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At least 19 recordsLinked to original sources
PubMed2004

Risk factors for xerophthalmia among mothers and their children and for mother-child pairs with xerophthalmia in Cambodia.

OBJECTIVE: To characterize the risk of xerophthalmia among nonpregnant women and their children and the risk factors for households in which both mother and child have xerophthalmia. METHODS: In case-control analyses of more than 15 000 households in the National Micronutrient Survey of Cambodia, univariate and multivariate logistic regression were used to estimate odds ratios (ORs) for nonpregnant mothers, children, and mother-child pairs with xerophthalmia. MAIN OUTCOME MEASURES: Risk factors for xerophthalmia. RESULTS: Of 10 942 children aged 18 to 60 months and 9587 nonpregnant women, the adjusted prevalence of xerophthalmia was 0.7% and 1.9%, respectively. In multivariate analyses, a child was at higher risk of xerophthalmia when the mother had xerophthalmia (OR = 4.36; 95% confidence interval [CI], 2.25-8.46), and a mother was at higher risk of xerophthalmia when a child had the disease (OR = 9.21; 95% CI, 3.56-23.82). Households were at higher risk for having both mother and child with xerophthalmia if there was a history of diarrhea in the mother (OR = 6.48; 95% CI, 1.49-28.23) or in a child younger than 60 months (OR = 10.16; 95% CI, 1.55-66.62) in the last 2 weeks. CONCLUSIONS: Xerophthalmia clusters among mothers and children in Cambodia and is associated with diarrheal disease. Interventions are needed to address vitamin A deficiency and diarrheal disease at the household level.

Adult↗
PubMed1993

Prevalence of xerophthalmia and efficacy of vitamin A prophylaxis in preventing xerophthalmia co-existing with malnutrition in rural Indian children.

Data of 4302 children, 0-6 years old were analysed to study the prevalence of vitamin A deficiency and the efficacy of vitamin A prophylaxis in preventing xerophthalmia co-existing with malnutrition. Manifestation of ocular signs of vitamin A deficiency were seen in 10 per cent children. The prevalence of xerophthalmia was higher in the normal and mild to moderately malnourished children, and lowest in the severely malnourished ones. The ability of vitamin A prophylaxis to curb xerophthalmia was greatest at the extreme ends of the nutritional grade spectrum. These findings have important implications for the existing national Vitamin A Prophylaxis Programme, and suggest that: (a) normal and mild to moderately malnourished children less than 6 years old, should be preferably considered for vitamin A mega dosing; (b) in the management of protein energy malnutrition, vitamin A status of the children should be monitored; and (c) the coverage should be improved as most children are in the mild and moderate degrees of malnutrition.

Age Factors↗
PubMed1978

Vitamin A deficiency in the Philippines: a study of xerophthalmia in Cebu.

An investigation of xerophthalmia was undertaken in four ecological zones in Cebu in the Philippines. One thousand seven hundred fifteen children aged 1 to 16 years were examined in 12 barrios. Clinical, biochemical and anthropometric data were collected from the children. Dietary and socioeconomic information was obtained from the households. Multivariate statistical techniques were used to examine factors possibly associated with xerophthalmia. Of children 47% had deficient or low serum vitamin A levels and 4.5% had clinical signs of xerophthalmia. Approximately 2% had both low serum vitamin A levels and clinical eye signs and were then defined as having active xerophthalmia. Vitamin A deficiency was more prevalent in males than females. Xerophthalmia was most common in the 4 to 6 year old age group. Diarrhea, roundworm infestation and measles were not positively correlated with xerophthalmia but whooping cough and tuberculosis were. Low intakes of carotene and vitamin A were associated with xerophthalmia but protein and fat intakes were not. A higher incidence of xerophthalmia occurred in children of working than nonworking mothers. Data on home production and use of vegetables and fruits are presented. The results of this study are being used to introduce three alternate intervention strategies to control xerophthalmia.

Adolescent↗
PubMed1983

Mortality associated with mild, untreated xerophthalmia.

