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Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia

European Journal of Clinical Nutrition volume 58, pages 1342–1349 (2004)Cite this article

Abstract

Objective: To determine provisional estimates of the extent of vitamin A (VA) deficiency and xerophthalmia among school-aged children.

Design: Literature search of published, unpublished and website-based population survey and study reports, with country-specific imputation of prevalence rates and numbers of children affected by: (1) VA deficiency based on measured or imputed distributions of serum retinol concentration <0.70 μmol/l (equivalent to <20 μg/dl) and (2) xerophthalmia, by country.

Setting: Countries within the WHO South-East Asian Region.

Subjects: The target group for estimation was children 5–15 y of age.

Interventions: None.

Results: The estimated prevalence of VA deficiency is 23.4%, suggesting that there are ∼83 million VA-deficient school-aged children in the region, of whom 10.9% (9 million, at an overall prevalence of 2.6%) have mild xerophthalmia (night blindness or Bitot's spot). Potentially blinding corneal xerophthalmia appears to be negligible at this age.

Conclusions: VA deficiency, including mild xerophthalmia, appears to affect large numbers of school-aged children in South-East Asia. However, nationally representative data on the prevalence, risk factors and health consequences of VA deficiency among school-aged children are lacking within the region and globally, representing a future public health research priority.

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References

  • Ahmed F (1998): Vitamin A deficiency in Bangladesh: a review and recommendation for improvement. Pub. Health Nutr. 1, 1–15.

    Article  Google Scholar 

  • Ahmed F, Hasan N & Kabir Y (1997): Vitamin A deficiency among adolescent female garment factory workers in Bangladesh. Eur. J. Clin. Nutr. 51, 698–702.

    Article  CAS  Google Scholar 

  • Ahmed F, Khan MR & Jackson AA (2001): Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. Am. J. Clin. Nutr. 74, 108–115.

    Article  CAS  Google Scholar 

  • Ahmed F, Khan MR, Karim R, Taj S, Hyderi T, Faruque MO, Margetts BM & Jackson AA (1996): Serum retinal and biochemical measures of iron status in adolescent schoolgirls in urban Bangladesh. Eur. J. Clin. Nutr. 50, 346–351.

    CAS  PubMed  Google Scholar 

  • Aravind Comprehensive Eye Survey (ACES) (1999): The Prevalence of Xerophthalmia in Children as a Function of Age, Gender and Socioeconomic Status: Data from the Aravind Comprehensive Eye Survey (ACES). Tamil Nadu, India: Aravind Eye Hospital. (unpublished).

  • Ash DM, Tatala SR, Frangillo Jr EA, Ndossi GD & Latham MC (2003): Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. Am. J. Clin. Nutr. 77, 891–898.

    Article  CAS  Google Scholar 

  • Ballew C, Bowman BA, Sowell AL & Gillespie C (2001): Serum retinol distributions in residents of the United States: third National Health and Nutritional Examination Survey, 1988–94. Am. J. Clin. Nutr. 73, 586–593.

    Article  CAS  Google Scholar 

  • Bangladesh Bureau of Statistics (1999): 1998 Statistical Yearbook of Bangladesh, 19th Edition. Bangladesh Bureau of Statistics, Statistics Division, Ministry of Planning, Government of the People's Republic of Bangladesh, Dhaka, Bangladesh.

  • Bloem MW, Wedel M, Egger RJ, Speek AJ, Chusilp K, Soawakontha S & Schreurs WHP (1989): A prevalence study of vitamin A deficiency and xerophthalmia in northeastern Thailand. Am. J. Epidemiol. 129, 1095–1103.

    Article  CAS  Google Scholar 

  • Bloem MW, Wedel M, Egger RJ, Speek AJ, Schrijver JK, Soawakontha S & Schreurs WHP (1990): Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhoea in preschool and school children in northeastern Thailand. Am. J. Epidemiol. 131, 332–339.

    Article  CAS  Google Scholar 

  • Brabin L, Frazio-Tirrozzo G, Brabin B, Agbaje O, Harper G & Broadhead R (1999): Vitamin A, vitamin E and anaemia status of non-pregnant Malawian adolescents. XIX IVACG Meeting, Durban, South Africa.

  • Brink EW, Davey W, Parera A, Broske SP, Cash RA, Smith JL, Sauberlich HE & Bashor MM (1979): Vitamin A status of children in Sri Lanka. Am. J. Clin. Nutr. 32, 84–91.

