INDIA: Vitamin A Deaths Fuel Debate on How to Cure Nutrition Woes

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Nov 21 2001 (IPS) - The deaths of 15 children and the hospitalisation of hundreds of others following a Vitamin A supplementation drive in India’s north-eastern Assam state last week may be the classic case of too much of a good thing.

Internationally-known nutritionists, among them C Gopalan of the Nutrition Foundation of India (NFI), are seeing in the deaths and reported headaches and diarrhoea among survivors, the toxic overdoses they have been warning against for some time.

Gopalan said the tragedy underscores the need for India to have “a food-based approach rather than a medicinal one to Vitamin A deficiency,” pointing to leafy vegetables and carotene-rich fruits like the papaya that are abundant in the country.

“These massive doses (of Vitamin A given in the supplementation drive) should be reserved only for emergencies and that too in pockets of distress,” said the distinguished nutritionist, a pioneer in supplementation programmes. He hinted at the “commercial exploitation of malnutrition” as being linked to what he feels is a mishandling of the approach to Vitamin A deficiency.

However, officials at the United Nations Children’s Fund (UNICEF) responsible for prophylactic programme directed against deficiency diseases, especially childhood blindness, see no link between the supplementation programme and the tragedy.

Maria Calivis, UNICEF representative in India, told IPS on Tuesday that on the face of it, she could see “no correlation between these most regrettable deaths and the programme”.

“We are still trying to find out what happened. We are checking the quality of the syrup. And we are awaiting the reports ordered by the Assam state government and the central health ministry,” Calivis said.

Although the reports were yet to be released, the central government has issued a circular directing all states to stop mass Vitamin A drives, citing the possibility of the children having died of toxic overdoses of this last week.

Soon after the deaths were reported, Union Health Minister C P Thakur, himself a doctor, said that the federal government was opposed to the Vitamin A campaigns and that the states were carrying them out on their own with UNICEF support.

Calivis, who toured the affected districts in Assam said an overdose of Vitamin A doses could not have produced such disastrous results, but admitted that the targeted public needed to be better informed through publicity drives.

“The one thing that was definitely needed was for the community to be more informed on the advantages and benefits of Vitamin A doses as well as side-effects which normally dissipate in one or two days,” she said.

Experts at UNICEF said Vitamin A supplementation was being carried out in 40 countries and that it was found to be absolutely essential in states like Assam, where coverage has actually dropped over the years.

“It is all very well for nutritionists like C Gopalan to talk about leafy vegetables and papayas, but how many people in this country can actually afford these?” a UNICEF expert, who asked not to be named, said.

There are conflicting scientific views on the usefulness or otherwise of Vitamin A drives, depending on who is citing them and for what reason.

UNICEF-supported research carried out this year in Chandigarh, joint-capital of western Punjab and Haryana states, forcefully recommends adding Vitamin A supplementation to annual pulse polio campaigns.

On the other hand, Umesh Kapil, a nutritionist at the central government’s prestigious All-India Institute of Medical Sciences (AIIMS), said deficiencies are better tackled by routine health care rather than on “campaign mode”.

Polio, he said, needed to be tackled through mass campaigns to achieve “herd immunity” against a communicable disease. But deficiency disorders were not communicable and should be addressed separately, he explained.

Kapil echoed Union Health Minister Thakur in accusing UNICEF of bypassing central government guidelines by teaming up with the states and taking advantage of the fact that states were empowered to handle health policies on their own.

Tuesday’s circular to the states was accompanied by copies of recommendations of a national consultation held here in September last year, which was unanimous in saying that Vitamin A campaigns were to be discouraged.

Kapil said there is a danger that the Assam tragedy could affect the confidence the public had in mass programmes, especially the pulse polio immunisation drives held at the end of each year – an apprehension shared by Calivis.

“We would like the polio immunisation day for the year to be launched soon and the public informed that there is no cause for panic,” the UNICEF representative said.