Prevalence Of Night Blindness Research Articles

A Pre-Experimental Study to Assess the Effectiveness of Video Assisted Teaching on Knowledge regarding Vitamin ‘A’ Deficiency among Mothers of Under Five Children in selected Urban Area

Background: Vitamin A deficiency affects about 190 million preschool-age children, mostly from Africa and South-East Asia. The vitamin A deficiency is a public health problem (prevalence of night blindness is 1% or higher in children 24–59 months of age or where the prevalence of vitamin A deficiency (serum retinol 0.70 μmol/l or lower) is 20% or higher in infants and children 6–59 months of age), high-dose vitamin A supplementation is recommended in infants and children 6–59 months of age. Objective: This study was performed To evaluate the effectiveness of video assisted teaching on knowledge regarding vitamin ‘A’ deficiency among mothers of under-five children in selected urban area. Material and Methods: Non probability convenient sampling technique was used for selection of sample and samples who met the inclusion criteria were included in this study. Structured questionnaire was used to assess the knowledge of mothers regarding Vitamin A deficiency. Sample consisted of 60 mothers of under five children in selected anganwadi. The pretest knowledge of the mothers is assessed by self-administered questionnaire. Video assisted teaching regarding Vitamin A deficiency was given on the same day. The posttest knowledge of mothers was assessed after 7 days with the same tools. The data collected was analyzed using descriptive and inferential statistics and presented using tables and graphs. Result: This study has helped to assess the knowledge regarding mothers of under-five children in selected urban area regarding vitamin ‘A’ deficiency. Knowledge of samples were displayed low 61.7% and average 38.3% in pre-test but in post-test it has been improved to displayed low 5% Average 46.7% and good 48.3% categories. The calculated t value was found to be 11.771 for overall knowledge of regarding vitamin ‘A’ deficiency. The video assisted teaching was an effective tool to improve the knowledge of samples regarding vitamin ‘A’ deficiency. Conclusion: By the analysis and interpretation it has been evaluated that there was an improvement in knowledge regarding vitamin A deficiency among mothers in selected Anganwadi after giving video assisted teaching Thus, it was concluded that video assisted teaching is effective tool to improve the knowledge regarding vitamin A deficiency among mothers of under-five children.

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.
 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.
 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.
 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.

Ocular Manifestations Of Vitamin A Deficiency Among The Rural Pre-school Children Of North India

Abstract Purpose: Vitamin A deficiency (VAD) is still a major nutritional problem of public health importance among the rural pre-school children in India, even after the implementation national vitamin A prophylaxis programme for prevention of nutritional blindness and ICDS have been in operation for more than three decades. The purpose of this communication is to assess the prevalence of ocular manifestations of vitamin A deficiency among rural pre-school children of north India. Methods: A community based cross-section study; adopting multi-stage random sampling procedure was carried out by NNMB among rural pre-school children of four north Indian states viz. Maharashtra, Madhya Pradesh, Orissa and West Bengal. A total of 36,111 rural pre-school children of 1-5years (Boys: 18408; Girls: 17703) were covered for this study. Results: The prevalence of conjunctival xerosis (2.5%), the first ocular sign of VAD and Bitot’s spot (0.9%), an objective ocular sign of VAD was higher than the cut-off values suggestive of public health nutritional problem among the rural children. While, the prevalence of night blindness, the first symptom VAD was reported among 0.5% of rural children. Similarly, the proportion of rural pre-school children with sub-clinical VAD was 64%, suggestive of severe public health importance. Conclusion: The prevalence of ocular manifestation and sub-clinical vitamin A deficiency was high among the rural children of north India. Therefore, rural communities are encouraged to consume diets rich in vitamin A and administer massive dose vitamin A solution to the children of under five for the prevention and control of vitamin A deficiency and its adverse impact on child morbidity and mortality.

Variability of total carotenoids in C. Moschata genotypes.

