V2020 REGIONAL RESOURCE CENTRE FOR
WEST AFRICA.
A Regional Resource Centre
Health/Prevention of Blindness.
for
Community
Eye
WEST AFRICAN POSTGRADUATE MEDICAL COLLEGE, NO.6 TAYLOR DRIVE,
P.M.B 2023.YABA-LAGOS.NIGERIA .e-mail: v2020wa_rescentre@yahoo.co.uk
NEWSLETTER –
3rd Quarter 2007
Dear Colleagues,
Our Newsletter this Quarter is on Vitamin A Deficiency and the Eye.
is an important cause of childhood ocular
morbidity, blindness and mortality, especially in the poor, developing
countries of the world. [Only 3% of the world’s blind populations are
children. However, because children have a lifetime of blindness ahead of
them, the number of ‘blind person years’ resulting from blindness starting
in childhood is second only to cataract – CEH Journal, Vol. 20, No.62. Pg 32. ]
We bring you recent articles and Web links [Year 2002 – 2007] on this
very important topic.
As usual, we would love to get feedbacks from you – comments, questions,
requests or reactions.
Please let us know how useful our information has been to you.
A fat-soluble vitamin absorbed in the GI tract, vitamin
A maintains epithelial tissue and retinal function. Consequently, deficiency of this
vitamin may result in night blindness, decreased color adjustment, keratinization of
epithelial tissue, and poor bone growth. Healthy adults have adequate vitamin A reserves
to last up to a year; children often don’t.
Causes and incidence
Vitamin A deficiency usually results from inadequate intake of foods high in vitamin A
(liver, kidney, butter, milk, cream, cheese, and fortified margarine) or carotene, a
precursor of vitamin A found in dark green leafy vegetables and yellow or orange fruits
and vegetables. (Six mg of beta-carotene is equal to 1 mg of vitamin A.) The
recommended daily allowance for vitamin A is 1 mg for adult males and 0.8 mg for adult
females.
Less common causes include:
❑ malabsorption due to celiac disease, sprue, cirrhosis, obstructive jaundice, cystic
fibrosis, giardiasis, or habitual use of mineral oil as a laxative
❑ massive urinary excretion caused by cancer, tuberculosis, pneumonia, nephritis, or
urinary tract infection
❑ decreased storage and transport of vitamin A due to hepatic disease.
Each year, more than 80,000 people worldwide — mostly children in underdeveloped
countries — lose their sight from severe vitamin A deficiency. This condition is rare in
the United States, although many disadvantaged children have substandard levels of
vitamin A. With therapy, the chance of reversing symptoms of night blindness and milder
conjunctival changes is excellent. When corneal damage is pres-ent, emergency treatment
is necessary.
Signs and symptoms
Typically, the first symptom of vitamin A deficiency is night blindness (nyctalopia),
which usually becomes apparent when the patient enters a dark place or is caught in the
glare of oncoming headlights while driving at night. This condition can progress to
xerophthalmia, or drying of the conjunctivas, with development of gray plaques (Bitot’s
spots); if unchecked, perforation, scarring, and blindness may result. Keratinization of
epithelial tissue causes dry, scaly skin; follicular hyperkeratosis; and shrinking and
hardening of the mucous membranes, possibly leading to infections of the eyes and the
respiratory or genitourinary tract. An infant with severe vitamin A deficiency shows signs
of failure to thrive and apathy, along with dry skin and corneal changes, which can lead
to ulceration and rapid destruction of the cornea.
Diagnosis
Dietary history and typical ocular lesions suggest vitamin A deficiency. Carotene levels
less than 40 mcg/dl also suggest vitamin A deficiency, but they vary with seasonal
ingestion of fruits and vegetables.
Confirming diagnosis A serum level of vitamin A that falls below 10 mcg/dl confirms the
diagnosis. Levels between 10 and 19 mcg/dl are also considered low but the patient isn’t
likely to have developed significant symptoms.
Treatment
Mild conjunctival changes or night blindness requires vitamin A replacement in the form
of cod liver oil or halibut liver oil. Acute deficiency requires aqueous vitamin A solution
I.M., especially when corneal changes have occurred. Therapy for underlying biliary
obstruction consists of administration of bile salts; for pancreatic insufficiency,
pancreatin. Dry skin responds well to cream-based or petroleum-based products.
In patients with chronic malabsorption of fat-soluble vitamins, and in those with low
dietary intake, prevention of vitamin A deficiency requires aqueous I.V. supplements or
an oral water-miscible preparation.
Special considerations
❑ Administer oral vitamin A supplements with or after meals or parenterally, as ordered.
Watch for signs of hypercarotenemia (orange coloration of the skin and eyes) and
hypervitaminosis A (rash, hair loss, anorexia, transient hydrocephalus, and vomiting in
children; bone pain, hepatosplenomegaly, diplopia, and irritability in adults). If these
signs occur, discontinue supplements and notify the physician immediately.
(Hypercarotenemia is relatively harmless; hypervitaminosis A may be toxic.)
❑ Because vitamin A deficiency usually results from dietary insufficiency, provide
nutritional counseling. Tell the patient that vitamin A comes from animal sources, such as
eggs, meat, milk, cheese, cream, liver, kidney, and cod and halibut fish oil, but that
healthier choices, such as carrots, pumpkins, sweet potatoes, and most dark green, leafy
vegetables are good sources of beta-carotene, vitamin A’s precursor form. Instruct the
patient that the more intense the color of a fruit or vegetable, the higher its beta-carotene
content. Provide referrals to appropriate community agencies if necessary.
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005
Lippincott Williams & Wilkins.
List of symptoms of Vitamin A deficiency:
The list of signs and symptoms mentioned in various sources for Vitamin A deficiency
includes the 11 symptoms listed below:
Eye symptoms
Reduced night vision
Night blindness
Dry eyes
Eye inflammation
Corneal inflammation
Rough skin
Dry skin
Vulnerability to respiratory infection
Vulnerability to urinary infection
Growth retardation in children
Note that Vitamin A deficiency symptoms usually refers to various symptoms known to a
patient, but the phrase Vitamin A deficiency signs may refer to those signs only noticable
by a doctor.
