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      Prevalence of Vitamin A Deficiency among Preschool Children in Ethiopia: A Systematic Review and Meta-Analysis

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          Abstract

          Background

          Vitamin A deficiency is a major nutritional concern in lower-income countries. The aim of this systematic review and meta-analysis was to show the magnitude of vitamin A deficiency among preschoolers in Ethiopia.

          Objective

          The present study was aimed at synthesizing qualitatively and quantitatively the existing literature on the prevalence of VAD in preschool children in Ethiopia.

          Methods

          Studies were searched through the search engine of Google Scholar, Hinari, MEDLINE/PubMed, Cochrane Library, and Africa-Wide Information. Searching was made using the keywords/MeSH of vitamin A deficiency, xerophthalmia, night blindness, Bitot's spot, retinol, children, and Ethiopia. Data were analyzed and compared with the WHO threshold criteria to declare a public health problem. Heterogeneity among studies was assessed using a Cochran Q test and I 2 statistics. A random-effects model with 95% confidence interval was used for prevalence estimations.

          Results

          Of the 13 studies included in clinical analysis, 12 of them reported the prevalence of night blindness and/or Bitot's spot among preschool children in Ethiopia which was above WHO cutoff point for the public health problem 1% and 0.5%, respectively. The prevalence of night blindness significantly decreased from moderate public health problem 4.2% (95% CI: 2.8%-5.7%) in a period from 1990 to 2004 to mild public health problem 0.8% (95% CI: 0.6%-1.0%) in a period from 2005 to 2019. Furthermore, statistically insignificant reduction was observed in the prevalence of Bitot's spot in a period from 1990 to 2004, 2.2% (95% CI: 1.3%-3.2%) to 1.8% (95% CI: 1.2%-2.3%) in a period from 2005 to 2019. Among 8 studies on subclinical vitamin A deficiency, 7 of them indicated a severe public health problem (>20%). The prevalence of subclinical vitamin A deficiency decreased from 55.7% (95% CI: 39.8%-71.6%) in a period from 1990 to 2004 to 28.3% (95% CI: 9.8%-46.7%) in a period from 2005 to 2019, but not statistically significant.

          Conclusions

          Despite the reduced proportion of night blindness and Bitot's spot, still both clinical and subclinical vitamin A deficiencies remain a public health problem in Ethiopia requiring strengthen intervention through the newly initiated health extension program.

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          Most cited references31

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          Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age.

          Aamer Imdad, Evan Mayo-Wilson, Kurt Herzer … (2017)
          Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence.
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            Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis

            Evan Mayo-Wilson, Aamer Imdad, Kurt Herzer … (2011)
            Objective To determine if vitamin A supplementation is associated with reductions in mortality and morbidity in children aged 6 months to 5 years. Design Systematic review and meta-analysis. Two reviewers independently assessed studies for inclusion. Data were double extracted; discrepancies were resolved by discussion. Meta-analyses were performed for mortality, illness, vision, and side effects. Data sources Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, Global Health, Latin American and Caribbean Health Sciences, metaRegister of Controlled Trials, and African Index Medicus. Databases were searched to April 2010 without restriction by language or publication status. Eligibility criteria for selecting studies Randomised trials of synthetic oral vitamin A supplements in children aged 6 months to 5 years. Studies of children with current illness (such as diarrhoea, measles, and HIV), studies of children in hospital, and studies of food fortification or β carotene were excluded. Results 43 trials with about 215 633 children were included. Seventeen trials including 194 483 participants reported a 24% reduction in all cause mortality (rate ratio=0.76, 95% confidence interval 0.69 to 0.83). Seven trials reported a 28% reduction in mortality associated with diarrhoea (0.72, 0.57 to 0.91). Vitamin A supplementation was associated with a reduced incidence of diarrhoea (0.85, 0.82 to 0.87) and measles (0.50, 0.37 to 0.67) and a reduced prevalence of vision problems, including night blindness (0.32, 0.21 to 0.50) and xerophthalmia (0.31, 0.22 to 0.45). Three trials reported an increased risk of vomiting within the first 48 hours of supplementation (2.75, 1.81 to 4.19). Conclusions Vitamin A supplementation is associated with large reductions in mortality, morbidity, and vision problems in a range of settings, and these results cannot be explained by bias. Further placebo controlled trials of vitamin A supplementation in children between 6 and 59 months of age are not required. However, there is a need for further studies comparing different doses and delivery mechanisms (for example, fortification). Until other sources are available, vitamin A supplements should be given to all children at risk of deficiency, particularly in low and middle income countries.
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              Assessment and control of vitamin A deficiency: the Annecy Accords.