Nowadays, the vitamin A deficiency (VAD) is still a public health concern, being one of the most important components of the high rate of morbidity and mortality among children in developing countries. There is a high prevalence of night blindness caused by deficiency of vitamin A. Children and pregnant women are particularly affected. Many pumpkins (C. moschata) genotypes present a great variability of carotenoid content mainly the beta-carotene. The objective of this work is to evaluate the variability of beta-carotene among pumpkins genotypes. Twenty biofortified pumpkins cultivated at Embrapa Table Coast land and Semiarid were evaluated regarding beta-carotene contents. The analyses were carried out by High rformance Liquid Chromatography. The pumkinks showed a large variability in the contents of total carotenoids varying, in fresh pumpkins from 699.06 (genotype 25) to 124.60 μg/g (genotype 26), from 106.96 (genotype 26) to 655.54 μg/g (genotype 25) in samples cooked in boiling water and 117.55 (genotype 19) and 650.54 μg/g (genotype 25) in steamed cooked, respectively.

Prevalence of night blindness in Bashagard district in Hormozgan, Iran, in 2011.

Background:Night blindness is a visual disorder associated with unusual vision during the night or in darkness. Vitamin A deficiency (VAD), which is easily preventable, is the main known etiology of night blindness. Malnutrition is a common health issue in Bashagard and some other areas in the Hormozgan province of Iran. The aim of the current study was to determine the prevalence of night blindness in Bashagard.Methods:This descriptive cross-sectional study was done on 814 Bashagard residences. Data was analyzed using SPSS software and descriptive studies.Results:About 60% of the study participants were uneducated people or people with low education. Thirty-two out of 814 people that were studied had problems with night vision. Therefore, the prevalence of night blindness in Bashagard was 3.93%.Conclusion:Prevalence of night blindness in Bashagard is three times higher than its prevalence in all of Iran. Therefore, preventive interventions such as dietary regimes with vitamin A enrichments or supplementations are recommended.

The role of prenatal nutrition assistance on the prevalence of night blindness in pregnant adults.

In developing countries, night blindness is a very common public health problem among pregnant women. Evaluate the effect of the changes occurred on prenatal care concerning prenatal nutritional care on the occurrence of night blindness (XN) in adult pregnant women in public maternity hospital in Rio de Janeiro between 1999-2001 and between 2007-2008. Two cross-sectional studies were conducted, been the first one conducted between 1999-2001 and the second one between 2007-2008. Were studied 402 puerperal women, 225 between 1999-2001 (GI) and 177 between 2007-2008 (GII). The gestational XN was investigated during the immediate puerperium (GI) and during the prenatal/puerperium (GII), diagnosed by the World Health Organization. The study collected sociodemographic, clinical, obstetric, anthropometric and prenatal care information. It verified significant reduce of prevalence of gestational XN (GI = 18.7% e GII = 0.6%, p < 0.001). The occurrence of gestational XN was associated to sanitary conditions, education level, more than six prenatal consultations, miscarriage at last pregnancy, higher average number of deliveries, average number of prenatal care consultations and prenatal nutritional (p < 0.05). There was no association between gestational XN and marital status, skin color, pre-gestational nutritional status, adequacy of gain of total gestational weight, gestational anaemia and average number of pregnancies (p > 0.05). The inclusion of nutritional care in routine prenatal care may have contributed to the reduction of gestational XN. Studies to assess the nutritional intervention in the prevention and treatment of gestational XN at regions at greatest risk are suggested.

Prevalence of Night Blindness among Children in Elhag Yousif Area, Khartoum, Sudan

A cross-sectional community-based study was conducted in El-Hag Yousif area, Khartoum, Sudan to measure the prevalence of night blindness in children. A total of 272 children were selected from four clusters in the study area using simple random sample technique. The diagnosis of night blindness was based on World Health Organization criterion which is identifying the blind children by lack of vision or inability to see well at night or in dim light. The prevalence of night blindness among children was 2.6%. The prevalence in females was 1.5%, males 1.1%, and in children less than 4 years was 4.2%. No statistical association found between night blindness and child sex and age. There was statistical significance of lack of vitamin A supplementation on prevalence of night blindness (Relative Risk = 4.732, 95% Confidence Interval from 1.337 to 16.749). The study concluded that the prevalence of night blindness was high and application of vitamin A supplementary was rapidly needed to prevent increasing of the problem.

