this presentation is about the governmental organised national vitamin A prophylaxis programme which aims to reduce or to prevent the prevalence of vitamin A deficiency.

1. NATIONAL VITAMIN A
DEFICIENCY PROPHYLAXIS
PROGRAMMES
ISABELLA THOBURN COLLEGE
PREPARED BY-
KANIKA RASTOGI
MSC. 3RD SEM.
180380755031
SUBMITTED TO-
SARIKA SHUKLA

2. VITAMIN A
•Vitamin A is one of a group of fat soluble vitamins that are essential for
life and health. Three active forms: retinol, retinal and retinoic.
•Vitamin A plays a critical role in:
•Vision (A is part of rhodopsin, the visual pigment)
•Epithelial tissues need to protect integrity.
•Growth
•Reproduction
•Pattern formation during embryogenesis
•Bone development
•Brain development
•Immune system function
•Deficiency Diseases: Keratinization, xerosis, Xerophthalmia, Infections,
Weak bones, poor teeth.

3. SOURCES
ANIMAL FOODS: Liver, eggs, butter, cheese,
whole milk, fish and meat
Fish liver oil- richest natural source of retinol
PLANT FOODS: green leafy
, most green andvegetables
yellow fruits and vegetables
, roots(carrot)
FORTIFIED FOODS: food fortified with Vit.A
such as vanaspati, margarine, milk.

4. VITAMIN A DEFICIENCY
Vitamin A deficiency is a preventable cause of blindness.
It is a well-known cause of blindness and is associated with elevated mortality among
infants and children.
People most at risk are children between six months to six years, pregnant women,
and lactating women.
One of the main causes of Xerophthalmia is the poor intake of vitamin A, this disease
is also associated with:
 Faulty feeding habits
 Mal absorption syndromes (cystic fibrosis, Whipple's disease, Crohn's
disease, ulcerative colitis, short bowel syndrome, gastroenteritis,
measles)
 Pancreatic disease
 Chronic liver disease
 Weight Loss Surgery
 Poverty
 Ignorance
and some other conditions among the entire population, but mainly in developing
countries and in young children all over the world in particular.

5. CAUSES
• Primary Vitamin A Deficiency is usually caused by prolonged dietary
deprivation.
• Secondary Vitamin A Deficiency may be due to
Decreased bioavailability of provitamin A carotenoids.
Interference with absorption , storage or transport of vitamin A.
• Fat malabsortion , cholestasis, inflammatory bowel disease, cystic
fibrosis, pancreatic insufficiency .
• Vegan diet
• Alcoholism
• Toddlers and preschool children living below the poverty line.
• In pregrant women,vitamin A deficiency occurs especially in the last
trimester due to higher demands by foetus and mother.
• In children with complicated measles.

6. A) NIGHT BLINDNESS
• Lack of Vit. A FIRST causes Nightblindness.
• It is the inability to see in DIM LIGHT.
• It occurs due to impairment in dark adaptation.
• The condition may get worse if Vit. A is not taken,
especially if they suffer from diarrhoea and other infections.
B) CONJUNCTIVALXEROSIS
• It is the FIRST SIGN of Vit.Adeficiency.
• The conjuctiva becomes dry and non-wettable.
• It appears muddy and wrinkled (instead of smooth
and shiny)
C) BITOT’S SPOTS
• They are triangular, pearly white or yellowish, foamy spots on
the BULBAR CONJUCTIVA on either side of the CORNEA.
• Usually bilateral.
• In YOUNG children, it indicates Vit.Adeficiency.
• In OLDER individuals, it is often an inactive sequelae of earlier
disease.
SYMPTOMS

7. D) CORNEALXEROSIS
• The cornea appears dull, dry and non-wettable and eventually
opaque.
• This stage is VERY SERIOUS.
• In more SEVERE DEFICIENCY, there maybe corneal ulceration
• The ulcer may heal leaving a corneal scar which may affect vision.
• It is the liquefaction of the cornea.
• This is an MEDICALEMERGENCY.
• The cornea(a part or the whole) may become soft and may
burst open.
• This process is rapid and if the eye collapses,vision is lost.
E) KERATOMALACIA
F) XEROPTHALMIA (dryeye)
• It refers to ALL the ocular manifestationsof Vit.Adeficiency.
• It is a serious nutritional disorder leading to blindness particularly in
South-EastAsia.
• It is MOST COMMON in children aged 1-3yrs, and often related to
weaning.
• It is associated with PEM.

