Vitamin A supplementation is a critical public health intervention for children aged 9–35 months, supporting vision development, immunity, growth, wound healing, and overall child survival. In India, Vitamin A doses are commonly delivered alongside routine immunisation and the Measles–Rubella (MR) vaccination programme. An analysis of the National Family Health Survey data reveals a notable change in Vitamin A coverage in Tamil Nadu between NFHS-4 (2015–16) and NFHS-5 (2019–21).
According to NFHS-4, 73.0% of children aged 9–35 months in Tamil Nadu received a Vitamin A dose in the six months preceding the survey. In NFHS-5, this proportion declined to 68.2%, representing a drop of nearly five percentage points. Under normal circumstances, such indicators are expected to show steady improvement over time due to expanded health infrastructure, improved outreach through anganwadi centres, and strengthened maternal and child health programmes. The observed decline therefore points to an external disruption rather than a systematic policy failure.
The timing of NFHS-5 coincides with the COVID-19 pandemic, which significantly disrupted routine health services across the country. Lockdowns, mobility restrictions, and the diversion of health personnel to pandemic response affected preventive services, including mass Vitamin A supplementation campaigns. According to World Health Organization, routine immunisation and child nutrition services were among the most affected during the pandemic period, particularly in low- and middle-income settings.
In Tamil Nadu, the disruption of large-scale outreach programmes had a direct impact on Vitamin A delivery. Administrative data highlights this slowdown: in 2015, approximately 72.9 lakh Vitamin A doses were administered in the state, whereas by 2019, the number had declined sharply to about 29.2 lakh doses. The absence of complete data for some intermediate years further reflects interruptions in programme implementation and reporting during the pandemic years. Since Vitamin A doses are often administered alongside MR vaccination drives, the postponement or scaling down of these campaigns contributed to reduced coverage among eligible children.
Despite this decline, Tamil Nadu continues to be recognised as a relatively high-performing state in terms of child nutrition. A 2022 study published in BMJ Global Health categorises Tamil Nadu among states with historically high Vitamin A Supplementation (VAS) coverage and better health, demographic, and socioeconomic indicators. Overall VAS coverage in the state stood at 68.3%, with district-level variation ranging from 55.0% to 89.7%, indicating that access was uneven during the pandemic period.
Data from the Comprehensive National Nutrition Survey (2016–2018) shows that 13.1% of children aged 1–4 years in Tamil Nadu were affected by Vitamin A deficiency. While this figure suggests that the state remains within relatively safe nutritional limits, even temporary declines in supplementation can increase vulnerability to infections such as measles and diarrhoea among young children.
In conclusion, the comparison of NFHS-4 and NFHS-5 clearly shows that Vitamin A supplementation coverage in Tamil Nadu was higher before the pandemic and declined during the COVID-19 period. The five-percentage-point drop observed in NFHS-5 reflects pandemic-related disruptions to routine health services rather than a long-term deterioration in public health policy. Strengthening post-pandemic outreach and restoring mass supplementation campaigns will be essential to sustain Tamil Nadu’s progress in child nutrition and prevent future deficiencies.
