Vitamin D deficiency and undernutrition are major public health concerns globally, particularly among children in low-resource and high-altitude settings. In Pakistan, the recent national nutrition survey has reported alarmingly high prevalence rates of vitamin D deficiency, especially in Ghizer District of Gilgit-Baltistan, where 85% of children under five years of age are vitamin D deficient, placing them at heightened risk for rickets, impaired growth, weakened immune function, cognitive impairments, and long-term socio-economic consequences. This survey did not provide any information on the vitamin D deficiency status of school-going children in Pakistan. However, a study conducted in Karachi reported that 65% of children aged 6-12 years were deficient in vitamin D. Despite abundant natural resources, such as trout fish and locally available cow's milk and eggs, these nutrient-rich foods are underutilized due to limited awareness among local communities about the health benefits for children.
This issue is particularly urgent for the Aga Khan University (AKU) and the Aga Khan Education Service Pakistan (AKESP) 's schools in the region, where children's health is integral to academic success and long-term community development. Addressing micronutrient deficiencies aligns closely with AKU's and the Aga Khan Development Network's (AKDN) strategic priorities of improving early childhood development, promoting health equity, strengthening food security, and fostering local capacity through evidence-based interventions.
Therefore, this proposal aims to assess whether targeted local food and supplementation, including trout fish, whole cow milk with egg, and vitamin D supplements, can significantly reduce vitamin D deficiency and improve nutritional and cognitive outcomes among school children in AKESP schools.
Aged 6-12 years
Enrolled in one of the selected AKESP schools
Parent/legal guardian provides written informed consent
Child provides written assent
Currently enrolled in another research study or regular consumption of nutritional supplements, including vitamin D
Known allergy or intolerance to fish, milk, or eggs
Diagnosed chronic medical conditions affecting growth or vitamin D metabolism (e.g., renal disease, liver disease, malabsorption disorders)
Severe acute illness at the time of enrolment
Parallel
Vitamin D supplement 4000 IU weekly
Dietary supplementVitamin D supplement 4000 IU weekly dose for 16 weeks, along with education on dietary diversity
200 grams of cooked trout fish
Other intervention200 grams of cooked trout fish (100 gram per serving, twice weekly) for 16 weeks, along with education on dietary diversity
250 milliliters of whole cow milk + whole egg
Other intervention250 milliliters of whole cow milk + whole egg 3 days a week during school hours for 16 weeks, along with education on dietary diversity
Serum 25(OH)D concentrations
Child weight measurement in kilograms
Weight in kilograms at baseline and endline
Child dietary diversity
Dietary diversity will also be assessed using a 24-hour food recall on a monthly basis
Neurocognitive development
Neurocognitive development will be assessed by using Digit span test and Word List Recall.
Morbidity history
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