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PubMed2004

Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia.

OBJECTIVE: To determine provisional estimates of the extent of vitamin A (VA) deficiency and xerophthalmia among school-aged children. DESIGN: Literature search of published, unpublished and website-based population survey and study reports, with country-specific imputation of prevalence rates and numbers of children affected by: (1) VA deficiency based on measured or imputed distributions of serum retinol concentration < 0.70 micromol/l (equivalent to < 20 microg/dl) and (2) xerophthalmia, by country. SETTING: Countries within the WHO South-East Asian Region. SUBJECTS: The target group for estimation was children 5-15 y of age. INTERVENTIONS: None. RESULTS: The estimated prevalence of VA deficiency is 23.4%, suggesting that there are approximately 83 million VA-deficient school-aged children in the region, of whom 10.9% (9 million, at an overall prevalence of 2.6%) have mild xerophthalmia (night blindness or Bitot's spot). Potentially blinding corneal xerophthalmia appears to be negligible at this age. CONCLUSIONS: VA deficiency, including mild xerophthalmia, appears to affect large numbers of school-aged children in South-East Asia. However, nationally representative data on the prevalence, risk factors and health consequences of VA deficiency among school-aged children are lacking within the region and globally, representing a future public health research priority.

Adolescent↗

PubMed1986

Breast-feeding, weaning patterns, and the risk of xerophthalmia in Southern Malawi.

A case-control study of breast-feeding and weaning patterns associated with xerophthalmia was conducted among children aged 24-71 mo in Southern Malawi in 1983. One hundred fifty-two children with active xerophthalmia were compared to 151 clinically normal children matched on age (+/- 12 mo), sex, and village of residence. All children were initially breast-fed; however, children with xerophthalmia began weaning onto porridge (p = 0.05) and ceased breast-feeding earlier (p less than 0.01 for 24-47 mo olds), had a shorter weaning interval (p less than 0.005), and were fully weaned from the breast for a longer duration (p less than 0.025) than the controls. The association between earlier cessation of breast-feeding and subsequent xerophthalmia was strongest during the immediate post-weaning years. These findings imply a protective role for breast-feeding against xerophthalmia in early childhood.

Age Factors↗

PubMed1991

Nutritional and household risk factors for xerophthalmia in Aceh, Indonesia: a case-control study. The Aceh Study Group.

Risk factors for xerophthalmia were assessed in 466 subjects [38% with night blindness (XN), 60% with Bitot's spots (X1B), 2% with corneal xerophthalmia (X2 or X3)] under age 6 y and their village-age-sex-matched control subjects during a community trial. Socioeconomic status and hygiene standards were lowest for households of xerophthalmic children and highest for nonstudy households in the trial population, with values for control households lying in between (P less than 0.001 by linear trend). Risk of xerophthalmia increased with less frequent consumption of dark green leaves, yellow fruits, or egg during weaning, adjusted for current intake and present age [odds ratio (OR) = approximately 3.5]. Exclusion of these same foods from the current diet (except for mango and papaya in older children) was associated with a two- to ninefold excess risk of xerophthalmia, adjusted for weaning influences. Xerophthalmic children aged less than 3 y were generally at higher risk of dietary imbalance than were older children. Xerophthalmia is associated with a chronic, infrequent consumption of key vitamin A foods from weaning through early childhood.

Age Factors↗

PubMed1999

Vitamin A intake and xerophthalmia among Indian children.

OBJECTIVE: To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y. DESIGN: Cross sectional study. STUDY SETTING: Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India. PARTICIPANTS: The study included 1094 all children under 6 y of age, from two randomly selected urban slums. METHODS: Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group. RESULTS: Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased. CONCLUSIONS: Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.

Child, Preschool↗

PubMed1976

Xerophthalmia.

Some characteristics of children with xerophthalmia are described and the difference in age between those with serious corneal xerophthalmia and those showing milder conjunctival xerophthalmia is noted. The various public health measures instituted to prevent xerophthalmia are examined. The particular importance of protein in food given to severely malnourished children suffering from xerophthalmia is stressed and studies on enzyme activities which are enhanced in the xerophthalmic cornea are briefly noted.

