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Epidemiology of Vitamin a Deficiency in Selected Vulnerable Population Groups of Bangladesh

Moududur Rahman Khan
Institute of Nutrition and Food Science, University of Dhaka

Luthfor Ahmed
Institute of Nutrition and Food Science, University of Dhaka

M. Mostafizur Rahman
Institute of Nutrition and Food Science, University of Dhaka

Mohammed Abdullah
Institute of Nutrition and Food Science, University of Dhaka

Abstract/ Executive Summary:

A prospective study was carried out among the population groups 'at-risk' in four different agro-ecological regions and two urban slums of Bangladesh. Following multistage sampling technique, sixty households having at least one child from 2-5 years were selected purposively from among the landless or marginally landholding groups in each location. Data on food intake (24 hour recall and food frequency questionnaire) and clinical examinations were collected in two different seasons, namely rainy season (June-July) and winter (December-January). Poor intake of energy and nutrients were observed among the studied population. Almost all vitamin A was provided by vegetable sources. Total intake of vitamin A was significantly higher (p< 0.05) in the rainy season in all the locations excepting the Lower Ganges Flood Plain, where a higher but statistically non significant intake was observed in winter (p > 0.05). Mean usual pattern of food (UPF) score of the observed children was significantly higher in the rainy season in all rural locations (p< 0.05). Such seasonal differences were not found in the urban locations. A shift in UPF score distribution toward high-risk category in the winter was observed in the rural locations and also in slum in Dhaka. Children with xerophthalmia were detected in 3 rural locations and in the slum in Chittagong, and it was higher in the rainy season. No cases of xerophthalmia were found in the coastal district of Patuakhali and slum in Dhaka. Prevalence of infectious diseases was higher in the rainy season, and most of the xerophthalmia affected children were found to have suffered from diarrhoea, dysentery, or measles before developing ocular signs. Seasonality and geographical variation in availability and intake of vitamin A rich food sources and prevalence of xeropthalmia were markedly observed. Children in the coastal region did not manifest any sign of vitamin A deficiency probably due to easy availability of small fishes.

Keywords: Vitamin A Deficiency, Xerophthalmia Prevalence, Pre-school Age Children, UPF score

Location: Gaibandha, Madaripur, Patuakhali and Jamalpur districts, Mohammadpur flood protection embankment, Dhaka and Double Mooring thana, Chittagong district, Bangladesh.

Start Date:

End Date:

Program Area: Socio-economic and Policy

Non-commodity: Performance

Objectives:

To delineate socioeconomic, environmental, ecological and seasonal attributes of vitamin A malnutrition.

Methodology:

Since the objective of the study was to delineate the ecological attributes of vitamin A deficiency, representation of various agro-ecological areas of the country was necessary. After consulting the Report on Land Resources Appraisal of Bangladesh, the whole country was divided in to 4 broad agro-ecological zones, namely Tista Meander Flood Plain, Lower Ganges Flood Plain, Southern Coastal Belt and Active Young Brahmaputra Jamuna Flood Plain. One union from a district in each of the agro-ecological area was selected. The districts were Gaibandha (Tista Meander Flood Plain), Madaripur (Lower Ganges Flood Plain), Patuakhali (Southern Coastal Belt) and Jamalpur (Active Young Brahmaputra Jamuna Flood Plain). Two urban slums in each of the two major metropolises of the country were also selected. One was on the Mohammadpur flood protection embankment in Dhaka and the other was the Jhautala slum under Double Mooring thana in Chittagong. Union council tax categories' A' and 'B' households with at least one child between 2-5 years of age were listed. Sixty households from the list or each location were selected by simple unrestricted random sampling technique. Household dietary intake was assessed by 24-hour recall method. Food consumption data were converted into nutrient intake using food composition. To account for seasonal variability in intake, dietary surveys were conducted in two different seasons. Rainy season (June-July) is characterized by plentiful carotene rich food while winter season is moderately lean period for carotene rich foods. Besides household dietary intake, data on habitual intake of food sources of vitamin A by the target children (2-5 years old) were obtained using the simplified method proposed by the IV ACG. Proportion of the target population at risk for vitamin A deficiency was calculated using the usual pattern of food (UPF) score according to simplified method recommended by the IV ACG. UPF score is computed by using a weighting factor for usual consumption pattern (daily, weekly and monthly) of foods rich in vitamin A and it's precursor. Risk categories are classified into high <120), moderate (120 to 210) and low (>210) based on the score. Clinical investigation and classification of ocular signs were done according to WHO. Statistical analysis was done by SPSS release 8.0 (SPSS Inc., Chicago, Illinois, U.S.A.). Means were tested by Student's 't' test or ANOV A with post-hoc Bonferroni test. Distributions were tested by X² test.

Source of Information: Bangladesh J. of Nutr. Vol. 16. December 2003; ISSN 1013-6037

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Achievement/Findings:

In summary, vitamin A deficiency disorders cannot be eradicated in isolation because of its complex nature. There is no easy way or short cut approach to solve the problem. Vitamin A intake of the subjects in Gaibandha was highest, yet several cases of xerophthalmia were detected there. It is noteworthy that all most all vitamin A of this population come from leafy vegetables. Recent findings suggest lower bioavailabilty of vitamin A from vegetable sources than hitherto thought. Composition of diet is also important for availability of vitamin A from food. Intake of fat was very low in the population studied. Dietary fat has been shown to increase vitamin A absorption. As the mucosal cells absorb β carotene incorporated in lipid micelles a diet low in fat may contribute to vitamin A deficiency. Moreover, carotene absorption requires not only sufficient fat in diet but also sufficient protein and zinc, while large amount of dietary fibre has been shown to reduce bioavailablity of carotenes. Besides food, hygiene practices also need to be improved. Otherwise, repeated attack of infectious diseases due to fecal contamination and poor personal hygiene with only negate the situation.

Knowledge Management: Journal