Vitamin A capsule distribution to control vitamin A deficiency in Indonesia: effect of supplementation in pre-school children and compliance with the programme

Design: Prospective cohort study conducted June–October 2000 in Semarang district, Central Java, Indonesia (Ungaran semi-urban and Banyubiru rural). Participants: 400 preschool children aged 12–60 months, random sampling from population lists; both sexes. Data collected at baseline (June 2000) and follow-up after 4 months (August 2000 supplementation). Measurements: anthropometry; haemoglobin (HemoCue); serum retinol (HPLC); ferritin, C-reactive protein (CRP), and alpha1-acid glycoprotein (AGP) by ELISA; caregiver questionnaire. Biochemical sub-samples: retinol n=79 semi-urban, n=110 rural; Hb n=146 semi-urban, n=157 rural; ferritin n=82 semi-urban, n=106 rural. Data completion: anthropometric n=305; Hb n=303; retinol n=189; ferritin/CRP/AGP n=186.

Oral vitamin A capsules given as part of a biannual supplementation program; one capsule per supplementation event; August 2000; dosage not stated; taken orally.

Vitamin A supplementation yielded modest improvements in micronutrient status and growth. Retinol rose in recipients to 0.89 mmol/L vs 0.78 mmol/L in non-recipients, with a decrease in low retinol from 18.8% to 14.5% among recipients and an increase from 31.9% to 37.5% among non-recipients. Ferritin and haemoglobin improved in recipients (ferritin from 26.5% deficient to 16.2%; Hb from 25.7% deficient to 15.3%); non-recipients showed no significant changes. Height gain was greater in recipients (2.57 cm) than non-recipients (2.21 cm). Stunting decreased among recipients (23.5% to 18.6%). Coverage of supplementation was 60%; compliance was associated with caregiver knowledge of benefits, the treatment setting, and child age. Authors conclude that vitamin A alone provides only marginal benefits; to improve effectiveness, a multi-nutrient approach (e.g., iron and zinc with vitamin A) and fortification, plus enhanced nutrition communication and involvement of private healthcare providers, are needed to increase coverage and impact.

Non-randomized, observational cohort; attrition with incomplete biomarker data; follow-up short (2–4 months); potential confounding; generalizability restricted to Central Java.