Age Factors↗

PubMed2005

Xerophthalmia: a study among malnourished children of West Mednipur District.

To study the correlation of stages of xerophthalmia in different grades of malnutrition, having 200 children clinically diagnosed having malnutrition as per criteria laid down by the Indian Academy of Pediatrics (IAP) were examined to detect the dinical stages of xerophthalmia as proposed by World Health Organisation (WHO). Out of 200 cases with different grades of malnutrition 81 (40.5%), 78 (39.0%), 22 (11.0%) and 19 (9.5%) were found malnourished in grades I, II, III, and IV respectively. Night blindness was earliest feature and seen in 97 cases (48.5%). All the 97 cases of night blindness fell in group of X(N) in which one case had corneal scar and falls in the group of X(S) in clinical staging of xerophthalmia. Thirty-nine (40.2%), 35 (36.1%), 19 (19.6%), 3 (3.1%) and (1.1%) were in clinical stages of xerophthalmia of X(1A), X(1B), X2, X(3A), X(3B)respectively. Severity of xerophthalmia was found directly proportional to severity of malnutrition.

Body Weight↗

PubMed1979

[Xerophthalmia].

Xerophthalmia results from an insufficient supply of vitamin A to the eye. Primary signs of xerophthalmia are conjunctival xerosis, Bitôt's spots with conjunctival xerosis, corneal xerosis, corneal ulceration with xerosis, keratomalacia. Secondary signs of xerophthalmia are night blindness, xerophthalmia fundus and corneal scars. According to the WHO 20 000--100 000 children in developing countries are struck annually with blindness due to xerophthalmia. With regard to the treatment immediate therapy with 100 000 I.U. vitamin A intramuscularly and 200 000 I.U. orally on the following day are advised in all cases of active disease. The doses should be reduced by half for children less than one year old. Prior to discharge from the clinic and additional dose of 200 000 I.U. vitamin A (children under the age of one year 100 000 I.U.) orally should be administered.

Administration, Oral↗

PubMed1995

Impact of vitamin A supplementation on prevalence and incidence of xerophthalmia in Nepal.

PURPOSE: To assess the impact of vitamin A supplementation at 4-month intervals on the prevalence and incidence of xerophthalmia among preschool-age children. METHODS: A stratified, random sample of 40 wards with 4766 children in Sarlahi district of Nepal was selected to participate in a randomized, controlled, community trial. In the vitamin A group, at 4-month intervals, neonates received 50,000 IU, 1- to 11-month-old infants received 100,000 IU, and children 1 through 4 years of age received 200,000 IU. Children underwent eye examination before the intervention and 16 months later. RESULTS: Before the intervention, 4318 children were examined for xerophthalmia. The prevalence was 2.3% in the vitamin A group and 3.3% in the placebo group. All children with xerophthalmia were treated with vitamin A at the time of the examination. Of those examined at baseline, 38 in the vitamin A group and 48 in the placebo group died in the 16 months after intervention. There were 1871 (84%) surviving children in the vitamin A group and 1711 (85%) in the placebo group examined at follow-up. After adjustment for the baseline prevalence of xerophthalmia, vitamin A reduced the prevalence at follow-up by 63% (95% confidence interval, 21% to 83%). The apparent incidence was 3.2/1000 per year in the vitamin A group and 9.2/1000 per year in the placebo group, an adjusted reduction of 62% (95% confidence interval, 0% to 86%). CONCLUSIONS: Supplementation was effective at reducing the prevalence and incidence of xerophthalmia.

Child, Preschool↗

PubMed1996

Vitamin A deficiency and xerophthalmia in western Yemen.

