1000
Asia Pacific J Clin Nutr (1996) 5(3): 170-172
Asia Pacific J Clin Nutr (1996) 5(3): 170-172
Assessment
of vitamin A deficiency indicators in urban slum communities of National
Capital Territory of Delhi
Umesh Kapil, Nandini Saxena, M Srivastava,
L Jailkhani, B Nayyar, P Chikkara, S Ramachandran, N Gnanasekaran*
Dept of Human Nutrition and Computer
Faculty*, All India Institute of Medical Sciences, New Delhi
A study was conducted to assess the magnitude of
Vitamin A deficiency in two urban slum communities of Delhi. Biological
and ecological indicators suggested by WHO/UNICEF 1992, were used.
Five hundred and fifty two children in the age group of 0-5 years
were studied. Data was collected on socio economic status, breastfeeding
pattern, immunisation, morbidity profile and presence of vitamin
A deficiency. Height and weight were recorded using standard techniques.
Vitamin A intake of subjects was assessed using food frequency and
24 hr recall methods. It was found that 63.9% children >1 year
of age were fully immunised. Colostrum was received by only 28.1%
of children. Only 32% infants <4 months of age were exclusively
breastfed. Breast milk was being received by 93.5% children <6
months old. 18.1% children had diarrhoea within last 15 days of
survey. 7.1% children gave history of helminthic infestations. 47.8%
children <3 yrs were stunted while 26.9% were wasted. None of
the children had Bitot's spots but nightblindness was observed in
1.2% children. 35.7% children (12-24 months) consumed vitamin A
rich foods less than once A week. The frequency of consumption of
vitamin A rich foods was significantly higher in winter as compared
to summer and rainy seasons (p<0.05). The mean daily vitamin
A intake for 6-11 months and 12-71 months old children was 1187±755
m g and 847±111m g respectively. It was concluded
that moderate vitamin A deficiency was present in the study area.
Introduction
Elimination of blindness due to vitamin A deficiency
(VAD) by the year 2000 AD is one of the National Nutrition goals1.
The National Programme for Prevention of Nutritional Blindness has
been functioning for the last 20 years in India2. However,
vitamin A deficiency continues to be a major public health problem3,4.
A joint WHO/UNICEF consultation of control of vitamin A deficiency
(1992) suggested specific biological and ecological indicators for
assessing the magnitude of VAD in a population5. The present
study was conducted to assess the magnitude of VAD in urban slum communities
of Delhi using these indicators.
Materials and method
The study was conducted in two urban slums of National
Capital Territory (NCT) of Delhi. A total population of 7000 constituted
the study population. All families with 0-5 years old children were
enlisted and every alternate fam 1000 ily was covered for the survey.
Thus, 552 children were studied in detail.
Tools for data collection
A pretested semi-structured questionnaire cum interview
schedule was administered to mothers of all the subjects to elicit
information of socio-demographic profile, awareness about vitamin
A deficiency, breast feeding status, immunisation status, current
and past morbidity of the children and taboos related to vitamin A
rich foods.
The frequency of consumption of vitamin A rich foods
by the households and by the children for last one year was assessed
using food frequency questionnaire. The information on frequency of
consumption of vitamin A rich food within last 7 days was also obtained.
Dietary intake of children was assessed using 24 hour recall method
by interviewing the mothers. The raw amounts of food cooked by the
family, volume of the cooked food and the volume consumed by the index
child was inquired using standardised utensils. Raw amounts consumed
by the child were derived from the above information6.
Mean daily vitamin A intake of index child was calculated using computer
software based on food composition tables. Nutritional status of children
was assessed by anthropometric measurements viz weight and height/length
using standard techniques7. Malnutrition was classified
using -2SD of the NCHS reference values as the cut-off8.
Observation method was used to detect presence of
Bitot's spots. Nightblindness amongst children >2 years was assessed
by asking a set of pretested questions from the mothers.
Biological and ecologic indicators suggested by joint
WHO/UNICEF consultation5 derived from the collected information
were used to assess the magnitude of VAD in the study population.
| Results
The present study was conducted on a total of 552 children in
the age group of 0-5 years. The age and sex distribution of
the subjects is presented in Table 1.