Impact of Different Protocols of Nutritional Supplements on the Status of Vitamin A in Class III Obese Patients after Roux-en-Y Gastric Bypass

This study aims to investigate the nutritional status of vitamin A (VA) using biochemical and functional indicators in subjects with class III obesity, before and after RYGB, supplemented with three protocols. The sample comprised 90 patients, with BMI ≥40kg/m(2), divided into three groups: G1 that received routine supplementation containing 5,000IU of retinol daily; G2 that received 10,000IU of retinol daily; and G3 that received routine supplementation plus complementary of 50,000IU of retinol intramuscularly every month. The status of VA was evaluated before (T0), 30days (T1), and 180days (T2) after surgery. The vitamin A deficiency (VAD) in G1, G2, and G3 was respectively 20.7, 21.2, and 20.2% as regards retinol and 37.8, 63.3, and 40% as regards β-carotene in T0; 26.7, 10, and 23.4% as regards retinol and 68, 37, and 32% as regards β-carotene in T1; and 21, 8.7, and 20.2% as regards retinol and 63.3, 20, and 32% as regards β-carotene in T2. A reduction of retinol and β-carotene with increasing BMI and waist circumference was observed in T0. The prevalence of night blindness (XN) in groups 1, 2, and 3 was respectively 23.3, 26.7, and 16.7% in T0; 56.7, 40, and 60% in T1; and 70, 43, and 63.3% in T2. The study showed high prevalence of VAD. Among the supplementation protocols used, the one containing 10,000IU of retinol showed the best impact. However, in cases of more severe VAD, intramuscular supplementation should be considered. The prevalence of XN, justifies attention to this segment of population.

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.

Xerophthalmia in a Traditional Quran Boarding School in Sudan

Purpose:To determine the prevalence of xerophthalmia at a traditional boarding school where children do not receive a diet adequate in vitamin A.Materials and Methods:A cross-sectional survey of 406 males residing in a Quranic traditional school was conducted using the World Health Organization xerophthalmia checklist. The association between the prevalence of night blindness and proportion of students staying at the school for 6 consecutive months and those eating solely at the school was investigated. The difference in age between children with night blindness and those without was investigated. Statistical significance was indicated by P<0.05.Results:The prevalence of night blindness, conjunctival xerosis and Bitot's spots was 24%, 12.5% and 1%, respectively. None of the boys had corneal ulceration, corneal scars and corneal xerosis. No significant association was observed between the differences in mean age and development of night blindness (P=0.657). There was a significant association between the duration of stay (cut-off of 6 months continuously) at the institute and the development of night blindness (P=0.023). There was no statistical significance between regularly eating at the maseed and outside the “maseed” and the development of night blindness (P=0.75).Conclusion:Children residing at a traditional school are vulnerable to developing xerophthalmia where the diet is inadequate in vitamin A. Institutional caregivers should be made aware of the importance of providing a balanced diet rich in vitamin A. Institutional caregivers should also be educated on the signs and symptoms of vitamin A deficiency for early detection of xerophthalmia.

