No abstract

Preschool-age rural Indonesian children were reexamined every 3 months for 18 months. An average of 3135 children were free of respiratory disease and or diarrhea at the examination initiating each of the six, 3-month follow-up intervals. Children with mild xerophthalmia (night blindness and/or Bitot's spots) at the start and end of an interval developed respiratory disease and diarrhea at twice (p less than 0.001) and three times (p less than 0.001) the rate, respectively, of children with normal eyes during the same interval, independent of age and anthropometric status (weight for length). The risk of respiratory disease and diarrhea were more closely associated with vitamin A status than with general nutritional status. These results may explain much of the excess mortality recently reported for mildly vitamin A-deficient children.

No abstract

Among 5925 preschool-age children examined in a house to house rural field study, X1B (Bitot's spot with xerosis) and/or an history of nightblindness (XN) was presented in 325. Mean serum vitamin A levels among those with isolated XN (13.9 microgram/dl), isolated X1B (13.4 micrograms/dl), and coexistent XN/X1B (12.1 microgram/dl) were similar, and significantly below that of normal age/sex/neighborhood matched controls (17.6, 17.1, and 18.3 microgram/dl, respectively). The mean serum vitamin A level of the matched controls was significantly below that of normal, randomly sampled children from the study population as a whole (20.6 microgarm/dl). As independent screening criteria, disregarding the presence of absence of other signs, twice as many children had a history of XN as had X1B (84 and 41% of all clinically abnormal children, respectively). Of randomly sampled children 55% but only 15% of cases of XN had serum vitamin A levels above 20 microgram/dl. Of children with a history of nightblindness 97% had impaired scotopic vision on objective testing, but the mean serum vitamin A levels among test positives and negatives were identical. These results suggest a properly eleicited history of nightblindness can be almost as specific and far more sensitive an index of vitamin A deficiency and early xerophthalmia than the prescence of Bitot's spots (X1B), and that vitamin A deficiency is a clustered, neighborhood phenomenon rather than an isolated, sporadic occurrence.

The stated frequency with which 30 Indonesian children with corneal xerophthalmia and age/sex/neighborhood matched controls ordinarily consumed vitamin- and provitamin A-rich foods was compared. Controls were more frequent consumers of eggs (p less than 0.05), fish (p less than 0.05), dark green leafy vegetables (p less than 0.05), carrots (p less than 0.01), and carotene-containing fruits (p less than 0.1). Similar data were collected on 358 children with Bitot's spots and on normal preschool age children in a countrywide survey. Breast-feeding was more common among normals than among cases (p less than 0.001). Normals were also more frequent consumers of mango and papaya during the 2nd and 3rd yr of life (p less than 0.05); and of dark green leafy vegetables and eggs during the 3rd through 6th yr of life (p less than 0.01). In two separate studies, differences in carotene consumption by normals and abnormals were confirmed by differences in their serum carotene levels. Approximately 80% of Indonesian families, with an without xerophthalmic children, consumed dark-green leafy vegetables at least once a day, and 99% at least once a week. Diet therefore appears to be an important factor in the genesis of xerophthalmia in Indonesia despite the availability of suitable provitamin A-rich foods.

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.

No abstract

A randomized community trial was carried out in Aceh, Indonesia, 1982-1984, to assess the impact of semiannual vitamin A (VA) supplementation (60,000 micrograms RE) on preschool child growth: 229 villages were randomized to VA program and 221 to control status. One thousand thirty-two program and 980 control children aged 1-5 y were assessed and followed for 12 mo. VA program males gained an additional approximately 110 g weight at age 2-3 y (NS), 190 g at age 4 y (p less than 0.05), and 263 g at age 5 y over control males (p less than 0.01). Arm circumference and muscle area expanded 2 mm (p less than 0.05) and approximately 36 mm2 (p less than 0.05) more per year, respectively, from ages 3 to 5 y of age and more arm fat was retained at every age (p less than 0.05 at 1 and 3 y) in VA males. There were no group differences in ponderal growth for females or in linear growth for either sex. VA supplementation may improve growth where endemic deficiency exists.