VITAMINA DEFICIENCY (VAD) QUESTIONNAIRE

Responding to the Questionnaire:

Thank you for taking the time to complete the following questionnaires. Please provide as complete of answers as
possible and email this form back to us at jmason2@tulane.edu by MARCH 6, 2002. To answer numbered questions,
place the cursor just after or one line below the question and start typing, making sure the insert key is active. To
avoid reformatting the questionnaire place the cursor where you would like to begin typing and DO NOT press
Enter (which may activate the automatic numbering). This will provide you with as much space as necessary for
your answers. Additional lines can be added to tables by going to the last cell of the last column and pressing the
tab key. For Yes/No questions, please type the appropriate answer. In order for us to differentiate our questions
from your answers, responses should be in either bold, italics or capital letters.
Sending Survey Reports:
We would appreciate it if you could send us copies of important survey reports, as well as providing the information in
the questionnaire. Survey reports may be sent via hard copy (e.g. on paper), or if you have them available as
computer files, these would be equally useful. If emailed, attachments usually transmit suitably up to 500k. If the
files are larger than 500k, or if there is a potential problem, please send the files on a floppy disk, zip disk, or CDROM (we can reimburse costs).
I am sending survey reports (Yes/No):
If yes, please list title of reports:
Otherwise, packages that weight less than one pound or 500 grams can be sent via FedEx or DHL. Please contact us
via email at jmason2@tulane.edu for payment information. Larger packages should be sent via UNICEF Pouch.
Method (check one):
Email
Fed Ex

DHL

UNICEF Pouch

I. CORE INFORMATION
Current Date:
Country:
Completed by:
Name:
Position:
Email Address:

II. EPIDEMIOLOGICAL DATA

Surveys of vitamin A deficiency (VAD): We would like to collect information on recent clinical and sub-clinical vitamin A
surveys. Please complete the questions and tables below regarding the major survey results. If the survey report is available,
please send us the report using one of the four ways listed above.
A. Clinical Vitamin A Deficiency
1. What was the most recent clinical VAD survey? Please give a brief description including: location or area surveyed (or
national), date and duration or survey, and groups surveyed (e.g. age, gender, sampling methodology and sample size, etc.):
(If more than one survey is relevant, please give additional information):
2. How was the sampling done and what was the overall sample size? Please give a brief description:

3. Please summarize the survey results in the table below, including overall findings and distribution by important group (e.g.
geographical area). Clinical vitamin A deficiency is commonly assessed in preschool aged children. Please indicate
if this or different groups were surveyed (e.g. night blindness in women). Night blindness (XN) and sometimes
Bitots spots (XIB) are the standard indicators used to measure clinical vitamin A deficiency. Please specify which
indicator was used, or if a different indicator was used, please identify the indicator. To add more rows hit tab in
the last column.
Survey Results for Estimated Clinical VAD Prevalence
Date of Survey_________
Specify Indicator (e.g. XN, X1B+XN, etc ) _________
Region/Group*

Sample size

Population in
region/group
(if available)

Prevalence in
sample %

#1
#2
#3
#4
#5
More groups
Hit tab
National Total:
* e.g. by geographic region (e.g. province) and 0 5 year old children; or by geographic region and all ages; etc
B. Sub-clinical Vitamin A Deficiency
1. What was the most recent sub-clinical VAD survey? Please give a brief description including: location or area surveyed
(or national), date and duration or survey, and groups surveyed (e.g. age, gender, etc.):
(If more than one survey is relevant, please give additional information):
2. How was the sampling done and what was the overall sample size? Please give a brief description:
3. . Please summarize the survey results in the table below, including overall findings and distribution by important group
(e.g. geographical area). Sub-clinical vitamin A deficiency is commonly assessed in preschool aged children.
Please indicate if this or different groups were surveyed. Prevalence of < 0.7 mmol/Liter serum retinol is the
standard indicator for sub-clinical vitamin A deficiency. Please specify if this or other indicator were used. To add
more rows hit tab in the last column.
Survey Results for Estimated Clinical VAD Prevalence
Date of Survey_________
Region/Group*

Sample size

Population in
region/group
(if available)

Indicator(s) specify
cutoff and/or median
serum etinol

Prevalence in
sample %

#1
#2
#3
#4
#5
More groups

Hit tab
2

National Total:
* e.g. by geographic region (e.g. province) and 0 5 year old children; or by geographic region and all ages; etc

III. POLICY AND LEGISLATIVE DATA

A. Status of legislation on VAD
Is there VAD legislation in your country?
If No, is legislation developed or about to be enacted into law?
If Yes, what year was it passed?
Please briefly describe:

YES
YES
Year:

NO
NO

Has that legislation been significantly revised?