Associated Conditions of Vitamin A deficiency
Vitamin A deficiency as a risk factor:
Another type of associated condition is one for which Vitamin A deficiency is itself a risk
factor. The conditions for which Vitamin A deficiency is listed as a risk factor includes:
Kidney stones
▲Top
About associated conditions for Vitamin A deficiency:
Associated conditions are those which appear statistically related, but do not have a clear
cause or effect relationship. Whereas the complications are caused by Vitamin A
deficiency, and underlying causes may be causes of Vitamin A deficiency, the following
list shows associated conditions that simply appear with higher frequency in people who
have Vitamin A deficiency. In some cases, there may be overlap between this list and risk
factors for Vitamin A deficiency. People with Vitamin A deficiency may be more likely
to get a condition on the list of associated conditions, or the reverse may be true, or both.
Whether they are causes of, caused by, or simply coincidentally related to Vitamin A
deficiency is not always clear. For general information, see Associated Condition
Misdiagnosis.
Misdiagnosis of Underlying Causes of Vitamin A
deficiency
On this Page:
List of Underlying conditions of Vitamin A deficiency
Vitamin A deficiency as a complication
About underlying conditions causing Vitamin A deficiency
Underlying
conditions
list:
The list of possible underlying conditions mentioned in various sources for Vitamin A deficiency
includes:
Malabsorption
Inadequate diet
Malnutrition
Certain lipid-lowering medications
Other underlying conditions related to Vitamin A deficiency:
Anisocytosis
Bitot's spots
Dry eyes
Keratitis
Keratomalacia
Microcytosis (erythrocyte)
Night blindness
Poikilocytosis
Xerophthalmia
Source: Diseases Database
▲Top
Vitamin A deficiency as a complication:
Other conditions that might have Vitamin A deficiency as a complication might be
potential underlying conditions. The list of conditions listing Vitamin A deficiency as a
complication includes:
Primary sclerosing cholangitis
▲Top
About underlying conditions:
With a diagnosis of Vitamin A deficiency, it is important to consider whether there is an
underlying condition causing Vitamin A deficiency. These are other medical conditions
that may possibly cause Vitamin A deficiency. For general information on this form of
misdiagnosis, see Underlying Condition Misdiagnosis or Overview of Misdiagnosis.
Treatments for Vitamin A deficiency
On this Page:
Treatment list for Vitamin A deficiency
Buy Products Related to Treatments for Vitamin A deficiency
Find a Therapist or Health Professional
Treatment list for Vitamin A deficiency:
The list of treatments mentioned in various sources for Vitamin A deficiency includes the
following list. Always seek professional medical advice about any treatment or change in
treatment plans.
Vitamin A
▲Top
Treatments of Vitamin A deficiency: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review the full text of medical books online, free,
without registration, for more information about the treatments of Vitamin A deficiency.
Vitamin A deficiency: Treatment
(Professional Guide to Diseases (Eighth Edition))
Mild conjunctival changes or night blindness requires vitamin A replacement in the form
of cod liver oil or halibut liver oil. Acute deficiency requires aqueous vitamin A solution
I.M., especially when corneal changes have occurred. Therapy for underlying biliary
obstruction consists of administration of bile salts; for pancreatic insufficiency,
pancreatin. Dry skin responds well to cream-based or petroleum-based products.
In patients with chronic malabsorption of fat-soluble vitamins, and in those with low
dietary intake, prevention of vitamin A deficiency requires aqueous I.V. supplements or
an oral water-miscible preparation.
Keratomalacia
General Discussion
Keratomalacia is an eye (ocular) condition, usually affecting both eyes (bilateral), that
results from severe deficiency of vitamin A. That deficiency may be dietary (i.e., intake)
or metabolic (i.e., absorption). Vitamin A is essential for normal vision as well as proper
bone growth, healthy skin, and protection of the mucous membranes of the digestive,
respiratory,
and
urinary
tracts
against
infection.
Early symptoms may include poor vision at night or in dim light (night blindness) and
extreme dryness of the eyes (i.e., xerophthalmia), followed by wrinkling, progressive
cloudiness, and increasing softening of the corneas (i.e., keratomalacia). With advancing
vitamin A deficiency, dry, "foamy," silver-gray deposits (Bitot spots) may appear on the
delicate membranes covering the whites of the eyes. Without adequate treatment,
increasing softening of the corneas may lead to corneal infection, rupture (perforation),
and degenerative tissue changes, resulting in blindness. In addition, in some cases,
vitamin A deficiency may have additional effects, particularly during infancy and
childhood.
In some developing countries, vitamin A deficiency in the diet and associated
keratomalacia are a major cause of childhood blindness. In such regions, vitamin A
deficiency often occurs as part of nonselective general malnutrition in infants and young
children. Although rare in developed countries, vitamin A deficiency and keratomalacia
may occur secondary to conditions associated with impaired absorption, storage, or
transport of vitamin A, such as celiac disease, ulcerative colitis, cystic fibrosis, liver
disease, or intestinal bypass surgery and any condition that affects absorption of fatsoluble vitamins.
Last Updated: 4/21/2003
Copyright 2003 National Organization for Rare Disorders, Inc.
2. Definition
Vitamin A deficiency exists when the chronic failure to eat sufficient amounts of vitamin
A or beta-carotene results in levels of blood-serum vitamin A that are below a defined
range. Beta-carotene is a form of pre-vitamin A, which is readily converted to vitamin A
in the body. Night blindness is the first symptom of vitamin A deficiency. Prolonged and
severe vitamin A deficiency can produce total and irreversible blindness.
Description
Vitamin A (called retinol in mammals) is a fat-soluble vitamin. The recommended
dietary allowance (RDA) for vitamin A is 1.0 mg/day for the adult man and 0.8 mg/day
for the adult woman. Since beta-carotene is converted to vitamin A in the body, the
body's requirement for vitamin A can be supplied entirely by beta-carotene. Six mg of
beta-carotene are considered to be the equivalent of 1 mg of vitamin A. The best sources
of vitamin A are eggs, milk, butter, liver, and fish, such as herring, sardines, and tuna.
