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Aetiology of severe vitamin A deficiency in children
L Rahmathullah1, M S Raj, T S Chandravathi
1Aravind Children's Hospital, Madurai, Tamil Nadu, India.
Insights
Severe vitamin A deficiency, or keratomalacia, affects infants and preschoolers, with two incidence peaks. Early infancy cases may stem from maternal nutrition issues, while preschool cases are linked to poor weaning practices.
Area of Science:
- Ophthalmology
- Pediatrics
- Nutritional Science
Background:
- Severe vitamin A deficiency, known as keratomalacia, is prevalent in young children.
- Traditionally associated with malnutrition from poor weaning, it typically appears in 3-4 year olds.
- Increased infant survival has led to earlier onset, observed in infants under 6 months.
Purpose of the Study:
- To investigate the bimodal incidence of keratomalacia in children.
- To identify potential causes for keratomalacia in early infancy versus preschool age groups.
Main Methods:
- Retrospective review of patient records from two hospitals (1971-1989 and 1991-1993).
- Analysis focused on vitamin A deficiency severity and protein-energy malnutrition.
- Data excluded records from 1990 due to unavailability.
Main Results:
- Over 4600 children treated for vitamin A deficiency between 1971-1989, with over 33% showing corneal involvement.
- In 1991-1993, 185 cases of vitamin A deficiency were identified, 69 with keratomalacia.
- Notably, 15 infants under one year, including 12 under six months, had keratomalacia.
Conclusions:
- Keratomalacia incidence in children exhibits two peaks: early infancy (<6 months) and preschool age.
- Early infancy cases are likely linked to maternal nutrition and reduced breastfeeding.
- Preschool cases are possibly associated with inadequate weaning practices.
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.