Prevalence of vitamin A deficiency and its determinants among the rural pre-school children of Madhya Pradesh, India

Background: Vitamin A deficiency (VAD) continues to be a major public health nutritional problem in India, even though the National Vitamin A Prophylaxis Programme has been in operation for more than three decades.Aim: To assess the prevalence of vitamin A deficiency among rural pre-school children.Subjects and methods: A community-based cross-sectional study was carried out in rural Madhya Pradesh. A total of 8777 pre-school children were clinically examined for VAD and blood vitamin A levels were estimated in a sub-sample by dried blood spot method.Results: Prevalence of night blindness and Bitot's spot, an objective sign of VAD, was 0.8% and 1.4%, respectively, and prevalence increased significantly (p < 0.001) with age. The proportion of children with blood vitamin A deficiency ( < 20 μg/dL) was 88% (95% CI: 84.8-91.2).The prevalence of Bitot's spot was significantly (p < 0.001) higher among children of lower socio-economic communities, 3–5-year age group and those of illiterate mothers.Conclusions: VAD is a major public health problem among rural children of Madhya Pradesh. Children of 3–5 years and those belonging to lower socio-economic communities are at high risk of VAD. Therefore, appropriate intervention measures are to be initiated to improve the vitamin A status of children.

Mapping Xerophthalmia in Mali: Results of a National Survey on Regional Distribution and Related Risk Factors

Background: Vitamin A deficiency is recognized to be a severe public health problem in most of the sahelian countries. In Mali, several surveys had been performed at the district or regional level. Unfortunately, they did not cover the entire territory. In the aim of getting a general picture, we collected information on the frequency and presentation of xerophthalmia among the children under 10 years old population recruited in the setting of a national survey planned in 1996 and 1997 to evaluate the prevalence and determinants of trachoma in Mali.Methods: In each of the seven regions (with the exception of Bamako district), a random sample of thirty villages was taken from the general population. In a subsample of those villages, children under 10 years of age were examined by an ophthalmologist and their related mothers interviewed. Diagnosis of night blindness and Bitot spot occurrence was used for data gathering. Information was collected on village's infrastructures and familial socioeconomic condition. Multiple logistic regression analyses were performed to purpose the best model to describe the relationship between each outcome variable and the various risk factors assessed.Results: The prevalence of night blindness was estimated to be 1.95% (95% Confidence Interval [CI]: 1.58–2.39) and Bitot spots frequency to be 1.10% (95% CI: 0.83–1.45) among children between 2 and 6 years of age. Xerophthalmia prevalence was 2.51% (95% CI: 2.09–3.00) and nearly similar according to gender (2.68% among boys and 2.32% among girls). By region of the country and for the same age group, the prevalence ranged from 0.26% in the Kayes region to 7.02% in the Timbuktu region. In Mali, in four regions out of seven, the WHO thresholds defining a serious public health problem have been exceeded. The higher prevalence rates were found in Timbuktu, Mopti and Segou. After adjustment to season, the main risk factors were latitude, village size and poor sanitary coverage. The main protective determinants were education and rice culture.Conclusions: This presentation illustrates a public health problem concerning vitamin A deficiency among young children in the general population and allows considering the effectiveness of substitutive intervention with vitamin A capsule distribution along with the improvement of vitamin A rich food production and consumption.

Improved Effect of School Meals with Micronutrient Supplementation and Deworming

A mid-day meal or school lunch program commenced in Gujarat, India from the sixties. In 1994, it was serving approximately 3 million schoolchildren. In 1994, the program was improved with the addition of a "package" of health inputs, including anthelmintics and micronutrient supplementation of iron and vitamin A, and iodine fortified salt. Tara Consultancy Services (TCS), India, a member of the Partnership of Child Development, Oxford University, evaluated Gujarat's improved midday meal program from 1993 to 1996. The program was implemented by the Commissionerate of the mid-day meal program, part of the government of Gujarat. The cost of the 'health package' in 1994, per child per year was 35 U.S. cents (1 U.S. dollars = Rs.30). The study to evaluate the improved program included the following components: FOCUS GROUP DISCUSSIONS: Government officials, teachers, students, parents, and community members participated in focus groups to elicit opinions on the proposed program which were predominantly positive. PROCESS EVALUATION: Logistical delivery defined as the adequacy, timeliness and cost of procurement of the anthelmintic drugs and micronutrients and the cost of this 'health package' per schooler per school year by the pharmaceutical companies was 100%. Efficiency of logistics to the schools, defined as the efficiency and cost of logistical delivery of the 'Health Package' from the State Head Quarters to the District to the Taluka to the School was 100%. Coverage defined as consumption of the 'Health Package' by schooler at least once in the 6-9 months of the school year, as stated by the implementing agency was 94%-100% (urban) and 42%-94% (rural); coverage as stated by the schoolchildren was 71%-79% (urban) and 50%-67% (rural). IMPACT EVALUATION: On average, students who received supplements were 1.1 kg heavier and 1.1 cm taller than those who did not; hemoglobin (Hb) levels were >12 g/dL intestinal parasite prevalence rates dropped from 71% to 39%; prevalence of night blindness and vitamin A deficiency were reduced from 67% to 34%. Since 2003, 4 states in India, namely, Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu covering approximately 30 million schoolers have adopted the "Gujarat Model."

