1. Development of purpose and justification for guideline work
In 1984, the 37th World Health Assembly adopted a resolution requesting the World Health Organization to support its Member States in the prevention and control of vitamin A deficiency. At the World Summit for Children convened by UNICEF in New York in 1990, a commitment was made to overcome the worst forms of malnutrition and a goal was set for the virtual elimination of vitamin A deficiency and all its consequences.
This commitment was reaffirmed by the World Health Assembly in 1991 (Resolution WHA44.33) and further strengthened at the FAO/WHO International Conference on Nutrition (Rome, 1992). At this meeting and in many other forums, it was recognized that the control of vitamin A deficiency was one of the most cost-effective child health and survival strategies available1.
The United Nations General Assembly Special Session on Children held in 2002 set as one of its goals the sustainable elimination of vitamin A deficiency by 2010 through dietary diversification, food fortification, and supplementation. One of the UN Millennium Development Goals (Goal 4) is to reduce by two thirds, between 1990 and 2015, the mortality rate among children under five. Vitamin A supplementation is an important component of the strategies needed to reach this goal2.
Vitamin A deficiency remains a significant public health problem with an estimated 190 million children and 19 million pregnant women affected globally3. Intensive efforts remain critically important to prevent and control vitamin A deficiency. Current WHO guidelines on vitamin A supplementation were published in 19974 and 19985.
Since this time, knowledge has expanded. In 2000, WHO commissioned reviews of the scientific literature to examine the current state of knowledge concerning the use of vitamin A supplements to control vitamin A deficiency and convened a Technical Consultation on vitamin A supplementation in Yverdon-les-Bains, Switzerland, March 1-3, 2000. The objectives of the Consultation were to undertake a critical review of the safety and efficacy of vitamin A supplementation in order to provide WHO with guidance on the use of vitamin A supplementation as a public health measure to prevent and treat vitamin A deficiency.
The reviews and conclusions of the Consultation were published in a special issue of the Food and Nutrition Bulletin in 20016. Additional research has been conducted since 2001 and the official WHO guidelines on vitamin A supplementation need to be revised in a systematic manner using the current evidence7.
The updated guidelines are intended to provide practical guidance and clear recommendations for the use of vitamin A supplements to Member States and their partners.
1. Countdown to 2015: tracking intervention coverage for child survival.
Bryce J, Terreri N, Victoria CG et al. The Lancet. 2006; 368:1067-1076
2. Child Survival Survey-based indicators: Report of a UNICEF/WHO Meeting 17-18 June, 2004.
WHO/UNICEF. New York: Authors; 2004
3. Global prevalence of vitamin A deficiency in populations at risk 1995-2005
4. Vitamin A supplements
5. Safe vitamin A dosage during pregnancy and lactation
6. Special Issue on vitamin A supplementation and the control of vitamin A deficiency
7. WHO handbook for guideline development