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Haselow NJ, Joshi V, Bayo PN, Murye JW, Shaban SN, Abebe KT, Kassim I, Shiweredo T, Vinathan H, Jaiswal CP, Miluwa KA, Ategbo EA, Ndiaye B, Ayoya MA. A Review of Vitamin A Supplementation in South Sudan: Successes, Challenges, and Opportunities for the Way Forward. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00660. [PMID: 36332070 PMCID: PMC9242605 DOI: 10.9745/ghsp-d-21-00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Although South Sudan's vitamin A supplementation program has demonstrated success, vitamin A supplementation remains a critical public health need for young children. How can South Sudan best maintain high vitamin A supplementation coverage for the short to medium term while planning a more sustainable delivery approach for the longer term? Aim: To identify vitamin A supplementation (VAS) trends in South Sudan and provide insights to refocus VAS programming vis a vis polio eradication campaigns recently phased out while access to health care, land, food, and markets remain challenging. Method: Review of data from survey and coverage reports; review of policy and program documents; key informant responses; general literature search. Results: Vitamin A deficiency (VAD) is likely a severe public health problem among preschool-aged children in South Sudan based on a high under-5 mortality rate (96.2 deaths/1,000 live births) and high levels of undernutrition, infections, and food insecurity. Vitamin A capsules, with deworming tablets (VASD), have been delivered to preschool-aged children during national immunization days (NIDs) for the past decade. Although areas of South Sudan and certain populations continue to have low VAS coverage, when comparing national VAS coverage (reported in the last 6 months) between 2010 and August 2019, a large improvement is noted from 4% to 76%. In 2021, VAS coverage was more than 90% at the national level during 2 stand-alone distribution campaigns. Deworming coverage trends generally mimicked VAS coverage. VAS is provided to postpartum mothers who deliver at health facilities (approximately 12%–25%), but coverage data are not available. Conclusion: Twice-yearly VAS should remain a key lifesaving intervention to address VAD, but alternative delivery strategies will be needed. Conducting events, such as child health days, supported by promotional activities or community-based VASD distribution activities for the youngest children and those missed during campaigns, should be considered. For the long term, a hybrid approach targeting underserved areas with mass distribution events while integrating VASD into community-based programs such as quarterly screening for wasting should be tested further and gradually scaled up everywhere as this has the potential to sustainably reach all vulnerable children twice yearly.
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Affiliation(s)
| | - Vandana Joshi
- UNICEF South Sudan, Juba, The Republic of South Sudan.
| | | | - Jesca W Murye
- UNICEF South Sudan, Juba, The Republic of South Sudan
| | | | | | | | | | - Hari Vinathan
- UNICEF Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic
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Bevis LE, Hestrin R. Widespread heterogeneity in staple crop mineral concentration in Uganda partially driven by soil characteristics. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:1867-1889. [PMID: 33165803 DOI: 10.1007/s10653-020-00698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/12/2020] [Indexed: 05/07/2023]
Abstract
Calcium (Ca), iron (Fe), selenium (Se), and zinc (Zn) deficiencies are widespread in sub-Saharan Africa, with severe implications for human health. In Uganda, where the predominant diet depends heavily on plant-based staples, crop mineral concentration is an important component of dietary mineral intake. Studies assessing the risk of nutrient deficiency or the effectiveness of nutrient-focused interventions often estimate dietary mineral intake using food composition tables that are based on crops grown in developed countries. However, little is known about the actual nutritional content of crops grown in Uganda. Here, we document the Ca, Fe, Se, and Zn concentration of staple crops collected from Ugandan household farms. While median mineral concentrations were similar to those reported previously, variation in crop mineral concentration was high, particularly for Fe and Se. An ordinary least squares regression showed that some soil characteristics were correlated with crop mineral concentrations. Of these, soil pH was often positively associated with crop mineral concentration, while sand and organic carbon concentrations were negatively associated with several crop mineral concentrations. However, much of the variation in crop mineral content was not associated with the soil characteristics measured. Overall, our results suggest that extensive heterogeneity in staple crop mineral concentration in Uganda is likely due to a combination of edaphic characteristics and other variables. Because staple foods constitute a large portion of dietary mineral intake in Uganda and other developing countries, these results have implications for estimates of dietary mineral intake and the development of effective intervention strategies in such regions.
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Affiliation(s)
- Leah Em Bevis
- Department of Agricultural, Environmental and Development Economics, The Ohio State University, Columbus, OH, USA.
| | - Rachel Hestrin
- Soil and Crop Sciences, School of Integrative Plant Science, Cornell University, Ithaca, NY, USA
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Raiten DJ, Darnton-Hill I, Tanumihardjo SA, Suchdev PS, Udomkesmalee E, Martinez C, Mazariegos DI, Mofu M, Kraemer K, Martinez H. Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum-Addressing the Safety and Effectiveness of Vitamin A Supplementation. Adv Nutr 2020; 11:185-199. [PMID: 31566677 PMCID: PMC7442412 DOI: 10.1093/advances/nmz100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/07/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023] Open
Abstract
An ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors' perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A-related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ian Darnton-Hill
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,The Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Emorn Udomkesmalee
- Department of Human Nutrition, Institute of Nutrition, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Carolina Martinez
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Dora Inés Mazariegos
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Musonda Mofu
- National Food and Nutrition Commission, Lusaka, Zambia
| | - Klaus Kraemer
- Sight and Life, Basel, Switzerland,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Homero Martinez
- Nutrition International, Ottawa, Ontario, Canada,Hospital Infantil de México Federico Gomez, Mexico City, Mexico,Address correspondence to HM (e-mail: )
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Aluisio AR, Perera SM, Yam D, Garbern S, Peters JL, Abel L, Cho DK, Kennedy SB, Massaquoi M, Sahr F, Brinkmann S, Locks L, Liu T, Levine AC. Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak. J Nutr 2019; 149:1757-1765. [PMID: 31268140 PMCID: PMC6768816 DOI: 10.1093/jn/nxz142] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. OBJECTIVE To evaluate the association between vitamin A supplementation and mortality in EVD. METHODS This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. RESULTS There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. CONCLUSION Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | | | - Derrick Yam
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Jillian L Peters
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Logan Abel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Lindsey Locks
- Department of Health Sciences, Boston University: Sargent College, Boston, MA, USA
| | - Tao Liu
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
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