6 Strategic Interventions to Combat Vitamin A Deficiency and Prevent Vision Loss

“Eat your carrots” My mother would coax me whenever I left a piece of carrots on my plate, “they are good for your eyesight”. Almost all of us can nostalgically recall those moments. How right were our mums!

Though carrots may not cure blindness if you do not have perfect eyesight, vitamins found in this root plant can promote your eyesight because carrots are rich in beta-carotene which is usually converted into vitamin A in the body.

Vitamin A (retinol) is a group of antioxidant compounds that play a significant role in maintaining many physiological processes in the body; maintaining normal growth and development, eyesight, bone growth, normal skin, and a healthy immune system by creating a barrier on the surface of the eye, mucous membrane, and the skin against viruses and bacteria thus reducing the risk of infections.

Vitamin A deficiency result from inadequate dietary intake of vitamin A to meet the physiological needs of the body. The body access vitamin A as either preformed or provitamin A. Preformed vitamin A is readily accessible to the body and is derived from animal sources. Provitamin also known as carotenoid, is derived from colorful fruits and vegetables and it must be converted into retinol to be easily used by the body. Beta-carotene is the most prevalent and effective provitamin A.

Carrots provide a rich source of beta-carotene.

Vitamin A deficiency global perspectives

Vitamin A deficiency is one of the top nutritional deficiencies worldwide. According to WHO reports, vitamin A deficiency affects over 190 million children, and about 19 million pregnant women globally. The distribution of vitamin A deficiency differs with less developed countries bearing the most burden. For example, vitamin A deficiency causes between 250,000 to 500,000 cases of blindness in malnourished children. About two-thirds of those who become blind die within a month of losing eyesight.

Lack of vitamin A causes dryness of the cornea, clouding of one’s vision, leading to loss of vision. The associated damage to the retina greatly compounds the vision loss, with subsequent blindness. This cause of blindness is preventable with proper nutrition rich in vitamin A.

Populations at a greater risk of vitamin A deficiency

Though vitamin A deficiency can affect everyone, children, pregnant women, and lactating mothers.

In children, vitamin A deficiency increases childhood infections such as diarrhea, and respiratory conditions, impairs growth, development, vision, and the immune system. In most severe cases, vitamin A deficiency increases poor health, blindness, and death.

Vitamin A requirement is greater during pregnancy. In addition to supporting the maternal ocular functions, it is important for the development of the skeletal system of the baby and vital organs. Nutrition demands during pregnancy increase to cater to the mother and unborn child. This can increase micronutrient deficiency such as vitamin A to cater for accelerated fetal development.

For lactating mothers, vitamin A deficiency occurs when the mother has a low reserve of vitamin A. This happens because the body gives priority to breastmilk concentration of vitamin A, depriving the mother who then becomes vitamin A deficient.

Causes of Vitamin A deficiency

Vitamin A deficiency can occur due to several reasons; a diet low in vitamin A, childhood infections, malabsorption syndromes, or when the liver is sick.

Inadequate dietary intake

Prolonged intake of inadequate vitamin A can lead to deficiency. This happens when the main stable diet is poor in vitamin A. For example, when rice is eaten as the main source of food, you are likely to experience vitamin A deficiency because rice does not contain vitamin A.

Malabsorption syndromes

Malabsorption syndrome is a digestive tract problem that prevents the body from absorbing essential nutrients like vitamin A from the diet. Malabsorption causes digestion distress from the body’s inability to digest certain types of food. Diarrhea is a common symptom associated with malabsorption. With diarrhea, food usually passes very fast through the gastric tract without giving enough time for nutrient absorption. This can result in micronutrient deficiency such as vitamin A deficiency.

Childhood Infections

Regular gastrointestinal infections are the most common cause of vitamin A deficiency. This is further complicated in populations where zinc deficiency is common because zinc is required for vitamin A absorption. Measles as well increases the risk of vitamin A deficiency in children by reducing vitamin A absorption from the gut and increasing vitamin A secretion.

Liver diseases.

Chronic liver disease of any type increases the risk of vitamin A deficiency. Though the mechanism of the relationship of vitamin A deficiency in liver disease is not well elaborated, poor secretion of bile fluid that is necessary for the absorption of vitamin A and altered storage capacity are possible causes.