    Article  CAS  Google Scholar 

  • Carlier C, Coste J, Etchepare M, Périquet B & Amédée-Manesme O (1993): A randomized controlled trial to test equivalence between retinyl palmitate and â carotene for vitamin A deficiency. BMJ 307, 1106–1110.

    Article  CAS  Google Scholar 

  • Christian P (2002): Recommendations for indicators: night blindness during pregnancy—a simple tool to assess vitamin A deficiency in a population. J. Nutr. 132, 2884S–2888S.

    Article  CAS  Google Scholar 

  • Christian P, West Jr KP, Khatry SK, Katz J, LeClerq SC, Kimbrough-Pradhan E, Dali SM & Shrestha SR (2000a): Vitamin A or â-carotene supplementation reduces symptoms of illness in pregnant and lactating Nepali women. J. Nutr. 130, 2675–2682.

    Article  CAS  Google Scholar 

  • Christian P, West Jr KP, Khatry SK, Katz J, Shrestha SR, Kimbrough-Pradhan E, LeClerq SC & Pokhrel RP (1998): Night blindness of pregnancy in rural Nepal—nutritional and health risks. Int. J. Epidemiol. 27, 231–237.

    Article  CAS  Google Scholar 

  • Christian P, West Jr KP, Khatry SK, Kimbrough-Pradhan E, LeClerq SC, Katz J, Shrestha SR, Dali SM & Sommer A (2000b): Night blindness during pregnancy and subsequent mortality among women in Nepal: effects of vitamin A and â-carotene supplementation. Am. J. Epidemiol. 152, 542–547.

    Article  CAS  Google Scholar 

  • Christian P, West Jr KP, Khatry SK, LeClerq SC, Kimbrough-Pradhan E, Katz J & Shrestha SR (2001): Maternal night blindness increases risk of infant mortality in the first 6 months of life in Nepal. J. Nutr. 131, 1510–1512.

    Article  CAS  Google Scholar 

  • Department of Women and Child Development (1998): India Nutrition Profile. New Delhi, India: Ministry of Human Resource Development, Government of India.

  • Djunaedi E, Sommer A, Pandji A, Kusdiono, Taylor HR & the Aceh Study Group (1988): Impact of vitamin A supplementation on xerophthalmia. Arch. Ophthalmol. 106, 218–222.

    Article  CAS  Google Scholar 

  • Emran N & Tjakrasudjatma S (1980): Clinical characteristics of vitamin A responsive and nonresponsive Bitot's spot. Am. J. Ophthalmol. 90, 160–171.

    Article  CAS  Google Scholar 

  • Ene-Obong HN, Odoh IF & Ikwuagwu OE (2003): Plasma vitamin A and C status of in-school adolescents and associated factors in Enugu State, Nigeria. J. Health Popul. Nutr. 21, 18–25.

    PubMed  Google Scholar 

  • Ghana VAST Study Team, Ross DA, Binka FN, Dollimore N, Smith PG, Addy HA, Tomkins AM, Kirkwood BR, Arthur P, Morris SS & Gyapong JO (1993): Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality. Lancet 342, 7–12.

    Article  Google Scholar 

  • Gouado I, Mbiapo TF, Moundipa FP & Teugwa MC (1996): Vitamin A and E status of some rural populations in the north of Cameroon. Int. J. Vit. Nutr. Res. 68, 21–25.

    Google Scholar 

  • Gupta SS, Aggarwal AK, Singh MMC, Ranjan, Kaur A & Kumar R (1998): Vitamin A deficiency (VAD)—still a major problem among the underprivileged population. Sight Life Newslett. 1, 23–26.

    Google Scholar 

  • International Vitamin A Consultative Group (IVACG) (1993): A Brief Guide to Current Methods of Assessing Vitamin A Status. Washington, DC: IVACG.

  • Kassaye T, Receveur O, Johns T & Becklake MR (2001): Prevalence of vitamin A deficiency in children aged 6–9 years in Wukro, northern Ethiopia. Bull. WHO 79, 415–422.

    CAS  PubMed  Google Scholar 

  • Katz J, Khatry SK, West Jr KP, Humphrey JH, LeClerq SC, Pradhan EK, Pokhrel RP & Sommer A (1995): Night blindness is prevalent during pregnancy and lactation in rural Nepal. J. Nutr. 125, 2122–2127.

    Article  CAS  Google Scholar 

  • Khandait DW, Vasudeo ND, Zodpey SP, Ambadekar NN & Koram MR (1999): Vitamin A intake and xerophthalmia among Indian children. Pub. Health 113, 69–72.

