Bitot's Spots Research Articles

Time to revisit the strategy of massive vitamin A prophylaxis dose administration to the under five children in India – An analysis of available evidence

Childhood blindness due to corneal ulceration has historically been prevalent among poor Indian children. To tackle this situation the National Institute of Nutrition (NIN), Hyderabad, India, launched (after field-testing) massive dose based national vitamin A (Vit-A) prophylaxis program. Over a period of time reduction in childhood mortality was also hailed as a beneficial effect of the program. Data from the Indian Council for Medical Research (ICMR) indicate that in most Indian states there has been a gradual reduction in the prevalence of Bitot's spots. However, it was not attributed to the prophylaxis program because of its low and patchy coverage. It was, rather, attributed to the control of malnutrition, along with measles vaccination and improvement in healthcare access. Various studies have concluded that massive dose vitamin A prophylaxis does not reduce childhood mortality; this may have been due to the Hawthorne effect; whereby beneficial effects arose from frequent contact of health workers with community members. Paradoxically, harmful effects of massive doses of Vit-A are documented, e.g. acute toxicity in certain groups of children, ranging from increased intracranial pressure, mental retardation (postnatal period), and even death. Vit-A also intensifies bone demineralization, and increased levels can lead to calcium deficiency and, hence, growth retardation in vulnerable children. According to the present authors, for children who have Bitot's spots or who have just recovered from an attack of measles, the best approach is to give Vit-A in therapeutic doses along with adequate daily intake of vegetables and fruits. Public-spirited citizens, along with the scientific community, must ensure the scrapping of the universal massive dose Vit-A prophylaxis approach, to avoid Vit-A toxicity and reduce economic burden to the health system.

Phasing out of the Universal Mega Dose of Vitamin-A Prophylaxis to Avoid Toxicity.

Childhood blindness due to corneal ulceration was prevalent among poor Indian children. To tackle this situation, the National Institute of Nutrition (NIN), Hyderabad, India, Vitamin-A (Vit-A) prophylaxis programme was launched nationally in 1970 after field testing. Research of Indian Council for Medical Research (ICMR) documented that prevalence of Vit-A deficiency signs such as Bitot's spot decreased among children, over a period of time. However, this decrease cannot be ascertained is due to mass Vit-A prophylaxis programme. This is because coverage was low and patchy. Improved nutrition status, wider vaccination coverage, increased rate in breast feeding and improvement of healthcare services played a crucial role. Rather many studies revealed that (mass prophylaxis to the child who is having adequate Vit-A level) it may be harmful to certain group of children as a result of acute toxic symptoms. High dose of Vit-A is capable of loss of bone density-hence retarded growth may be observed in susceptible individuals. To tackle this issue food based approach should be promoted (which includes breast feeding) along with timely measles vaccination. The children who have signs of Vit-A deficiency (e.g. night blindness, xeropthalmia, Bitot's spot) or post measles children should receive Vit-A in age specific daily doses for two weeks along with Vit-A rich food, like green leafy vegetables, red palm oil, liver etc. Public spirited citizens, together with scientific community in India, should discourage this “one size fit to all” approach. It will not only avoid the ill effects of high dose of Vit-A but also it will help us optimal utilization of health resources in a resource poor country like India.

Biofortification to combat Vitamin A deficiency sustainably through promoting Orange-fleshed Sweet Potato in eastern Uttar Pradesh

India is among top few countries for Vitamin A deficiency as 60,000 children go blind annually. Other than blindness, a number of eye diseases like night blindness, bitot spot, xerothalmia and others are caused by vitamin A deficiency. More than 6% children in Uttar Pradesh suffer from clinical vitamin A deficiency. Vitamin A deficiency among poor children in Gorakhpur average to 42% (as high as 65% in 3 year age group). Government of India, supported by CIDA, Helen Keller International, Micro-nutrient Initiative, UNICEF, USAID and the World Bank distributed free vitamin A capsule. Results were positive and dramatic but met failure due costs involved, problem in distribution, and corruption. Sustainable solution with no costs to government is popularization of Orange Fleshed Sweet Potato (OFSP) varieties, which have yellow or orange flesh due to very high level of â-carotene (precursor of Vitamin A). OFSP also supply required quantity of Potassium, dietary fibre, and energy. OFSP produces more edible energy per unit and people can grow, store and consume throughout the year. Supported by Tata Trusts since last 3 years, PRDF tested more than 50 OFSP varieties and identified ST-14, CIP-440127 and VA-43 adapted to the region now popularizing its growing and consumption enjoining hundreds of farmers and thousands of school children. A cycle of multiplying healthy vines has been perfected and being practiced. A number of products of leaf and tuber like Pakora, chips, juice etc have been developed. More needs to be done on research and awareness fronts.