Signs and Symptoms of Vitamin A Deficiency

• Dry Skin. Since Vitamin A is necessary for the creation and repair of skin cells, vitamin A deficiency presents with skin problems such as eczema, and dry skin.
• Dry eyes. Eye problems are some of the most cited vitamin A deficiency issues that present with dry cornea with spots known as Bitot’s spots. Dry eyes, with the inability to produce tears, is the first sign of Vitamin A deficiency.
• Night blindness. This is the inability to see well in the darkness or in dim light. The inability to adopt from well-light to poorly light space. Night blindness is not a disease but a symptom of an underlying eye problem.
• Infertility. Vitamin A is critical for reproduction in both men and women and for the development of the fetus.
• Delayed Growth. Inadequate dietary vitamin A is associated with an increased risk of stunted growth in young children. Stunting is defined as impaired growth characterized by height below the expected normal standard height for the child’s age.
• Throat and Chest infections. Frequent infections in the chest and throat may be the first sign of vitamin A deficiency.
• Poor wound healing. Vitamin A promotes the creation of collagen which is necessary for healthy skin. A deficiency of vitamin A increases the risk of poor wound healing after injury or surgery.
• Acne and skin breakouts. Vitamin A has anti-inflammatory properties.

Dietary Sources of Vitamin A 

There are two sources of vitamin A. The animal sources of vitamin A referred to as preformed because it is easily absorbed and utilized by the body. The highest sources of preformed vitamin A include ox and lamb liver, salmon, oysters, cod liver oil, tuna, mackerel, trout, eggs, whole milk, cheese, and butter.

The other source of vitamin A is known as provitamin A. Provitamin has to be converted into preformed vitamin A before the body can use it. Dark green leafy vegetables, orange and yellow vegetables, fruits, and some vegetable oils are rich sources of provitamin A. Specifically, diversify your diet and include sweet potatoes, butternut squash, kales, collard green, carrots, sweet red pepper, spinach, lettuce, mangoes, cantaloupe, watermelon, papaya, apricot, tangerine, guava, and passion fruits.

Strategic Interventions to Combat Vitamin A Deficiency

1. Food-based strategies

Food and crops-based interventions offer a long-term approach to controlling vitamin A deficiency.

Growing and consuming crops that have high levels of beta-carotene show promising results. Orange-fleshed sweet potatoes are promising. Sweet potatoes have a high amount of natural beta-carotene which the body converts to vitamin A offering an inexpensive solution to vitamin A deficiency. In the high-risk group, sweet potatoes provide up to 100% of the daily requirement.

2. Exclusive breastfeeding

Promotion of exclusive breastfeeding for the first six months of the child’s life will ensure that the baby gets an adequate supply of vitamin A through breast milk. Breast milk is rich in vitamin A. In populations where vitamin A is deficient in the diet, vitamin A supplementation in lactating mothers raises breast milk vitamin A content.

3. Micronutrient Supplementation with Vitamin A

Vitamin A supplementation is a cost-effective way to promote vitamin A status in the population at risk of vitamin A deficiency. Guidelines on vitamin A supplementation recommend high doses of vitamin A supplementation to at-risk populations, and low doses of vitamin A supplements to the population at reduced risk of vitamin A deficiency. Children between 6 and 59 months of age, and pregnant women face a greater risk of vitamin A deficiency. Including vitamin A supplementation in the child’s welfare clinic is the best way to achieve this.

4. Food Fortification

Food fortification of stable foods is one-way micronutrient deficiency can be eliminated from a population. The process involves adding minerals and vitamins to the most commonly consumed foodstuff to increase their nutritional value. Reports from industrialized countries where food fortification is established indicate that food fortification is a cost-effective strategy to curb micronutrient deficiencies.

5. Nutrition education

Creating awareness on dietary diversification by growing vitamin A-rich crops throughout the years, how to store the crops after harvesting, and cooking methods that optimize vitamin A retention. Home gardening nutrient-rich foods and keeping chicken is one way to ensure that the family has nutrient-rich food throughout the year, a strategy that offers a long-term solution to vitamin A deficiency.

6. Access to better sanitation, water, and health care

Infections of the gastrointestinal tract increase malabsorption of vitamin A and secretion through urine and feces. Access to proper sanitation, safe drinking water, and early health care reduces the risk of gastro infections. Prevention of diseases like measles that exacerbate malnutrition through immunizations impacts vitamin A nutritional status.

Vitamin A-related deficiency can easily be prevented with the right nutritional knowledge.  Understanding the implications of vitamin A, the signs and symptoms of Vitamin A deficiency, and how you can strategically prevent vitamin A deficiency will go a long way to support your nutrition decision-making.

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