              , Alfred Sommer, Wendy Davidson (2002)
              Comprehensive recommendations for the assessment and control of vitamin A deficiency (VAD) were rigorously reviewed and revised by a working group and presented for discussion at the XX International Vitamin A Consultative Group meeting in Hanoi, Vietnam. These recommendations include standardized definitions of VAD and VAD disorders. VAD is defined as liver stores below 20 micro g (0.07 micro mol) of retinol per gram. VAD disorders are defined as any health and physiologic consequences attributable to VAD, whether clinically evident (xerophthalmia, anemia, growth retardation, increased infectious morbidity and mortality) or not (impaired iron mobilization, disturbed cellular differentiation and depressed immune response). An estimated 140 million preschool-aged children and at least 7.2 million pregnant women are vitamin A deficient, of whom >10 million suffer clinical complications, principally xerophthalmia but also increased mortality, each year. A maternal history of night blindness during a recent pregnancy was added to the clinical criteria for assessing vitamin A status of a population, and the serum retinol criterion for a "public health problem" was revised to 15% or more of children sampled having levels of <20 micro g/dL (0.7 micro mol/L). Clinical trials and kinetic models indicate that young children in developing countries cannot achieve normal vitamin A status from plant diets alone. Fortification, supplementation, or other means of increasing vitamin A intake are needed to correct widespread deficiency. To improve the status of young infants, the vitamin A supplements provided to mothers during their first 6 wk postpartum and to young infants during their first 6 mo of life should be doubled.
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                Author and article information

                Contributors
                Delelegn Yilma:
                ORCID: https://orcid.org/0000-0002-4961-2310
                Journal
                Journal ID (nlm-ta): Biomed Res Int
                Journal ID (iso-abbrev): Biomed Res Int
                Journal ID (publisher-id): BMRI
                Title: BioMed Research International
                Publisher: Hindawi
                ISSN (Print): 2314-6133
                ISSN (Electronic): 2314-6141
                Publication date Collection: 2020
                Publication date (Electronic): 27 February 2020
                Volume: 2020
                Electronic Location Identifier: 8032894
                Affiliations
                1Ambo University, College of Medicine and Health Science, Department of Public Health, P.O. Box 19 Ambo, Ethiopia
                2Addis Ababa University, College of Health Science, Department of Medical Radiological Technology, P.O. Box 11950 Addis Ababa, Ethiopia
                3Kotebe Metropolitan University, Menelik II Health Science and College of Medicine, Addis Ababa, Ethiopia
                4Addis Ababa University, College of Health Sciences, School of Public Health, P.O. Box 11950 Addis Ababa, Ethiopia
                5Ambo University, College of Medicine and Health Science, Department of Midwifery, P.O. Box 19 Ambo, Ethiopia
                6Addis Ababa University, College of Health Science, School of Public Health, P.O. Box 27285 1000 Addis Ababa, Ethiopia
                Author notes

                Academic Editor: Anjali Joshi

                Author information
                https://orcid.org/0000-0002-7215-9489
                https://orcid.org/0000-0002-4961-2310
                https://orcid.org/0000-0001-7703-9577
                https://orcid.org/0000-0002-0357-7812
                Article
                DOI: 10.1155/2020/8032894
                PMC ID: 7073500
                PubMed ID: 32258145
                SO-VID: ccf0e8e4-47e7-4410-a4ae-ff610d7f35aa
                Copyright © Copyright © 2020 Zekariyas Sahile et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 November 2019
                Date revision received : 31 January 2020
                Date accepted : 13 February 2020
                Categories
                Subject: Review Article

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