has drawn flak outside the court.
The petitioner points out that the programme is being implemented across age groups though there is no evidence that every child needs it. According to Umesh Kapil, department of gastroenterology and human nutrition, All India Institute of Medical Sciences, unicef, mohfw's partner in the programme, is pushing it to benefit Roche, with which it has links.
Dubious design Experts have raised questions about the design of mohfw's National Programme for Prophylaxis against Blindness in Children Caused Due to Vitamin a Deficiency. Though unicef and mohfw guidelines say children between 9 to 36 months should be given the supplement, children as old as 11 years are being included in the programme. The Indian Academy of Pediatrics also said in October 2005 that there is no evidence to show that vitamin A helps children above three. It added vitamin A deficiency was not a problem in all parts of the country and supplements should be given after assessing need.
Experts say an overdose of the vitamin can actually be harmful, sometimes even fatal, because the vitamin accumulates in fatty tissue and becomes toxic. Seventeen children in Ladhuwala village in Sriganganagar district in Rajasthan fell sick after 70 of them were given the dose in 2005, according to newspaper reports. In November 2001, some children died in Assam after being given the supplements. Children in the area were not deficient in vitamin a: a survey carried out by the Indian Council of Medical Research (icmr) In Dibrugarh and Nagaon areas found that only 0.3 percent of children had Bitot's spot, the definitive symptom of vitamin a deficiency. In September 2003, the Guwahati High Court ruled unicef and the Assam government were responsible for administering an overdose. Doctors said the children had died because unicef had replaced 2ml spoons with 5ml cups, which confused those who were administering the vitamin.
The petition mentions other discrepancies: the vitamin a programme is under mohfw, but in Rajasthan, the department of women and child development is administering the supplement under unicef's instructions. The petitioner also suggested doctors supervise the administration of supplements, instead of anganwadi workers.
A unicef spokesperson said, however, that the organisation was funding the programme because governments had requested it. He added that the supplements would be withdrawn when conditions were conducive to tackling the problem through improved diet, but that was not possible at present. Commenting on the doubts raised about the efficacy of the programme, he said vitamin a supplements were beneficial, and such programmes had done well in all other countries.
Going ahead Even as the date for the final hearing nears, the Rajasthan government is going ahead full steam with the programme despite the misgivings in many quarters. In fact, similar programmes continue to be pushed in other states like Uttar Pradesh, Uttaranchal and Jharkhand. In Jharkhand, a special drive was carried out in 2003 to extend the vitamin A supplement programme as the department of health felt that routine immunisation was reaching only 8 per cent of children.
Given all the doubts, the petitioner has pleaded that the court should ask Rajasthan's secretary, health, and director, women and child development, to carry out a survey to identify children who need the supplement and concentrate on diet. In 2004, icmr began a survey in Assam and Rajasthan to do this. Results are awaited.