1. This exploratory study was an attempt to make
a provisional estimate of the magnitude of xerophthalmia and its
predictors in the field practice areas sub-served by the Dept. of
Community Medicine. Lack of a specific sampling frame as is usually
employed in multicentric community surveys and deemed to be more
representative of the prevalence in the respective geographical
areas; was a limitation in the study.
2. The Odds Ratio was used as a measure of the
effect size, which is also a surrogate marker of the association
between selected predictor variables and xerophthalmia. Also,
computation of ‘Adjusted’ Odds Ratio is an integral component of
multivariate binary logistic regression analysis, which we had used
to demonstrate independent determinant variables of xerophthalmia.
For example, the ‘Odds’ of having xerophthalmia in the presence of
rural dwellings, predominant maize diet and maternal xerophthalmia
were respectively 2.2, 3.3 and 1.2 in the current study.
3. Severe varieties of xerophthalmia have been
reported to occur only rarely in large scale community based surveys
conducted by the NNMB and ICMR [2,3]. We came across a few cases of
corneal scarring, probably due to antecedent xerophthalmia as other
common causes were ruled out by history. Two cases among the five
with active corneal disease deserve a mention as they had reportedly
died by the time we made a follow up visit. All these children were
administered Vitamin A in therapeutic doses, nutritional advice
given and were also referred for specialist eye care. The high death
rates associated with keratomalacia as proven in other studies [4]
helps to explain the low prevalence of keratomalacia observed in
past and current community surveys.
4. The actual proportion of the potential
beneficiaries of the National Vitamin A Prophylaxis Program is far
from optimum in certain geographical areas as reflected in the
surveys reflecting utilization of health care services in these
areas [5]. It is indeed alarming that such a high prevalence of
xerophthalmia should be present in children who are supposedly
getting supplementation of Vitamin A ‘regularly’, under the
Integrated Child Development Scheme (ICDS). Areas with a high
magnitude of severe xerophthalmia indicate the existence of the
lowest levels of health care utilization and perhaps none/minimal
receipt of prophylactic vitamin A vis-a-vis areas with milder forms
of deficiency. The package of MCH services promoted by the scheme is
either not properly utilized by the community due to major
deficiencies in the ‘supply’ or ‘demand’ or both these components of
program implementation.