Risk factors for nightblindness among women of childbearing age in Cambodia.

To characterize risk factors for nightblindness among nonpregnant women of childbearing age, a group recently recognized to be at high risk of vitamin A deficiency in some developing countries. Case-control study. The study included >15 000 households in National Micronutrient Survey of Cambodia conducted in 2000. The prevalence of nightblindness among 13 358 nonpregnant women was 2.0%. A total of 328 nonpregnant women with nightblindness were matched by province with 1009 nonpregnant women without nightblindness. Univariate and multivariate logistic regression models were used to estimate odds ratios (ORs) as estimates of the relative risk of factors associated with nightblindness. In a final model, materials in the wall of the house (OR 1.4, 95% confidence interval (CI) 0.9-2.0), land ownership < or =0.5 hectares (OR 1.4, 95% CI 1.0-1.9), nightblindness in last pregnancy (OR 44.5, 95% CI 29.2-67.8), parity >3 (OR 1.5, 95% CI 1.0-2.1), diarrhea within the last 2 weeks (OR 1.9, 95% CI 1.3-2.8), maternal body mass index <18.5 (OR 1.8, 95% CI 1.2-2.7), and lack of consumption of vitamin A-rich animal foods in the last 24 h (1-60 retinol equivalents (RE) OR 1.1, 95% CI 0.7-1.6; > or =60 RE, OR 0.7, 95% CI 0.4-1.0) were associated with nightblindness among nonpregnant women. Women of childbearing age in Cambodia with low socioeconomic status, low consumption of vitamin A-rich animal foods, a history of nightblindness during the previous pregnancy, parity >3, malnutrition, and diarrhea have a higher risk of nightblindness. United States Agency for International Development (442-G-00-95-00515-00).

Vitamin A status and nutritional intake of carotenoids of preschool children in Ijaye Orile community in Nigeria.

This study was carried out to determine the vitamin A status and nutritional intake of carotenoids of 213 children between the ages of 6 months and 6 years in a rural community in Nigeria. There were 109 males and 104 females. A total of 57 (26.8 per cent) children were deficient in serum retinol levels (< 10 microg/dl) while 102 (47.9 per cent) had low levels (10-19 microg/dl). The highest prevalence of serum retinol deficiency was in the 6-12 months age group, most of whom were breastfeeding and there was poor correlation between duration of breastfeeding and serum retinol levels. The prevalence of night-blindness was 1.5 per cent; however, none of the children had xerophthalmia. Chronically malnourished children had lower mean serum retinol levels than well nourished children. There was a high consumption of carotenoid-containing food, but despite this there was a high prevalence of vitamin A deficiency. We therefore suggest that measures to combat vitamin A deficiency should include vitamin A supplementation on a short-term basis. On a long-term basis parents should be educated on the importance of the consumption of locally available sources of provitamin A and pre-formed vitamin A rich foods, and the avoidance of overcooking. Parents should also be encouraged to grow more beta-carotene containing foods.