Study of clinical profile of vitamin-a deficiency in malnourished children visiting a medical college hospital

Introduction: Vitamin A deficiency (VAD) disorders exist as a public health nutrition problem among preschool-aged children in 118 developing countries worldwide, with the South-East Asian Region harboring the maximum number of cases. Materials and methods: The present study was conducted on 100 children with protein energy malnutrition. Clinical assessment was done by noting the symptoms and ophthalmic signs of vitamin A deficiency in both eyes and classified according to W.H.O. classification. Results: Majority of the children were below 6 years of age (82%). Pre-school children were affected the most (84.7%). In this study 76% of the children had one or other infections. 52% had infections like respiratory infections (20%), diarrhea (19%), measles (10%) and urinary tract infections (3%). Children with acute infections were found to have severe form of Vitamin A deficiency more often (28.8%). Out of 100 children 17% were grade –I, 23% were grade-II, 32% were grade-III and 28% were grade IV malnourished according to IAP classification. Conjunctival xerosis was the most common sign (45.83%) of all Vitamin A deficiency cases followed by Bitot spots were seen in 30.55% of cases. Conclusion: Supplementation of the vitamin A rich food to the at risk mothers and children, proper weaning practices, eliminations of infections by immunization, implementation of various nutritional programs and regular deworming will go a long way in prevention of Vitamin A deficiency in children.

Prevalence of Childhood Blindness and Ocular Morbidity in a Rural Pediatric Population in Southern India: The Pavagada Pediatric Eye Disease Study-1

ABSTRACTPurpose: To determine the prevalence of childhood blindness and ocular morbidity in a rural pediatric population in South India.Methods: A population-based, cross-sectional survey of children was conducted in three phases in Pavagada and Madhugiri taluks (subdivisions) of Tumkur district in the state of Karnataka, India. In the first phase, trained fieldworkers screened 23,100 children. In the second phase, children with eye diseases were referred to the peripheral hospital to be examined by a general ophthalmologist. In the third phase, children with major eye diseases were examined by a pediatric ophthalmologist.Results: The prevalence of ocular morbidity was 2.66% (95% confidence interval, CI, 2.46–2.87%). The most commonly observed ocular morbidity was Bitot spots (1%) followed by refractive error (0.6%). In total, 18 children were blind and the prevalence of childhood blindness (best-corrected visual acuity <3/60) was 0.08% (95% CI 0.04–0.11%); 8 (44.44%) had retinal blindness, 5 (27.76%) had lens-related blindness, 2 (11.11%) had bilateral microphthalmos, 1 (5.56%) was blind due to anterior staphyloma in the right eye and anophthalmos in the left eye, 1 (5.56%) had bilateral uveal coloboma and 1 (5.56%) had cortical visual impairment.Conclusions: Nearly half of the blindness in the population was due to unavoidable causes (retinal). In addition to providing eye care services, an appropriate service delivery model would include the provision of rehabilitative and low vision services and implementation of genetic studies to understand the causes and increase awareness of inherited eye diseases.

THE PREVALENCE OF VITAMIN A DEFICIENCY AMONG CHILDREN BETWEEN 6- 9 YEARS OLD, EL FATEH QURAN SCHOOL, OMDURMAN LOCALITY, KHARTOUM STATE, SUDAN

There is a substantial documentation of prevalence, severity and health consequences of vitamin A deficiency (VAD) in preschool-aged children, very few studies have been done to find out the extent of VAD among Quran pupils. This was a cross-sectional descriptive analytical study conducted in Elfateh Quran School, Omdurman locality. The objectives were to measure the prevalence of Xerophthalmia among Quran pupils in El-Fateh city and to relate it with socio demographic factors.&#x0D; All students between 6 to 9 years age in ELfatih Quran pupils were considered as target of this study, total coverage was done during the study period from(august to October)2012, and they were 220 students. Data was collected by using a questionnaire and eye examination to all students targeted age group. Data analyzed by using SPSS programs.&#x0D; The study found that the prevalence of VAD was 19.1%, of which 18.2% among boys which is significantly lowers than 0.9% among girls. The prevalence of night blindness was 7.3%, Bitots spots were 4.1%, corneal xerosis 5% and 2.7% were night blindness ± eye sign.&#x0D; The study concluded that the prevalence of VAD among study population was (19.1%). Institutional caregivers should be made aware of the importance of providing a balanced diet rich in vitamin A. They should also be aware of the signs and symptoms of VAD for early detection of xerophthalmia and hence take measures of early treatments.

