The Feasibility of Delivering Vitamin A to Newborns

In 2018, the World Health Organization (WHO) conducted a systematic review of neonatal vitamin A supplementation, which concluded that insufficient evidence existed to recommend a global policy of supplementing newborns with vitamin A. However, the review also highlighted the need for further efficacy trials in appropriate populations. In response to this recommendation, the WHO is currently supporting additional efficacy studies in Africa and Asia, as well as studies investigating potential mechanisms through which neonatal vitamin A supplementation may decrease the risk of early infant mortality. These studies aim to provide more robust evidence on the effectiveness of vitamin A supplementation in newborns. In South Asia, where vitamin A deficiency is a significant public health concern, innovative programs are being developed to deliver vitamin A to newborns. These programs aim to identify and engage neighborhood "watch" networks to detect births and rapidly dose infants, or use cell phones to contact health workers at the time of birth. The capsule could be included as a component in "safe birth kits" for women to use themselves, or provided at the time of home-delivery by trained birth attendants. In Nepal, the government has piloted vitamin A supplementation in four districts, in partnership with the USAID-funded Nepal Family Health Program, UNICEF, and the Micronutrient Initiative. Two distribution models have been selected for feasibility testing: the "FCHV Dosing" model, where female community health volunteers dose newborns in their homes, and the "Mother/Family Member Dosing" model, where mothers are counseled on vitamin A supplementation and given a capsule to administer to their newborn. Monitoring and evaluation of the intervention are being conducted through the government's health management information system, with data compiled and sent to the district and national levels. External monitors provide support visits and interview health workers and mothers who have received the vitamin A supplementation. Two population-based surveys are being conducted at baseline and end-line to assess the effectiveness of the intervention. Preliminary findings suggest that 62% of newborns are reached in the FCHV and community health worker dosing model, and 45% in the mother/family member dosing model. High vitamin A supplementation coverage is observed in districts with high institutional delivery rates and well-established community-based services targeting newborns. However, low ANC attendance, particularly the last visit at eight months' gestation, appears to lead to low vitamin A supplementation coverage. In Bangladesh, the Ministry of Health and Family Welfare has approved feasibility testing activities for vitamin A supplementation in three districts and six sub-districts. The intervention aims to identify and engage neighborhood "watch" networks to detect births and rapidly dose infants, or use cell phones to contact health workers at the time of birth. The capsule could be included as a component in "safe birth kits" for women to use themselves, or provided at the time of home-delivery by trained birth attendants. Monitoring and evaluation of the intervention are being conducted through the government's health management information system, with data compiled and sent to the district and national levels. External monitors provide support visits and interview health workers and mothers who have received the vitamin A supplementation. Preliminary findings suggest that the intervention has been successful in reaching a significant proportion of newborns, with high coverage observed in districts with high institutional delivery rates and well-established community-based services targeting newborns. The feasibility of delivering vitamin A to newborns in Nepal and Bangladesh has been demonstrated through the implementation of innovative programs and the use of existing health infrastructure. These programs aim to provide vitamin A supplementation to newborns in a timely and effective manner, reducing the risk of vitamin A deficiency and early infant mortality.