The high mortality rate among children with severe corneal xerophthalmia is well recognized. The present study investigates, for the first time, mortality among the very much larger number of otherwise healthy free-living children with mild xerophthalmia (night blindness and Bitot's spots). An average of 3481 children (under 6 years of age) living in six Indonesian villages were reexamined by an ophthalmologist, pediatrician, and nutritionist every 3 months for 18 months. The overall prevalence of mild xerophthalmia was 4.9%. During the 18 months of observation, 132 children died. Of these, 24 had mild xerophthalmia and 108 had normal eyes at the 3-monthly examination preceding their death. Mortality rates were calculated for each 3-month interval by classifying all children by their ocular status at the start of the interval, and then dividing the number of deaths within the interval by the number of children of the same ocular status followed up for that interval. Mortality rates for the six 3-month intervals were then added together, and the results expressed as deaths per 1000 "child-intervals" of follow-up. Overall mortality rates for children with mild xerophthalmia and for children with normal eyes were 23.3 and 5.3, respectively, a ratio of 4 to 1. Excess mortality among the mildly xerophthalmic children increased with the severity of their xerophthalmia. Mortality rates for children with night blindness, with Bitot's spots, and with the two conditions concurrently were 2.7, 6.6, and 8.6 times the mortality rate of non-xerophthalmic children. This direct, almost linear relation between mortality and the severity of mild xerophthalmia was still present after standardizing for age and for the presence or absence of respiratory infection and protein-energy malnutrition. In the population studied, 16% of all deaths in children 1 to 6 years of age were directly related to vitamin A deficiency identified by the presence of mild xerophthalmia. These results suggest: that the existence of mild vitamin A deficiency in a community justifies initiation of vigorous intervention measures to reduce mortality, as much as to prevent the rarer cases of blindness; that night blindness and Bitot's spots should be accorded the same respect as is low "weight for height" in identifying those children in urgent need of medical attention; that ocular criteria used for determining the existence and severity of a vitamin A problem be reevaluated; and that the ophthalmic community, which has long been responsible for managing xerophthalmia, must now re-alert nutritionists, pediatricians, and public health workers to the serious systemic consequences accompanying even mild

Child↗
PubMed1996

Risk factors for xerophthalmia in the Republic of Kiribati.

OBJECTIVES: To identify risk factors for xerophthalmia in the Republic of Kiribati. DESIGN: Case-control study. SETTING: The Republic of Kiribati. SUBJECTS: 666 xerophthalmic preschool children (cases) and 816 children without xerophthalmia (controls) from a population-based sample of 4619 children who participated in a xerophthalmia prevalence survey. MAIN OUTCOME MEASURES: Clinical signs of xerophthalmia (night blindness, Bitot's spots, corneal xerophthalmia and keratomalacia). RESULTS: Multivariable logistic regression models showed older age [1.35(1.24, 1.47)] [odds ratio (95% confidence interval)]; male sex [1.32(1.05, 1.67)]; recent diarrhea [1.45(1.10, 1.89)]; severe [3.82(2.73, 5.35)], moderate [3.55(2.04, 6.18)], and mild [3.07(2.33, 4.04)] protein-energy malnutrition; current breast-feeding [0.30(0.19, 0.46)]; higher frequency of consumption of carotenoid-containing fruits and vegetables [0.93(0.80, 0.96)]; and the presence of a Foundation for the Peoples of the South Pacific garden project [0.70(0.52, 0.93)] were each independently associated with xerophthalmia. A recent history of measles was associated with corneal xerophthalmia [7.73(1.78, 33.65)]. CONCLUSIONS: These data provide further evidence of the relationship between xerophthalmia and factors that may be amenable to intervention, and suggest that greater availability and consumption of provitamin A carotenoids is associated with decreased risk of xerophthalmia among preschool children.

Breast Feeding↗
PubMed1992

Xerophthalmia clinics in rural eye camps.

Even though the primary prevention of many eye diseases can be effectively incorporated into the existing pattern of rural eye camps, efforts in this direction are restrained and insubstantial. We describe our technique and experience in the prevention of xerophthalmia by organising a distinct entity called a xerophthalmia clinic in our eye camps. The clinic consists of an Ophthalmologist or an Ophthalmic assistant who will exclusively examine children who come to the eye camp. This is perhaps, the first report on rural xerophthalmia clinics, in ophthalmic literature. Over a seven year period from 1984 to 1990 we have conducted 71 xerophthalmia clinics amongst the ninty eye camps organised. A total of 11,370 children were examined in the xerophthalmia clinic out of which 18.9% were afflicted with the disease. Therapeutic doses of Vitamin A were administered on the spot to the afflicted and prophylactic doses were administered to the rest. Intensive health education efforts are made through clinics to effectuate change in dietry habits towards consumption of locally grown DGLV (Dark Green Leafy Vegetables) like Anthenum, chenopodium and Amaranthus. A bipronged offensive consisting of mega-dosing and health education is, for the present and the foreseeable future, the best strategy to combat xerophthalmia in this desert region. A year by year breakdown of prevalence rates in the present study shows that in years of severe drought the prevalence of xerophthalmia increases three fold over the non-drought or mild drought years, thereby demonstrating that drought is a substantial risk factor in developing countries leading to vitamin A deficiency and xerophthalmia.