Biofortification to combat Vitamin A deficiency sustainably through pro-moting orange-fleshed sweet potato (Ipomoea batatas) in eastern Uttar Pradesh

India is among top few countries for Vitamin A deficiency as 60,000 children go blind annually. Other than blindness, a number of eye diseases like night blindness, bitot spot, xerothalmia and others are caused by vitamin A deficiency. More than 6% children in Uttar Pradesh suffer from clinical vitamin A deficiency. Vitamin A deficiency among poor children in Gorakhpur average to 42% (as high as 65% in 3 year age group). Government of India, supported by CIDA, Helen Keller International, Micro-nutrient Initiative, UNICEF, USAID and the World Bank distributed free vitamin A capsule. Results were positive and dramatic but met failure due costs involved, problem in distribution, and corruption. Sustainable solution with no costs to government is popularization of Orange Fleshed Sweet Potato (OFSP) varieties, which have yellow or orange flesh due to very high level of β-car- otene (precursor of Vitamin A). OFSP also supply required quantity of potassium, dietary fibre, and energy. OFSP produces more edible energy per unit and people can grow, store and consume throughout the year. Supported by Tata Trusts since last 3 years, PRDF tested more than 50 OFSP varieties and identified ST-14, CIP-440127 and VA-43 adapted to the region now popularizing its growing and consumption enjoining hundreds of farmers and thousands of school children. A cycle of multiplying healthy vines has been perfected and being practiced. A number of products of leaf and tuber like Pakora, chips, juice etc have been developed. More needs to be done on research and awareness fronts.

Estimation of Coverage of Vitamin A Supplementation in Children Less than Three Years in Odisha

In India, Vitamin A Deficiency (VAD) has been recognized to be a major controllable public health and nutritional problem. Milder forms such as affecting the conjunctiva, like bitot's spots are observed in 1 - 5% of pre-school children. Objective of this study was to estimate the coverage of vitamin A supplementation in children of 9-36 months age group in the State of Odisha. It was a cross sectional study conducted in Odisha in May 2005 after vitamin A supplementation round with sample size 2700. Out of the total, 88.2% children were in the age group of 12-36 months. More than half 52.2% of the mothers and nearly 1/3 rd (33.2%) of the fathers were illiterate. The coverage of VAS for May, 2005 round in males was 75.2% and for females was 77.3%. It was found that 85.3% of this age group had received measles vaccine and 82.8% were also simultaneously given vitamin A supplementation during measles immunization. The study revealed that measles vaccine coverage among the infants of 9 - 12 months age was 85.3%. It was noted that children of all sections of the society irrespective of their caste, area of living, occupation of parents, type of housing, household size and even the literary status of mothers had taken vitamin A supplement.

Children with Sub-Clinical Vitamin-A Deficiency are at Risk for Significant Nutritional Iron and Zinc Deficiencies

Nutrient interaction and vitamin A deficiency were studied using several biochemical markers of nutritional deficiency in 100 socio-economically deprived children living in the slums of Mumbai, India. The purpose of the study was to examine whether children with sub-clinical vitamin A deficiency are at risk for nutritional iron and zinc deficiencies. Children were originally identified to suffer from sub-clinical vitamin A deficiency as manifested by the presence of abnormal conjunctival impression cytology for early epithelial changes with/without associated (1) night blindness (XN), (2) conjunctival xerosis (XIA) or (3) bitot's spots (XIB). Twenty five per cent of these children had adequate serum vitamin A levels (>0.698μmol/L) thereby suggesting that vitamin A levels were insensitive for determining likelihood of clinical disease. In contrast Retinol Binding Protein (RBP) measurements more accurately profiled the clinical disease status. All children with sub-clinical vitamin A deficiency had significantly lower RBP values compared to control children. In addition, these children had significant iron-deficiency anemia (hemoglobin 99.5 g/dL) and low serum iron along with low serum zinc compared to control children. These results suggest that malnourished children with sub-clinical evidence of vitamin A deficiency, despite normal vitamin A levels were at risk of inadequate iron and zinc nutriture. Children with sub-clinical vitamin A deficiency should receive vitamin A therapy that includes iron and zinc supplementation. Furthermore, this points to a significant under-reported health problem that impacts intellectual development of many of the world's children.