Recommendations for Indicators: Night Blindness during Pregnancy— A Simple Tool to Assess Vitamin A Deficiency in a Population

Night blindness during pregnancy caused by vitamin A deficiency is associated with an increased risk of morbidity and mortality among women. Because a history of maternal night blindness is simple and reliable to use, it is recommended as a population-based indicator of vitamin A deficiency. Furthermore, a maternal night blindness prevalence of >/=5% is recommended as a cut-off at which vitamin A deficiency may be considered to be a problem of public health significance within the community. This paper provides the justification for these recommendations. Night blindness during pregnancy is strongly associated with low serum and breast milk vitamin A concentration, abnormal conjunctival impression cytology and impaired dark adaptation, which suggests that it is a valid indicator of vitamin A deficiency. The prevalence of night blindness during pregnancy tends to be high in countries where the prevalence of xerophthalmia in children is high and in countries where interventions are in place to reduce childhood vitamin A deficiency. Existing data suggest that misclassification of self-reported maternal night blindness may account for a prevalence of up to 3%. The suggested cut-off, 5%, is set higher than this potential level of false-positive prevalence (3%). Illustrative data from India and Cambodia on childhood xerophthalmia and maternal night blindness rates are used to demonstrate the validity of using a 5% prevalence of maternal night blindness as indicative of a community vitamin A deficiency problem. Finally, it is recommended that night blindness history be elicited for a previous pregnancy that ended in a live birth in the past 3 y, using the local term for night blindness whenever possible.

Vitamin A deficiency in children with acute diarrhoea: a community-based study in Bangladesh.

The prevalences of nightblindness and xerophthalmia were assessed in 400 children, aged 6-59 months, with acute diarrhoea in a rural community in Bangladesh. The prevalences of nightblindness, conjunctival xerosis, and Bitot's spot were 7.8%, 9.5%, and 2.7% respectively. Fifty-two percent of the children who complained of nightblindness had ocular signs of vitamin A deficiency compared to 9% of those without nightblindness (p < 0.000). The nightblindness was significantly higher among the male children, aged 24-59 months, who were dysenteric and undernourished, did not consume vitamin A-containing foods daily, and were not breastfed. The coverage of periodic administration of vitamin A capsule was inversely related to the prevalence of nightblindness. This finding was determined by logistic regression analysis of data indicating that a combination of male sex, history of dysentery, absence of periodic administration of vitamin A treatment, and daily intake of vitamin A-containing foods gave the best-fitted model with an overall prediction of 92.5% of being nightblind. The findings of the study suggest that mothers should be educated to observe their diarrhoeal children about development of nightblindness and to seek treatment for it. The locally-relevant nutrition education should also be offered to them.

Vitamin A deficiency in Bangladesh: a review and recommendations for improvement.

This article provides a comprehensive review of the change in vitamin A status and the extent of vitamin A deficiency among different population groups in Bangladesh up to the present time. The result of experience with different strategies and interventions designed to improve vitamin A status are then reviewed, leading to a discussion of key options for action, as well as important areas for research and evaluation. All the available data have been examined in detail, including data from nationally representative samples and nationwide surveys, as well as small studies in different population groups. Reports on the effectiveness of different intervention programmes have been used. Over the past three decades a number of studies, which include national nutrition surveys, have been carried out to investigate the prevalence of vitamin A deficiency among different population groups in Bangladesh, and they have demonstrated a significant public health problem. Studies have shown that the prevalence of severe deficiency, based on the prevalence of night blindness in preschool children, decreased from 3.6% in 1982-83 to 1.78% in 1989 and 0.6% in 1996. However, there is still a high prevalence of subclinical vitamin A deficiency, based on the biochemical assessment of serum retinol levels in preschool children, estimated mainly from hospital-based groups. Night blindness and Bitot's spot are also found to exist among school-age children and adolescents. Recent reports indicate that night blindness among rural mothers is as high as 1.4%. Only a limited number of studies, with small sample sizes, are available where serum retinol has been reported for school-age children, adolescents and pregnant women. Nevertheless, these studies confirm the presence of low levels of serum retinol and hence, the existence of subclinical vitamin A deficiency. Furthermore, the dietary intake of vitamin A in each population group has been found to be less than the Recommended Daily Allowance (RDA), indicating a significant risk of deficient intakes of vitamin A. To address the problem of vitamin A deficiency, the government of Bangladesh started the Nutritional Blindness Programme in 1973. The main activities of the programme include vitamin A capsule (VAC) supplementation to children of 6 months to 6 years old, nutrition education to increase the production and consumption of vitamin A rich foods, and training of primary health-care workers on the clinical diagnosis and treatment of vitamin A deficiency, VAC distribution and nutrition education. Since 1988, as a long-term strategy, Helen Keller International has been implementing community home gardening promotion projects. To date, the possibility that foods may be fortified with vitamin A, has not been explored as a possible approach in Bangladesh. Although short- to long-term prevention and control programmes are to some extent in place, to improve the situation of vitamin A deficiency, Bangladesh needs a more appropriate mix of interventions for the entire population. More operational research and evaluation are needed if a fully effective programme to alleviate the problem of vitamin A deficiency is to be developed. Finally, to achieve the goal of virtual elimination of vitamin A deficiency will require an integrated approach which brings together appropriate actions at every level, within and across the many sectors of society.

