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Risk Factors for Developing Mild Nutritional Blindness in Urban Bangladesh

Risk Factors for Developing Mild Nutritional Blindness in Urban Bangladesh Abstract • Mild vitamin A deficiency may be associated with increased morbidity and mortality among children in developing countries. A community-based case-control study was performed to determine risk factors for mild ophthalmologic manifestations of vitamin A deficiency in urban Bangladeshi children. Cases were identified in children less than 14 years of age with night blindness with or without other signs of mild xerophthalmia detected in a house-to-house survey. Controls were randomly selected neighbors who lacked subjective and objective ophthalmologic evidence of vitamin A deficiency. Demographic characteristics that were independently associated with vitamin A deficiency in a logistic model included male gender, greater age (mean, 6.1 years in children with cases and 2.8 years in controls), and a greater number of children living with the family. After controlling for these demographic characteristics, poor intake of locally available vitamin A–rich foods, cessation of breast-feeding, and a recent history of protracted diarrhea remained associated with vitamin A deficiency. Maternal ignorance of prevention and control of vitamin A deficiency was also associated with increased risk. The results support programs that educate mothers to breast-feed and to provide appropriate food supplements and suggest that clinicians caring for children with chronic diarrhea should initiate vitamin A supplementation. (AJDC 1986;140:584-588) References 1. Northrup RS: Vitamin A Capsule Distribution in Bangladesh . Dhaka, Bangladesh, Helen Keller International, 1982. 2. Roels O: Vitamin A physiology . JAMA 1970;214:1097-1102.Crossref 3. Nutritional Blindness Prevention Project: Final Report of Directorate of Nutrition . Jakarta, Indonesia, Ministry of Health, Republic of Indonesia and Helen Keller Institute, 1980. 4. Khan MU, Haque ME, Khan MR: Nutritional ocular diseases and their association with diarrhea in Matlab , Bangladesh. Br J Nutr 1984;52:1-9.Crossref 5. Sommer A, Katz J, Tarwotza I: Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency . Am J Clin Nutr 1984;40:1090-1095. 6. Sommer A, Tarwotjo I, Hussain G, et al: Increased mortality in children with mild vitamin A deficiency . Lancet 1983;2:585-588.Crossref 7. Stanton B, Clemens J, Khair T, et al: The urban volunteer program: A community based primary health care and research initiative . Trop Geogr Med 1985;37:183-189. 8. Joint report of WHO, UNICEF, USAID, HKI, IVACG Meeting: Control of vitamin A deficiency and xerophthalmia. WHO Tech Rep Ser No. (672) , 1982. 9. Expert Committee on Medical Assessment of Nutrition Status. WHO Tech Rep Ser 1963;258:49-61. 10. Roa KV, Singh D: An evaluation of the relationship between nutritional status and anthropometric measurements . Am J Clin Nutr 1970;23:83-93. 11. Trowbridge FL: Clinical and biochemical characteristics associated with anthropometric nutritional categories . Am J Clin Nutr 1979;32: 758-763. 12. Schlesselman JJ, Stolley PD: Case-control Studies: Design, Conduct, Analysis . Oxford, England, Oxford University Press, 1982, pp 227-290. 13. Behrman RE, Vaughan VC (eds): Nelson Textbook of Pediatrics . Philadelphia, WB Saunders Co, 1983, pp 1855-1857. 14. Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research 1982 . Belmont, Calif, Lifetime Learning Publishers, 1983. 15. Brown KH, Black RE, Becker S, et al: Consumption of foods and nutrients by weanlings in rural Bangladesh . Am J Clin Nutr 1982;36: 878-889. 16. Chen LC, Chowdhury AKMA, Huffman SL: Epidemiology of causes of death among children in a rural area of Bangladesh . Int J Epidemiol 1980;9:25-33.Crossref 17. Khan ML: Infant feeding practices in rural Meheran, Comilla , Bangladesh. Am J Clin Nutr 1980;33:2356-2364. 18. Smith D, Clemens J, Crede W, et al: The problem of multiple comparisons in contemporary randomized clinical trials . Clin Res 1983;31: 238A. 19. Solon MA: The role of education in the prevention of vitamin A deficiency. Read before the World Health Organization Meeting on Vitamin A Deficiency and Xerophthalmia, Jakarta, Indonesia, Oct 13-17, 1980. 20. Oomen HAPC, McLaren DS, Escapini H: Epidemiology and public health aspects of hypo vitaminosis A: A global survey on xerophthalmia , Trop Geogr Med 1964;16:271-315. 21. Brink EW, Perera DA, Broske SP, et al: Vitamin A status of children in Sri Lanka . Am J Clin Nutr 1979;32:84-91. 22. Kusin JA, Kardjati S, Soewono W, et al: Vitamin A deficiency in East Java, Indonesia. Read before the World Health Organization Meeting on Vitamin A Deficiency and Xerophthalmia, Jakarta, Indonesia, Oct 13-17, 1980. 23. Cohen N, Measham C, Khanum S, et al: Xerophthalmia in urban Bangladesh: Implications for vitamin A deficiency preventive strategies . Acta Pediatr Scand 1983;72:531-536.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Risk Factors for Developing Mild Nutritional Blindness in Urban Bangladesh