Beef is a poor source of vitamin A. Plants do not contain vitamin A, but they do contain
beta-carotene and other carotenoids. The best sources of beta-carotene are dark-green,
orange, and yellow vegetables; spinach, carrots, oranges, and sweet potatoes are excellent
examples. Cereals are poor sources of beta-carotene.
Vitamin A is used for two functions in the body. Used in the eye, it is a component of the
eye's light-sensitive parts, containing rods and cones, that allow for night-vision or for
seeing in dim-light circumstances. Vitamin A (retinol) occurs in the rods. Another form
of Vitamin A, retinoic acid, is used in the body for regulating the development of various
tissues, such as the cells of the skin, and the lining of the lungs and intestines. Vitamin A
is important during embryological development, since, without vitamin A, the fertilized
egg cannot develop into a fetus.
Causes and symptoms
Vitamin A deficiency occurs with the chronic consumption of diets that are deficient in
both vitamin A and beta-carotene. When vitamin A deficiency exists in the developed
world, it tends to happen in alcoholics or in people with diseases that affect the intestine's
ability to absorb fat. Examples of such diseases are celiac disease (chronic nutritional
disorder), cystic fibrosis, and cholestasis (bile-flow failure or interference). Vitamin A
deficiency occurred in infants during the early 1900s in Denmark. The deficiency
resulted when milk fat was made into butter for export, leaving the by-product (skimmed
milk) for infant feeding. Vitamin A deficiency has taken place in infants in impoverished
populations in India, where the only foods fed to the infants were low in beta-carotene.
Vitamin A deficiency is also common in areas like Southeast Asia, where polished rice,
which lacks the vitamin, is a major part of the diet.
The earliest symptom of vitamin A deficiency is night blindness. Prolonged deficiency
results in drying of the conjunctiva (the mucous membrane that lines the inner surface of
the eyelids and extends over the forepart of the eyeball). With continued vitamin A
deficiency, the drying extends to the cornea (xerophthalamia). The cornea eventually
shrivels up and becomes ulcerated (keratinomalacia). Superficial, foamy gray triangular
spots may appear in the white of the eye (Bitot's spots). Finally, inflammation and
infection occur in the interior of the eye, resulting in total and irreversible blindness.
Diagnosis
Vitamin A status is measured by tests for retinol. Blood-serum retinol concentrations of
30-60 mg/dl are considered in the normal range. Levels that fall below this range indicate
vitamin A deficiency. Night blindness is measured by a technique called
electroretinography. Xerophthalamia, keratinomalacia, and Bitot's spots are diagnosed
visually by trained medical personnel.
Treatment
Vitamin A deficiency can be prevented or treated by taking vitamin supplements or by
getting injections of the vitamin. The specific doses given are oral retinyl palmitate (110
mg), retinyl acetate (66 mg), or injected retinyl palmitate (55 mg) administered on each
of two successive days, and once a few weeks later if symptoms are not relieved.
Prognosis
The prognosis for correcting night blindness is excellent. Xerophthalamia can be
corrected with vitamin A therapy. Ulcerations, tissue death, and total blindness, caused
by severe vitamin A deficiency, cannot be treated with vitamin A.
Prevention
Vitamin A deficiency can be prevented by including foods rich in vitamin A or betacarotene as a regular component of the diet; liver, meat, eggs, milk, and dairy products
are examples. Foods rich in beta-carotene include red peppers, carrots, pumpkins, as well
as those just mentioned. Margarine is rich in beta-carotene, because this chemical is used
as a coloring agent in margarine production. In Africa, Indonesia, and the Philippines,
vitamin A deficiency is prevented by public health programs that supply children with
injections of the vitamin.
Key Terms
Bitot's spots
Bitot's spots are superficial, foamy gray, triangular spots on the white of the
eyeball.
Carotenoids
Carotenoids are yellow to deep-red pigments.
Conjunctiva
The conjunctiva is a clear layer of cells that covers the eye and directly contacts
the atmosphere. The conjunctiva is about five-cells thick.
Cornea
The cornea is a clear layer of cells that covers the eye, just under the conjunctiva.
The cornea is about 50-cells thick.
Fat-soluble vitamin
Fat-soluble vitamins can be dissolved in oil or in melted fat. Water-soluble
vitamins can be dissolved in water or juice.
Keratomalacia
Keratomalacia is ulceration of the cornea.
Recommended Dietary Allowance (RDA)
The Recommended Dietary Allowances are quantities of nutrients in the diet that
are required to maintain good health in people. RDAs are established by the Food
and Nutrition Board of the National Academy of Sciences, and may be revised
every few years. A separate RDA value exists for each nutrient. The RDA values
refer to the amount of nutrient expected to maintain good health in people. The
actual amounts of each nutrient required to maintain good health in specific
individuals differ from person to person.
Xerophthalmia
Xerophthalmia is a dry, thickened, lusterless condition of the eyeball resulting
from vitamin A deficiency.

Brody, T. Nutritional Biochemistry. San Diego: Academic Press, Inc.,
1998.
Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The
Essay Author is Tom Brody, PhD.
3. –
Unite For Sight® Operation Teens
Vitamin A Deficiency- Xerophthalmia
What?
Vitamin A is an important nutrient to maintain eye health. Lack of vitamin A causes eye
disease and can lead to blindness. In fact, vitamin A deficiency is the single greatest
preventable cause of childhood blindness. People most at risk are children between six
months to six years, pregnant women, and lactating women.
Night blindness:
The child cannot see in the dim light or twilight. Nightblindness is also found in
pregnant women in some instances, especially during the last trimester of
pregnancy when the vitamin A needs are increased.
Bitot Spots:
These are foamy and whitish cheese-like tissue spots that develop around the eye
ball, causing severe dryness in the eyes. These spots do not affect eye sight in the
day light.
Blindness:
Once the dry eyes set in, the eye becomes very sensitive and begins to scratch and
scar. The eyelids become swollen and sticky. This eventually leads to blindness.
Once blindness occurs, it cannot be reversed.
Other symptoms of deficiency:
When the body lacks vitamin A, the systems that resist infection and disease do
not work very well. That is why children with Vitamin A deficiency fall sick
more often, take much longer to recover and are more likely to die. Problems with
bones and teeth can also occur frequently.