Validity of Bitot's Spots in Evaluation of Impact of Vitamin A Supplementation Programmes in Children between One and Five Years of Age.

Validity of Bitot's Spots in Evaluation of Impact of Vitamin A Supplementation Programmes in Children between One and Five Years of Age.

Resolution of Bitot's Spots Following Mega-Dose Vitamin a Supplementation in Children between 1 and 5 Years of Age

Resolution of Bitot's Spots Following Mega-Dose Vitamin a Supplementation in Children between 1 and 5 Years of Age

Reappearance of Bitot's spots after complete resolution in children between 1 and 5 years of age.

There is limited data on proportion of Bitot's spots (BS), which could reappear after receiving mega dose of Vitamin A (MDVA), and their complete resolution. A prospective, community-based, cohort study with 12 months follow-up was conducted among children (1-5 years) with BS at a district from North India. On diagnosis, 200,000 IU of vitamin A was administered on the same day, then after 4 weeks and subsequently after 6 months. Out of 262 children with BS, 157 (59.9%, 95% CI: 54.1-65.9) children had shown resolution of BS after the MDVA supplementation. Out of 157 children, 97 (61.8%, 95% CI: 54.2-69.4) had reappearance of BS after complete resolution. Kaplan-Meir analysis found that median duration of reappearance of BS was 5 months (95% CI: 3.8-6.2) after their complete resolution. The reappearance of BS after administration of two MDVA within 12 months suggests that children with possibly adequate serum retinol level status may have reappearance of BS.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.

Xerophthalmia—a potential epidemic on our doorstep?

Xerophthalmia refers to the ocular manifestations associated with vitamin A deficiency, including xerosis, keratomalacia, nyctalopia and Bitot's spot. Hypovitaminosis A is well-recognised in developing countries, but is rare in the developed world. Most cases in the latter relate to fat malabsorption. Conditions in which vitamin A metabolism or storage is deranged (chronic liver disease, including alcoholism) are also aetiologies. We wanted to see whether this was common in our department. Oral vitamin A supplements were given to patients who presented with hypovitaminosis A. All patients were found to have hypovitaminosis A on biochemical testing and responded dramatically to oral vitamin A supplementation, resulting in an improved final visual outcome. This series demonstrates that prompt recognition and treatment of xerophthalmia can lead to rapid recovery and avert significant visual morbidity. The prevalence of xerophthalmia is likely to increase in the developed world largely owing to alcoholic liver disease. It is thought by some that we are on the verge of a potential epidemic. We hope that by increasing the profile of this important public health issue, we may be able to influence future prevalence of hypovitaminosis.

Prevalence of Vitamin A Deficiency in Pregnant and Lactating Women in the Republic of Congo

Vitamin A status in a sample of pregnant and lactating women living in several representative regions of Congo was assessed and compared between August and September 2004. This survey was conducted using a randomized two-stage cluster-sampling method with stratification on 90 clusters, each consisting of at least 15 women. Vitamin A status was determined in a total of 1,054 individuals, using the impression cytology with transfer (ICT) test, the modified relative dose response test (MRDR test) on dried blood spots (DBS), and clinical examination to detect signs of xerophthalmia. The clinical criterion defining vitamin A deficiency was the presence of active xerophthalmia (Bitot's spots [X1B]), active corneal disease), and/or night blindness (XN stage). The prevalence of clinical signs of stage XN and X1B xerophthalmia in the Republic of Congo was found to be 16% and 19% respectively. The prevalence of clinical signs (X1B) was greater in the rural north than in urban areas, with a gradient running from urban (5%) to rural area (33%); 27% of all the ICT tests showed that the subjects were suffering from vitamin A deficiency. The deficiency rates were significantly higher (p < 0.001) in urban surroundings (Brazzaville) than in the rural northern regions. The biochemical MRDR test showed the presence of vitamin A deficiency (> or = 0.06) in 26% of the mothers in Brazzaville compared to 6% in the town of Kouilou; 44% of the women had retinol levels of < 10 microg/dL in the rural north whereas these percentages were significantly lower in the urban areas surveyed (chi-square = 62.30, p < 0.001). A significant correlation was found to exist (p < 0.001) between the ICT test and the MRDR test on DBS. In the population as a whole, 30% of the mothers suffering from malarial attack had abnormally low MRDR levels (> or = 0.06) compared to no malaria. The results of the present study confirm that vitamin A deficiency is a serious public-health issue in pregnant and lactating mothers in the Republic of Congo.

