HEALTH : Vitamin A Cited as Simple, Inexpensive Lifesaver

TIMES STAFF WRITER

The remedy is so simple that, for years, many people would not believe it.

The United Nations Children's Fund reports that 1 million to 3 million lives could be saved annually if children in the Third World took a Vitamin A pill two or three times a year. The annual cost per child: 4 to 6 cents.

In its latest annual report, UNICEF displays some striking statistics to back up this assertion. It estimates that, in 1994, in impoverished areas with a high risk of infectious disease, feeding the Vitamin A supplement to about two-thirds of children younger than 6 saved 220,000 lives in India and 9,700 in Brazil. In Bangladesh, where 94% of the children received Vitamin A, 70,500 lives were saved.

But UNICEF does not believe the statistics are striking a loud enough chord: Many governments have failed to implement large-scale programs to wipe out the deficiency.

"In the meantime," Dr. Alfred Sommer, dean of Johns Hopkins University School of Hygiene and Public Health in Baltimore, wrote in the report, "at least two children are dying every minute for the lack of the protection that Vitamin A can bring. The 2-cent capsules are therefore an essential weapon for the defense of children. . . . There can be no excuse for further delay."

Sommer, who has conducted research on Vitamin A deficiency for two decades, said in the report and in a subsequent telephone interview that it has long been known that a lack of Vitamin A in children causes an eye disease known as xerophthalmia, which leads to blindness and destruction of the eyes.

But doctors did not realize at first that the same deficiency that causes xerophthalmia also weakens the respiratory and gastrointestinal systems and makes them susceptible to infection. In this weakened state, children deficient in Vitamin A can die of measles or diarrhea, or some other disease, even before they are blinded by xerophthalmia.

Sommer wrote that, despite experimental testing he led in Indonesia in the 1980s that showed a one-third reduction in death rates among children taking Vitamin A, "the response was the long silence of disbelief."

With its penchant for high technology, Sommer wrote, "the medical and research Establishment found it difficult to accept that something as simple and cheap as a 2-cent capsule of Vitamin A could represent such a breakthrough for human life and health."

That Establishment was persuaded, however, when an experiment in Tanzania showed that the death rate would fall by half if Vitamin A was distributed to children with measles. Sommer said he and his colleagues were subsequently astonished to learn that the same results had been demonstrated by an experiment with measles-infected children in a London hospital half a century ago--and then ignored.

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When studies in Ghana, India, Indonesia and Nepal in the 1990s confirmed the Tanzania results, Sommer wrote, "The medical community accepted our conclusions as unanimously as it had dismissed them a decade earlier."

Although Vitamin A deficiency in a society can be overcome by educating people about the need to eat green leafy vegetables or carrots and to fortify their foods--the way Vitamin A is added to milk and other foods in the United States--Sommer said that the most efficient way to eradicate the deficiency is still distribution of 2-cent vitamin pills every four to six months.

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An Ounce of Prevention

UNICEF reports that 1 million to 3 million child deaths could be prevented annually with Vitamin A supplements to children in impoverished areas with a high risk of infectious disease. Below are 1994 figures for some areas where children age 6 or younger received the supplements two or three times a year.

% of children in risk areas Lives Lives that could receiving supplements saved have been saved* India 60 220,000 145,400 Bangladesh 94 70,500 4,500 Nepal 65 9,800 5,300 Brazil 59 9,700 6,800 Vietnam 95 7,800 450 Malawi 70 5,000 2,100 Zambia 60 4,200 2,800 Burkina Faso 30 2,700 6,300 Niger 24 2,100 6,700 Myanmar 6 1,000 15,700 Haiti 25 670 2,000 Cambodia 5 410 7,700

* If all children had received supplements

Source: UNICEF annual report

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