|Culture, Environment, and Food to Prevent Vitamin A Deficiency (International Nutrition Foundation for Developing Countries - INFDC, 1997, 208 pages)|
|Part I. Vitamin A in food and diets|
|1. Vitamin A and food: The current situation|
Actions aimed at preventing vitamin A deficiency may draw on several potential types of solutions. Solutions at the community level can be diverse and may involve a variety of multisectoral community and development programs. Public health programs in breastfeeding, immunizations, family planning, health education, and maternal and child care are relevant, as are agricultural extension, agricultural education, horticultural promotion, etc. Education sector involvement might include food education, school gardens, and hygiene promotion for the prevention of infection (WHO/UNICEF, 1994). The training of professionals delivering services and programs is key to appropriate activities that will effect positive change.
In general, providing more vitamin A to vulnerable populations has been undertaken in three major intervention activity categories: distribution of large doses of vitamin A supplements, fortification of selected food items, and dietary modification to include more vitamin A-rich food. These have been accomplished in context with public health, agriculture, and/or education sector programs as noted above. A combination of these activities together with various public health measures and economic improvements is considered appropriate and effective (Subcommittee on Nutrition, 1994).
It is recognized that distribution of supplements provides a quick-acting intervention, best accomplished with sufficient health infrastructure to targeted populations, in particular to children at risk for protein-energy malnutrition and various infections. Improving vitamin A status in this way resulted in reduced mortality and morbidity (Beaton et al., 1993).
Fortification of food with vitamin A and its distribution is most feasible where the processed food industry is well-developed and supported, which may not be the case in resource-poor areas where vitamin A is lacking in the diet, deficiency is most extreme, and various barriers exist for the most vulnerable to access fortified food (Trowbridge et al., 1993). Examples of vitamin A fortification programs have been reported (McKigney, 1983), and include cod liver oil in margarine, and vitamin A in milk, sugar, and monosodium glutamate.
Lack of vitamin A in the diet is the root cause of vitamin A deficiency and dietary modification is generally regarded as the ultimate goal for the prevention of vitamin A deficiency in all members of households and communities. This is a long-term approach and requires improvements in food availability and education of those most vulnerable to take advantage of improved food supplies. One important dietary modification is the sustained breastfeeding of infants when mothers have sufficient dietary vitamin A. It is thought that the most effective dietary modification programs target improvement of dietary intake of vitamin A for women in the child-bearing years, during pregnancy and lactation, and for young children at weaning and during rapid growth and development (Subcommittee on Nutrition, 1994; Underwood, 1994; Wasantwisut and Attig, 1995).
Considerations for Sustainability
To solve the root cause of vitamin A deficiency, more vitamin A must be present in the diets of vulnerable people. Program planners and development leaders in health, agriculture, education, and other sectors must understand the culture and ecology of food availability and consumption at the local level. This understanding will lead to improvements in the dietary quality and quantity of vitamin A, through dietary modification and food fortification programs. With respect to food supplies, it requires understanding the species of vitamin A-rich foods that are culturally acceptable and available, their seasonality, methods of preservation and preparation, and barriers to their use due to cost, health beliefs, or other reasons of accessibility are also important. Only when these factors are known will agricultural, food processing, social marketing, and public health education programs have a sustained impact on behavior change and in improving dietary modification for vitamin A (Wasantwisut and Attig, 1995).
The elements of understanding the culture and ecology of food availability and consumption at the local level are addressed in several avenues of scientific communications including agriculture, food science, nutrition and social science journals, and other publications. The use of food sources to solve the vitamin A problem has recently been reported by Gopalan et al., 1992; IVACG, 1992; Smitasiri et al., 1993; Wasantwisut et al., 1994; and Wasantwisut and Attig, 1995. These publications give examples of successful programs to improve dietary vitamin A.