Introduction

  • Flagship public health intervention under National Health Mission (NHM), Child Health Division, Ministry of Health & Family Welfare (MoHFW), Government of India
  • Launched in 1970s; revised & strengthened as part of RMNCH+A strategy to combat Vitamin A deficiency (VAD)
  • VAD is major preventable cause of childhood blindness, increased morbidity & mortality from measles & diarrhea
  • Provides prophylactic mega-dose oral Vitamin A to prevent subclinical & clinical deficiency in under-5 children
  • Universal coverage approach – no screening required; biannual fixed-day strategy

Objectives

  • Prevent & control Vitamin A deficiency disorders (night blindness, Bitot’s spots, corneal xerosis/ulceration, keratomalacia)
  • Reduce under-5 mortality & morbidity (especially measles case-fatality, diarrhea severity)
  • Improve child survival, growth & immunity
  • Achieve >90% coverage of 9 doses in 9–59 months age group
  • Integrate with routine immunization, deworming, growth monitoring & nutrition programs

Target Group & Dosage Schedule (Current NHM Guidelines)

  • All children 9–59 months (universal coverage)
  • Total 9 doses till 5 years of age:
Age GroupDose (IU)VolumeTiming / Frequency
9 months100,0001 mlWith MR-1 vaccine
16–23 months200,0002 mlWith DPT booster / MR-2
24–59 months200,0002 mlEvery 6 months (biannual rounds)
  • First dose at 9 completed months (co-administered with measles/MR vaccine)
  • Subsequent doses every 6 months up to 59 months
  • Oral oil-based preparation (100,000 IU/ml syrup)
  • Not given below 6 months or above 5 years routinely

Implementation Strategy

  • Delivery Platforms:
    • Routine Immunization sessions (fixed & outreach)
    • Village Health Sanitation & Nutrition Days (VHSND)
    • Anganwadi Centers (ICDS)
    • ASHA home visits & MCP card tracking
    • Special biannual Vitamin A supplementation rounds (2 fixed days per year)
  • Service Providers: ANM, ASHA, AWW – trained on administration, contraindications & recording
  • Supply Chain: Vitamin A syrup supplied free through NHM; cold-chain not required (stable at room temperature)
  • Contraindications: None for prophylaxis; defer only in acute illness with vomiting or known hypervitaminosis
  • Counseling: Mothers advised on side-effects (transient vomiting, bulging fontanelle – rare), benefits & next due date

Integration with National Programs

  • Routine Immunization & MR campaign: First dose linkage mandatory
  • National Deworming Day: Often co-administered with Albendazole
  • MCP Card: Recording of each dose with date & batch number
  • POSHAN Abhiyaan & Anemia Mukt Bharat: Synergistic with micronutrient supplementation
  • IMNCI & HBNC: VAD screening & supplementation in sick-child management
  • Rashtriya Bal Swasthya Karyakram (RBSK): Referral of clinical VAD cases
  • Facility-based care of SAM: Therapeutic Vitamin A as per WHO protocol for severe acute malnutrition

Monitoring & Evaluation

  • Indicators: Coverage of ≥2 doses in last 6 months (NFHS-5: ~71% national average)
  • Tools: MCP Card, RCH portal / MCTS, HMIS reporting, rapid coverage evaluation surveys
  • Supervision: District & block monitoring; supervisory checklists
  • Adverse event reporting: Through pharmacovigilance system (rare)

Impact & Evidence

  • Significant decline in clinical VAD & childhood blindness
  • Reduces all-cause under-5 mortality by 12–24% in deficient populations (WHO evidence)
  • Contributes to India’s progress towards SDG 2 & 3 targets
  • Cost-effective intervention (high return on investment)
  • Current focus (2024–26): Improve last-mile coverage in hard-to-reach areas, urban slums & migratory populations; linkage with digital tracking