Sustaining vitamin A supplementation requires a new vision.

摘要

Although vitamin A supplementation has been ongoing for decades in some countries, systematic scaling-up in the context of child survival programmes began in the late 1990s. There has been a renewed commitment to vitamin A supplementation and an increasing focus on achieving universal coverage as part of UNICEF's integrated health and nutrition strategy,1 largely informed by the Lancet's child survival series.2When UNICEF first began reporting on progress through The State of the World's Children report in 2000,3 global coverage with at least one dose was about 50%, achieved in large part by linkage of vitamin A supplementation with national immunisation days for poliomyelitis eradication. Although nationalimmunisation days guarantee delivery of one supplemental dose, only 18 countries distributed the requisite second dose in 1999, translating into rpughly 16% of children receiving supplements as per international recommendations.4 Although many expressed concern that progress would falter with the phase-out of national immunisation days for poliomyelitis, coverage has steadily improved in recent years: 42 countries ensured two rounds of vitamin A supplementation in 2004, the most recent reporting year; increasing global two-dose coverage to 58%. Gains might be attributed to the advent of integrated delivery mechanisms-either modelled around child survival or, to a lesser extent, other rriicronutrient interventions.