Prevalence and Determinants of Micronutrient Deficiencies among Rural Children of Eight States in India

Background/Aims: Micronutrient deficiencies continue to be a major public health problem in India. The aim of this study was to assess the prevalence and determinants of micronutrient deficiencies among rural children. Methods: A community-based cross-sectional study was carried out by adopting a multistage stratified random sampling procedure. A total of 71,591 preschool children were included for ocular signs, 3,291 preschool children and 6,616 adolescents for hemoglobin, and 28,437 school-age children for iodine deficiency disorders. Results: The prevalence of Bitot's spots was 0.8% (CI = 0.6-0.9) and anemia among preschool children and adolescents was 67% (CI = 64.4-69.5) and 69% (CI = 67.0-71.4), respectively. The prevalence of total goiter was 3.9% (CI = 3.4-4.6). The risk of Bitot's spots was 2.4 times higher among preschool children of Scheduled Caste (SC) or Scheduled Tribes (ST) than others and risk of anemia was twice as high (CI = 1.5-2.6) among adolescents of SC and ST. The micronutrient deficiencies were significantly lower in children who used sanitary latrines. Conclusions: Micronutrient malnutrition is a public health problem among rural children, and it was higher among children of SC/ST, illiterate parents and those not possessing a sanitary latrine. Thus, there is a need to improve environmental sanitation; fortification of foods could also help in mitigating the problem.

Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial

SummaryBackgroundIn north India, vitamin A deficiency (retinol <0·70 μmol/L) is common in pre-school children and 2–3% die at ages 1·0–6·0 years. We aimed to assess whether periodic vitamin A supplementation could reduce this mortality.MethodsParticipants in this cluster-randomised trial were pre-school children in the defined catchment areas of 8338 state-staffed village child-care centres (under-5 population 1 million) in 72 administrative blocks. Groups of four neighbouring blocks (clusters) were cluster-randomly allocated in Oxford, UK, between 6-monthly vitamin A (retinol capsule of 200 000 IU retinyl acetate in oil, to be cut and dripped into the child's mouth every 6 months), albendazole (400 mg tablet every 6 months), both, or neither (open control). Analyses of retinol effects are by block (36 vs 36 clusters). The study spanned 5 calendar years, with 11 6-monthly mass-treatment days for all children then aged 6–72 months. Annually, one centre per block was randomly selected and visited by a study team 1–5 months after any trial vitamin A to sample blood (for retinol assay, technically reliable only after mid-study), examine eyes, and interview caregivers. Separately, all 8338 centres were visited every 6 months to monitor pre-school deaths (100 000 visits, 25 000 deaths at ages 1·0–6·0 years [the primary outcome]). This trial is registered at ClinicalTrials.gov, NCT00222547.FindingsEstimated compliance with 6-monthly retinol supplements was 86%. Among 2581 versus 2584 children surveyed during the second half of the study, mean plasma retinol was one-sixth higher (0·72 [SE 0·01] vs 0·62 [0·01] μmol/L, increase 0·10 [SE 0·01] μmol/L) and the prevalence of severe deficiency was halved (retinol <0·35 μmol/L 6% vs 13%, decrease 7% [SE 1%]), as was that of Bitot's spots (1·4% vs 3·5%, decrease 2·1% [SE 0·7%]). Comparing the 36 retinol-allocated versus 36 control blocks in analyses of the primary outcome, deaths per child-care centre at ages 1·0–6·0 years during the 5-year study were 3·01 retinol versus 3·15 control (absolute reduction 0·14 [SE 0·11], mortality ratio 0·96, 95% CI 0·89–1·03, p=0·22), suggesting absolute risks of death between ages 1·0 and 6·0 years of approximately 2·5% retinol versus 2·6% control. No specific cause of death was significantly affected.InterpretationDEVTA contradicts the expectation from other trials that vitamin A supplementation would reduce child mortality by 20–30%, but cannot rule out some more modest effect. Meta-analysis of DEVTA plus eight previous randomised trials of supplementation (in various different populations) yielded a weighted average mortality reduction of 11% (95% CI 5–16, p=0·00015), reliably contradicting the hypothesis of no effect.FundingUK Medical Research Council, USAID, World Bank (vitamin A donated by Roche).