OBJECTIVE: To determine the prevalence of xerophthalmia and the extent of vitamin A deficiency in western Yemen. DESIGN: A stratified cluster sample of children aged 1-5 years with clinical examination for signs of xerophthalmia as well as blood serum survey. SETTING: The 18 districts of western Yemen, of which 10 clusters were chosen at random. SUBJECTS: All children aged 1-5 years resident in the cluster sites (n = 2438). MAIN OUTCOME MEASURES: Clinical signs of xerophthalmia, a history of night blindness, serum retinol levels in a random sample of clinically normal children (n =338) in addition to all children with xerophthalmia. RESULTS: Night blindness was found in 0.5% of the children, Bitot's spots in 1.7%, corneal ulceration in 0.04% and corneal scars in 0.04% Of the subsample, 7.2% (95% confidence interval [c.i.] 4.4-10.0%) had serum retinol values below 10 micrograms/dl; 63.0% (95% c.i. 57.6- 68.4%) had values below 20 micrograms/dl. CONCLUSIONS: Xerophthalmia and vitamin A deficiency are public health problems in western Yemen.

Child Nutrition Disorders↗

PubMed1977

Xerophthalmia in North Sumatra.

During a preliminary survey on xerophthalmia in North Sumatra, Indonesia, a total of 1754 children of 0-6 years of age were examined clinically as well as with a vital staining technique, using Rose-Bengal 1%-Fluorescein sodium 1% eyedrops. Differences in prevalence were found between children from the rural villages, from Gunung Pamela rubber estate and from one Health Centre and two kindergartens in Medan town. None of the children in the estate and in Medan had Bitot spots or acute corneal involvement; conjunctival xerosis (XIA) was found in 28% among boys and 11% among girls at the rubber estate, whereas in Medan only 1% had XIA. In the village, the calculated minimum point prevalence rates for X1B, X2 + 3 and XS were respectively 0.29%, 0.16% and 0.45% for age-group 0-6 years, sexes combined. According to WHO criteria xerophthalmia should, therefore, be considered of public health importance in the rural area visited. The potential use of the vital staining technique in early diagnosis of xerophthalmia is discussed. WHO criteria for assessment of the magnitude of the xerophthalmia problem as well as the guidelines for xerophthalmia surveys from the International Vitamin A Consultative Group have been analysed in this survey as a casestudy.

Child↗

PubMed1996

A population-based study of xerophthalmia in the extreme North Province of Cameroon, West Africa.

OBJECTIVE: To obtain cross-sectional data on clinical and nutritional vitamin A deficiency from which to design appropriate intervention strategies. DESIGN: A population-based survey using multistage, cluster sampling. SETTING: Extreme North Province of Cameroon, West Africa. PARTICIPANTS: Children aged 0 to 5 years. MAIN OUTCOME MEASURES: Clinical signs of active xerophthalmia and dietary vitamin A intake. RESULTS: Of 5352 children examined, signs of active xerophthalmia were noted in 0.62%. Bitot's spots, corneal xerosis, and corneal ulceration were noted in 0.47%, 0.06%, and 0.12% of the subjects, respectively. Children with xerophthalmia had lower vitamin A intake scores when compared with age-matched controls and with a 20% systematic subsample of children. CONCLUSION: Xerophthalmia is a major public health problem in this region.

Cameroon↗

PubMed1993

Vitamin A supplementation and dietary vitamin A in relation to the risk of xerophthalmia.

We examined the effect of 60-mg (200,000-IU) supplements of vitamin A administered every 6 mo on the incidence of xerophthalmia among preschool children who were free of eye symptoms and signs of vitamin A deficiency. We also prospectively studied the relationship of dietary vitamin A intake with the same endpoint. After 18 mo of follow-up, 400 children developed xerophthalmia during 80,104 child-periods of follow-up. Vitamin A supplementation only modestly reduced the risk of xerophthalmia (relative risk 0.88, 95% confidence interval 0.72-1.07, P = 0.19). On the other hand, total dietary vitamin A intake was strongly associated with reduced risk of xerophthalmia; the multivariate relative risk when children in extreme quintiles were compared was 0.38 (95% confidence interval 0.19-0.74; P for trend over quintiles = 0.002). These results emphasize the need for further data on factors that modify the bioavailability of large-dose vitamin A supplements. Increased consumption of inexpensive vegetables and fruits is highly likely to reduce significantly the risks of vitamin A deficiency, including nutritional blindness in developing countries.

