January 2013
Abstract
Nutrition Evidence – the Challenge of Moving to Implementation Assessment. It’s with some irony that this India special of Sight and Life Magazine coincides with the publication of the Deworming and Enhanced Vitamin A (DEVTA1) study. While the DEVTA study rep-resents an earnest attempt to evaluate a large Government of India program delivering vitamin A to children, it contradicts the results of a number of randomized controlled trials (RCTs) carried out in different regions, which have conclusively demonstrated that vitamin A supplementation to children under the age of five every four to six months results in a 24% reduction in under-five mortality. DEVTA, however, showed only a non-significant 4% reduction in child mortality. The reasons for this lack of effect are likely to be found in how the program was run and evaluated – the problems it experienced are common in large intervention strategies and point to the urgent need for us to consider how scaled-up implementation research should best be undertaken. It is legitimate that governments and donors demand the best possible scientific evidence to make informed decisions regarding nutrition programs. But how much and what kind of evidence is required before going forward with interventions that potentially reduce morbidity and mortality? Should such decisions always be based on RCTs and meta-analyses? In a paper published last year, we emphasized the totality of evidence gathered from epidemiology, basic science, and meta-analyses to inform policy and guideline development for program implementation, with close collaboration between program planners and scientists.
