Women by area: Urban F Women by area: Rural F

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1 Vitamin and Mineral Nutrition Information System (VMNIS) WHO Global Database on Vitamin A Deficiency The Vitamin A Deficiency database includes data by country based on xerophthalmia and/or serum or plasma retinol concentration GHANA Last Updated: Level Date Location and sample descriptor Sex Prevalence of xerophthalmia (%) Age Sample Prevalence (%) (years) size Current Previous X1B X2 X3A X3B XS <0.35 <0.70 < 1.05 XN XN Serum / plasma retinol concentration (µmol/l) L 2006 P Kintampo district: LW F NS N 2003 National: Women: Total F Women by age F Women by age F Women by age F Women by age F Women by age F Women by area: Urban F Women by area: Rural F Women by region: Ashanti F Women by region: Brong Ahafo F Women by region: Central F Women by region: Eastern F Women by region: Greater Accra F Women by region: Northern F Women by region: Upper East F Women by region: Upper West F Women by region: Volta F Women by region: Western F S regions: Pre-SAC B L 2001 Nkoranza district: PW: Total F NS Nkoranza district: PW by group: Placebo F NS Nkoranza district: PW by group: Vitamin A F NS LR 2000 P Gomoa Onyadze village: Pre-SAC: Total B Pre-SAC by age B NS Pre-SAC by age B NS Pre-SAC by age B NS Pre-SAC by age B NS D 2000 Kwahu South district: Pre-SAC B a Kwahu South district: PW F NS Kwahu South district: Pre-SAC B L 1999 P Saboba village: Pre-SAC B Mean SD Reference Notes General Line

2 Vitamin and Mineral Nutrition Information System (VMNIS) WHO Global Database on Vitamin A Deficiency The Vitamin A Deficiency database includes data by country based on xerophthalmia and/or serum or plasma retinol concentration GHANA Last Updated: Prevalence of xerophthalmia (%) Serum / plasma retinol concentration (µmol/l) Level Date Location and sample descriptor Sex Age Sample Prevalence (%) (years) size Current Previous X1B X2 X3A X3B XS <0.35 <0.70 < 1.05 XN XN Mean SD Reference Notes General Line R regions: Pre-SAC B regions: Pre-SAC: Total B Pre-SAC by area: Urban B Pre-SAC by area: Rural B Pre-SAC by region: Ashanti B Pre-SAC by region: Brong-Ahafo B Pre-SAC by region: Central B Pre-SAC by region: Eastern B Pre-SAC by region: Greater Accra B Pre-SAC by region: Volta B Pre-SAC by region: Western B Pre-SAC by location: Coastal B Pre-SAC by location: Forest B Pre-SAC by location: Savanna B D 1997 Kwahu South district: Pre-SAC B b Kwahu South district: PW F NS Kwahu South district: Pre-SAC B LR Kintampo: Women by group: Supplementation F NS Kintampo: Women by group: Placebo F NS Kintampo: Infants by group: Supplementation B Kintampo: Infants by group: Placebo B D 1994 Jasikan, Hohoe and Kpandu districts: SAC B NS D 1994 Kintampo district: Pre-SAC B Kintamo district: Pre-SAC B D Kassena Nankana district: Pre-SAC B a 28 Kassena Nankana distict: Pre-SAC B D Kassena Nankana district: Pre-SAC B b 30 Kassena Nankana district: Pre-SAC B

3 NOTES Reference No: 5806 General notes: Baseline data of randomized controlled trial. Women selected within 6 weeks of delivery from rural villages in Kintampo district, which has a relatively poor socioeconomic status. Reference No: 4943 General notes: Two-stage PSS cluster sampling stratified by urban/rural strata, based on enumeration areas from the 2000 census. Sample comprised of women in 6600 households in 412 enumeration areas. Sample is representative by area and by region. Sample comprised of women who gave birth in the 5 years preceding the survey. Previous XN is XN during previous pregnancy, for women with two or more live births in the five-year period, data refer to the most recent birth. Note 1 XN prevalence adjusted for daytime visual problems: 1.90% Note 2 XN prevalence adjusted for daytime visual problems: 1.40% Note 3 XN prevalence adjusted for daytime visual problems: 1.70% Note 4 XN prevalence adjusted for daytime visual problems: 2.50% Note 5 XN prevalence adjusted for daytime visual problems: 1.50% Note 6 XN prevalence adjusted for daytime visual problems: 2.10% Note 7 XN prevalence adjusted for daytime visual problems: 2.00% Note 8 XN prevalence adjusted for daytime visual problems: 1.90% Note 9 XN prevalence adjusted for daytime visual problems: 0.80% Note 10 XN prevalence adjusted for daytime visual problems: 0.40% Note 11 XN prevalence adjusted for daytime visual problems: 1.30% Note 12 XN prevalence adjusted for daytime visual problems: 0.50% Note 13 XN prevalence adjusted for daytime visual problems: 2.00% Note 14 XN prevalence adjusted for daytime visual problems: 3.70% Note 15 XN prevalence adjusted for daytime visual problems: 0.60% Note 16 XN prevalence adjusted for daytime visual problems: 5.60% Note 17 XN prevalence adjusted for daytime visual problems: 5.00% Note 18 XN prevalence adjusted for daytime visual problems: 2.30% Reference No: 5099 General notes: Multi-stage PPS cluster sampling (Upper East region, Upper West region and Northern region). Reference No: 5633 General notes: Baseline values of randomized, double-blind, placebo-controlled trial. Facility based study of women recruited from antenatal clinics at Nkoranza district hospital and 3 rural health clinics in Brong Ahafo region, Central Ghana. Gestational ages of women at baseline ranged from 4 to 29 weeks (median:16 weeks). Plasma retinol concentrations converted from µg/dl to µmol/l. Reference No: 3931 General notes: Sample comprised of pre-sac from Gomoa Onyadze village (rural). Subjects with overt sign of infection excluded. Serum retinol concentrations converted from µg/ml to µmol/l. Note 19 Median: 1.03 µmol/l Note 20 Median: 0.89 µmol/l Note 21 Median: 0.87 µmol/l Note 22 Median: 0.86 µmol/l

