Risk factors of nutritional blindness and determinants of a successful vitamin A prophylaxis programme.

Data on 7668 children (0-72 months) and their 4621 mothers and 81 Anganwadi Workers (AWWs) collected for the USAID Assisted ICDS Evaluation Surveys were analysed. The results indicated that the major risk factors of nutritional blindness were lack of nutrition and health knowledge among mothers; presence of iron deficiency anemia in the children; and history of the child having had measles in the past one year. Mother's health and nutrition, knowledge and maternal literacy status were the determinants of the success of a vitamin A prophylaxis programme. Factors that determined AWW's performance in vitamin A supplementation were her nutrition and health knowledge, her literacy status and the amount of supervisory assistance she received from Auxillary Nurse Midwife (ANM).

Agreement between arm circumference, weight for age, and weight for height measures of malnutrition in children.

Agewise agreement between mid-upper arm circumference (AC), weight for age and weight for height assessment of nutritional status was analyzed for 5,509 Indian children 1 to 5 years of age. Sensitivity specificity and positive predictive value of AC are presented. The sensitivity of AC for detecting moderate malnutrition by weight for age or weight for height was found to be low, except in children 13-24 months of age. From 25-58% of the severely malnourished children by weight for age in the age group 25-60 months were misclassified as normal by AC. Specificity of AC was high across the age range indicating that most of the children identified as not malnourished by weight for age or weight for height also had normal AC. The positive predictive value of AC was low for severe malnutrition but high for moderate to mild malnutrition compared to weight for age and weight for height. The findings indicate that AC is not constant over the age range 1 to 5 years, and use of fixed cut-off points for assessing malnutrition from 1 to 5 years is inappropriate. Sensitivity of AC using a fixed-cut-off point clearly decreases with age, and specificity increases with age. Where possible, weight of children is preferable to AC for nutritional status assessment, due to large number of moderately or severely malnourished children likely to be wrongly classified as normal by AC.

A simple field test for identification of night-blindness.

A simple and replicable field test to measure dark adaptation time has been developed. It required a darkened room with a 5 watt bulb covered with a piece of black cloth, a spherical white object of 22 cm diameter suspended vertically from a horizontal string, a stool, a black curtain, a Maxwell electronic photographic flash unit and a stop-watch. The spherical object behind the closed curtain was hung 1.5 m away from the subject either to his left or right, or in the centre of the room. The seated subject was then exposed to 3 consecutive flashes, the curtain drawn, and the time taken to identify the position of the object was noted on the stop-watch. The test was conducted for 3 consecutive days on non-night blind young adult girls (n = 46) of the high income group (PC); underprivileged school-age children (n = 44) with a positive history of night-blindness (NB), and their age/sex pair-matched (n = 44) non-night-blind controls (NNB). The NB group had a significantly higher mean dark adaptation time as compared to the NNB and PC groups (14.9 sec vs 11.9 and 11.3 sec respectively). The mean serum vitamin A levels of NB, NNB and PC groups (15.8, 17.5 and 29.5 micrograms/dl respectively) were correlated with the dark adaptation times.