Dr. Priscilla Benner MD
The construction begins
The main building at the
Building the dining room
One of the first mission
Making new contacts
The moms are working in the
garden at the Nutrition Center.
The harvest is ready.
Focus on Vitamin A
Vitamin A distribution and food fortification
has become a standard part of Child Survival
efforts around the world.
Vitamin A saves children's lives, eyes and
Vitamin A Functions
Vision (night, day, colour)
Epithelial cell integrity against infections
Fertility (male and female)
Severe Vitamin A deficiency is a wide spread problem
in Nigeria, especially in the Northwest, and is one of
the reasons that children suffer so many infections.
Why do children become
vitamin A deficient?
Mothers of poor children often have Vitamin A Deficiency
and produce deficient breast
Children’s diets provide too little vitamin
spend a large part of their childhood being
in vegetables and fruits are less
weaning is often onto foods low in vitamin
velocity, and therefore vitamin A requirement, is
higher during pre
school age than at any other time
Humphrey, Katz et al
is distributed every 4
6 months to infants, children, and new
mothers according to established protocols
is part of child
over the world
Vitamin A distribution…
Vitamin A Mega
200,000 International Units/Capsule
Prevention & Treatment Doses
Repeat this dose as recommended for emergency indications
Infants less than 6 months:
fed, or breast
fed if mother
has not received supplemental vitamin A
Infants 6 to 12 months:
Children over 12 months:
Not safe for
Mothers within 6 weeks
Amount of Vitamin A to be
Time of Administration
doses of 50,000 IU each
with at least 1 month
interval between doses
At each DTP
and 14 weeks) otherwise at
100,000 IU as a single dose
At any opportunity (e.g.,
Children 12 months and
200,000 IU as a single dose
At any opportunity
doses of 200,000 IU at
least 1 day apart
As soon after
possible and not more than
6 weeks later.
In acute emergencies such as measles, pneumonia, TB,
malaria, meningitis, severe diarrhea, severe
malnutrition, or when signs impeding loss of vision
from nutritional blindness, or risk of mouth infection
leading to noma are detected,
Vitamin A Emergency
Triple Dose Treatment
This will replenish acutely depleted Vitamin A sores and
can be life SAVING!
Also, use all other appropriate treatments for the
conditions. SEEK CONSULTATION!
Emergency Triple Dose Treatment:
For noma, malaria,
or any life
Give the age
appropriate Vitamin A
One dose today
One dose tomorrow
One dose in 2 weeks
Vitamin A Single (Extra) Dose
Treatment for Malnourished Children
with Moderate Infections
In addition to other appropriate treatments, when a
malnourished child presents with a serious, but not
threatening condition such as:
Give one extra dose of Vitamin A but do not repeat
more often than once per month in the absence of
may occur if Vitamin A
is not given
Hazy Dry Cornea
Now the cornea is
according to the
International Norms but
be given now!
Bulging, about ready to
If that happens, the eye
will be permanently
There is still a chance
that this eye can be
saved by 3 doses of
Same eye, healed by
timely Vitamin A
capsules. Scar remains,
but vision is good. This
eye was saved by 3
Vitamin A capsules!
Hazy dry cornea
bulging, about ready
to rupture. If that
happens, the eye will
be permanently blind
Same eye, healed by
remains, but vision
Besides Vitamin A, there are many other
essential micronutrients (vitamins and
minerals) that are found to be lacking in
children who get noma, nutritional blindness,
and other deadly infections (“Hidden
Improving nutrition by better diet in
pregnancy, exclusive breast feeding early in
life, and food fortification with COMPLETE
ESSENTIAL MICRONUTRIENTS will prevent
many deaths from childhood infections.
The Scope of the Problem
Most common infection worldwide
Prevalence rates in resource poor communities
can be over 90%.
In 2008, 3.5 billion people (mostly children) were
estimated to be infested with intestinal parasites.
Tropical Medicine Institute of Sao Paulo
Estimated over 300 million suffer severe
impairments because of high worm burdens.
Intestinal parasites cause
illness and death from:
Impairment of physical growth
stunting and wasting
Poor intellectual development
WHERE DO INTESTINAL
PARASITES COME FROM?
They enter the body through food and water
that has been contaminated by human or
fecal waste, or through skin if the person
steps (or sits) in mud that contains human or
Many people infested with intestinal
parasites are not clinically ill but can still
spread the disease by not using latrines or
A large burden
with children for
Children with heavy worm burdens may be
forced to share ¼ or more of their daily
nutrients with their parasites.
Deworming promotes child
Therefore, national level mass
been implemented in many developing countries.
One tablet of deworming medicine, usually
, is given every 6 months according to
standardized protocols to everyone in the community.
This is effective in controlling the worm burden and
usually well accepted by communities.
Deworming can be integrated into Child Health Day
Events along with immunizations, vitamin A
distribution, bed net distribution and growth
three major intestinal
Other medicines that may be
MEBENDAZOLE 500mg tablets can also be used
as single dose treatments of intestinal parasites
LEVAMISOLE 80mg can be used for school age
is a problem in the region,
PRAZIQUANTEL is used. Instructions may be
added to this seminar if there is need for this
medication in the target population.
Each parasite produces a
different set of problems:
is the large roundworm with a
voracious appetite for calories and vitamins.
is the parasite that attaches itself to
the intestinal lining and dines on the blood of
is the one which attaches to the
size of the parasite in
Children over age 1 and all
adults can be
Follow the recommendation of
the Ministry of Health regarding
Albendazole is safe in lactation
but the woman can save her pill
to take after the first 3 months
Note: Follow norms of MOH in
country for children age 12
months and pregnant women.
not enrolled in school in
400mg Chewable Tablets
International Norms for
Vitamin A Capsules
Infants under 1 year
No treatment with Albendazole
200mg (1/2 tablet)
(Crushed and suspended in
over 2 years
400mg (1 tablet)
(Crushed and suspended in
water up to age 3, or as long as
Safe in pregnancy after the first
1. Wash your hands with soap and water if you
touch the child’s mouth.
2. Ask all mothers to help you by washing their hands
first, then you give the pill to the mother, who places it
in her child’s mouth after reassuring the child.
3. Never put pill in the mouth of a crying child.
4. Do not coerce, threaten, or unnecessarily
frighten the child. Treat him or her gently and
A child that is regularly treated for worms:
is more active in school.
grows and learns better.
is more resistant to other infections.
Do not give
less than 1
Crush the tablet.
Mix with water.
Have mother help child to drink.
Give with Vitamin A capsule at the same time.
Don’t risk aspiration by forcing a child to take
the medicine until they are calm.
Than 3 Years Old:
Have the child chew the tablet and swallow
Ask the child to show you that he or she has
swallowed the tablet and has the residue in
his or her mouth.
Children may not want to take their medicine.
It is also okay to crush the tablet for any
child or adult and mix with water that has
been boiled and cooled.
Teach hygiene! The community needs to
learn to protect the water that is used
for drinking and bathing, to wear shoes,
dispose of human waste properly, keep
animals away from homes and children,
and much more! When habits change,
deworming programs will not be needed