4 NOTES Reference No: 5104a General notes: Two survyes conducted by MICAH, baseline (year 1997, reported in refenece No. 5104b) and final (year 2000) survey following an intervention project. MICAH implemented in 108 communities in Kwahu South district (Eastern region). 20 communties selected for baseline and final survey, along with 3 randomly selected comparsion communities (non-micah controls) Simple random sampling of households. Local term for night blindness used (term not specified). For final survey in 2000, only non-micah controls included in the database. Note 23 XN during previous pregnancy with child under 5 years of age. Reference No: 3988 General notes: Sample comprised of pre-sac from Saboba village, sub Sahelian village in Northern Ghana. Serum retinol concentrations converted from µg/ml to µmol/l. Reference No: 3004 General notes: Multi-stage cluster sampling, covering 7 southern regions (Ashanti, Brong-Ahafo, Central, Eastern, Greater Accra, Volta and Western). Serum retinol concentrations converted from µg/ml to µmol/l. Note 24 XN prevalence: <1.00% Reference No: 5104b General notes: Two survyes conducted by MICAH, baseline (year 1997) and final (year 2000, reported in reference No. 5104a) survey following an intervention project. MICAH implemented in 108 communities in Kwahu South district (Eastern region). 20 communties selected for baseline and final survey, along with 3 randomly selected comparsion communities (non-micah controls) Simple random sampling of households. Local term for night blindness used (term not specified). Note 25 XN during previous pregnancy with child under 5 years of age. Reference No: 4732 General notes: Sample copmrised of women and their newborns identified in a rural area of Brong Ahafo region (Kintampo) who agreed to participate. Study designed to assess the safety and efficacy of postpartum maternal vitamin A supplementation. Study methods in reference No Previous XN is XN during last pregnancy, which ended with delivery 6 weeks prior to the start of the study. Reference No: 1772 General notes: Sample comprised of randomly selected SAC from Jasikan, Hohoe and Kpandu districts, Volta region. Serum retinol concentrations converted from µg/ml to µmol/l. Note 26 Median: 1.09 µmol/l, two age groups included: 8-9 years and years old. Reference No: 39 General notes: Sample comprised of pre-sac who attended 4 selected immunization clinics in Kintampo district. Note 27 Total xerophthalmia prevalence: 0.00% Reference No: General notes: Note 28 Note 29 Reference No: General notes: Note a Sample comprised of pre-sac from Kassena Nankana district (rural), Upper East region. All children in the study area eligible to the study. "Health Study Trial" - Baseline data. Same survey reported in references No. 35, 195, 213 and Total xerophthalmia (XN, X1B, X2, XS) prevalence: 1.50% Sample size taken from reference No b Sample comprised of pre-sac from Kassena Nankana district (rural), Upper East region. All children in the study area eligible to the study. "The Survival Study Trial" - Baseline data. Same survey reported in references No. 35, 195, 213 and Total xerophthalmia (XN, X1B, X2, XS) prevalence: 0.70%

