Fortification of Vegetable oil and Sugar with Vitamin A in Uganda

CHAPTER ONE
I. Introduction
A. Vitamin A Deficiency in Uganda
In 2001, 28 percent of Ugandan children 6 to 59 months old suffered from vitamin A
deficiency (VAD), based on low serum retinol levels as determined by HPLC from blood
samples spotted on paper filter. Although substantial variation in VAD prevalence across
Uganda’s four regions exists (see Figure 1.1), throughout the country the VAD level
exceeds the 15 percent prevalence threshold that the International Consultative Group of
Vitamin A (IVACG) recommends to identify a national public health problem. The most
recent valid and reliable nationally representative data about vitamin A status in Uganda
is from 2001, 3 however, VAD prevalence has likely fallen since then due to two factors:
(1) the start in 2004 of a vegetable oil fortification program which now covers an
estimated 85 percent of the domestic vegetable oil market, and (2) the introduction of
Child Days Plus (CDP) the same year. CDP is a twice-annual campaign-style event
designed to increase the coverage of vitamin A, de-worming, immunization, treatment of
neglected tropical diseases and, depending on the districts’ decisions, one or more health
services. Since its inception, the CDP posted generally increasing coverage rates,
ranging from 52 to 74 percent. Then, in 2007, coverage fell dramatically to 29 percent
(see Figure 1.2). It is uncertain whether the CDP program has recovered lately, but if not
VAD prevalence rates may once again be increasing. However, given vitamin A oil
fortification and the fact that the CDP covers nearly a third of children 6-59 months
means that prevalence is still probably less than in 2001.
40%
35%
36%
30%
28%
29%
28%
Prevalence of VAD
25%
20%
15%
22%
10%
5%
0%
Central Eastern Northern West Nationwide
Figure 1.1: The prevalence of low serum retinol levels in pre-schoolers (6-59 months old) of
different regions of Uganda in 2001. Source: UDHS 2001.
3 The 2006 Ugandan DHS used a vitamin A test that is not reliable for providing acceptably information
about vitamin A status.
1