8. PREVENTION
•Distribution of massive dose capsules
(with polio vaccine)
•Food Fortification (to improve nutrition by enriching commonly-used food products with
important vitamins and minerals)
»Cooking Oil
»Wheat Flour
•Horticulture and agriculture
Green leafy vegetables
Orange colored fruits & vegetables
•Mothers will need advice about:
Breast feeding
Weaning in general
How to prepare them, E.g. giving fried egg to the child
Liver, egg, cheese, butter, fish liver oil etc are good sources of vitamin A.
•Immunization----Measles
•Avoid traditional healers
Herbs
Tooth paste etc

9. TREATMENT
• Vit.A deficiency should be treatedurgently
• Nearly ALL the early stages of Xeropthalmiacan be REVERSED by:
• Administration of MASSIVE DOSE of 200,000 IU (or 110mg) of retinol
palmitate ORALLY on 2 successive days.
• ALL children with corneal ulcers aregivenVit. A whether or not a deficiency is
suspected.
Timing Vitamin Adosage
Immediately on diagnosis
<6months of age 50,000 IU
6-12 months of age 1 lakh IU
>12months of age 2 lakh IU
Next day Same age specific dose
At least 2 weeks later Same age specific dose

10. NATIONAL VITAMIN A
PROPHYLAXIS PROGRAMME

11. Vitamin A prophylaxisprogramme
 The National Prophylaxis Programe against Nutritional Blindness due to vitamin A
deficiency (NPPNB due to VAD) was started in 1970.
In 2006, the age group of eligible children was revised as 9 months to 5
yr. of age (oral prophylactic dose):
One dose, 1,00, 000 IU along with measles immunization (operational
feasibility).
8 doses at six – monthly intervals of 2.00, 000 IU.
The specific aim of preventing nutritional blindness due to keratomalacia.
Objectives :
Promoting consumption of vitamin A rich food:-
Promotion of regular dietary intake of vitamin A rich foods by all pregnant and
lactating mother and by children under 5 years of age by increasing local
production and consumption of green leafy vegetable and other foods those are
rich sources of carotenoids.
Creating awareness about the importance of preventing Vitamin A Deficiency:-
Among the women’s attending Antenatal clinics, immunization sessions, as well as
women and children registered under ICDS programme.
Prophylactic Vitamin A as per the following dosage schedule :-
100,000 IU at 9 months with measles immunization.
200,000 IU at 16-18 months with DPT booster.
200,000 IU every 6 months up to the age of 5 years.

12. National Vitamin A Prophylaxis Programme – Current Scenario
(2016)
• Clinical VAD has declined drastically during the last 40 years.
– There has been virtual disappearance of keratomalacia.
– A sharp decline in the prevalence of Bitot spots
• Vitamin A supplementation (VAS) is implemented through the PHCs and sub-
centres.
– The services of ICDS functionaries are also utilized for Programme
implementation.
• Universal supplementation of vitamin A to Indian children is being
undertaken irrespective of their family background and nutritional status
• Recently it has been suggested that India is currently at a stage when universal
vitamin A supplementation should transit to -:
– A targeted supplementation programme.
– The primary focus should now be on sustainable food based approaches to
combat vitamin A deficiency.
• To increase local production and consumption of green leafy vegetables and
other plant foods those are rich sources of carotenoids.
• Green leafy vegetables, many fruits and other plant foods are also good
sources of folate, vitamin C, Fe, Ca and many other micronutrients

13. THANK
YOU