5 NOTES Note 31 Sample size taken from reference No. 195.

6 R E F E R E N C E S GHANA Reference 39 Reference 226 Reference 226 Reference 1772 Reference 3004 Reference 3931 Reference 3988 Reference 4732 Reference 4943 Reference 5099 Reference 5104 Reference 5104 Reference 5633 Reference 5806 Arthur P. Prevalence of vitamin A deficiency in Kintampo District: report of a survey. London, UK, London School of Hygiene and Tropical Medicine [Anonymous]. Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality. Lancet, 1993, 342 :7-12. [Anonymous]. Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality. Lancet, 1993, 342 :7-12. [Anonymous]. The health and nutritional status of schoolchildren in Africa, evidence from school-based health programmes in Ghana and Tanzania: the Partnership for Child Development. Transactions of the Royal Society of Tropical Medicine and Hygiene, 1998, 92 : Quarshie K, Amoaful E. Proceedings of the workshop on dissemination of findings of vitamin A and anaemia prevalence surveys; 1998 Nov 24-25; Accra, Ghana. Accra, Takyi EE. Correlation between vitamin A and zinc levels in Ghanaian pre-school children. East African Medical Journal, 2000, 77 : Takyi EE. Nutritional status and nutrient intake of preschool children in northern Ghana. East African Medical Journal, 1999, 76 : Bahl R, Bhandari N, Wahed MA, Kumar GT, Bhan MK; WHO/CHD Immunization-Linked Vitamin A Group. Vitamin A supplementation of women postpartum and of their infants at immunization alters breast milk retinol and infant vitamin A status. Journal of Nutrition, 2002, 132 : Ghana Statistical Service, Noguchi Memorial Institutte for Medical Research, ORC Macro. Ghana Demographic and Health Survey Calverton, MD, ORC Macro, David P. Evaluating the vitamin A supplementation programme in northern Ghana: has it contributed to improved child survival. Massachusettes, The Micronutrient Initiative, John Snow, Inc, Micronutrient and Health (MICAH). MICAH Ghana follow-up survey report. Ghana, World Vision Ghana, MICAH Project, Micronutrient and Health (MICAH). MICAH Ghana follow-up survey report. Ghana, World Vision Ghana, MICAH Project, Cox SE, Arthur P, Kirkwood BR, Yeboah-Antwi K, Riley EM. Vitamin A supplementation increases ratios of proinflammatory to anti-inflammatory cytokine responses in pregnancy and lactation. Clinical and Experimental Immunology, 2006, 144 : Tchum SK, Tanumihardjo SA, Newton S, de Benoist B, Owusu-Agyei S, Arthur FKN, Tetteh A. Evaluation of vitamin A supplementation regimens in Ghanaian postpartum mothers with the use of the modified-dose-response test. American Journal of Clinical Nutrition, 2006, 84 :

7 Reference 4 Reference 35 Reference 188 Reference 213 Reference 307 Reference 1962 Reference 1963 Reference 2078 Reference 2080 Reference 2085 Reference 2274 Reference 2758 Reference 3866 Reference 3868 Reference 5634 Reference 5635 ADDITIONAL REFERENCES Rossler H. Vitamin A deficiency and eye diseases in northern Ghana: report on a survey carried out in April-May, Morris S. Ghana VAST child health study [personal communication] Ministry of Health. Country assessment prepared for 'Ending Hidden Hunger', Ghana. A Policy Conference on Micronutrient Malnutrition;1991 Oct 10-12; Montreal, Canada. Atlanta, Task Force for Child Survival and Development, VAST (Ghana Vitamin A Supplementation Trials) [editorial]. Xerophthalmia Club Bulletin, 1991, 48 :5. Arthur P. Vitamin A deficiency in Ghana: implications of the finding from Ghana Vitamin A Supplementation Trials (VAST). Vital News, 1992, 3 :1-2;9. Filteau SM, Morris SS, Abbott RA, Tomkins AM, Kirkwood BR, Arthur P, Ross DA, Gyapong JO, Raynes JG. Influence of morbidity on serum retinol of children in a community-based study in northern Ghana. American Journal of Clinical Nutrition, 1993, 58 : Takyi EK, Rikimaru T, Harisson E, Kennedy DO. Vitamin A status and nutrient intake in a rural community in southern Ghana. West African Journal of Medicine, 1994, 13 : London School of Hygiene and Tropical Medicine, University of Science and Technology [Ghana]. Ghana vitamin A supplementation trials (VAST) survival study [final report October March 1995] VAST-CHS. Ghana vitamin A supplementation trials [final report].. US Agency for International Development, The Micronutrient Initiative. West African conference on vitamin A deficiency: Accra, Ghana Simic BS. Nutrition and diseases related to nutritional status of the population in Ghana. Food and Nutrition in Africa, 1971, : Sullivan J, Mansour M. Vitamin A deficiency prevalence, causes & program activities in Africa. Vital News, 1992, 3 :3-4. Lartey A, Manu A, Brown KH, Peerson JM, Dewey KG. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. American Journal of Clinical Nutrition, 1999, 70 : Lartey A, Manu A, Brown KH, Dewey KG. Predictors of micronutrient status among six- to twelve-month-old breast-fed Ghanaian infants. Journal of Nutrition, 2000, 130 : Cox SE, Staalsoe T, Arthur P, Bulmer JN, Tagbor H, Hviid L, Frost C, Riley EM, Kirkwood BR. Maternal vitamin A supplementation and immunity to malaria in pregnancy in Ghanaian primigravids. Tropical Medicine & International Health, 2005, 10 : Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics, 2006, 117 :e380- e386.

Women by area: Urban F Women by area: Rural F

Women by area: Urban F Women by area: Rural F Vitamin and Mineral Nutrition Information System (VMNIS) WHO Global Database on Vitamin A Deficiency The Vitamin A Deficiency database includes data by country based on xerophthalmia and/or serum or plasma