Examples of what early symptoms might look like
1.
Bitot's
2. Wrinkled Conjunctiva
1. Fine line of Bitot's spots
1. Bitot's spots
Conjunctiva
and
rough
1. Foamy Bitot's spots
spots
Why is it important?
Vitamin A maintains healthy cells in various structures of the eye and is required for
converting light into nerve signals in the part of the eye called the retina. When vitamin A
is not available to the body, gradual changes begin to affect the eye. The first sign of a
problem is when a child or a pregnant or lactating woman finds it difficult to adjust to
seeing in the dark. This condition is called night blindness.
Copyright © 2007 Unite for Sight, Inc. web services provided by JF Designs.com
Terms of Use Acknowledgments
4. Recent evidence that vitamin A supplementation may save the lives - as well as the sight
- of children affected by the eye disease xerophthalmia due to vitamin A deficiency has
given new urgency to a 10-year United Nations programme aimed at the control and
prevention of vitamin A deficiency. Launched by a UN interagency meeting in October
1985, the programme focuses on 34 developing countries known to have serious vitamin
A deficiency problems. Despite unprecedented agreement on the need for the
programme, however, the SCN annual session in February 1987 noted with concern that
commitment of resources has been with few exceptions slow and requests for assistance
from national governments limited in number and scope. A shortage of “start-up” funding
is causing considerable problems for the programme. In 198 7 WHO transferred
operational responsibility of the programme to its regional offices. Now, a study in
Indonesia of the effectiveness of vitamin A capsule distribution in preventing eye damage
has provided crucial evidence that the vitamin may have a direct effect in reducing
mortality. After reviewing the study's findings in 1986, the SCN's Advisory Group on
Nutrition said a difference of some 30 percent in pre-school child mortality between
treated and control villages was “likely to be attributable” to vitamin A supplementation.
The AGN statement continued: “It is appropriate to advise countries mounting high dose
vitamin A programmes for the control of xerophthalmia that reduction of childhood
mortality is a reasonable expectation and is a further justification for such programmes.”
The AGN statement adds weight to the SCN's call for concerted international action to
reduce the worldwide prevalence and severity of vitamin A deficiency, xerophthalmia
and nutritional blindness to a point where they are no longer significant public health
problems. At present, the effects of vitamin A deficiency in the developing world are
devastating, especially among children. Of an estimated 700,000 pre-school children who
develop severe corneal xerophthalmia each year, as many as 400,000 die from the
deficiency and accompanying factors such as protein-energy malnutrition, debilitating
diarrhoea, respiratory tract infections and measles. About 25 percent of the survivors
remain totally blind and 50 to 60 percent partially blind. Every year another eight to 10
million children are believed to develop milder, non-corneal xerophthalmia, leading to
night blindness and associated with a higher risk of respiratory infections and diarrhoea.
Research has also established that inadequate vitamin A causes damage to urinary and
gastrointestinal tracts, impairs growth, bone formation and immune functions, and may
cause anaemia. “At this point,” concluded an SCN study, “we should recognize that
vitamin A deficiency may be as far-reaching in its pathological effects on the individual
as proteinenergy malnutrition, and that prevention of the deficiency syndrome, even in its
mild form, may have very important effects on child health, development and survival.”
Vitamin A deficiency is a nutritional disease, caused by inadequate dietary intake of the
vitamin, or its plant-based precursors, and often aggravated by low absorption from the
intestine. It has a primary, nutritional solution: improving vitamin A status to a
physiologically acceptable level. In theory, this is as simple and inexpensive as
administering to each affected child twice yearly a 200,000 IU vitamin A capsule costing
two cents. But effective prevention and control of the disease depends on the correct
choice of interventions and action to reach a much larger population than those
immediately affected. This is because many more people are believed to be at risk than
actually show signs of the deficiency and because preventive measures cannot be targeted
only to those who would otherwise develop it. In practical terms, prevention depends on
establishing national programmes employing various types of intervention, including
mass distribution of oral doses of vitamin A, fortification of widely distributed food
commodities and, in the longer term, dietary modification to increase the intake of the
vitamin. The SCN reports that while national efforts are increasing, by 1987 only eight of
the 34 countries known to be affected had such programmes and in most of these the
coverage of preventative programmes was still very low.
Reaching the estimated 40 million pre-school children already suffering from mild or
moderate vitamin A deficiency in the 34 target countries is a considerable challenge.
Providing total coverage for these countries' pre-school child population of 280 million and for children in a further 2 3 countries considered at risk - is an even more mammoth
task. The 10-year UN programme aims to greatly accelerate the process of prevention and
control of vitamin A deficiency by marshalling international assistance in five main
areas: assessment of the prevalence and severity of the deficiency; prevention of the
deficiency in high-prevalence areas; treatment of those suffering from vitamin A
deficiency, xerophthalmia and nutritional blindness; training of health personnel and
community workers; and investigation of technical, logistical and other problems
affecting the implementation of programmes. An essential part of this process is the
setting up, or strengthening, of national prevention and control programmes. This will
involve a number of government sectors, particularly agriculture, health, education and
the social services. Programme development will require assessment of the problem and
of potential interventions, decisions on policy and resource commitments and, in many
cases, external financial, material and technical assistance from UN agencies and donors.
Missions, Reviews
Since the programme's launch, several UN members and bilateral agencies have
undertaken a variety of activities. WHO, the lead agency, has helped Bhutan, Burma,
India and Sri Lanka assess their programme needs and prepare requests for assistance,
while its regional offices for Africa and Southeast Asia have begun developing with
concerned member states regional strategies for prevention and control of vitamin A
deficiency. WHO has also prepared a technical review on the relationship between
vitamin A and diarrhoea, explored the feasibility of distributing vitamin A through
immunization schemes and distributed information on vitamin A deficiency to publishers
in 40 countries. FAO has prepared and begun implementing a long-term plan for
increasing the production and consumption of foods rich in the vitamin. It is conducting
food consumption surveys of vitamin A and carotene intake in urban and rural areas, is
planning nutrition education programmes and has sent experts to help a number of
countries to assess their programme needs. It fielded missions with WHO to Bangladesh,
Indonesia and Nepal. UNICEF, as part of its plan of action to complement the activities
of WHO and FAO, has conferred with 10 countries of Africa and Asia to ascertain their
needs and in 1986 provided a record number of vitamin A capsules - more than 80
million - to meet a growing demand from developing countries. WFP continues to
provide skim milk fortified with vitamin A to vulnerable groups, particularly pre-school
age children, while USAID has committed some $3 million to preventative programmes
in six countries.
