Vitamin A supplementation in children 6–59 months of age with severe acute malnutrition
In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.
Vitamin A deficiency affects about 190 million preschool-age children, mostly from Africa and South-East Asia, and there is evidence of an association with severe acute malnutrition. Vitamin A is essential to support rapid growth and to help combat infections and vitamin A deficiency left untreated may lead to blindness and increased risk of illness and death from childhood infections.
Children who are 6–59 months of age with severe acute malnutrition should receive the daily recommended nutrient intake of vitamin A throughout the treatment period. Children with severe acute malnutrition should be provided with about 5000 IU vitamin A daily, either as an integral part of therapeutic foods or as part of a multi-micronutrient formulation.
Children who are 6–59 months of age with severe acute malnutrition do not require a high dose of vitamin A as a supplement if they are receiving F-75, F-1002 or ready-to-use therapeutic food that complies with WHO specifications (and therefore already contains sufficient vitamin A), or vitamin A is part of other daily supplements.
This is a summary of one of several WHO recommendations on the management of SAM in infants and children. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines and guidance documents under ‘WHO documents’ below.
Updates on the management of severe acute malnutrition in infants and children
Pocket book of hospital care for children: second edition. Guidelines for the management of common illnesses with limited resources
Other guidance documents
Community-based management of severe acute malnutrition. A joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children's Fund
The treatment of diarrhoea: a manual for physicians and other senior health workers
Management of severe malnutrition: a manual for physicians and other senior health workers
Systematic reviews used to develop the guidelines
Systematic review of vitamin A supplementation in the treatment of children with severe acute malnutrition
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review