Aetiology of severe vitamin A deficiency in children.

ABSTRACT

BACKGROUND: Severe forms of vitamin A deficiency or keratomalacia are common in young children. Keratomalacia is thought to be associated with malnutrition due to poor weaning practices and manifests at 3 to 4 years of age. As survival rates for infants have increased, keratomalacia is being seen in children less than 6 months of age. Hence, keratomalacia shows two peaks--one in early infancy and the other in the toddler or pre-school age groups. However, the reasons for its occurrence at these ages may be different. METHODS: Records of children admitted to the Nutrition Rehabilitation Centre at the Government Rajaji Hospital during 1971-89 and at the Aravind Children's Hospital during 1991-93 were reviewed for severity of vitamin A deficiency associated with protein-energy malnutrition. Records of 1990 were not available. RESULTS: During 1971-89, 4691 children were admitted to the Nutrition Rehabilitation Centre for Nutritional rehabilitation and treatment of vitamin A deficiency. Of these, 1575 (33.6%) children had corneal involvement due to vitamin A deficiency. During 1991-93, 7439 children in the age group of 0-15 years were seen at the Aravind Children's Hospital--185 had vitamin A deficiency; 133 were below the age of 5 years and 69 had keratomalacia. Fifteen children with keratomalacia were below the age of one year and 12 were below 6 months of age. CONCLUSION: The incidence of severe vitamin A deficiency of keratomalacia shows two peaks; one in early infancy (< 6 months) and the other in the pre-school age group. The first peak is probably related to maternal nutrition and decreased breast-feeding while the second peak is possibly related to poor weaning practices.