In a recent review of its efforts, WHO said “these steps are only the start of what must be,
by definition, a sustained effort of an appropriate scale if the programme's primary
objective is to be achieved”. It said further progress seemed to require greater efforts in
developing countries to formulate and implement prevention/control strategies and to
create mechanisms to harmonize and maximize the effectiveness of external support;
greater support from donors; and sustained technical, managerial and financial assistance
from UN agencies.
The SCN 14th Session recalled a statement by participants at the October 1985
interagency meeting which launched the programme: “It would be a terrible irony if, at a
time when all the major ingredients of success are at hand - scientific knowledge,
inexpensive and effective technology, and accumulated practical experience - the world
community were prevented from taking concerted action for want of a modest shift in
resources.” While discussions go on, vitamin A deficiency continues to kill or blind
hundreds of thousands of children each year.
Costs and Benefits of Vitamin A Capsules
A single 200,000 I.U. dose of vitamin A, delivered every four to six months at a cost of
less than 50 cents a year, may be enough to protect a young child against vitamin A
deficiency and the threat of nutritional blindness and death. That is one conclusion of an
SCN policy discussion paper on the prevention of vitamin A deficiency, published in
June 1987. “Preliminary cost-benefit analysis shows that the benefits of preventing
xerophthalmia calculated in monetary terms can far outweigh programme costs,” said the
paper, “Delivery of Oral Doses of Vitamin A to prevent Vitamin A Deficiency and
Nutritional Blindness.” What is more, “given the emerging evidence that vitamin A
supplementation may reduce mortality among children with even mild deficiency, the
benefit from improving vitamin A nutrition in a population may be even greater than
those so far assessed”. However, the paper cautioned, while vitamin A supplementation
programmes were conceptually simple, ensuring their adequacy and efficiency posed
major challenges.
Capsules Containing Doses of Vitamin A are Given Six-Monthly by Mouth
Br J Ophthalmol 2000;84:1075 ( September )
WEB LINKS
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Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001479. Review.
PMID: 16235283 [PubMed - indexed for MEDLINE]
12: Feldon K, Bahl S, Bhatnagar P, Wenger J.
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Severe vitamin A deficiency in India during pulse polio immunization.
Indian J Med Res. 2005 Sep;122(3):265-7. No abstract available.
PMID: 16251786 [PubMed - indexed for MEDLINE]
13: Nabakwe EC, Lichtenbelt WV, Ngare DK, Wierik M, Westerterp
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Vitamin a deficiency and anaemia in young children living in a malaria endemic
district of western Kenya.
KR, Owino OC.
East Afr Med J. 2005 Jun;82(6):300-6.
PMID: 16175781 [PubMed - indexed for MEDLINE]
14: Lee WB, Hamilton SM, Harris JP, Schwab IR.
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Ocular complications of hypovitaminosis a after bariatric surgery.
Ophthalmology. 2005 Jun;112(6):1031-4.
PMID: 15885783 [PubMed - indexed for MEDLINE]
15: Velasco Cruz AA, Attie-Castro FA, Fernandes SL, Cortes JF, de Tarso P
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Adult blindness secondary to vitamin A deficiency associated with an eating
disorder.
Pierre-Filho P, Rocha EM, Marchini JS.
Nutrition. 2005 May;21(5):630-3.
PMID: 15850971 [PubMed - indexed for MEDLINE]
16: Shaw C, Islam MN, Chakroborty M, Biswas MC, Ghosh T, Biswas
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Xerophthalmia: a study among malnourished children of West Mednipur District.
G.
J Indian Med Assoc. 2005 Mar;103(3):180, 182-3.
PMID: 16173295 [PubMed - indexed for MEDLINE]
17: McCarthy M.
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Profile: Alfred Sommer: a life in the field and in the data.
Lancet. 2005 Feb 19-25;365(9460):649. No abstract available.
PMID: 15726696 [PubMed - indexed for MEDLINE]
18: Khan MA, Khan MD.
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Classification of 154 clinical cases of vitamin A deficiency in children (0-15
years) in a tertiary hospital in North West Frontier Province Pakistan.
J Pak Med Assoc. 2005 Feb;55(2):77-8.
PMID: 15813635 [PubMed - indexed for MEDLINE]
19: Gouado I, Ejoh RA, Kenne M, Ndifor F, Mbiapo FT.
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Serum concentration of vitamins A and E and lipid in a rural population of north
Cameroon.
Ann Nutr Metab. 2005 Jan-Feb;49(1):26-32. Epub 2005 Feb 25.
PMID: 15735365 [PubMed - indexed for MEDLINE]
20: Avgonov ZT, Gaibov AG, Tazhibaev ShS, Khairov KhS.
[Revalence of vitamin deficiency in Tajik children]
Vopr Pitan. 2005;74(4):14-6. Russian.
PMID: 16265909 [PubMed - indexed for MEDLINE]
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21: Pedro MR, Madriaga JR, Barba CV, Habito RC, Gana AE,
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Deitchler M, Mason JB.
The national Vitamin A Supplementation Program and subclinical vitamin A
deficiency among preschool children in the philippines.
Food Nutr Bull. 2004 Dec;25(4):319-29.
PMID: 15646309 [PubMed - indexed for MEDLINE]
22: Ferraz IS, Daneluzzi JC, Vannucchi H, Jordao AA Jr, Ricco RG, Del
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Links
Detection of vitamin A deficiency in Brazilian preschool children using the
serum 30-day dose-response test.
Ciampo LA, Martinelli CE Jr, Engelberg AA, Bonilha LR, Flores H.