Child↗
PubMed1993

Clustering of xerophthalmia within households and villages.

The clustering of xerophthalmia within households and villages was estimated among preschool age children using data from studies conducted in Malawi, Zambia, Indonesia and Nepal over the past decade. Pairwise odds ratios (OR) were used to measure the magnitude of clustering. This OR measures the risk of xerophthalmia for a preschool child given that another randomly chosen preschool child from the same household (or same village but different household) had xerophthalmia, relative to the risk if that randomly chosen preschool child did not have xerophthalmia. Village pairwise OR ranged from 1.2 in Malawi to 2.2 in Nepal. Household pairwise OR ranged from 4.4 in Malawi to 9.7 in Indonesia, indicating that xerophthalmia clustering was much greater within households than villages. The magnitude of this clustering was as large, or larger than, infectious outcomes such as diarrhoea, fever and cough. Although xerophthalmia was associated with a weekly history of infectious morbidity, the clustering of diarrhoea, fever and cough explained very little of the xerophthalmia clustering observed in each of these studies, Hence, other household factors such as food availability and dietary practices should be examined for their role in the clustering of xerophthalmia within certain households.

Child, Preschool↗
PubMed1995

Epidemiology of xerophthalmia in Nepal. A pattern of household poverty, childhood illness, and mortality. The Sarlahi Study Group.

A case-control study of xerophthalmia (120 cases, two with corneal disease; 3377 children without xerophthalmia, 12 to 60 months of age) was conducted in the rural plains of Nepal. Relative household wealth (ownership of animals and goods, house quality) and social standing (parental education, nondaily laboring, more affluent castes) were inversely related to risk of xerophthalmia. Mothers of cases were more likely to have had children die than mothers of controls (odds ratio, 1.85; 95% confidence interval, 1.22 to 2.78); case households were more likely to have had a young child die in the past year (odds ratio, 2.85; 95% confidence interval, 1.43 to 5.67). Children with xerophthalmia were more wasted and stunted than controls, although these associations largely disappeared after adjusting for socioeconomic influences. Frequency of breast-feeding was highly protective against xerophthalmia in a dose-response manner (odds ratio, 0.32 for 1 to 10 times a day, 0.12 for > 10 times a day) after adjusting for age and other factors. The risk of xerophthalmia rose directly with reported duration of dysentery in the previous week (odds ratio, 2.13 and 5.81 for durations of 1 to 6 days and > or = 7 days, respectively, vs none). Mild xerophthalmia is reflective of a lower, local standard of living within which child health, nutrition, and survival are compromised.

Case-Control Studies↗
PubMed1976

Xerophthalmia and measles in Kenya.

In many African countries measles is considered to be an important cause of blindness. On the basis of his observations in Kenya and Tanzania in 1972 Franken presumed, however, that in the majority of these cases xerophthalmia was the real cause of blindness, precipitated by the "catalyst" measles. In order to gain a better understanding of this important complicated problem, we performed in the first half of 1974 an investigation in Kenya into the prevalence of xerophthalmia. In December 1974 we had the opportunity to evaluate our Kenyan findings on Java, in the company of Dr. J. ten Doesschate and Professor H.A.P.C. Oomen. The results of this investigation in Kenya and Indonesia are presented in this thesis. (see article) 1. Xerophthalmia occurred nearly everywhere in Kenya in 1974. This demonstrates the prevalence of xerophthalmia in communities which - do not have rice but - have maize for their staplefood. 2. Xerophthalmia appears to be the main cause of blindness in Kenyan children. 3. Measles often plays - by means of local and general "catalysing" effects - an important role in the development of blindness caused by xerophthalmia. 4. In well-nourished children measles is of no consequence as a cause of blindness. 5. Vital staining by 1% rose bengal or 1% lissamine green appears to be a real asset for the early diagnosis of xerophthalmia in Health Centres and in field surveys. This method is therefore of great importance for the prevention of severe, blindness inducing vitamin A deficiency.

Adolescent↗
PubMed1995

The decline of admissions for xerophthalmia at Cicendo Eye Hospital, Indonesia, 1981-1992.