The mean per capita monthly income of the families
was found to be Rs. 468 ± 342 indicating low socio-economic
status of the population. Local terminology for night blindness
was known to nearly 75% of the families studied.
|
Table 1. Age and sex distribution
of the subjects.
| Age (months) |
Male
|
Female
|
Total
|
| 0-5 |
14 (5.3)
|
22 (7.6)
|
36 (6.5)
|
| 6-11 |
1000
38 (14.5)
|
39 (13.5)
|
77·(13.9)
|
| 12-23 |
50 (19.1)
|
59 (20.3)
|
109 (19.8)
|
| 24-35 |
50 (19.1)
|
65 (22.4)
|
115 (20.8)
|
| 36+ |
110 (41.9)
|
105 (36.2)
|
215 (38.9)
|
Note: figures in parentheses denote percentages.
|
| The prevalence of vitamin
A deficiency indicators in the study population are presented
in Tables 2 and 3.
It was found that 63.9% of children, more than
one year of age, were fully immunised against tuberculosis,
diphtheria, pertussis, tetanus, poliomyelitis and measles. An
episode of diarrhoea within last two weeks of the survey was
reported in 18.1% of children. 7.1% of children gave history
of passage of worms in stool within last 2 days.
Colostrum was received by 28.1% of the children
studied. The exclusive breastfeeding rate was 0.32. Nearly 94%
children under six months of age were breastfed on the day of
survey.
52.1% of children above one year of age had
received at least one megadose of Vitamin A while 41.5% children
had received Vitamin A megadose within last six months of the
survey.
Anthropometric data revealed that 47.8% children
below three years of age were stunted while 26.9% of all the
children were wasted.
No clinical signs of VAD ie Bitot's spots and
corneal scars were found amongst the subjects. However, the
prevalence of nightblindness was 1.2% in the children above
two years of age.
|
Table 2. Biological and Nutrition
related indicators of Vitamin A deficiency.
| Indicator |
Prevalence suggested for identifying VAD
|
PS*
Prevalence
|
| Bitot's spots |
>0.5%
|
0
|
| Night blindness |
>1%(mild)
|
1.2%
|
| (24-71 months) |
1% <5% (moderate)
|
|
| |
> 5% (severe)
|
|
| % children (12-24
months) consuming vitamin A rich foods once a week |
<75%
|
64.3%
|
| % children (<6
months) not receiving breast milk |
>50%
|
6.5%
|
| Full immunisation
coverage at 12 months of age |
<50%
|
63.9%
|
| Diarrhoeal disease
rate |
>20%
|
18.1%
|
* PS = Present Study
|
| The dietary data revealed
that the m 1000 ean daily vitamin A intake of children (6-12 months
and 13-72 months) was 1187 ±7 55 m g and 841 ± 111 m g respectively. Nearly 55% children showed an intake deficit
of >60% as compared to the RDA for their age. A higher deficit
in intake was observed as the age of the children increased.
It was found that 35.7% of children 12-24 months
were not consuming Vitamin A rich foods even once a week. Nearly
73% of children in the age group 12-71 months consumed Vitamin
A rich foods less than three times per week.
69.5% household prepared Vitamin A rich foods
less than three times per week. Of the concurrent market survey,
it was found that dark green leafy vegetables (DGLVs) were available
for 11 months of the year.
The pattern of consumption of Vitamin A rich
foods for the past year was enquired and the data revealed that
the frequency of consumption of vitamin A rich foods in the
households varied in different seasons, with significantly higher
consumption in winters as compared to summers and rainy seasons
(p<0.05). The price of DGLVs was also found to be minimum
in winters followed by rainy and summer seasons. No statistically
significant difference was found in the frequency of consumption
of Vitamin A rich foods in families with or without the young
children. No taboos for feeding of Vitamin A rich foods to children
were found in the study population.
|
Table 3. Prevalence of other
suggested indirect indicators of Vitamin A deficiency in the study
area.
| Indicator |
Prevalence suggested for identifying VAD
|
PS* data
|
| Anthropometric |
|
|
| stunting in children
<3 yr |
>30%
|
47.8%
|
| wasting in children
<5 yr |
>8%
|
26.9%
|
| % households consuming
vitamin A rich food > 3 times/week |
<75%
|
30.5%
|
| Market Availability
(DGLV) |
<6 mo/yr
|
11.2(mo/yr)
|
| % children (12-71
months) consuming vitamin A rich foods <3 times/week
|
>75%
|
73.3%
|
| Helminthic infestations
|
>50%
|
7.1%
|
* PS = Present Study
|
Discussion
Biological indicators, both clinical and biochemical,
are widely used to assess prevalence and severity of VAD and to evaluate
the effectiveness of VAD control programmes. However, certain ecological
and related indicators, called the ‘indirect indicators’,
have been recommended to identify populations at risk for VAD. These
indicators focus of factors responsible for, or which contribute to,
the problems of VAD5.