Eur J Clin Nutr. 2004 Oct;58(10):1372-7.
PMID: 15054418 [PubMed - indexed for MEDLINE]
23: Singh V, West KP Jr.
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Vitamin A deficiency and xerophthalmia among school-aged children in
Southeastern Asia.
Eur J Clin Nutr. 2004 Oct;58(10):1342-9.
PMID: 15054414 [PubMed - indexed for MEDLINE]
24: Mihora LD, Jatla KK, Little T, Campbell M, Rahim A, Enzenauer
RW.
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Vitamin A deficiency in Afghanistan.
Eye Contact Lens. 2004 Jul;30(3):159-62.
PMID: 15499237 [PubMed - indexed for MEDLINE]
25: Blum LS, Pelto GH, Pelto PJ.
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Coping with a nutrient deficiency: cultural models of vitamin A deficiency in
northern Niger.
Med Anthropol. 2004 Jul-Sep;23(3):195-227.
PMID: 15370198 [PubMed - indexed for MEDLINE]
26: Coles CL, Levy A, Gorodischer R, Dagan R, Deckelbaum RJ, Blaner
WS, Fraser D.
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Subclinical vitamin A deficiency in Israeli-Bedouin toddlers.
Eur J Clin Nutr. 2004 May;58(5):796-802.
PMID: 15116083 [PubMed - indexed for MEDLINE]
27: Fiore P, De Marco R, Sacco O, Priolo E.
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Nightblindness, xerophthalmia, and severe loss of visual acuity due to
unnecessary dietary restriction.
Nutrition. 2004 May;20(5):477. No abstract available.
PMID: 15105037 [PubMed - indexed for MEDLINE]
28:
Semba RD, de Pee S, Panagides D, Poly O, Bloem MW.
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Risk factors for xerophthalmia among mothers and their children and for motherchild pairs with xerophthalmia in Cambodia.
Arch Ophthalmol. 2004 Apr;122(4):517-23.
PMID: 15078669 [PubMed - indexed for MEDLINE]
29: Becher H, Muller O, Jahn A, Gbangou A, Kynast-Wolf G, Kouyate
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Risk factors of infant and child mortality in rural Burkina Faso.
Bull World Health Organ. 2004 Apr;82(4):265-73.
PMID: 15259255 [PubMed - indexed for MEDLINE]
30: Varenne B, Petersen PE, Ouattara S.
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Oral health status of children and adults in urban and rural areas of Burkina Faso,
Africa.
Int Dent J. 2004 Apr;54(2):83-9.
PMID: 15119798 [PubMed - indexed for MEDLINE]
31: Wedner SH, Ross DA, Congdon N, Balira R, Spitzer V, Foster
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Validation of night blindness reports among children and women in a vitamin A
deficient population in rural Tanzania.
Eur J Clin Nutr. 2004 Mar;58(3):409-19.
PMID: 14985678 [PubMed - indexed for MEDLINE]
32: Underwood BA.
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Vitamin A deficiency disorders: international efforts to control a preventable
"pox".
J Nutr. 2004 Jan;134(1):231S-236S. Review.
PMID: 14704325 [PubMed - indexed for MEDLINE]
33: West KP Jr.
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Vitamin A deficiency disorders in children and women.
Food Nutr Bull. 2003 Dec;24(4 Suppl):S78-90. Review.
PMID: 17016949 [PubMed - indexed for MEDLINE]
34: Zagre NM, Delpeuch F, Traissac P, Delisle H.
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Red palm oil as a source of vitamin A for mothers and children: impact of a pilot
project in Burkina Faso.
Public Health Nutr. 2003 Dec;6(8):733-42.
PMID: 14641943 [PubMed - indexed for MEDLINE]
35: Mi J, Lin LM, Ma GF, Gu X, Liu M, Cheng H, Hou DQ, Tan ZW,
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Links
[Prevalence of vitamin A deficiency in children under six years of age in Tibet,
China]
Liu CY.
Zhonghua Yu Fang Yi Xue Za Zhi. 2003 Nov;37(6):419-22. Chinese.
PMID: 14703496 [PubMed - indexed for MEDLINE]
36: Carvajal Fernandez D, Alfaro Calvo T, Monge-Rojas R.
Related Articles, Links
[Vitamin A deficiency among preschool children: a re-emerging problem in
Costa Rica?]
Arch Latinoam Nutr. 2003 Sep;53(3):267-70. Spanish.
PMID: 14694809 [PubMed - indexed for MEDLINE]
37: Munene RM, Adala HS, Masinde MS, Rana FS.
Related Articles, Links
Vitamin A deficiency among Kenyan children as detected by conjunctival
impression cytology.
East Afr Med J. 2003 Sep;80(9):476-9.
PMID: 14640169 [PubMed - indexed for MEDLINE]
:
38 Titiyal JS, Pal N, Murthy GV, Gupta SK, Tandon R, Vajpayee RB,
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Gilbert CE.
Causes and temporal trends of blindness and severe visual impairment in
children in schools for the blind in North India.
Br J Ophthalmol. 2003 Aug;87(8):941-5.
PMID: 12881329 [PubMed - indexed for MEDLINE]
39: Kello AB, Gilbert C.
Related Articles, Links
Causes of severe visual impairment and blindness in children in schools for the
blind in Ethiopia.
Br J Ophthalmol. 2003 May;87(5):526-30.
PMID: 12714383 [PubMed - indexed for MEDLINE]
40: Palafox NA, Gamble MV, Dancheck B, Ricks MO, Briand K,
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Semba RD.
Vitamin A deficiency, iron deficiency, and anemia among preschool children in
the Republic of the Marshall Islands.
Nutrition. 2003 May;19(5):405-8.
PMID: 12714090 [PubMed - indexed for MEDLINE]
41: Schemann JF, Banou A, Malvy D, Guindo A, Traore L, Momo G.
Related Articles, Links
National immunisation days and vitamin A distribution in Mali: has the vitamin
A status of pre-school children improved?
Public Health Nutr. 2003 May;6(3):233-44.
PMID: 12740072 [PubMed - indexed for MEDLINE]
42: Pathak P, Singh P, Kapil U, Raghuvanshi RS.
