Vitamin A status of children in five Ecuadorian provinces

In mid-1993 Ecuador's Health Research Institute conducted a survey to evaluate the general nutrition and vitamin A status of children in five provinces (three in the mountains and two on the coast) containing pockets of extreme poverty. The survey enrolled 1555 children 12-59 months old who constituted a multi-phased stratified cluster sample obtained by random selection methods. Among its other aims, the survey sought to assess all or part of the study subjects' serum retinol levels, dietary vitamin A intake and ocular signs of vitamin A deficiency, and to weigh the influence on vitamin A status of age, sex, parental (maternal) education, residence in a rural or urban area, and the ethnic background of the residence area. Questionnaire interviews were conducted to gather information about each survey child's identify, diet, pathologic history, and breast-feeding history; a blood sample was obtained; and the child was weighed, measured, and given a complete physical examination (including an eye examination). Of the 1232 survey children whose serum retinol levels were measured, 18% and 2% were found to have levels below 0.7 and 0.35 mumol/L, respectively. Low serum retinol levels were more common among children of mothers who had relatively little education and resided in rural areas. The presence of Bitot's spots was confirmed in two of the study children. Interviews conducted with 39% of the study children's families to assess the children's diets showed the risk of insufficient vitamin A intake to be greater in the mountain provinces and among Indian populations, children born to mothers with no formal education, children living in rural areas, and underweight and stunted children. Forty-eight percent of the study population had serum retinol levels between 0.70 and 1.05 mumol/L, indicating marginal vitamin A deficiency. It would therefore appear that dietary supplementation would cause a substantial part of the Ecuadorian population to improve its vitamin A status. Overall, the results of the survey were consistent with a previous national survey and confirmed the existence of a pronounced subclinical vitamin A deficiency that clearly constitutes a public health problem, especially in Ecuador's rural Andean areas.