e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Vitamin A supplementation in children 6–59 months of age with severe acute malnutrition

Intervention | Last updated: 9 August 2023

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

Vitamin A deficiency affects about 190 million preschool-age children, mostly from Africa and South-East Asia, and there is evidence of an association with severe acute malnutrition. Vitamin A is essential to support rapid growth and to help combat infections and vitamin A deficiency left untreated may lead to blindness and increased risk of illness and death from childhood infections.

WHO Recommendations

Children who are 6–59 months of age with severe acute malnutrition should receive the daily recommended nutrient intake of vitamin A throughout the treatment period. Children with severe acute malnutrition should be provided with about 5000 IU vitamin A daily, either as an integral part of therapeutic foods or as part of a multi-micronutrient formulation.

Children who are 6–59 months of age with severe acute malnutrition do not require a high dose of vitamin A as a supplement if they are receiving F-75, F-100 or ready-to-use therapeutic food that complies with WHO specifications (and therefore already contains sufficient vitamin A), or vitamin A is part of other daily supplements.

 



Evidence

Systematic reviews used to develop the guidelines

Systematic review of vitamin A supplementation in the treatment of children with severe acute malnutrition

Manary M, Iannotti L, Trehan I. Geneva: World Health Organization; 2012.

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review

Picot J, Hartwell D , Harris P, Mendes D, Clegg AJ, and Takeda A. Health Technology Assessment. 2012; Vol.16:No.19(for Guideline: Updates on the management of severe acute malnutrition in infants and children).

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Cost-effectiveness analyses

Except for the first analysis listed below, the analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

Using cost-effectiveness analysis to evaluate targeting strategies: the case of vitamin A supplementation

Loevinsohn BP, Sutter RW, Costales MO. Health Policy Plan. 1997; 12(1):29-37.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

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