Xerophthalmia due to vitamin A deficiency is a leading cause of blindness in children and has been a serious problem in Indonesia. To determine whether progress has been made in the eradication of xerophthalmia, we assessed hospital admissions for xerophthalmia at Cicendo Eye Hospital, Bandung, Indonesia. The hospital admission registry from 1981 to 1992 was reviewed. Between January 1981 and December 1992, there were 117 admissions for xerophthalmia, and of these, 63 were boys and 54 were girls, with an average age of 3.9 +/- 0.3 years. Hospital admissions for xerophthalmia declined steeply from 1981 to 1985, with a few rare cases from 1985 through 1992. During the same period from 1981 through 1992, there were no overall changes in total hospital admissions or total pediatric admissions. These results suggest that xerophthalmia is becoming less common in Indonesia.

Age Distribution↗
PubMed2006

Xerophthalmia secondary to alcohol-induced malnutrition.

BACKGROUND: Xerophthalmia refers to the ocular manifestations associated with vitamin A deficiency. Vitamin A deficiency can be caused by numerous disorders, including alcohol-induced malnutrition. The ocular manifestations of xerophthalmia include conjunctival and corneal xerosis (drying), keratomalacia (corneal necrosis/ulceration), nyctalopia (night blindness), and Bitot's spots (conjunctival lesions). CASE REPORT: A 47-year-old white male with complaints of dryness and difficulty seeing at night presented to our clinic for consultation from general medicine to rule out xerophthalmia. Laboratory testing and general medicine, psychiatry, and nutrition evaluations confirmed the systemic diagnosis of alcohol-induced malnutrition. He admits that his alcoholism was induced by depression. Confirmed associated disorders compounding the malnutrition include alcoholic cirrhosis, protein deficiency, and megaloblastic anemia. The patient had xerophthalmia diagnosed in the optometry clinic as a result of symptoms, slit lamp examination signs, and the associated disorders. The associated disorders were treated with systemic medications and vitamins. Ophthalmic treatment consisted of carboxymethylcellulose-based artificial tears. CONCLUSIONS: Although xerophthalmia and vitamin A deficiency are more common in underdeveloped countries, their presentation in the United States may be induced by conditions such as liver cirrhosis, malnutrition, and alcoholism. This report summarizes ocular manifestations of alcoholism and presents a case of xerophthalmia secondary to alcohol-induced malnutrition and the role of optometry in its treatment and management.

Alcoholism↗
PubMed2026

Xerophthalmia and ocular manifestations of vitamin A deficiency in children in high-income countries: A systematic review.

Xerophthalmia is a vision-threatening eye condition caused by vitamin A deficiency (VAD). Cases of xerophthalmia in high-income countries (HICs) are vulnerable to misdiagnosis, causing delays in treatment and adverse visual outcomes. We define the features, causes and complications of VAD and xerophthalmia in children of HICs. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42024492023). We performed a search for eligible articles on Scopus, Web of Science, Cochrane, PubMed and Medline. Cases reporting on children under 18 years of age residing in HICs with ocular features of VAD were eligible for inclusion. The search yielded 2474 results; 43 case reports and case series met the inclusion criteria consisting of a total of 61 cases (mean age 9.9 ± 4.2 years, range 3-17 years). Xerophthalmia was graded according to the most advanced finding for each case: 21.3% had night blindness only; 29.5% had conjunctival xerosis or Bitot spots; 29.5% had corneal xerosis, ulceration or scarring; 1.6% had xerophthalmia fundus only; and 18.0% had ocular manifestations associated with VAD that are not encompassed under the WHO classification. These features included swollen optic discs, optic neuropathy, or ocular dryness. Restrictive dietary practises were the most common mechanism of deficiency (75%), and autism was the most common underlying condition (49%). This shows that VAD remains a cause of severe visual impairment in HICs, especially when associated with delays in diagnosis and treatment. Further research is required to establish the prevalence of xerophthalmia in HICs.

Humans↗
PubMed1997

Infant feeding practices reflect antecedent risk of xerophthalmia in Nepali children.