YES
Does that legislation focus on:
Supplementation:
Fortification:
Has the government published any documents that state
national policy regarding VAD? (e.g. white paper)
YES
NO
B. Government agency to address VAD
Is there a government agency that deals with VAD?
If Yes, what is its name?
Contact Information:
If Yes, is that agencys function:
Coordination:

YES

NO
Both:

NO

Monitoring:

IV. PROGRAM DATA

A. Supplementation
1. Please briefly describe current vitamin A supplementation programs (type, coverage, target groups, when the program
started, etc.)
2. How many people are targeted by the major supplementation programs?
3. Is there a policy to address vitamin A supplementation for mothers within 8 weeks of delivery?
If yes, please briefly describe including coverage, when the program stated, etc:
If no, is it under consideration?
4. Is vitamin A supplementation given through:
National Immunization Day/Week (Yes/No):
Other Mass Campaigns (Yes/No):
Market Days (Yes/No):
Schools (Yes/No):
Clinics (Yes/No):
5. If distribution by regional group is known, please enter in the table below:
Region/Group*
Estimated # of people supplemented, number of times/year

National Total:
*Please specify target group (e.g. children 1-5 years old; post-partum) as well as geographical area.
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6. Please complete the table below:

Vitamin A Supply (for target year)
Source
200,000 IU
No.
$

Supplementation: Capsules
No. & Value of Capsules (000)
100,000 IU
50,000 IU
No.
$
No.
$

Imported into country

Locally produced
Totals
B. Food Fortification
1. Please describe current vitamin A food fortification programs:
Which foods
Yes No Status of program
Approx. %
are now
(e.g. legislated,
commodity
fortified?
piloted, implemented)
fortified

Level of food
fortification

10,000 IU
No.
$

Is food
fortification
monitored?
YES *
NO

Sugar
Maize
Oil
Milk
Wheat flour
Margarine
Rice
Other (specify)
* If yes, please describe how vitamin A fortified commodities are monitored in Section V below.
2. For main fortified products:
Product
Annual production fortified
commondity

Hit Tab

Estimated number of people consuming

Hit Tab
3. For fortification pre-mix:
Specification/or
name of premix

Annual
Tonnage

Value
(give currency or in $)

Imported
Locally produced
Total
C. Dietary Promotion
Yes

No

Are there large-scale or national programs (including mass media campaigns) to promote
improved vitamin A status through dietary change?
If so, please briefly describe:
Are there community-based programs to promote improved vitamin A status through dietary
change? (Please describe, including target group covered, e.g. women, rural children,
pregnant women, etc.)
If YES, are these programs run by:

Clinics?
Health Centers?
Health Professionals?
Other?

V. MONITORING
A. Clinical and Sub-clinical VAD
1. Please summarize current monitoring activities for clinical and sub-clinical vitamin A deficiency.
2. Are the surveys described in Section II being repeated? (Yes/No):
3. Which indicators are used for monitoring clinical VAD?
4. Which indicators are used for monitoring sub-clinical VAD?
B. Supplementation Programs
1. Is the number of capsules imported or produced monitored? If yes, how?
2. Is coverage of supplementation program (e.g. capsule distribution) monitored? If yes, how?
C. Fortification
1. Is content and distribution of vitamin A fortified commodities monitored? If yes, how?

VI. RESOURCES FOR PROGRAMS

1. What donors and implementing agencies are involved in VAD programs?
Implementing
Agency

Description of Activities

Expenditure and source of funds in

current year
Supplementation Fortification
Other
(specify)

National/State
Governments
External
Agencies*

Hit Tab
*Please list major agencies individually if feasible, plus totals.
2. Is there a project plan developed which provides information on further funding needs for VAD control? If yes, what
amount of money is designated in the plan? If sufficient detail exists, please complete the following table:
Total VAD Program Funding History and Forecast for Country
VAD Activity
Year
Supplementation $(000)
Fortification $(000)
1998
1999
2000
2001
2002
2003
2004
2005

Other (specify)
Activity
$(000)

Total $(000)

Thank you for your time and effort in completing the VAD questionnaire.
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Your information will be of great assistance.