Under-nutrition continues to be one of the major public health problems in the developing countries including India. Young children are considered as the most vulnerable group to under-nutrition (NNMB 2001). In recent years, micronutrient malnutrition has been attracting attention of the scientific community as well as policy makers. Micronutrients are essential to ensure proper growth, development and maintenance of health and play a critical role in physiological, biochemical and immunological functions of the body. The consequences of micronutrient malnutrition are wide ranging and include increased risk of childhood mortality, nutritional blindness physical disability mental retardation, lowered physical work capacity etc. leading to lowered productivity at household, community as well as at the National level (NNMB 2002).
Vitamin A deficiency is a significant public health problem, affecting a large population all over the country. Though the dietary inadequacy, in terms of both quality and quantity is the primary cause, a host of other socio-economic, socio-cultural and environmental factors like poverty, illiteracy, ignorance, faulty food habits, food fads, and even customs contribute significantly to the problem of micronutrient deficiencies (Kapil et al 1996). The general objective of the study was to assess the prevalence of VAD and the health index including BMI among primary school children of the village.
A baseline survey was conducted to Village Shivali, of Taluka Maval of Pune district from India to assess the prevalence of vitamin A deficiency and health index. The trained surveyors went to the village for survey. The survey was done in the Primary School of Shivali Village. For health index, height and weight of children were taken and Body Mass Index (BMI) was calculated. Clinical examination for the presence of vitamin A deficiency (Xerophthalmia) was carried out by the surveyors.
A total of 98 students of age group 6 to 13 years were covered for the survey of health index and prevalence of sub-clinical signs of vitamin A deficiency. Out of which, 51 were boys and 47 were girls. The children were from 1st to 6th standard. 91% of the children were found to have chronic energy deficiency (CED) while 6% were underweight.
The survey revealed 34% prevalence of VAD in Shivali village, out of which, 4% night blindness, 33% conjunctival xerosis and 9% Bitot spot found. The prevalence of VAD was well above the WHO cut off level of 1%, 10% and 0.5% respectively, indicating that VAD was a significant public health problem in the village surveyed. The prevalence of VAD was higher among boys than girls (21% & 12% respectively). 5 cases with xeroderma (dry skin) were also seen. 28% of the children were found to have dental fluorosis.
In India although, severe forms of vitamin A deficiency (VAD) has declined in the past two decades, yet clinical VAD exists as a public health problem in many pockets and data on serum retinol levels is scant to assess the extent of sub clinical deficiency. In the present study baseline prevalence of VAD was 33%. No case of corneal scar or keratomalacia was found. Sub clinical vitamin A deficiency was present in primary school children.
To combat and prevent VAD, Government of India, in 1970, initiated National Prophylaxis Program against Nutritional Blindness. The program involves supplementation with massive dose of vitamin A as a direct strategy and nutrition education as an indirect long term strategy to combat VAD. After more than three decades of operation, the program however suffers from poor compliance (NNMB 2002). Lack of awareness in the community about the program is one of the possible factors for poor compliance. The intervention model was successful in improving knowledge, attitude and practices. There was an indication of change in prevalence of sub clinical VAD. However, sub-clinical deficiency should be assessed at a larger scale to ascertain impact. Moreover, nutrition education interventions should be strengthened by logistic support.
The author is grateful to Dr. N.L. Ghorpade, Principal of Prof. RMACS College, Dr. T.N. Salve and Dr. Savita Kulkarni of NSS for giving such an opportunity to conduct the survey. She is obliged to Prof. V.M. Bansod, Head of Department of Zoology for the support. She also thanks all the surveyors i.e., the students of TYBSc. Zoology and the entire NSS team, for their unstinted cooperation.
1. NNMB National Nutrition Monitoring Bureau (2001). Technical report No: 21.National Institute of Nutrition, Hyderabad.
2. NNMB National Nutrition Monitoring Bureau (2002). Prevalence of Iron Deficiency Anaemia and Vitamin A Deficiency in the state of Jharkhand. National Institute of Nutrition, Hyderabad.
3. Kapil U, Saxena N, Srivastava M, Jailkhani L, Nayyar B, Chikkara P et al.(1996). Assessment of vitamin A deficiency indicators in urban slum communities of National Capital Territory of Delhi. Asia Pac J Clin Nutr; 5: 170-172.