Moving a health system from a medical towards a dietary approach in Thailand

Abstract

Amidst the picture of subclinical vitamin A deficiency in north and north-east Thailand, hospital records revealed 31 cases of infant xerophthalmia in the lower southern region in 1991. Major risk factors included inadequate breast-feeding, consumption of non-fortified sweetened condensed milk, and the presence of pneumonia, diarrhoea, or both. A survey conducted jointly by the Ministry of Public Health (MOPH) and the Institute of Nutrition, Mahidol University (INMU), indicated a public health problem of vitamin A deficiency in pre-school children. A partnership relationship was established between MOPH as an implementation agency and INMU in the technical support role towards alleviating vitamin A deficiency in the lower southern provinces. Intervention began with distribution of high-dose vitamin A capsules in the high-risk areas, followed by fortification of sweetened condensed milk with vitamin A (330 retinol equivalents/100 g). At the same time, a dietary diversification strategy was planned to promote consumption of vitamin A-rich foods in the local menus or fish chips enriched with chicken or beef liver. No new cases of xerophthalmia have been reported since 1995. Periodic subsample surveys indicated that the severity of the problem has declined to a subclinical stage. Key elements of progress include partnership between MOPH and INMU from planning to implementation, transition of MOPH to a more preventive and promotive approach, continuous communication from top to grass-roots-level officers, and coupling of research with programmes.