    Article  CAS  Google Scholar 

  • Kjolhede CL, Stallings RY, Dibley MJ, Sadjimin T, Dawiesah S & Padmawati S (1995): Serum retinal levels among preschool children in Central Java: demographic and socioeconomic determinants. Int. J. Epidemiol. 24, 399–403.

    Article  CAS  Google Scholar 

  • Muhilal (1995): Noodle: a suitable fortification vehicle. Nutriview 2, 1–5.

    Google Scholar 

  • Muhilal, Tarwotjo I, Kodyat B, Herman S, Permaesih D, Kharyadi D, Wilber S & Tielsch JM (1994): Changing prevalence of xerophthalmia in Indonesia, 1977–1992. Eur. J. Clin. Nutr. 48, 708–714.

    CAS  PubMed  Google Scholar 

  • Nambiar VS & Kosambia P (2003): Prevalence of vitamin A deficiency in two urban slums of urban Vadodara, Gujarat, India. Improving the Vitamin A Status of the Population. XXI IVACG Meeting, Marrakech, Morocco.

  • Natadisastra G, Wittpenn JR, Muhilal, West Jr KP, Mele L & Sommer A (1988): Impression cytology: a practical index of vitamin A status. Am. J. Clin. Nutr. 48, 695–701.

    Article  CAS  Google Scholar 

  • National Nutrition Monitoring Bureau, Government of India (2000): Report on Nutritional Status of the Rural Population, 1996, Summarized in Background Document for the National Consultation on Vitamin A, September 29–30, 2000. New Delhi, India: National Nutrition Monitoring Bureau, Government of India.

  • Nepal Micronutrient Status Survey (1998): Ministry of Health, Child Health Division, His Majesty's Government of Nepal; New ERA, Micronutrient Initiative. Nepal and Kathmandu, Nepal: UNICEF and WHO.

  • Pant I & Gopaldas T (1987): Effect of mega doses of vitamin A on the vitamin A status of underprivileged school-age boys (7–15 years). Indian J. Med. Res. 86, 196–206.

    CAS  PubMed  Google Scholar 

  • Population Reference Bureau (2001): 2001 World Population Data Sheet. Washington, DC: Population Reference Bureau.

  • Pratinidhi AK, Shah U & Bapat VS (1987): Screening tests for vitamin A deficiency. Indian J. Pediatr. 54, 563–570.

    Article  CAS  Google Scholar 

  • Rahmathullah L, Underwood BA, Thulasiraj RD, Milton RC, Ramaswamy K, Rahmathullah R & Babu G (1990): Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N. Engl. J. Med. 323, 929–935.

    Article  CAS  Google Scholar 

  • Ramakrishnan U, Martorell R, Latham MC & Abel R (1999): Dietary vitamin A intakes of preschool children in South India. J. Nutr. 129, 2021–2027.

    Article  CAS  Google Scholar 

  • Reddy V, Rao V, Arunjyothi & Reddy M (1989): Conjunctival impression cytology for assessment of vitamin A status. Am. J. Clin. Nutr. 50, 814–817.

    Article  CAS  Google Scholar 

  • Ross DA (2002): Recommendations for vitamin A supplementation. J. Nutr. 132, 2902S–2906S.

    Article  CAS  Google Scholar 

  • Semba RD, Wirasasmita S, Natadisastra G, Muhilal & Sommer A (1990): Response of Bitot's spots in preschool children to vitamin A treatment. Am. J. Ophthalmol. 15, 416–420.

    Article  Google Scholar 

  • Singh K & Sharma S (2003): Vitamin A status of street and working children in Delhi, India. Improving the Vitamin A Status of the Population. XXI IVACG Meeting, Marrakech, Morocco.

  • Sommer A (1982): Nutritional Blindness: Xerophthalmia and Keratomalacia. New York: Oxford University Press.

    Google Scholar 

  • Sommer A (1995): Vitamin A Deficiency and its Consequences. A Field Guide to Detection and Control, 3rd Edition, Geneva: World Health Organization.

    Google Scholar 

  • Sommer A & Davidson FR (2002): Assessment and control of vitamin A deficiency: the Annecy Accords. J. Nutr. 132, 2845S–2851S.

    Article  CAS  Google Scholar 

  • Sommer A & West Jr KP (1996): Vitamin A Deficiency: Health, Survival and Vision. New York: Oxford University Press.

