Percent of women with a live birth in the last two years who received high-dose Vitamin A within eight weeks (six weeks if not breastfeeding) of their last live birth
The most recent WHO evidence-based guideline is that postpartum vitamin A supplementation is not recommended for the prevention of maternal and infant morbidity and mortality. Rather women should be encouraged to receive adequate nutrition which is best achieved through consumption of a balanced healthy diet. However, recommendations for treatment of xerophthalmia are not covered in this guideline (WHO, 2011).
The percent of women with a live birth in the previous two years who received postpartum high dose supplements (200,000 IU per dose) of vitamin A (retinyl palmitate)within eight weeks for breastfeeding women or within six weeks for non-breastfeeding women.
This indicator is calculated as:
(Number of women who received postpartum high-dose Vitamin A within 8 weeks (breastfeeding) or 6 weeks (non-breastfeeding) of last live birth / Total number of women with live birth in last 2 years) x 100
The total number of births during a given reference period and the number of women receiving two high-dose vitamin A supplements within six or eight weeks of delivering depending on breastfeeding status. Evaluators should disaggregate findings for lactating versus non-lactating women (to ensure that the program is reaching both groups), by age groups, parity and, where available, by relevant socioeconomic and demographic factors such as education, income, and urban/rural residence.
Program statistics (usual source); population-based surveys (e.g. DHS, UNICEF-MICS)
High-dose vitamin A supplementation early postpartum helps replace maternal stores used up during pregnancy and raises or maintains the concentration of vitamin A in the breast milk of lactating women with vitamin A deficiency (VAD). Based on serum retinol levels from 406 surveys conducted between 1995 to 2005, WHO (2009) estimated 19.1 million pregnant women (15.3 percent) worldwide are at risk for VAD. In addition to contributing to maternal mortality and other poor outcomes of pregnancy and lactation, VAD diminishes the body’s ability to fight infections and is a risk factor for anemia. In its more severe forms, VAD can lead to night blindness in children and pregnant women and to blindness through progressive drying, ulceration, and necrosis of the cornea. The main underlying cause of VAD is a diet that is chronically insufficient in vitamin A and B-carotene that can lead to reduced body stores and fail to meet basic physiologic needs, such as, supporting tissue growth, normal metabolism, and resistance to infection. This indicator can be used as a proxy for the coverage and quality of postpartum care and relates to three of the Millennium Development Goals: #1. Reduce poverty and hunger; #4. Reduce child mortality; and #5. Improve maternal health.
Mega-doses of vitamin A can potentially harm a fetus, therefore, women who could become pregnant must not receive high doses of vitamin A. WHO recommends a single oral dose of 200,000 iu in the early postpartum period to minimize the risk of a woman being pregnant. The recommended time frames are prior to 8 weeks for breastfeeding women and prior to 6 weeks for non-breastfeeding women (WHO, 2009). The dose of 200,000 iu is considered sufficient to raise and maintain the vitamin A content of breast milk and to offset the depleting effect lactation may have on the mother’s own vitamin A stores. The International Vitamin A Consultative Group (IVACG) reports on a series of studies that compared the single mega-dose of vitamin A with a second 200,000 iu dose within the recommended time frame and no significant differences were found at 6 months for breast milk retinol or the prevalence of VAD (IVACG, 2004).
An alternative indicator reflecting the adequacy of the program in meeting the needs of specific clients is the number of capsules distributed per eligible client.
A potential problem in the calculation of this indicator is the clients may deliver at a different place from the one where they receive the supplementation. If the indicator is based on an overall figure for a district, it is generally more accurate than if it were based on the data from specific clinics. Similarly, it is important to specify whether this indicator measures supplements distributed through outreach workers to mothers delivering at home, or only those given at service delivery points. If heath facility client records or community-based distribution records are used, these may not be consistently accurate.
Because there have been varying recommendations about the number and timing of the postpartum vitamin A mega-doses, women’s recall from their last live birth in the past two years may be biased by the dosing regimen. Women who received two mega-doses may be more likely to remember than those who received one.
access, nutrition, newborn (NB), safe motherhood (SM)
IVACG, 2004,Vitamin A and the common agenda for micronutrients, Report of the XXII IVACG Meeting, Lima, Peru: Nov. 15-17.
WHO, 2011, Evidence-Informed Guidelines: Vitamin A Supplementation in Postpartum Women, Geneva: WHO. http://apps.who.int/iris/bitstream/10665/44623/1/9789241501774_eng.pdf
WHO, 2009, Global prevalence of vitamin A deficiency in populations at risk 1995-2005: WHO database on vitamin A deficiency, Geneva: WHO.