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A child receives a dose of vitamin A supplementation in Bangladesh.Nutrition International

Public health experts say the pandemic will have a devastating impact on child survival in countries around the world. Nutrition International is working to mitigate this impending crisis by helping countries catch up on lifesaving vitamin A supplementation.

As COVID-19 continues to wreak havoc around the world, public health experts are raising the alarm about the pandemic’s effects on children in developing countries.

While it is too early to quantify the long-lasting and indirect effects of COVID-19, Nutrition International’s Alison Greig believes the impact on child survival will be shocking once the data is available.

“I think we are going to see increases of not just illness, but unfortunately deaths in children under five,” says Greig, Nutrition International’s Director of Technical Services.

The increase in child mortality will not necessarily be as a direct result of COVID-19, but because children were not receiving lifesaving nutrition interventions, such as vitamin A supplements.

Vitamin A deficiency, common in low- and middle-income settings where vitamin A intake through the diet is limited, puts children under five at an increased risk of dying from some childhood diseases. Vitamin A supplementation is a low-cost intervention that helps reduce this risk. It strengthens immune systems, reduces all-cause mortality in children under the age of five by up to 24 per cent, reduces the incidence of measles by 50 per cent and the risk of death due to diarrhea by 28 per cent, explains Greig. Diarrhea is a leading cause of preventable death in children under the age of five and claims the lives of 1,300 children a day.

Canada’s global vitamin A supplementation program is one of the most successful public health interventions ever brought to global scale, saving the lives of over five million children to date. Canada, through Nutrition International – a global not-for-profit headquartered in Canada – has been the largest procurer of vitamin A capsules for the past 25 years, with up to 75 per cent of the world’s global supply being produced by two Canadian businesses in Ontario.

However, with the COVID-19 lockdowns that started in March, “we estimate that 100 million children missed their first dose of vitamin A in 2020,” says Greig.

Children receiving vitamin A supplements should have their first dose at six months of age and a boost every four to six months until the age of five. Even before COVID-19, many children were not receiving vitamin A supplementation at all. When COVID-19 hit, the numbers of children receiving this lifesaving supplement was even further reduced, with some children approaching nearly one year old without any coverage.

Nutrition International and its partners at UNICEF, the World Health Organization (WHO) and international ministries of health have been working diligently to bridge this gap in the vitamin A supplement program.

Dr. Mandana Arabi, Chief Technical Advisor for Nutrition International, explains that COVID-19 self-isolation and lockdown measures have made navigating health care difficult for anyone experiencing illness or disease all over the world. Routine services have been disrupted in many places, leaving families and children who were already experiencing a multitude of deprivations before the pandemic in even more vulnerable situations.

“Unfortunately, the nature of nutritional deficiencies is that they are accumulated over time, and your body’s stores get depleted with every exposure to disease,” says Dr. Arabi. Any gap in receiving the supplement leaves children unprotected. Vitamin A deficiency weakens the immune system, and “leaves children vulnerable to common childhood illnesses, which can cause irreversible damage or even death,” she adds.

Fear of infection during COVID-19 has also been a barrier, says Dr. Mustafizur Rahman, head of National Nutrition Services in Bangladesh, one of many countries where Nutrition International has focused their efforts in the fight against vitamin A deficiency.

In order to reach children under the age of five, vitamin A supplements are administered to children over the course of their regular immunization schedule. While the WHO and their international partners worked quickly to provide guidance for health care workers to ensure these programs continued uninterrupted, the number of children who missed their regular health checks because of fear of the pandemic, especially at the beginning, was alarming, says Dr. Rahman.

“80 per cent of people were not coming to health care centres, not only for vitamin A, but for any kind of illness,” he says.

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A child receives a dose of vitamin A supplementation in Kenya.Nutrition International

In Kenya, the vitamin A supplementation program experienced the same sharp drop in reach at the beginning of the pandemic and has marked a steady increase since July. The challenges in implementing the program nationally are complicated by varied government structures in counties, health care privatization across Kenya and the country’s geography.

Julia Rotich, a program manager with Kenya’s National Micronutrient Program, explains that some of the remote areas in the country can be so hard to reach that the only way in or out of the village is either by motorbike or on foot.

“In order to reach children outside of school during the lockdowns, our strength was with the community health workers,” says Rotich. These are residents of the villages who take the vitamin A capsules into their communities, administer the doses and mobilize caregivers to take their children to the nearest health facilities.

Rotich says that Kenya had consistent and reliable support from Nutrition International and UNICEF, ensuring there was no shortage in supply of Vitamin A supplements.

Meanwhile, in Bangladesh and many other countries, the biggest challenge is catching up on the provision of vitamin A supplements to children who missed it as a result of COVID-19.

In December, the Governments of Canada and Bangladesh, in partnership with the Government of Japan and support from the Bill & Melinda Gates Foundation, launched a Nutrition for Growth Year of Action. This international initiative aims to help reverse the impacts of COVID-19 and position nutrition as an essential development priority in 2021.

At the launch, Canada announced it will provide $520-million for nutrition programming over the next five years, including a $280-million investment in Nutrition International.

Canada also provided a further $29.5-million in funding for Nutrition International to lead a global emergency catch-up campaign for vitamin A supplementation, to address the effects of the COVID-19 disruption for the millions of children who missed this lifesaving intervention.

These funds will go a long way to prevent the needless deaths of children around the world, says Greig.

“This is an intervention that can’t wait. There are children being born every day into settings where they are not getting enough vitamin A through the diet, and every day we wait, they are at increased risk.”

To learn more about Nutrition International, the vitamin A supplementation program, or Nutrition for Growth, visit

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