Vitamin A supplementation during pregnancy
RHL practical aspects by Okonofua F
FIRST CONTACT (PRIMARY CARE LEVEL)
Efforts at addressing vitamin A deficiency in pregnant women at the primary health care level should be directed towards providing information on appropriate diet to pregnant women. Women should be advised at this level to consume local diets that are rich in vitamin A.
In certain communities in Africa, dietary taboos exist which may limit the consumption of food rich in vitamin A by pregnant women. Thus, primary health care workers should be aware of the existence of such sociocultural factors in communities where they work and be able to provide appropriate information to pregnant women to counter the harmful effects of such dietary restrictions. The primary health care level would also be ideal for providing vitamin A supplements to pregnant women, should such supplementation be decided on in future.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Referral hospitals would also be active in providing information on vitamin A to pregnant women, and also function as distribution channels for vitamin A supplements. Additionally, they would provide secondary prevention against vitamin A-related morbidity disorders in pregnant women, especially anaemia. Pregnant women found to be anaemic, would be treated in secondary care centers, which would in some cases include specific treatment of vitamin A deficiency.
AT HOME OR IN THE COMMUNITY
Information about vitamin A deficiency and its effects on pregnant women should be provided to the community and efforts made to involve community members in prevention and treatment programmes. Where dietary practices or taboos limit the availability and consumption by pregnant women of vitamin-A-rich foods , such information should be provided to communities in a culturally sensitive and appropriate manner. They should then be assisted to develop strategies to overcome the problem. In particular, communities should be involved in efforts to introduce dietary supplementation or food fortification as measures to prevent vitamin A deficiency in pregnant women. Once the community is sufficiently well informed, it would become much easier to adopt the recommended measures in individual homes.
Acknowledgement: I am grateful to Dr L O Omo-Aghoja, for his assistance with literature search for this commentary.
This document should be cited as: Okonofua F. Vitamin A supplementation during pregnancy: RHL practical aspects (last revised: 15 December 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.