Vitamin A deficiency: An eye sore

Vitamin A deficiency is a major cause of childhood mortality and morbidity in India and other developing countries. The ocular manifestations of vitamin A are collectively called xerophthalmia and range from conjunctival xerosis to severe blinding complications such as keratomalacia. Vitamin A deficiency exists as a major public health nutrition problem among preschool-aged children, especially in the South East Asian region, as well as among the pregnant and lactating women. Deficiency can be diagnosed by the ocular manifestations such as Bitot's spots, serum retinol levels, and conjunctival impression cytology (CIC). Improving vitamin A status in the diet or by periodic administration of vitamin A to children can reduce both mortality and blindness. This review is an attempt to highlight the ocular manifestations of vitamin A deficiency, its prevalence, treatment, and preventive strategies.

Onchocerciasis as a Risk Factor for Night Blindness

Purpose: In the Kaduna State Nigeria Onchocerciasis focus, the prevalence of reported night blindness (RNB ) was 12.9%, higher than the national average (1%), and a control non-onchocercal community (0.83%, P < 0.0001). Risk factors for RNB were explored.Methods: This was an analysis of baseline data from the phase three ivermectin trials in Kaduna (1988–1995). 6831 subjects in the onchocercal zone and 1563 in the control zone were examined. Ordinal logistic regression was used to assess the relationship between microfilaria load (uninfected, low (<10 mf/mg), moderate (10–49 mf/mg) and high (50+ mf/mg)) and likelihood of RNB.Results: Ocular evidence of vitamin A deficiency (Bitot spots or xerophthalmia) was absent in both populations. The excess risk of nightblindness attributable to domicile in this onchocerciasis-endemic area was 11.9% with a population attributable fraction of 92.2%. The prevalence of RNB and age-adjusted odds ratio increased with higher microfilaria load (P < 0.0027.) Subjects with onchocerciasis-related ocular lesions such as optic nerve disease (OND; age-adjusted OR 2.29, 95% confidence interval, CI, 1.86–2.83), sclerosing keratitis (OR 2.75, 95% CI 2.10–3.50), and onchocercal chorioretinitis (OR 1.66, 95% CI 1.22–2.26) were significantly more likely to report night blindness.Overall, subjects with a primary diagnosis of ‘ocular onchocerciasis’ were 50% more likely to report night blindness. OND, cataract and trachoma together accounted for 52% of all RNB but OND (onchocerciasis-related in 80% of cases) emerged as the single most common associated pathology in 30% of cases.Conclusions: Onchocercal infection probably accounted for the excess of RNB in this focus.

Nutritional status of children in food insecure households in two districts of North Showa Zone, Ethiopia

Malnutrition is one of the leading causes of morbidity and mortality of children in Ethiopia. However, little information is available on nutritional status of the lower socioeconomic segment of the community to devise targeted tackling solutions and overcome severe malnutrition. Therefore, the objective of this study is to assess nutritional status of children and other related information in food insecure households. Two hundred food insecure households (HHs) were selected from two districts of North Showa zone of Amhara in 2007. The criteria for inclusion were being landless, oxen-less, and/ or female headed. Anthropometric and clinical data were collected from a total of 239 (151 &lt; 5yrs and 88, 6-12yrs) children. Data on demographic, childcare, feeding practices and morbidity status of children were collected using an interview, community focus group discussion and secondary data from district offices. The overall prevalence of stunting, underweight and wasting was 54.2%, 40.2% and 10.6 %, respectively. Prevalence of night blindness and Bitot's spot were 3.1% and 3.5%, respectively. The median level of urinary iodine excretion by 6-12 years children was 1.5μg/L. Seventeen percent of the children were found iron deficient. Exclusive breastfeeding up to 6 month was practiced by less than 20% of the households. About fifty six percent of the households have cropland less than half a hectare and 50.8% of the households are getting water from unprotected well or spring. The main type of toilet facility being used was open bush/field (84.5%). The main income of the households was agriculture. The majority (45-50%) of the household heads in both districts are in the age ranges of 20-30 years. Fifty percent of the household heads can read and write. Lack of enough arable land, unreliable rain fall, extension of desertification, lack of scientific agricultural knowledge, absence of irrigation schemes, and shortage of skill in land use and management are some of the problems reported to contribute to food insecurity. The households are under severe malnutrition, food insecurity and poor childcare. Therefore, improvement of household resources by initiation of income generating livelihood options and knowledge based agriculture is needed.