MAGNITUDE AND ASSOCIATED FACTORS OF VITAMIN A DEFICIENCY AMONG SCHOOL-GOING CHILDREN

Abstract

Background: Vitamin A deficiency (VAD) is an important public health problem in India and recent evidence suggests that school-age children could still carry a measurable burden of VAD despite the presence of national supplementation programmes aimed at pre-school children.

Objective: The study aimed to assess the magnitude and ocular manifestations of vitamin A deficiency and its associated socio-demographic, nutritional and morbidity factors amongst school going children in rural government schools of central India.

Methods: 500 students aged 7–14 years from rural government schools of central India were selected for a school based cross-sectional study spread over one year. Vitamin A deficiency was assessed based on the ocular clinical signs according to WHO. The collection of data on socio-demographic, dietary, anthropometric, and morbidity was done using a structured proforma. The associations were evaluated using the Fisher exact test and also Firth's penalized logistic regression considering the few VAD cases.

Results: The overall prevalence of vitamin A deficiency was 1.8 percent (9/500). Bitot spots were the most common manifestation among children with VAD 88.9%. Others were corneal xerosis/ulceration/keratomalacia 11.1%. There was no night blindness or conjunctival xerosis cases noted. A significant association was found between VAD and maternal education below secondary level (p=0.013), undernutrition/obesity (p=0.004), less intake of green leafy vegetables (p=0.047), less intake of yellow/orange fruits (p=0.039), recent diarrhoea (p=0.012), and history suggestive of measles (p=0.020). In multivariable analysis, independent predictors were maternal education below secondary level (AOR 4.18, 95% CI 1.09–16.08), undernutrition/obesity (AOR 5.74, 95% CI 1.44–22.91) and recent diarrhoea (AOR 4.69, 95% CI 1.20–18.27). In addition, having a history suggestive of measles indicated an increased risk. This association was seen with an AOR of 4.21 and a 95% CI 1.01–17.54.

Conclusion: Despite a low prevalence of vitamin A deficiency (1.8%) among school-going children from rural central India, presence of ocular manifestations like Bitot spots and corneal disease warrants serious public health concern. The main predictors include maternal education, nutritional status, and recent infections. It is recommended that maternal education and nutrition programmes, deworming and infection prevention be strengthened.