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.

PIP: Since 1971, records on Indian children from Tamil Nadu with ocular manifestations due to vitamin A deficiency have been maintained, first (1971-89) at the Nutritional Rehabilitation Center in Mandurai and, later (1991-93) at the Aravind Children's Hospital. An analysis of the age distribution of such cases revealed two distinct peaks in the incidence of keratomalacia. During 1971-89, 4691 children were admitted for treatment of vitamin A deficiency, 1575 (33.6%) of whom had corneal involvement. During 1991-93, 185 children under 15 years of age were admitted with vitamin A deficiency; 133 (72%) were under 5 years of age and 69 (37%) of them had keratomalacia. 15 children (22%) with keratomalacia were under 1 year of age and 12 were under 6 months of age. All the children with keratomalacia had low birth weight and were from poor families. The first peak in keratomalacia incidence, in early infancy, is presumed to reflect poor maternal nutrition and its effect on breast feeding. Of the 15 children under 1 year of age with keratomalacia during 1991-93, 12 were not breast-fed at all, primarily because of lack of milk secretion. The second peak, in the preschool age group, is possibly related to inadequate weaning practices. As a result of poverty, low availability, and cultural restrictions, foods rich in vitamin A are rarely consumed. Recommended, to prevent keratomalacia in infants and young children, is synthetic vitamin A (200,000 IU) supplementation within 1 month of delivery or a lower dose (6000 IU) for pregnant women from 20 weeks onward.