Antecedent risk factors of xerophthalmia among Indian rural preschool children.

PURPOSE: To determine the risk factors of xerophthalmia among preschool children in rural India.
METHODS: This cross-sectional study was carried out between January and June 1998 in the area of Bihta Primary Health Center in Bihar, India and included 4,205 preschool children from 14 villages. The main outcome measures were risk factors of xerophthalmia, namely socioeconomic status and a history of repeated diarrhea, measles, passing worms in stool, and respiratory tract infection. The survey module was developed from information provided in the World Health Organization's publication from global experts for ensuring feasibility, acceptability, time management, and reliability with a pilot study. A pretested questionnaire was then administered to the caregivers of 144 preschool children diagnosed by a specially trained investigator with vitamin A deficiency by interview technique.
RESULTS: In a random sample of 4,205 preschool children, the overall prevalence of xerophthalmia, based on night blindness (XN) and Bitot spots (X1B), was of moderate public health importance, according to World Health Organization criteria, at 144 (3.42%). The proportion of those xerophthalmic children with known risk factors for malnutrition-associated xerophthalmia (i.e., poverty, diarrhea, roundworm infection, measles, and respiratory infection) was described. A significant difference in magnitude was observed between more affluent families with a higher monthly average income and less affluent families (P<0.01). Children with a history of repeated diarrhea were incidentially less affected than those without this history, but this difference was not significant (P>0.5). Vitamin A-deficient children not passing worms accounted for only 22.50% of the sample versus a corresponding value in children passing worms, which was significantly high (P<0.01), at 87.50%. A history of measles or respiratory tract infection was not at all related as an antecedent risk factor. The caregivers were counseled in multiple sessions on vitamin A-rich, locally available, cost-effective foods.
CONCLUSIONS: The socioeconomic status of families, a history of passing roundworms in stool, and diarrhea were important antecedent risk factors in vitamin A- deficient preschool children. The undisputed long-term solution to prevent this nutrition-related, avoidable blindness lies in changing the dietary habits of the rural Indian population through behavior change communication by nutritional education, nutritional supplementation, and nutritional rehabilitation.