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Indian Pediatr 2011;48:
853-854 |
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Vitamin A Deficiency is Still a Public Health
Problem in India |
N Arlappa
Scientist ‘D’, Division of Community Studies, National
Institute of Nutrition, (Indian Council of Medical Research),
Jamai-Osmania PO, Hyderabad 500 007, Andhra Pradesh, India.
Email: [email protected]
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A pproximately one third of the world’s preschool-age
population is estimated to be vitamin A deficient; with highest prevalence
(44-50%) being reported in regions of Africa and South-East Asia
[1].Vitamin A deficiency continues to be a major public health nutritional
problem in India. The prevalence of Bitot’s spot, the objective sign of
clinical VAD (0.8%) was higher than the figures recommended by the WHO (≥0.5%),
indicating the public health significance in rural pre-school children of
India [2]. While in case of blood vitamin A deficiency (<20µg/dL),
the prevalence (61%) was a severe public health problem (≥20%)
[4] in all NNMB states, ranging from 52% in Maharashtra to 88% in Madhya
Pradesh. The proportion of severe blood VAD (<10µg/dL) was (21.5%)
also ≥5%,
indicating severe public health problem [3] in all the National Nutrition
Monitoring Bureau (NNMB) states [4].
In this issue of Indian Pediatrics, Sachdeva,
et al. reported the prevalence of clinical VAD and various determining
factors associated with the high prevalence of VAD (9.1%) among pre-school
children of Aligarh district, Uttar Pradesh [5]. This study reported the
prevalence of Bitot’s spots as 5.4% and night blindness as 2.8%, both
higher than the WHO cut-off levels, indicating significant public health
concern. This study reported the lower social status and mother’s
illiteracy for high prevalence of VAD among children, which is in
accordance with earlier studies in India [6,7]. This article also reported
that dietary factors are the major determinants of VAD. NNMB study also
reported similar observation i.e. the diets of rural pre-school children
in India were grossly deficient in vitamin A, where the median intakes
were deficient by 66-81% as against the RDA of 400 µg and about 84%
of pre-school children were not even meeting 50% of their RDA [8].
This article also reported high prevalence of severe
forms of clinical VAD such as corneal ulceration and corneal scar. This
re-emergence of severe forms of VAD is alarming and challenges the
commonly held opinion of many nutritionists and public health personnel
who believe that VAD has declined considerably in India, as none of the
earlier studies including NNMB reported severe forms of VAD. This article
also reveals that the prevalence of clinical VAD is on rise, in contrast
to NNMB and other studies, which reported persistent reduction in clinical
VAD over a period. The article could have contained the operational
definition of corneal ulceration and corneal scar in the methodology,
because the prevalence was unusually high and the same may be contributed
by injuries and infections.
This article has few errors, which needs to be
rectified/explained. It is not clear which variable is taken as reference
and which variable is at risk in Tables. In this case, calculation of
proportion for each variable is more appropriate than Odd’s ratios. The
authors reported the prevalence of underweight, stunting and wasting as
32%, 65% and 72%, respectively among children of Aligarh district, Uttar
Pradesh. However, if we calculate carefully, the actual prevalence of
underweight was 67.9%, while the proportion of stunting and wasting was
35% and 27.6%, respectively. Also, if we calculate prevalence of
xerophthalmia with the existing figures, the prevalence would be 70% among
children of working mothers and 37.3% in children of working mothers.
Since there is a serious error either in analysis or typing, the authors
need to rectify these errors. The authors mentioned in the discussion,
that mother’s literacy has positive impact on VAD; however, if we
calculate carefully, the prevalence is more in children of literate
mothers (6.1%) compared to illiterate mothers (0.8%). Authors reported a
significant association between wasting and xerophthalmia; however,
similar association is observed with stunting also.
References
1. World Health Organization (WHO). Global prevalence
of vitamin A deficiency in populations at risk 1995-2005. WHO Global
Database on Vitamin A Deficiency. Geneva: WHO;2009.
2. National Nutrition Monitoring Bureau (NNMB).
Prevalence of Micronutrient deficiencies. Hyderabad, India: National
Institute of Nutrition; 2003.
3. World Health Organization (WHO). Indicators for
assessing Vitamin A deficiency and their application in monitoring and
evaluating intervention programmes. Geneva: WHO;1996.
4. National Nutrition Monitoring Bureau (NNMB).
Prevalence of vitamin A deficiency among rural pre-school children.
Hyderabad: National Institute of Nutrition: 2006.
5. Sachdeva S, Alam S, Beig FK, Khan Z, Khalique N.
Determinants of vitamin A deficiency amongst children in Aligarh district,
Uttar Pradesh. Indian Pediatr. 2011; 48:861-66.
6. Arlappa N, Balakrishna N, Laxmaiah A, Raghu P, Vikas,
Nair KM, Brahmam GNV. Prevalence of vitamin A deficiency and its
determinants among rural pre-school children of Madhya Pradesh, India.
Ann Hum Biol. 2011;38:131-6.
7. Arlappa N, Venkaiah K, Brahmam GNV. Severe drought
and the vitamin A status of rural pre-school children in India.
Disasters. 2011; 35:577-86.
8. National Nutrition Monitoring Bureau (NNMB). Diet
and Nutritional status of population and prevalence of hypertension among
adults in rural areas. Hyderabad: National Institute of Nutrition; 2006.
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