Related Articles, Links
Prevalence of iron, vitamin A, and iodine deficiencies amongst adolescent
pregnant mothers.
Indian J Pediatr. 2003 Apr;70(4):299-301.
PMID: 12793305 [PubMed - indexed for MEDLINE]
43: Oso OO, Abiodun PO, Omotade OO, Oyewole D.
Related Articles, Links
Vitamin A status and nutritional intake of carotenoids of preschool children in
Ijaye Orile community in Nigeria.
J Trop Pediatr. 2003 Feb;49(1):42-7.
PMID: 12630720 [PubMed - indexed for MEDLINE]
44:
West KP Jr.
Related Articles, Links
Vitamin A deficiency disorders in children and women.
Food Nutr Bull. 2003 Dec;24(4 Suppl):S78-90. Review.
PMID: 17016949 [PubMed - indexed for MEDLINE]
45: Gorstein J, Shreshtra RK, Pandey S, Adhikari RK, Pradhan A.
Related Articles, Links
Current status of vitamin A deficiency and the National Vitamin A Control
Program in Nepal: results of the 1998 National Micronutrient Status Survey.
Asia Pac J Clin Nutr. 2003;12(1):96-103.
PMID: 12737018 [PubMed - indexed for MEDLINE]
46: Haidar J, Tsegaye D, Mariam DH, Tibeb HN, Muroki NM.
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Vitamin A supplementation on child morbidity.
East Afr Med J. 2003 Jan;80(1):17-21.
PMID: 12755237 [PubMed - indexed for MEDLINE]
47: Sommer A.
Related Articles, Links
Vitamin A deficiency and the global response.
Forum Nutr. 2003;56:33-5. Review. No abstract available.
PMID: 15806787 [PubMed - indexed for MEDLINE]
48: Miningou SD, Zoubga AZ, Meda H, Meda N, Tiendrebeogo H.
Related Articles, Links
[Prevalence of asthma in subjects aged 15-64 years in Bobo-Dioulasso (Burkina
Faso) in 1998]
Rev Pneumol Clin. 2002 Dec;58(6 Pt 1):341-5. French.
PMID: 12545132 [PubMed - indexed for MEDLINE]
49: Schemann JF, Banou AA, Guindo A, Joret V, Traore L, Malvy D.
Related Articles, Links
Prevalence of undernutrition and vitamin A deficiency in the Dogon Region,
Mali.
J Am Coll Nutr. 2002 Oct;21(5):381-7.
PMID: 12356778 [PubMed - indexed for MEDLINE]
50: Khatib IM.
Related Articles, Links
High prevalence of subclinical vitamin A deficiency in Jordan: a forgotten risk.
Food Nutr Bull. 2002 Sep;23(3 Suppl):228-36.
PMID: 12362802 [PubMed - indexed for MEDLINE]
51: Ross DA.
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Recommendations for vitamin A supplementation.
J Nutr. 2002 Sep;132(9 Suppl):2902S-2906S.
PMID: 12221268 [PubMed - indexed for MEDLINE]
52: Christian P.
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Recommendations for indicators: night blindness during pregnancy--a simple
tool to assess vitamin A deficiency in a population.
J Nutr. 2002 Sep;132(9 Suppl):2884S-2888S.
PMID: 12221265 [PubMed - indexed for MEDLINE]
53: West KP Jr.
Related Articles, Links
Extent of vitamin A deficiency among preschool children and women of
reproductive age.
J Nutr. 2002 Sep;132(9 Suppl):2857S-2866S. Erratum in: J Nutr 2002 Nov;132(11):3432.
PMID: 12221262 [PubMed - indexed for MEDLINE]
54: Sommer A, Davidson FR; Annecy Accords.
Related Articles, Links
Assessment and control of vitamin A deficiency: the Annecy Accords.
J Nutr. 2002 Sep;132(9 Suppl):2845S-2850S.
PMID: 12221259 [PubMed - indexed for MEDLINE]
55: De Souza WA, Da Costa Vilas Boas OM.
Related Articles, Links
[Vitamin A deficiency in Brazil: an overview]
Rev Panam Salud Publica. 2002 Sep;12(3):173-9. Review. Portuguese.
PMID: 12396635 [PubMed - indexed for MEDLINE]
56: Lin L, Liu Y, Ma G, Tan Z, Zhang X, Jiang J, Song X, Wang L, Zhang
J, Wang H, Li M.
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Links
[Survey on vitamin A deficiency in children under-6-years in China]
Zhonghua Yu Fang Yi Xue Za Zhi. 2002 Sep;36(5):315-9. Chinese.
PMID: 12411191 [PubMed - indexed for MEDLINE]
57: Swami HM, Thakur JS, Bhatia SP.
Related Articles, Links
Mass supplementation of vitamin A linked to National Immunization Day.
Indian J Pediatr. 2002 Aug;69(8):675-8.
PMID: 12356218 [PubMed - indexed for MEDLINE]
58: Ramalho RA, Flores H, Saunders C.
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[Hypovitaminosis A in Brazil: a public health problem]
Rev Panam Salud Publica. 2002 Aug;12(2):117-22. Spanish.
PMID: 12243697 [PubMed - indexed for MEDLINE]
59: Asrat YT, Omwega AM, Muita JW.
Related Articles, Links
Prevalence of vitamin A deficiency among pre-school and school-aged children
in Arssi Zone, Ethiopia.
East Afr Med J. 2002 Jul;79(7):355-9. Erratum in: East Afr Med J. 2002 Sep;79(9):501..
PMID: 12638829 [PubMed - indexed for MEDLINE]
60: Al-Kubaisy W, Al-Rubaiy MG, Nassief HA.
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Xerophthalmia among hospitalized Iraqi children.
East Mediterr Health J. 2002 Jul-Sep;8(4-5):496-502.
PMID: 15603030 [PubMed - indexed for MEDLINE]
61: Radhika MS, Bhaskaram P, Balakrishna N, Ramalakshmi BA, Devi S,
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Links
Effects of vitamin A deficiency during pregnancy on maternal and child health.
Kumar BS.
BJOG. 2002 Jun;109(6):689-93.