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References (22)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140200094036
Publisher site
See Article on Publisher Site

Abstract

Abstract • Mild vitamin A deficiency may be associated with increased morbidity and mortality among children in developing countries. A community-based case-control study was performed to determine risk factors for mild ophthalmologic manifestations of vitamin A deficiency in urban Bangladeshi children. Cases were identified in children less than 14 years of age with night blindness with or without other signs of mild xerophthalmia detected in a house-to-house survey. Controls were randomly selected neighbors who lacked subjective and objective ophthalmologic evidence of vitamin A deficiency. Demographic characteristics that were independently associated with vitamin A deficiency in a logistic model included male gender, greater age (mean, 6.1 years in children with cases and 2.8 years in controls), and a greater number of children living with the family. After controlling for these demographic characteristics, poor intake of locally available vitamin A–rich foods, cessation of breast-feeding, and a recent history of protracted diarrhea remained associated with vitamin A deficiency. Maternal ignorance of prevention and control of vitamin A deficiency was also associated with increased risk. The results support programs that educate mothers to breast-feed and to provide appropriate food supplements and suggest that clinicians caring for children with chronic diarrhea should initiate vitamin A supplementation. (AJDC 1986;140:584-588) References 1. Northrup RS: Vitamin A Capsule Distribution in Bangladesh . Dhaka, Bangladesh, Helen Keller International, 1982. 2. Roels O: Vitamin A physiology . JAMA 1970;214:1097-1102.Crossref 3. Nutritional Blindness Prevention Project: Final Report of Directorate of Nutrition . Jakarta, Indonesia, Ministry of Health, Republic of Indonesia and Helen Keller Institute, 1980. 4. Khan MU, Haque ME, Khan MR: Nutritional ocular diseases and their association with diarrhea in Matlab , Bangladesh. Br J Nutr 1984;52:1-9.Crossref 5. Sommer A, Katz J, Tarwotza I: Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency . Am J Clin Nutr 1984;40:1090-1095. 6. Sommer A, Tarwotjo I, Hussain G, et al: Increased mortality in children with mild vitamin A deficiency . Lancet 1983;2:585-588.Crossref 7. Stanton B, Clemens J, Khair T, et al: The urban volunteer program: A community based primary health care and research initiative . Trop Geogr Med 1985;37:183-189. 8. Joint report of WHO, UNICEF, USAID, HKI, IVACG Meeting: Control of vitamin A deficiency and xerophthalmia. WHO Tech Rep Ser No. (672) , 1982. 9. Expert Committee on Medical Assessment of Nutrition Status. WHO Tech Rep Ser 1963;258:49-61. 10. Roa KV, Singh D: An evaluation of the relationship between nutritional status and anthropometric measurements . Am J Clin Nutr 1970;23:83-93. 11. Trowbridge FL: Clinical and biochemical characteristics associated with anthropometric nutritional categories . Am J Clin Nutr 1979;32: 758-763. 12. Schlesselman JJ, Stolley PD: Case-control Studies: Design, Conduct, Analysis . Oxford, England, Oxford University Press, 1982, pp 227-290. 13. Behrman RE, Vaughan VC (eds): Nelson Textbook of Pediatrics . Philadelphia, WB Saunders Co, 1983, pp 1855-1857. 14. Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research 1982 . Belmont, Calif, Lifetime Learning Publishers, 1983. 15. Brown KH, Black RE, Becker S, et al: Consumption of foods and nutrients by weanlings in rural Bangladesh . Am J Clin Nutr 1982;36: 878-889. 16. Chen LC, Chowdhury AKMA, Huffman SL: Epidemiology of causes of death among children in a rural area of Bangladesh . Int J Epidemiol 1980;9:25-33.Crossref 17. Khan ML: Infant feeding practices in rural Meheran, Comilla , Bangladesh. Am J Clin Nutr 1980;33:2356-2364. 18. Smith D, Clemens J, Crede W, et al: The problem of multiple comparisons in contemporary randomized clinical trials . Clin Res 1983;31: 238A. 19. Solon MA: The role of education in the prevention of vitamin A deficiency. Read before the World Health Organization Meeting on Vitamin A Deficiency and Xerophthalmia, Jakarta, Indonesia, Oct 13-17, 1980. 20. Oomen HAPC, McLaren DS, Escapini H: Epidemiology and public health aspects of hypo vitaminosis A: A global survey on xerophthalmia , Trop Geogr Med 1964;16:271-315. 21. Brink EW, Perera DA, Broske SP, et al: Vitamin A status of children in Sri Lanka . Am J Clin Nutr 1979;32:84-91. 22. Kusin JA, Kardjati S, Soewono W, et al: Vitamin A deficiency in East Java, Indonesia. Read before the World Health Organization Meeting on Vitamin A Deficiency and Xerophthalmia, Jakarta, Indonesia, Oct 13-17, 1980. 23. Cohen N, Measham C, Khanum S, et al: Xerophthalmia in urban Bangladesh: Implications for vitamin A deficiency preventive strategies . Acta Pediatr Scand 1983;72:531-536.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jun 1, 1986

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