    Google Scholar 

  • Stoltzfus RJ, Habicht JP, Rasmussen KM & Hakimi M (1993): Evaluation of indicators for use in vitamin A intervention trials targeted at women. Int. J. Epidemiol. 22, 1111–1117.

    Article  CAS  Google Scholar 

  • Stoltzfus RJ, Hakimi M, Miller KW, Rasmussen KM, Dawiesah S, Habicht JP & Dibley MJ (1992): High dose vitamin A supplementation of breast-feeding Indonesian mothers: effects on the vitamin A status of mother and infant. J. Nutr. 123, 666–675.

    Article  Google Scholar 

  • Suharno D, West CE, Muhilal, Kharyadi D & Hautvast JGA (1993): Supplementation with vitamin A and iron for nutritional anemia in pregnant women in West Java, Indonesia. Lancet 342, 1325–1327.

    Article  CAS  Google Scholar 

  • Sunn MM, Toe T & Naing KM (1989): Vitamin A status survey of Myanmar children. International Vitamin A Consultative Group Meeting, Kathmandu, Nepal.

  • Tanumihardjo SA, Muherdiyantiningsih, Permaesih D, Komala, Muhilal, Kharyadi D & Olson JA (1996): Daily supplements of vitamin A (8.4 μmol, 8000 IU) improve the vitamin A status of lactating Indonesian women. Am. J. Clin. Nutr. 63, 32–35.

    Article  CAS  Google Scholar 

  • Task Force for Child Survival and Development (1991): Conference on ending hidden hunger. Proceeding of a Policy Conference on Micronutrient Malnutrition, Montreal, October 1991. Presents data for Indonesia, Bhutan and Ghana. Task Force for Child Survival and Development, Atlanta.

  • The Micronutrient Initiative (1998): Progress in Controlling Vitamin A Deficiency, Tulane University, Ottawa, Canada: The Micronutrient Initiative, United Nations Children's Fund.

  • Thein D & Myint T (1989): Vitamin A status of children in Myanmar. Interdepartmental Workshop on Prevention and Control of Vitamin A Deficiency, Myanmar, National Nutrition Center.

  • Tilden R (1986): Prevention and Control of Vitamin A Deficiency, Xerophthalmia and Nutritional Blindness in Bhutan- Assignment Report, 3–12 March 1986. New Delhi. (WHO Project ICP NUT 005).

  • UNICEF, Progotir Pathey (1998): Achieving the Goals for Children in Bangladesh. Dhaka, Bangladesh: Bangladesh Bureau of Statistics, Ministry of Planning, Government of the People's Republic of Bangladesh, and UNICEF.

  • UNICEF (2001a): National Report-Multiple Indicator Cluster Survey-2. Department of Women and Child Development, Government of India and United Nations Children's Fund (UNICEF), New Delhi.

  • UNICEF (2001b): The State of the World's Children 2001. New York: United Nations Children's Fund.

  • United Nation's Development Programme (1999): Human Development Report 1999. New York, NY: UNDP.

  • West Jr KP (2002): Extent of vitamin A deficiency among pre-school children and women of reproductive age. J. Nutr. 132, 2857S–2866S.

    Article  CAS  Google Scholar 

  • West Jr KP, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, Connor PB, Dali SM, Christian P, Pokhrel RP & Sommer A (1999): Double blind, cluster randomized trial of low dose supplementation with vitamin A or â-carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group. BMJ 318, 570–575.

    Article  CAS  Google Scholar 

  • World Health Organization (1995): The global prevalence of vitamin A deficiency. Micronutrient deficiency information system (MDIS), Working Paper 2: WHO/NUT/95 3, Geneva: World Health Organization.

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Acknowledgements

We thank Parul Christian for sharing early, unpublished tables on vitamin A deficiency in India. This study was funded by Cooperative Agreement No. HRN-A-00-97-00015-00 between the Office of Health and Nutrition, US Agency for International Development (USAID), Washington, DC, USA and the Center for Human Nutrition, Department of International Health, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA with additional support from The Bill and Melinda Gates Foundation, Seattle, WA, USA and the Sight and Life Research Institute, Baltimore, MD, USA.

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  1. Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    V Singh & K P West Jr

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Guarantor: KP West Jr.

Contributors: VS studied the literature, calculated estimates and wrote the paper. KPW conceptualized the problems, guided the analyses and contributed to writing the paper.

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Correspondence to K P West Jr.

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Singh, V., West, K. Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia. Eur J Clin Nutr 58, 1342–1349 (2004). https://doi.org/10.1038/sj.ejcn.1601973

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