ABSTRACT
Objectives: Vitamin A (VA) deficiency (VAD) is a significant burden among children under-5- years-old and pregnant and lactating women in sub-Saharan Africa. We assessed the levels of VA and prevalence of VAD among children age 6-23 mo in 2 counties in western Kenya. Methods: Dry-Blood-Spot (DBS) samples were obtained from 1838 infants in a community-based cross-sectional survey. Laboratory analysis of retinol-binding protein (RBP) and C-reactive protein (CRP) was carried out using a rapid EIA to estimate VA and subclinical inflammation statuses, respectively. A validation of DBS as a matrix using 60 matching serum-DBS samples was carried out. Values were adjusted for influence of inflammation using CRP (CRP, >5 mg/L) and population prevalence of VAD (RBP<0.825 μmol/L, biologically equivalent to 0.70 μmol/L retinol) estimated. Results: Mean (geometric±SD) concentration of RBP was adequate (1.56±0.79 μmol/L) with inflammation-adjusted mean (±SE) prevalence of VAD being high (18.3±1.1%). The level of CRP was within normal range (1.06±4.95 mg/L) whilst 18.4±0.9% had subclinical inflammation (CRP>5 mg/L). VAD was not associated with child sex (Chi-squared, Χ2=0.42, P=0.51), child nutritional status (wasting (P=0.68) and stunting (P=0.91), reported child intake of VA capsule within the past 1 year (P=0.84), maternal VA nutritional knowledge (Χ2=0.10, P=0.80), or reported maternal intake of VA capsule within 2 months of delivery (P=0.27). Older children had a 10% increased risk of VAD. Conclusions: Prevalence of VAD in this sample of infants was high irrespective of intake of VA capsule or maternal VA nutrition knowledge. A sustainable food-based intervention in this area of western Kenya to combat VAD especially in pregnant women and infants is warranted.