An ethnographic study of night blindness “ratauni” among women in the Terai of Nepal

Night blindness is the most common ocular condition representing moderate-to-severe vitamin A deficiency in children. Very little, however, is known about maternal night blindness, which has recently been reported to occur frequently during pregnancy in parts of south-east Asia. In Nepal, the prevalence of night blindness is reported to be 16%. We carried out an ethnographic study of night blindness during pregnancy in the south-eastern, rural plains of Nepal as preliminary research for a case-control study of the determinants of this condition. The purpose of the research was to identify local terms and concepts of night blindness and to examine women's perceptions of its causes, symptoms, severity, and consequences during pregnancy. Data collection involved in-depth interviews, case studies, unstructured observations and structured anthropologic methods, such as free listing and quick sort ranking. Women considered night blindness to be an important illness of pregnancy, ranking it second (to vaginal bleeding) in perceived severity from a list of 15 “women's illnesses”. Local terms for night blindness were identified in three different languages from the region. Informants described a complex ethnomedical model of night blindness that included causes, symptomatology, and treatment alternatives. However, there was no perceived link between food intake and the occurrence of night blindness. The major causes of night blindness were attributed to pregnancy, weakness, or “hotness”. Some women sought treatment for the condition but most women chose not to treat it since they believed that it was a transient condition of pregnancy. Interviews with women who had previously experienced night blindness and home-based observations of women exhibiting concurrent night blindness showed that it adversely affected their activity patterns, especially those related to child care and food preparation. Night blindness increased reliance on family members to perform various domestic chores and was also associated with personal injury and accidents. The findings of this study have relevance for women's reproductive health and nutrition throughout the Indian sub-continent. A simple history of night blindness may be a practical tool to identify women with nutritional and health risks. Maternal night blindness should be more routinely investigated in vitamin A deficient areas of the world, both to define the magnitude of the problem, and to develop programs/interventions that specifically target this population.

Night Blindness Is Prevalent during Pregnancy and Lactation in Rural Nepal

The prevalence of night blindness during pregnancy and lactation was assessed in a sample of 426 women living in the rural teral of Nepal. These women were also examined for ocular signs of vitamin A deficiency. Among 241 lactating women, 16.2% reported experiencing night blindness at some time during the pregnancy that produced the infant they were now breast-feeding. Among 185 pregnant women, 8.1% reported being night-blind at the time of the interview. The odds of night blindness in the current pregnancy were six times greater for women who reported night blindness in their previous pregnancy. Night-blind women were more likely to come from households with lower socioeconomic status. Teenage women and those over the age of 30 were at highest risk, particularly those of higher parity within these age groups. Vitamin A deficiency, for which night blindness is a marker, seems to be a problem in this population of pregnant and lactating women, with potential health consequences for women and their infants.