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Department of Human Nutrition
All India Institute of Medical Sciences
New Delhi
India
E-mail: kapilumesh{at}hotmail.com
Dear Sir:
A scientific debate was initiated in 2001 after >30 children died and many became ill in Assam (state), India, after a vitamin A campaign in which children were given a mega-dose of vitamin A (1–4).
Surveys conducted by the Indian Council of Medical Research in 1999 in Dibrugarh and Nagaon districts of Assam state, in which >11 000 children per district were evaluated with the use of the 30-cluster approach, found only 0.3% of children to have Bitot's spot, a marker of vitamin A deficiency. These data suggest that vitamin A deficiency was not a public health problem; however, in these 2 districts, vitamin A was administered by a campaign approach, as if there were an epidemic of vitamin A deficiency. After the deaths of children following vitamin A supplementation in these districts, Indian scientists opened a debate on the justification of supplementation with vitamin A via a campaign approach when there was no evidence of clinical vitamin A deficiency in these districts (6).
The deaths of children in Assam in 2001 were referred to the judiciary (7). The Guwahati High Court of Assam ruled that both the United Nations Children's Fund (UNICEF) and the government of Assam are to be blamed for the death of >30 children who were given vitamin A in the state. A 2-judge bench of the High Court pronounced its verdict in a public-interest case filed by 2 Assam residents against the state government and UNICEF. The court ordered the state government to pay compensation to the families of the children who died, at the rate of 20 000 rupees (US$400) in addition to the paltry 5000 rupees (US$100) that each family had already been paid. Chief Justice PP Navlekar and Justice AH Saikia said in their judgment that UNICEF had introduced stronger doses of vitamin A by replacing the traditional 2-mL dosing spoon with 5-mL medicine cups. The justices stated that the health workers involved were not properly trained and briefed and had administered greater doses than many of the sick children could tolerate. In the justices' judgment, there was an element of negligence in the way the Assam health department had administered the vitamin A, and that negligence led to the death of many children (8).
The court judgment addressed the questions that were raised by scientists as to the possible cause of the deaths of children in Assam (5). In an editorial recently published in the Journal, however, Solomons and Schümann (9) stated that the facts remain elusive, pending the filing of an official inquiry.
Developing countries should learn from what has happened in India and should take appropriate precautions to prevent similar episodes in the future. We should adopt the globally advocated policy of UNICEF—ie, assessment, analysis, and action—before we undertake a public health intervention (9).
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