Vitamin A deficiency among adolescent female garment factory workers in Bangladesh

Abstract

Objective: To investigate the prevalence of vitamin A deficiency among adolescent female factory workers in Bangladesh, and examine the association between various factors and vitamin A status.

Design: A cross-sectional study.

Setting: Garment factories in Dhaka city, Bangladesh.

Subjects: Three hundred and eighty eight adolescent girls aged 12-19 y from ten garment factories were selected randomly for the present study. Information on socio-economic conditions and usual pattern of dietary intake were obtained by interview. Anthropometric data and blood samples were collected following the interview.

Results: By NCHS reference standard, 15.5% of the participants were thin (< 90% Wt/Ht) and about 7% overweight (> 120% Wt/Ht). In about 56%, serum vitamin A level was below the adequate level of 1.05 mumol/l, with 14% having vitamin A deficiency (< 0.70 mumol/l). Forty four per cent of the participants were found to be anaemic (haemoglobin < 120 g/l). Food frequency data on vitamin A rich foods revealed that a large percentage of the participants do not take eggs (41%), milk (64%), liver (85%) and sweet pumpkin (85%); while about 40% of the girls take dark green leafy vegetables (DGLV) and 17% take small fish at least four servings a week. The girls who consumed four or more servings per week of DGLV had significantly higher serum vitamin A level than the girls who took three servings or less. There was a significant positive association between the level of serum vitamin A and frequency of intake of DGLV (r = 0.12; P = 0.023). When age, level of education, percapita income, haemoglobin concentration, serum protein concentration, menstruation at the time of blood collection, prevalence of current morbidity, frequency of intake of egg, milk, small fish, DGLV, liver and sweet pumpkin were accounted for by multiple regression analysis, a strong relationship was found for serum vitamin A concentration with age, menstruation, haemoglobin level and frequency of intake of DGLV. For every unit change in the frequency of consumption of DGLV, there was 0.013 mumol/l change in serum vitamin A level whilst taking other factors into account.

Conclusion: The data show that there is a high prevalence of subclinical vitamin A deficiency among the adolescent female garment factory workers in Bangladesh, although the anthropometric indices suggest that they do not suffer from acute under nutrition. Consumption of DGLV appears to have an important relation with the vitamin A status of these girls.

PIP: A cross-sectional study of 388 adolescent girls 12-19 years of age employed in garment factories in Dhaka, Bangladesh, revealed a high prevalence of subclinical vitamin A deficiency despite a lack of anthropometric evidence of acute undernutrition. Only 15.5% of participants were classified as thin (under 90% weight-for-height by US National Center for Health Statistics reference standards). Mean hemoglobin concentration was 119.7 g/l (range, 74-157 g/l). Assuming a cut-off point of under 120 g/l, 44% of these young women were anemic. The average serum vitamin A concentration was 1.04 mcgmol/l (range, 0.31-2.47 mcgmol/l); 56.2% of girls had a low (under 1.05 mcgmol/l) serum vitamin A level and 14.2% were vitamin A deficient (under 0.70 mcgmol/l). Mean frequencies of intake of egg, milk, small fish, and dark green leafy vegetables were 1.3, 0.8, 2.1, and 3.4 servings per week, respectively. 85% did not eat any liver or sweet pumpkin in the week preceding the interview. Serum vitamin A was significantly lower among participants who consumed less than 4 servings of milk and/or dark green leafy vegetables per week than among those who consumed 4 or more servings of these foods. Stepwise multiple regression analysis indicated that age, menstruation, hemoglobin concentration, and frequency of intake of dark green leafy vegetables were significantly independently related to serum vitamin A level. For every unit change in the frequency of consumption of dark green leafy vegetables, there was a 0.013 mcgmol/l change in serum vitamin A level.