Govt's vitamin-A project fails to save dying children

Expert opinion against continuing costly programme was ignored

Giving vitamin A supplements orally to babies and pre-school children does not save them from death even though the government spends crores in buying and supplying these vitamin drops all over India.

Carried out on two million school children from 8,000 towns in Uttar Pradesh for five years, a new study has found no significant difference in death rate between those who received the oral vitamin A supplements and those who did not. “It contradicts the expectation from other trials that vitamin A supplementation would reduce child mortality by 20-30 per cent. No specific cause of death was significantly affected,” says the study published in March 16 issue of the medical journal Lancet.

The finding supports views held by a section of Indian doctors who felt scarce resources were wasted by the government in procuring and supplying vitamin A to children. Vitamin A supplement was given since 1970s to counter nutritional blindness in children up to 5 years. But as the food and nutrition situation improves in the next two decades, an Indian Council of Medical Research expert group suggested in 2005 to restrict the supplement for children between 9 months and three years.

The Centre, however, ignored the expert panel's advice and continued with vitamin A supplements to children up to 5 years arguing it would increase their chances of survival from other diseases.

The DEVTA (De-worming and Enhanced Vitamin A) trial results now suggests barely any benefits for children who received the vitamin A drops. In certain cases the results showed marginal improvements, which can be explained by other factors. Many public health officials had earlier questioned the vitamin A supplement policy claiming adverse side effects.  

In the Lancet paper, the team demonstrated while the effect of supplementation was not absolutely nil, it was certainly not as high as 20-30 per cent as claimed by previous research. The effect could be a quarter of half (between 5 and 15 per cent) of the past claims, according to the researchers including a team from King George Medical University in Lucknow.  

“The trial estimates mortality reduction at 4 per cent, ranging from an 11 per cent reduction to 3 per cent increase. It creates uncertainty around this intervention—or at least uncertainty around the effect size that has been attributed to vitamin A up until now,” says an accompanying comment in the same issue of Lancet written by three independent doctors including veteran Indian paediatrician H P S Sachdev, who is not involved with DEVTA trial. “Mortality is generally evaluated as an important justification for vitamin A intervention. But there was no evidence of mortality reduction in the trial,” Sachdev told Deccan Herald from Geneva.

Incidentally, even though the research was completed by 2007, the team took almost six years to publish the data giving rise to speculations among the public health community on the role played by the “Vitamin-A lobby” in the delay.