The substance is critical in pregnancy and in the development of children; a lack of it has dire consequences.
At first Grace Mwatathe was not too worried. Yes, in the twilight she did struggle to tell which was her goat to milk, even though it was only a herd of five. And in the evening she could no longer find her cooking utensils by the light of her lantern.
Maybe it was her pregnancy playing tricks with her mind, Mwatathe thought. Or perhaps it was an effect of the heat as the drought slowly strangled the life out of animals and plants; not only in Matsanjeni village, but in the whole of the coastal Kilifi county in southeast Kenya.
But, as her nightly trips to the pit latrine increased in the weeks before she was due to give birth, she realised she was in serious trouble — she would wander off course and trip over objects as she could no longer see anything in the dark.
Fearing for her unborn child’s safety, Mwatathe visited the local clinic. There a doctor diagnosed her with maternal night blindness and explained that her inability to see normally after dusk or at night was caused by a deficiency in vitamin A.
It can be found in green leafy vegetables such as spinach as well as in orange and yellow vegetables and fruit, such as sweet potatoes, carrots and mangoes. Liver, kidney, milk, cheese, cream and butter are also rich sources of the vitamin.
The main cause of for a vitamin A deficiency is malnutrition.
Although the vitamin is generally essential for good health — it is involved in the growth of all cells — the need for it is particularly critical during periods of rapid growth and early childhood, as explained in a 2001 study in the peer-reviewed academic journal Food and Nutrition Bulletin.
Vitamin A is an essential nutrient, the researchers write, because of its important roles in vision, reproduction, growth and the immune system.
In pregnant women, vitamin A deficiency causes night blindness and often also increases the risk of a mother dying while giving birth, or shortly thereafter, according to the World Health Organisation (WHO). Pregnant women are more likely to suffer from a shortage of the vitamin in the third trimester of pregnancy when the nutritional demands of the developing fetus and the mother are the highest.
The WHO does not recommend routine vitamin A supplements for pregnant women, unless there is a severe public health problem relating to a deficiency in their country, and then only in low doses.
Vitamin A deficiency becomes a public health problem when more than 1% of school children and 5% or more of pregnant women have xerophthalmia (abnormally dry eyes), which can develop into vitamin A-related night blindness, a 2009 study in the Journal of Ophthalmic Epidemiology found.
Times of scarcity set their sights on mothers, babies
The WHO says that pregnant women should try to eat a healthy, balanced diet, rather than opt for vitamin A supplements.
But that was far beyond Mwatathe’s means. “I could hardly afford a meal, let alone a balanced diet,” she shrugs.
Kilifi county is one of Kenya’s farming areas that has been so hard hit by three seasons of low rainfall that the government declared a drought emergency in February. The cost of food has skyrocketed as the drought decimated cattle and goats and successive crops failed.
Mwatathe believes it was inevitable that she would become ill. It was the effect of her poor diet on her baby’s health that worried her more than her own wellbeing, especially after the doctor explained that her breast milk might not contain enough vitamin A for the baby to thrive after birth.
For children, a lack of vitamin A leads to severe visual impairment and blindness: it is the leading cause of preventable blindness in children worldwide, says the WHO. It also causes anaemia and raises the risk of disease and death from common childhood illnesses such as measles and diarrhoea.
The organisation estimates up to half-a-million children who lack vitamin A become blind every year. Half of them die within 12 months of losing their sight. In many African countries, where nearly 50% of children between the ages of six months and five years are affected, vitamin A deficiency is a public health problem.
Since her son’s birth nine months ago, Mwatathe has been checking him for signs of illness. Although she has not noticed any problems with his eyesight, physical growth or cognitive abilities, she has brought him to her clinic. Here she has been waiting patiently in a long queue, the gurgling baby strapped tightly on her back.
“I don’t want to take chances,” she says. “My baby isn’t ill, but I have brought him for a vitamin A supplement, just in case.”
What’s the price of good eye sight? Just a few cents it turns out
Giving children supplements make them more resistant to disease and reduces the chances of them dying by about 23%, according to Unicef data.
The supplements are normally given in the form of either a syrup or a soft gelatin capsule.
One dose between six and 11 months and thereafter two each year until a child is five are needed to prevent vitamin A-related diseases, including blindness.
The WHO, however, stresses that eating a diet that includes foods rich in vitamin A is the first choice.
Some countries fortify staple food by adding minerals and vitamins to products such as maize and wheat flour or rice.
But, until these programmes have been widely implemented, Unicef says, vitamin A supplementation programmes are crucial to ensure child survival. And at just two American cents a supplement dosage, it comes cheaply, the World Bank points out.
Studies show that more than 80 countries worldwide have implemented vitamin A supplementation programmes for children under five.
School-based programmes no cure-all
In 2007, the Kenyan government started its Malezi Bora (Good Nurturing) initiative, which includes vitamin A supplementation, immunisation and growth monitoring. The food security and nutrition policy followed in 2012 and the Nutrition Action Plan 2012-2017.
But 84% of children in Kenya under the age of five still lack vitamin A, according to the Global Nutrition Report 2014. The country’s demographic and health survey 2014 found routine coverage was less than 50%, much lower than the WHO recommendation of 80%. Only about a quarter of children under five received two high doses of vitamin A supplements in 2015.
One of the greatest challenges for providing vitamin A supplements has been finding the right mechanism to get it to younger children, a Unicef report on vitamin supplementation shows.
Until last year, vitamin A supplements were provided through schools, which meant children under five, who are most vulnerable to the effects of vitamin A deficiency, were not being reached.
Kenya’s ministry of health and three international nongovernmental organisations are running a mass drug administration programme to bridge this gap.
Called Every Child Thrives, the four-year project in the sub-counties of Kilifi and Siaya was launched last year by the international aid organisation, Medical Assistance Programmes International, Effect Hope and Vitamin Angels, with funding from the Canadian government.
The programme addresses intestinal worm infections, which cause and can aggravate malnutrition and anaemia, in addition to vitamin A.
“Intestinal worms contribute to vitamin A deficiency and exacerbate malnutrition and anaemia,” explains Jane Muller from Effect Hope.
Children under five get deworming medicines and a vitamin A supplement every six months at health facilities such as clinics, early childhood development centres and in community outreach programmes.
Julien Ake, a senior technical adviser at Effect Hope, adds that the education of parents and children’s guardians will play a crucial role.
“Our goal is to see parents increase their demand for supplementation of vitamin A and deworming for their children and ensure that the demand is met 100%,” says Ake.
Mwatathe needs little encouragement. Her experience with night blindness is still fresh. As she slowly shuffles to the front of the snaking clinic queue, she says: “I do not want my child to go through what I did if I can get the medicine here.”