Vitamin A supplementation and child survival: magic bullet or false hope?

Vitamin A deficiency is a common problem in many of the poorercountries of the world, especially in Asia and certain partsof Africa. Vitamin A deficiency causes xerophthalmia, a potentiallyblinding eye condition, and it has been estimated that at least500 000 of the world's children develop severe corneal xerophthalmiaeach year, 50% of whom will later become blind; three-quartersof this 50% die within a few months of becoming blind. This paper summarizes the epidemiology of vitamin A deficiencyin the world, both in terms of its geographical distributionand some important risk factors for its occurrence. Evidenceon the relationships between vitamin A deficiency, xerophthalmiaand mortality and non-visual morbidity are discussed, with theconclusion that, although strong associations undoubtedly exist,causality has not been proved conclusively. Methods of interventionto improve vitamin A status at a population level - periodicadministration of large doses of vitamin A, food fortificationand dietary modifications - are then considered     

Fertility and contraceptive use in poor urban areas of developing countries

The population in urban areas of developing countries continuesto grow rapidly. Poor urban areas may have high growth ratesthrough a number of mechanisms including continued migration,a youthful age structure, high age-specific fertility rates,and population movement. Fertility among the urban poor variesbetween and within cities, and is affected by many factors.Those with fertility-enhancing effects include decreases inbreastfeeding and sexual abstinence taboos. Reasons behind thesechanges may include ideas of modernity, increases in women'semployment, the need for further child labour, and the breakdownof the extended family. Factors with fertility-reducing effectsinclude the proportions marrying, age at first marriage, increasedspousal separation and increased use of contraception. Thesein turn are driven by increased access to contraception, smallernorms for family size, increases in female education and employment,improved child survival and, possibly, changes in family structureand earning power. This paper characterizes both these factors and those whichinfluence fertility and family planning in urban settings, particularlyin poor urban areas. It examines policy options for improvingaccess to contraception, taking into account issues importantin the unban context, including HIV infection and adolescentpregnancy. Despite the potential social marketing and family planning haveof reaching large numbers of people in a small area, contraceptiveuse remains low in many cities, and inaccessible or poor qualityservices are often given as the reason. Services need to promotechoice through improved contraceptive accessibility and qualityand by strategic planning, recognizing the marginalized natureof many of the urban poor and the economic constraints underwhich many of them operate.