Although the National Nutrition Monitoring Bureau
(NNMB) repeat surveys in India have revealed a 60% decline in the
prevalence of Bitot’s spots since 1975-784, VAD still
continues to be a public health problem in the country5.
In the study area also, the prevalence of nightblindness was 1.2%,
indicating a public health problem of moderate level. This indicator
was further supported by low frequency of consumption of Vitamin A
rich foods by children (above 12 months of age) and by the households.
The anthropometric indicators also pointed to high
risk of VAD in the area. The extent of stunting observed in the area
was lower than the NNMB data while wasting was higher in the present
study4.
The colostrum receipt and exclusive breast feeding
rate were low, 28% and 32%, respectively in the study population.
A recent multicentric study in urban and rural communities has shown
similar results in which 20% mothers fed colostrum to newborns while
only 5-15% mothers exclusively breastfed their children9.
The Vitamin A intake of nearly half of the subjects
was below 60% of the RDAs. This is reflective of low frequency of
consumption of Vitamin rich foods by the children mainly due to low
frequency of preparation of these foods in the family.
The frequency of consumption of Vitamin A rich foods
by the family was significantly higher during winters as compared
to summer and rainy season and this could be due to comparatively
higher cost in summers and rainy seasons.
Since the present study was conducted during summer
season, the lower frequency of consumption of Vitamin A rich foods
could be due to higher price and poor purchasing power of the study
population.
In the present study, one bi e6f ological indicator
ie nightblindness was supported by three indirect indicators viz consumption
of Vitamin A rich foods less than once a week by children 12-24 months
old (63.4%), consumption of Vitamin A rich foods less than three times
per week by the households (69.5%), stunting in children below three
years of age (47.8%) and wasting in the children (26.9%). It can be
concluded that VAD was a public health problem of moderate severity
in the study area.
Assessment of vitamin A deficiency
indicators in urban slum communities of National Capital Territory
of Delhi
Umesh Kapil, Nandini Saxena,
M Srivastava, L Jailkhani, B Nayyar, P Chikkara, S Ramachandran, N
Gnanasekaran
Asia Pacific Journal of Clinical
Nutrition (1996) Volume 5, Number 3:170-172
References
- National Nutrition Policy. Department of Women
and child Development, Government of India, Government of India
Press, New Delhi, 1993.
- Vijayraghavan K. National plan of Action. In: Carotene
Rich Foods for combating Vitamin A Deficiency. Eds-Reddi V and Vijayraghavan
K. National Institute of Nutrition, Government Press, Hyderabad,
1995, pp 49-51.
- Vijayraghavan K. Vitamin A Deficiency: Consequences
and Control Programmes. In: Nutrition in children-developing country
concerns. Eds. Sachdev HPS and Chowdhary P, Cambridge Press, New
Delhi, 1994, pp-537.
- National Nutrition Monitoring Bureau. Report on
Repeat Surveys (1988-90), National Institute of Nutrition, Indian
Council of Medical Research, Hyderabad, 1991.
- Indicators for assessing vitamin A deficiency and
their application in monitoring and evaluating intervention programmes.
Report on A joint WHO/UNICEF consultation, 9-11 November, Geneva,
1992.
- Thimmayamma BVS. A handbook of schedules and guidelines
in socio-economic and diet surveys. National Institute of Nutrition,
Indian Council of Medical Research, Hyderabad, 1990, pp22-26.
- Jelliffe DB. Assessment of nutritional status of
the community. WHO Monograph No. 53, Geneva, 1966, pp 60-75.
- Measuring change in Nutritional Status. World Health
Organization, Geneva, 1983,pp 6-75.
- Bhargava SK, Singh KK, Saxena BN. Identification
of High Risk Families, Mothers and Outcome of their offspring. Indian
Council of Medical Research task force study, ICMR, New Delhi, 1990,
pp 66-76.
Copyright © 1996 [Asia Pacific Journal of Clinical Nutrition]. All
rights reserved.
Revised:
January 19, 1999
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