PMID: 12118649 [PubMed - indexed for MEDLINE]
62: Khan NC, Khoi HH, Giay T, Nhan NT, Nhan NT, Dung NC, Thang
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Links
Control of vitamin A deficiency in Vietnam: achievements and future
orientation.
HV, Dien DN, Luy HT.
Food Nutr Bull. 2002 Jun;23(2):133-42.
PMID: 12094663 [PubMed - indexed for MEDLINE]
63: Amaya-Castellanos D, Viloria-Castejon H, Ortega P, Gomez G,
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[Vitamin A deficiency and the anthropometric nutritional status of urban and
rural marginalized children in the state of Zulia, Venezuela]
Urrieta JR, Lobo P, Estevez J.
Invest Clin. 2002 Jun;43(2):89-105. Spanish.
PMID: 12108030 [PubMed - indexed for MEDLINE]
64: Tan Z, Ma G, Lin L, Liu C, Liu Y, Jiang J, Ren G, Wang Y, Hao Y,
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Prevalence of subclinical vitamin A deficiency and its affecting factors in 8 669
children of China.
He L, Yao J.
Zhonghua Yu Fang Yi Xue Za Zhi. 2002 May;36(3):161-3.
PMID: 12410947 [PubMed - indexed for MEDLINE]
65: Kynast-Wolf G, Sankoh OA, Gbangou A, Kouyate B, Becher H.
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66: Reyes H, Villalpando S, Perez-Cuevas R, Rodriguez L, Perez-Cuevas
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Frequency and determinants of vitamin A deficiency in children under 5 years of
age with pneumonia.
M, Montalvo I, Guiscafre H.
Arch Med Res. 2002 Mar-Apr;33(2):180-5.
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67: Ngah NF, Moktar N, Isa NH, Selvara S, Yusof MS, Sani HA, Hasan
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Ocular manifestation of vitamin A deficiency among Orang asli (Aborigine)
children in Malaysia.
ZA, Kadir RA.
Asia Pac J Clin Nutr. 2002;11(2):88-91.
PMID: 12074186 [PubMed - indexed for MEDLINE]
68: D'Souza RM, D'Souza R.
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Vitamin A for treating measles in children.
Cochrane Database Syst Rev. 2002;(1):CD001479. Review. Update in: Cochrane Database Syst
Rev. 2005;(4):CD001479.
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69: Rabiu MM, Kyari F.
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Vitamin A deficiency in Nigeria.
Niger J Med. 2002 Jan-Mar;11(1):6-8.
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70: Villamor E, Mbise R, Spiegelman D, Hertzmark E, Fataki M, Peterson
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Vitamin A supplements ameliorate the adverse effect of HIV-1, malaria, and
diarrheal infections on child growth.
KE, Ndossi G, Fawzi WW.
Pediatrics. 2002 Jan;109(1):E6.
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71: Zagre NM, Delisle H, Tarini A, Delpeuch F.
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[Changes in vitamin A intake following the social marketing of red palm oil
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UPCOMING CONFERENCES, SEMINARS AND WORKSHOPS.

The World Sight Day holds every second Thursday of the month of October.

November 01, 2007 - November 01, 2007
Current Concepts in Primary Eye Care
Rochester, MN, United States

November 10, 2007 – November 13, 2007
American Academy of Ophthalmology - 111th Annual Meeting
Ernest N. Morial Convention Center, New Orleans, U.S.A.

November 28, 2007 - November 30, 2007
XXVII Glaucoma Course
Valladolid, Spain

December 10, 2007 - December 11, 2007
Moorfields Ophthalmology Course for General Practitioners
London, England, United Kingdom

February 28, 2008 - March 02, 2008
7th International Symposium on Ocular Pharmacology and Therapeutics
Budapest, Hungary

Jun 28-Jul 02, 2008 2008 | Hong Kong | Hong Kong
WORLD OPHTHALMOLOGY CONGRESS 2008
Contact: Angela Cho, Secretariat, Tel: 011-852-2762-3128, Fax: 011-852-21940695, Email: angelacho@woc2008hongkong.org, Website:
www.woc2008hongkong.org
Optometry:

Jun 25-29, 2008 | WA | Seattle
2008 OPTOMETRY’S MEETING
Contact: American Optometric Association (AOA), Tel: 314-991-4100, Fax: 314991-4101, Website: www.aoa.org
Contact: CAO, Tel: 888-263-4676, Fax: 613-235-2025, Email:
info@opto.ca,webbsite: www.opto.ca
SEMINARS
SEMINARS 2007
WRITING RESEARCH PROPOSALS
Location: The Royal College of Ophthalmologists, London
Date: a new date for 2008 tbc
Chaired by: Professor Harminder Dua and Professor Alan Stitt
Download Registration Form
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VITREO-RETINAL UPDATE
Location: The Royal College of Ophthalmologists, London
Date: A new date for 2008 tbc
Chaired by: Mr Ian Pearce
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Download programme
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OCULOPLASTICS
Location: The Royal College of Ophthalmologists
Date: Wednesday 10th October 2007
Chaired by: Mr Tony Tyers
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ASSESSING SURGICAL SKILLS
Location: The Royal College of Ophthalmologists
Date: Monday 15th October 2007
Chaired by: Mr Larry Benjamin
Download registration form
Further details will be available soon
RETINAL VEIN OCCLUSIONS
Location: The Institute of Physics, London
Date: Friday 19th October 2007
Chaired by: Mr Declan Flanagan and Mr Winfried Amoaku
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Download Map
ELIZABETH THOMAS SEMINAR: AMD
Location: The East Midlands Conference Centre, Nottingham
Date: Friday 30th November 2007
Chaired by: Mr Winfried Amoaku
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Download Map
Page Updated: 1st May 2007 (HB-A)
Copyright © 2006 The Royal College of Ophthalmologists, 17 Cornwall Terrace, London, NW1 4QW
TRAINING

-
ECCE/IOL + SICS COURSE – 6 WEEKS
Location: National Eye Centre, Kaduna, Nigeria.
Date: 15th. October 2007
Contact: Dr. Achi – 08028619112