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Risk factors for xerophthalmia in the Republic of Kiribati
D A Schaumberg1, J O'Connor, R D Semba
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Xerophthalmia risk factors in Kiribati include malnutrition and diarrhea, while breastfeeding and consuming fruits/vegetables reduce risk. Interventions targeting these factors, especially increasing provitamin A carotenoid intake, are crucial for prevention.
Area of Science:
- Ophthalmology
- Nutritional Science
- Public Health
Background:
- Xerophthalmia, a leading cause of preventable childhood blindness, is a significant public health concern in developing nations.
- Identifying specific risk factors is crucial for developing targeted interventions to combat this vitamin A deficiency-related condition.
Purpose of the Study:
- To investigate the epidemiological risk factors associated with xerophthalmia in preschool children in the Republic of Kiribati.
- To inform public health strategies aimed at reducing the prevalence of xerophthalmia in the region.
Main Methods:
- A population-based case-control study was conducted in the Republic of Kiribati.
- Data were collected from 666 children with xerophthalmia (cases) and 816 children without xerophthalmia (controls) identified during a prevalence survey.
- Multivariable logistic regression analysis was employed to identify independent risk factors.
Main Results:
- Independent risk factors for xerophthalmia included older age, male sex, recent diarrhea, and varying degrees of protein-energy malnutrition.
- Factors associated with a reduced risk of xerophthalmia were current breastfeeding and higher consumption of carotenoid-rich fruits and vegetables.
- A history of measles was significantly associated with corneal xerophthalmia.
Conclusions:
- The study confirms the link between xerophthalmia and several modifiable factors, highlighting the importance of nutritional status and hygiene.
- Increased availability and consumption of provitamin A carotenoids show a protective association against xerophthalmia in preschool children.
- These findings support the implementation of interventions focused on dietary improvements and disease prevention to mitigate xerophthalmia risk.
Objectives:
To identify risk factors for xerophthalmia in the Republic of Kiribati.
Design:
Case-control study.
Setting:
The Republic of Kiribati.
Subjects:
666 xerophthalmic preschool children (cases) and 816 children without xerophthalmia (controls) from a population-based sample of 4619 children who participated in a xerophthalmia prevalence survey.
Main Outcome Measures:
Clinical signs of xerophthalmia (night blindness, Bitot's spots, corneal xerophthalmia and keratomalacia).
Results:
Multivariable logistic regression models showed older age [1.35(1.24, 1.47)] [odds ratio (95% confidence interval)]; male sex [1.32(1.05, 1.67)]; recent diarrhea [1.45(1.10, 1.89)]; severe [3.82(2.73, 5.35)], moderate [3.55(2.04, 6.18)], and mild [3.07(2.33, 4.04)] protein-energy malnutrition; current breast-feeding [0.30(0.19, 0.46)]; higher frequency of consumption of carotenoid-containing fruits and vegetables [0.93(0.80, 0.96)]; and the presence of a Foundation for the Peoples of the South Pacific garden project [0.70(0.52, 0.93)] were each independently associated with xerophthalmia. A recent history of measles was associated with corneal xerophthalmia [7.73(1.78, 33.65)].
Conclusions:
These data provide further evidence of the relationship between xerophthalmia and factors that may be amenable to intervention, and suggest that greater availability and consumption of provitamin A carotenoids is associated with decreased risk of xerophthalmia among preschool children.