Child↗

PubMed1988

Village and household clustering of xerophthalmia and trachoma.

The clustering of xerophthalmia in villages and in households was assessed among preschool children surveyed in the Lower Shire Valley, Malawi, and in Aceh province, Indonesia. Trachoma clustering was similarly assessed among the same children in Malawi. Trachoma clustered much more than xerophthalmia among villages and among households. The impact of xerophthalmia clustering on sample size considerations for future surveys or interventions was similar in Malawi and Indonesia. Village clustering of xerophthalmia would necessitate a twofold increase in sample size. Household clustering in the absence of village clustering would have almost no impact on sample size. Village clustering of trachoma would necessitate a ninefold increase in sample size. Household clustering would increase sample size requirements by 26%.

Child, Preschool↗

PubMed1997

Sampling designs for xerophthalmia prevalence surveys.

BACKGROUND: The purpose of this study was to estimate the bias and design effects associated with the Expanded Program on Immunization's (EPI) sampling design when estimating xerophthalmia prevalence, and to estimate the savings associated with EPI in terms of distance travelled within selected clusters. METHODS: Computer simulation of the EPI sampling strategy was done using maps from a xerophthalmia survey of 40 wards in Sarlahi district, Nepal. Samples of fixed cluster sizes of 7, 10, 15, 20 and 25 were compared. The estimated prevalence using the EPI design was compared with the true prevalence in the 40 wards to estimate the bias. The design effect was estimated by taking the ratio of the variance under EPI sampling to that of stratified random sampling (SRS) with fixed cluster sizes. The EPI was also modified by increasing the distance between selected houses from nearest neighbour to skipping 1-4 houses between selected ones. The difference between the distance travelled within clusters using SRS compared with EPI was weighed against the bias and increased variance. RESULTS: The prevalence of xerophthalmia was 2.8%. The EPI design overestimated xerophthalmia prevalence by between 0.27% and 1.16%. The design effects of EPI cluster sampling within wards varied between 0.73 and 1.35. Neither the bias nor the design effect was related to distance between households or cluster size. Distance travelled within wards was always less for EPI designs with cluster sizes of 7 or 10. There was no saving in terms of distance travelled for designs with cluster sizes from 15 to 25 if there were two or more houses between selected ones. For fixed cluster sizes of 15 or fewer, the EPI sampling design using nearest or next nearest neighbours is a better choice than SRS in terms of minimizing the distance travelled and the mean square error. CONCLUSIONS: The choice of an optimum method would need to account for the density of clusters and difficulty of travel between clusters, as well as the costs of travel within clusters. Based on certain assumptions, EPI with 15 children per cluster would be favoured over examining all children in selected wards unless the travel time between wards was more than 2 days.

Bias↗

PubMed2007

Submandibular gland transfer for severe xerophthalmia.

OBJECTIVE: To report early clinical experience with a new microvascular reconstructive procedure for patients with severe xerophthalmia. STUDY DESIGN: Retrospective clinical series. METHODS: Patients with severe xerophthalmia were referred for treatment after having exhausted all conventional means of treatment. The ipsilateral submandibular gland was transferred to the temporal fossa, as described by Macleod et al., and revascularized using the superficial temporal artery and appropriate vein(s). The submandibular duct was directed to the superolateral fornix so that the saliva produced moistened the eye. Results and complications were reviewed. RESULTS: Seven microvascular submandibular gland transfer procedures were performed in five patients, ages 6 to 54. The etiology of severe xerophthalmia was Stevens-Johnson syndrome in four and chemical burn in one. Follow-up time was 4 to 20 months. Successful transfer with revascularization was achieved in six of seven (86%) cases. Schirmer's test scores improved from 1.3 pretransfer to 8.1 posttransfer (P = .005). Patients experienced symptomatic relief within 1 month, and the microenvironment of the eye surface improved enough to make them candidates for visual restorative eye surgery. There were no major complications. CONCLUSIONS: Microvascular submandibular gland transfer is an effective approach for correcting severe xerophthalmia. The procedure should be within the skills of any reconstructive microsurgeon. This procedure offers a unique opportunity for otolaryngologist-head and neck reconstructive surgeons to help restore vision to this unfortunate group of patients.

