Health Condition: Vitamin A deficiency affects approximately 21 percent of the developing world's preschool-aged children and leads to the deaths of over 800,000 women and children each year. Because it compromises the immune system, vitamin A deficiency is estimated to be responsible for nearly one-fourth of global child mortality from measles, diarrhea and malaria and for a fifth of all-cause maternal mortality. In the 1990s, 2-8 percent of preschool-aged Nepali children experienced severe vitamin A deficiency, or xerophthalmia, associated with blindness and risk of child death.
Intervention or Program: In 1993, the government of Nepal initiated the National Vitamin A Programme (NVAP) with the support of UNICEF, USAID, and local researchers and NGOs. NVAP aimed to reduce child mortality and morbidity related to vitamin A deficiency by providing twice-yearly supplements of vitamin A capsules to children in priority districts; treating xerophthalmia, severe malnutrition, prolonged diarrhea and measles; and encouraging dietary intake of vitamin A and breastfeeding. A large cadre of women who served as community-based volunteers was integral to the rapid expansion of the program to Nepal’s 75 districts.
Impact: NVAP prevents blindness in approximately 2,000 children each year, and was found to reduce under-five mortality in Nepal by about half between 1995 and 2000.
Cost and Cost-Effectiveness: The cost of delivering two rounds of vitamin A per year was approximately $1.25 per child covered. With an estimated cost of $327 –$397 per death averted and $11-12 per disability-adjusted life year (DALY) gained, NVAP is considered highly cost-effective.