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The time is not right for a change to the Vitamin A Supplementation Programme for Children in India

European Journal of Clinical Nutrition volume 77, pages 142–144 (2023)Cite this article

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We have gone through several scientific articles in recent times that have appeared on analysis of Vitamin A deficiency (VAD) with implications on change in Vitamin A Supplementation (VAS) Policy [1, 2]. These papers rely heavily on the results of Comprehensive National Nutrition Survey (CNNS) National Report 2016–18 of the Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF, and Population Council, 2019 [3]. The issues deliberated in [1, 2, 4, 5] based on results of CNS survey have implication on the policy related to a National VAS programme for children. The results of the CNS survey are required to be examined critically in terms of sample coverage, precision attached with the estimates and the Prevalence of VAD. We Statisticians working in community health and nutrition present our perspective in this note.

The CNN survey covered a sample of 7387 children aged 1–4 years against the target of 20,350 resulting into a shortfall of 64%. Importantly two States namely Rajasthan and Nagaland were not covered. As high as 23 out of remaining 28 states/Union territories showed a shortfall of 50% or more and in another 4 States/Union Territories, the coverage shortfall was between 30–50% of the target. This is a gross protocol deviation which is unacceptable. The large under coverage would introduce an unknown bias. It is commented by Reddy et al. [6, 7] that a “comparison of the demographic characteristics of samples with valid measurements and with missing/invalid measurements did not indicate any bias.” This is an over simplification of the issue relating to bias in the sample. For estimation of bias rather than just the demographic profile, it is essential to compare the stunting and wasting of children and the socio-economic profile of parents for those whose measurements were available on serum retinol and for those it was missed. In all probability, the difference in these parameters will be significant

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Data availability

Authors have used secondary data from Comprehensive National Nutrition Survey (CNNS) National Report 2016–18. https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf.

References

  1. Arlappa N. Vitamin A supplementation policy: a shift from universal to geographical targeted approach in India considered detrimental to health and nutritional status of under 5 years children. Eur J Clin Nutr. 2022;28:1–6.

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  2. Sachdev HS, Reddy GB, Pullakhandam R, Ghosh S, Rajkumar H, Kurpad AV. Flawed analyses and historical data inflate vitamin A deficiency in India to misdirect policy. Eur J Clin Nutr. 2022. https://doi.org/10.1038/s41430-022-01164-9.

  3. Comprehensive National Nutrition Survey (CNNS). CNNS National Report 2016-18. New Delhi, India: Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council 2019. https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf.

  4. Reddy GB, Pullakhandam R, Gosh S, Boiroju NK, Tattari S, Laxmaiah A, et al. Vitamin A deficiency among children younger than 5 y in India:an analysis of national data sets to reflect on the need for vitamin A supplementation. Am J Clin Nutr. 2021;113:939–47.

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Authors and Affiliations

  1. Indian Council of Medical Research (ICMR), New Delhi, India

    Padam Singh

  2. Institute of Applied Statistics and Development Studies, Lucknow, India

    Arun Nigam

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  1. Padam Singh
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  2. Arun Nigam
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PS and AN have contributed equally to conceptualisation, critical review of articles, identification of secondary data sources, in depth statistical analysis of secondary data, writing of original article and its revision.

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Correspondence to Padam Singh.

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Singh, P., Nigam, A. The time is not right for a change to the Vitamin A Supplementation Programme for Children in India. Eur J Clin Nutr 77, 142–144 (2023). https://doi.org/10.1038/s41430-022-01210-6

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