Adult↗

PubMed1983

Xerophthalmia in urban Bangladesh. Implications for vitamin A deficiency preventive strategies.

Eight per cent of children attending a nutrition unit in urban Bangladesh had the eye signs and symptoms of vitamin A deficiency. About 1 in 10 of children with xerophthalmia and moderate-to-severe protein-energy malnutrition (PEM) had corneal involvement (X2,X3A/B): seasonal variation in prevalence was striking. Xerophthalmia was commonest in the 2-3 years age group and was associated with gastro-enteritis and measles. Breast feeding rates were low for PEM children with or without xerophthalmia. Poverty and overall shortage of food are the common denominators for both PEM and xerophthalmia. Effective vitamin A deficiency preventive strategies in urban Bangladesh will need, therefore, to include a broad range of measures such as the present limited distribution of high potency vitamin A capsules (200 000 IU) to children aged 0-6 years, food subsidies and food fortification if the most vulnerable children in the slums are to be reached.

Bangladesh↗

PubMed1995

[Xerophthalmia: current data].

Xerophthalmia is a term covering a range of ophthalmologic manifestations due to vitamin A deficiency. This condition occurs in preschool children in tropical regions affected by protein-caloric malnutrition. Clinical manifestations of the disease have been summarized in the 1974 five-grade WHO classification. Clinical diagnosis was traditionally made using a slit lamp to detect the pathognomonic manifestations and consequences of corneal and conjunctival xerosis. Currently diagnosis is greatly facilitated by determination of plasma levels using a micromethod, especially the relative dose response (RDR) test, and by conjunctival impression cytology (CIC). CIC is a simple and reliable method which allows mass screening and thus more effective evaluation of the impact of xerophthalmia on public health in Africa. The relationship between xerophthalmia and measles is complex. Vitamin A deficiency promotes measles which can in turn hasten perforation of keratomalacia especially in undernourished children. Vitamin A has a beneficial effect on both xerophthamia and measles. Curative and prophylactic administration of vitamin A at doses recommended by the W.H.O. considerably reduces not only xerophthalmia-related morbidity but also child mortality in tropical areas.

Disease Progression↗

PubMedDate not supplied

[Xerostomia and Xerophthalmia in haemodialysis patients].

BACKGROUND: A reduction in salivary and lachrymal secretion has been described in many pathologies; however, such alterations have not been described in patients with renal failure. This study was designed to estimate the frequency of alterations in salivary and lachrymal secretion in haemodialysed patients. PATIENTS ABD METHODS: We studied 63 haemodialysed patients and 23 healthy control subjects. In all of them we tested salivary secretion (Saxon test), lachrymal secretion (Shirmer test) as well as the presence of symptoms of xerostomia and xerophthalmia. In a subgroup of patients We investigated any evidence of ocular lesions and tissue damage of salivary glands (histopathology). We also tested the correlation between salivary and lachrymal secretion and autonomic nervous system function. Furthermore, we also studied the association between xerostomia and xerophthalmia and serum auto antibodies (anti nuclear, anti-Ro (SS-A), anti-La (SS-B)) and anti HCV antibodies. RESULTS: On average salivary and the lachrymal secretion was markedly reduced in uraemic patients compared with healthy controls. We found the alterations in salivary glands function to be strongly related to salivary glands fibrosis and atrophy and independent of amyloid accumulation. On the other hand, we observed that xerostomia and xerophthalmia were unrelated to autonomic dysfunction as well as to HCV infection and circulating auto antibodies. Moreover, xerophthalmia was frequently associated with evidence of corneal damage. CONCLUSIONS: Reduced salivary and lachrymal secretion is frequent in uraemic patients. Such alterations are often asymptomatic and could be an expression of the accelerated age-dependent decline in glandular function and the attendant fibrosis and atrophy.

Adolescent↗