Objective: To determine the prevalence of xerophthalmia and the extent of vitamin A deficiency in western Yemen.
Design: A stratified cluster sample of children aged 1-5 years with clinical examination for signs of xerophthalmia as well as blood serum survey.
Setting: The 18 districts of western Yemen, of which 10 clusters were chosen at random.
Subjects: All children aged 1-5 years resident in the cluster sites (n = 2438).
Main outcome measures: Clinical signs of xerophthalmia, a history of night blindness, serum retinol levels in a random sample of clinically normal children (n =338) in addition to all children with xerophthalmia.
Results: Night blindness was found in 0.5% of the children, Bitot's spots in 1.7%, corneal ulceration in 0.04% and corneal scars in 0.04% Of the subsample, 7.2% (95% confidence interval [c.i.] 4.4-10.0%) had serum retinol values below 10 micrograms/dl; 63.0% (95% c.i. 57.6- 68.4%) had values below 20 micrograms/dl.
Conclusions: Xerophthalmia and vitamin A deficiency are public health problems in western Yemen.
PIP: In June 1992, the Ministry of Health (MOH) of the Republic of Yemen, UNICEF/Sana'a, the Saudi Eye Foundation, and Helen Keller International joined together to screen 2438 children aged 1-5 from 18 rural districts in the Tihama region of Yemen for xerophthalmia (abnormal dryness of the eye due to a deficiency of tears), followed by trachoma (chronic eye infection characterized by granulations and scarring of the cornea) screening, blood sampling, and anthropometry and collection of morbidity prevalence data on a subsample (338 children). 2.21% of the children had active xerophthalmia. Boys were more likely to have xerophthalmia than girls (odds ratio [OR] = 2.1). Children aged 4-5 were more likely to have it than those under age 4 (OR = 2.9). In fact, no child aged 12-23 months had xerophthalmia. Most xerophthalmia cases (77.8%) had Bitot's spots. Bitot's spots cases tended to have the spots in both eyes (71%) and be children aged 4-5 (66.6%). The prevalence of Bitot's spots exceeded the minimum criteria for public health significance of xerophthalmia (1.72% vs. 0.50%). The prevalence of night blindness stood at 0.45%. One xerophthalmia case had keratomalacia and another had bilateral corneal scarring (0.04% each). 94% of the children with xerophthalmia who provided blood samples had serum retinol levels below 20 mcg/dl. Children with xerophthalmia had much lower retinol levels than those without xerophthalmia (11.4 vs. 18.8 mcg/dl; p .001). Likewise, children with night blindness had lower levels than those without night blindness (10.9 vs. 18.3 mcg/dl; p .001). Among the subsample, the proportion of children with deficient or marginal serum retinol levels ( 10 mcg/dl and 20 mcg/dl, respectively) exceeded the minimum criteria for public health significance of vitamin A deficiency (7.2% vs. 5% and 62.3% vs. 15%, respectively). 70% of children with marginal serum levels were 24-47 months old. Excess undernutrition existed at levels of 70% for below the 25th percentile norms, 78% for below the 10th percentile, and 71% for below the 5th percentile. These findings demonstrate that xerophthalmia and vitamin A deficiency are clear public health problems in western Yemen.