Severe vitamin A deficiency in a rural village in the Hararge region of Ethiopia.

ABSTRACT

PIP: In late 1988 in Ethiopia, a physician and a nutritionist examined 240 registered children in the village of Melkaye (Farmers' Association No. 34) in Darolobo District of Habro Province for vitamin A deficiency. These children had been dependent on food aid because of consistent drought and crop failures since, at least, 1982. The food aid, which was the main food source, included food deficient in vitamin A and beta-carotene: wheat flour, vegetable oil, butter-oil, and beans. 53.2% of the boys and 43.1% of the girls had at least 1 sign of vitamin A deficiency, especially night blindness, an early manifestation of vitamin A deficiency. 28.8% of all children had night blindness without signs of xerophthalmia compared with the WHO cut-off point of 1%. (The cut-off point is used to determine the public health significance of vitamin A deficiency.) 6.7% had Bitot's spots compared with a cut-off point of 0.5%. 7.1% had corneal xerosis/ulceration compared with a cut-off point of .01%. 5.8% had corneal scars compared with a cut-off point of .05%. 30.2% had a serum retinol level less than .35 mcmol/l compared with a cut-off point of 5%. 17 of 70 children (24.3%) who had died in the last 2 years had ruptured or damaged eye(s). The median levels of serum retinol-binding protein, iron, transferrin saturation, and ferritin were lower than normal levels. On the other hand, parameters of iodine status, total triiodothyronine, and total thyroxine and thyrotropin were all normal. 78.8% and 82.4% of the children experienced high levels of IgG and IgM, respectively. 42.4% had high C-reactive protein levels. Wasting was more common than stunting (33% vs. 10%). 8% suffered from both stunting and wasting. The severity of xerophthalmia was perhaps the most severe ever recorded and prompted health workers to distribute vitamin A capsules to all children in Melkaye and nearby villages.