Click here to open it.

Image: WHO document stating: “In rural South and Southeast Asia, nightblindness is common among women in the latter half of pregnancy, affecting 10-20%.”

The first response to the paper by Professor Latham that is available in the next post was the following:

May 5, 2010 at 12:46 pm | Reply

Unfortunately, the only “fiasco” here is the paper by Dr. Latham. It’s shocking to find that a new journal seeking legitimacy would publish, as its launch, such a meandering, opinionated, unscientific, 28-page diatribe that distorts the evidence on vitamin A and child mortality from over a half-dozen randomized trials reported in peer-reviewed journals, as it attempts to rewrite the history of one of the most successful nutrition-based, child survival strategies in the developing world.

Keith P. West, Jr and Alfred Sommer

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Six days later I provided the following response to theirs, which ought to be accessible as the fifth comment here, but just in case, I reproduce it below:

Professors West and Sommer make three points:

1. They disparage the author of the article and the journal which published it.
2. They complain about the article, calling it a poorly written diatribe that distorts the evidence (but do not say how).
3. They call universal VAC distribution one of the most successful child survival strategies (the lack of proof of which is one of Professor Latham’s major points).

Instead of encouraging examination of the issues Professor Latham raises, their message seems calculated to squash any such discussion. Who is being unscientific here?

Here in my opinion are five issues that desperately need further exploration, not disparagement:

1. How can we rule out the possibility that all or most of the apparent impact of vitamin A on child mortality was simply due to poor or ineffective coverage with measles immunizations? Since measles tends to come in epidemics, their absence during the trials might explain why two of them found no impact.

2. Why has no one funded research to determine whether the enormous scale of universal vitamin A capsule (VAC) distribution now going on is actually having any impact on young child mortality? This has been done for oral rehydration (ORS), for breastfeeding promotion, and for folate fortification. Why not for vitamin A?

3. If the large-dose enthusiasts really were interested in achieving a cost-effective solution that does not risk fooling policy makers and donors into thinking that universal VAC distribution is all that is needed (ie, a “policy block”), why has there not been any experimentation comparing universal VAC distribution with “disease-targeted” distribution? If indeed improved vitamin A status improves the body’s ability to fight severe infection, then surely, at least in countries with reasonable primary health care coverage, most children at risk could be reached when they present with moderate to severe infections, with malnutrition, with chronic diarrhea, or with any other condition where VAC might prove useful. The needed VAC could be part of essential drug programs, and simple training could ensure that primary health care workers know who to give it to. This would avoid a vertical program and would be unlikely to cause a policy block.

4. A randomized trial needs to be done to determine whether common helminth infections and low-fat diets are a large part of the reason that carotene in many vegetable foods is often so poorly absorbed. Both have been known about for many years but inadequately studied. Presumably the reason is that it was so “convenient” for the VAC programs being rolled out to have research that seemed to rule out food-based approaches as competing options. The International Vitamin A Consultative Group (IVACG) 2002 statement that food cannot be used to achieve normal vitamin A status reveals more about the politics of vitamin A than the science.

5. Sadly, universal VAC distribution programs have served as a damper to vitamin A fortification as well. When I discussed vitamin A fortification of rice with policy makers in several countries, they understandably were worried that heavily dosed children would then get too much vitamin A.

Thus universal VAC distribution ensures that nothing is done to try relieving vitamin A deficiency in the rest of the population. Because disease-targeted VAC distribution would be given only to children who needed it, it would probably not have this effect. Given that women often suffer from vitamin A deficiency, that a study by Professor West in Nepal suggested that this could have an equally large impact on maternal mortality, and that VAC cannot be given to them, the continued lack of concern about this particular policy block by donors, academics and policy makers seems rather unfair if not outright cruel.

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Ted Greiner provided input into Professor Latham’s article. He is currently Professor of Nutrition at Hanyang University in Seoul Korea, and is serving as Chair of the Non-governmental Organization/Civil Society constituency of the United Nations System Standing Committee on Nutrition.

This is the first article to be published by a free new journal called World Nutrition. While I am not a coauthor, as acknowledged, I provided a good deal of input. I think many will appreciate its call for a new way of behaving among many donor agencies. Click here to open the article by Michael Latham, my professor at Cornell University.

This letter to Lancet expresses my dismay at the way heads of UN agencies are chosen and points out one of the “costs” this incurs.

Click here to open a Word version of the article.

This is Vincent Assey’s PhD dissertation from Bergen University. I was a minor advisor, perhaps the one that was with him longest in his epic journal to a doctorate, starting perhaps 15 years previously in IMCH in Uppsala. Congratulations and kudos for your hard work and persistence, Vincent!

Click here to open the dissertation.

This latest study of PATH’s rice fortification technology, Ultra Rice, found that simply fortifying rice with iron improved iron status more among infants in the vulnerable 6-24 month age group more than iron drops. It was published in the Journal of Nutrition and you can open the full-text version free here.

It was presented at the 15th Congress of La Sociedad Latinoamericana de Nutrición in Sangiago Chile. Click here to access the presentation. SLAN holds congresses every three years. In Chile we were delighted that it received the Kellogg’s Award for the best study in the field of nutrition to emerge from Latin America since the previous meeting. The award is uploaded here. The judges stated that it won for its interesting methodology and “for its creative form of using rice as a vehicle for iron fortification.”

This was published in the World Alliance for Breastfeeding Action Mother Support Task Force Newsletter. You can download a copy here. This paper was translated into French by Herrade Hemmerdinger, available here.

This is a report of the first national IDD survey completed in Tanzania, published in BMC Public Health. It shows that after 20 years of effort, both with large-scale distribution of iodized oil capsules, and with iodation of salt, Tanzania has succeeded in making impressive progress in normalizing the iodine status of a previously deficient population. Click here to open the full text pdf file.

The melamine scandal in China resulted in over 50,000 hospitalizations and probably increased breastfeeding there and in countries that were importing milk from China. But it carries a more permanent and universal message about a potentially harmful infant feeding practice that is probably second only to breastfeeding in how widespread it is. Click here to open the prepublication pdf file.

Image: Picture showing kidney stones formed from mineral deposits in the kidney from rafflesbiosoc.blogspot.com/2008/10/melamine.html

This power point presentation was given at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa by Margaret Waithaka of PATH Kenya. It summarizes research done by PATH in Kenya with funding from USAID based on a proposal I wrote while at PATH. The main intention was to examine how infant feeding counseling for HIV-infected mothers was being done and how well infants were doing during the period when breastfeeding was stopping. Click here to download the power point.