Of Vitamin A Supplementation in the Early 1970s

Community-based high-dose vitamin A supplementation was advocated by several scientists (116-118). A 4-yr field study conducted in India in the late 1960s showed that an annual dose of 300,000 IU of vitamin A to children aged 1 to 5 yr reduced the prevalence of Bitot spots and keratomalacia (119). In 1971, a national program to distribute high-dose vitamin A capsules, 200,000 IU every 6 mo, to all children between the ages of 1 and 5 yr was initiated in India (120,121). The distribution of vitamin A was carried out by the personnel of the primary health centers, maternal and child health centers, and family-planning centers (121). From 1973 to 1975, the government of Indonesia conducted a pilot program of high-dose vitamin A capsules every 6 mo to every preschool child in 20 selected subdistricts in the island of Java (122). In 1972, the Ten-Year Health Plan approved by the Third Special Meeting of Ministers of Health of the countries of the Americas adopted the formal goal to reduce the prevalence of vitamin A deficiency by about one-third and to promote legislation to enforce the fortification of foods with vitamin A (123). Vitamin A fortification of sugar was implemented in Guatemala in 1974 with the underlying rationale of improving growth and increasing resistance to infectious diseases in children (124). In the late 1970s, the Indonesian government also began to consider vitamin A fortification of wheat flour, sugar, or monosodium glutamate (MSG) (125). After further deliberation, of the three, only MSG was considered a suitable carrier. Indonesian government officials were concerned that fortification of MSG would appear to be government endorsement of a commercial product. An analysis by Carl Fritz at Helen Keller International in 1982 showed that fortification of MSG with vitamin A, even if only 10% effective, would be cost-effective in reducing mortality of an estimated 20,000 Indonesian children each year (125).

The "Xerophthalmia Club" and Xerophthalmia Club Bulletin were founded in Jerusalem in 1971 at the Conference on the Prevention of Blindness, and H.A.P.C. Oomen was elected its first president. The bulletin was produced three times a year and was meant to provide an interdisciplinary tool to inform and coordinate efforts to eradicate vitamin A deficiency. In 1974, an expert group met in Jakarta, Indonesia under the auspices of WHO and the US Agency for International Development. A standardized classification of xerophthalmia, criteria for defining vitamin A deficiency as a public health problem, and dosage schedules for vitamin A were adapted (126).

The International Vitamin A Consultative Group (IVACG) was established in 1975 with support from the US Agency for International Development (127).

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