OBJECTIVE: To determine the relationship between infant feeding history and risk of xerophthalmia due to vitamin A deficiency (VAD) in early childhood. DESIGN: A case-control study of previously xerophthalmic and non-xerophthalmic children. SETTING: Rural lowland region of Nepal. SUBJECTS: One hundred and fifty-six children (aged 1-6 y old), half of whom previously had xerophthalmia due to vitamin A-deficiency, the other half matched by locale, age and the presence and age of a younger sibling (n = 102). METHODS: Xerophthalmia was determined by trained ophthalmic assistants on the basic of current Bitot's spots, corneal xerosis or report of night blindness. Infant feeding history was collected through a diet history method obtained from the mother of the focus child. Exploratory factor analysis was conducted to determine the presence of underlying patterns in infant feeding practices. Conditional logistic regression was used to estimate odds ratios. RESULTS: Mothers of control children tended to have a higher level of education (P < 0.10) and to have fewer children who had died (P < 0.10) than mothers of case children. Feeding of meat (OR = 0.09, CI = 0.01-0.70) or fish (OR = 0.41, CI = 0.17-0.99) with liver, eggs (OR = 0.11, CI = 0.01-0.88) and mango (OR = 0.28, CI = 0.13-0.60) were protective in association with xerophthalmia in early childhood. Factor analysis uncovered several distinct patterns in infant feeding, which varied by age of the infant. Only the 'animal flesh' feeding pattern (factor), practiced in the second year of life, proved significantly protective from xerophthalmia (OR = 0.43, CI = 0.20-0.94). Feeding patterns of younger children closely paralleled those of their older siblings with and without VAD. CONCLUSIONS: The study supports the hypothesis that infant dietary practices can influence subsequent risk for VAD. Our findings emphasize the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.

Case-Control Studies↗
PubMed1983

Interactions of community nutritional status and xerophthalmia in Indonesia.

In order to determine which community level factors best explain the variation in the prevalence of xerophthalmia, an analysis was done on risk factors of xerophthalmia from the Indonesian Nutritional Blindness Study (1976 to 1979). Because of the common belief that xerophthalmia is closely linked to malnutrition, and the fact that within the study itself, it was demonstrated that children with xerophthalmia had a much higher prevalence of malnutrition than normal children, the relationship between the prevalence of malnutrition and the prevalence of xerophthalmia was explored. Using two different statistical approaches the prevalence of malnutrition within a community could not be demonstrated to be a good predictor of the prevalence of xerophthalmia within that community.

Body Height↗
PubMed1992

Xerophthalmia and growth in preschool Indonesian children.

Approximately 4000 preschool children in West Java, Indonesia, were examined for xerophthalmia and weighed and measured at 3-mo intervals from March 1977 to December 1978. Children recovering from xerophthalmia over a 3-mo interval gained an average of 124 g (95% CI 42-206) more over 3 mo than normal children. Their height gain was similar to normal children's. Children who developed xerophthalmia during a 3-mo period gained 199 g (95% CI 114-313) less and grew 0.28 cm (95% CI 0.12, 0.44) less than their normal peers. Children with chronic xerophthalmia gained 120 g (95% CI 49-191) less and grew 0.21 cm (95% CI 0.05-0.37) less than normal children. These data suggest that linear and ponderal growth is adversely affected by chronic and incident xerophthalmia, but that catch-up ponderal growth is experienced by children recovering from xerophthalmia.

Body Height↗
PubMed1989

Xerophthalmia in school children.

The prevalence of xerophthalmia was studied in 5135 school children of Jodhpur ranging between 6 and 16 years of age. The total prevalence of xerophthalmia was found to be 9.89%. Night blindness (XN) and milder conjunctival form (XIA, XIB) of the disease were predominantly prevalent in the studied population. Corneal disease (X2, X3A, X3B) was found in 8 cases and xerophthalmia scar (XS) in only one case. Recognition of early xerophthalmia and urgent vitamin A therapy is of paramount importance to preclude the onset of the corneal stage and irreversible blindness. It is suggested that xerophthalmia screening be made an essential component of routine medical check-up in schools with XN (night blindness with or without conjunctival xerosis) and XIB (Bitot's spots) used as criterion for screening to effectuate early detection and treatment of xerophthalmia.

Humans↗
PubMed1993

A prevalence study of xerophthalmia in the Philippines: implications for supplementation strategies.

In three provinces of the Philippines (Quezon, Northern Samar and Zamboanga del Sur), 11,378 children between 6 and 83 months of age were examined for signs of xerophthalmia and weighed to determine weight-for-age status. Xerophthalmia prevalence ranged from 1.6% to 4.4% for nightblindness and 0.6% to 2.7% for Bilot's spots in the three provinces indicating a serious vitamin A deficiency problem. These levels contrast sharply with the recent national xerophthalmia prevalence (0.7% for night blindness and 0.2% for Bitot's spots). There was a preponderance of mild xerophthalmia among males, and among children 4-6 years of age. No consistent association between weight-for-age status and xerophthalmia was found. The study recommends the universal distribution of vitamin A to children in high-prevalence regions, rather than the current practice of providing vitamin A supplements to moderately and severely underweight children identified through the annual village-based child weighing sessions, to ensure reaching children most at risk for xerophthalmia. The study also suggests the need for regional vitamin A assessments to identify areas endemic for vitamin A deficiency because the aggregate national prevalence may mask a more serious localized problem.

Child↗