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correspondence

Indian Pediatr 2012;49: 504-505

Reply (Xerophthalmia: Are We Turning a Blind Eye to It..?)

Sandeep Sachdeva,

Email: [email protected]  


In response to a letter published in the previous issue of Indian Pediatrics [1], I wish to make the following statements:

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.

References

1. Kapil U, Sachdev HPS. Prevalence of vitamin D deficiency in isolated geographical pockets of India. Indian Pediatr. 2012;49:419.

2. National Nutrition Monitoring Bureau. NNMB Micronutrient Survey. Indian National Institute of Nutrition, Hyderabad, 2002.

3. Indian Council of Medical Research. Micro¬nutrient Profile of Indian Population. ICMR, New Delhi, 2004.

4. Menon K, Vijayaraghavan K. Sequelae of severe xerophthalmia -a follow-up study. Am J Clinical Nutr. 1980;33:218-20.

5. Prevalence and determinants of xerophthalmia in preschool children in urban slums, Pune, India—A preliminary assessment. Ophthalmic Epidemiol. 2009;16:8-14.

 

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